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Tip Reinforcement Flap

An Original Technique for Improving Nasal Tip Support and Definition

Irmak, Fatih, MD*; Serin, Merdan, MD; Sirvan, Selami Serhat, MD*; Kurt Yazar, Sevgi, MD; Kuran, Ismail, MD; Sevim, Kamuran Zeynep, MD*; Karsidag, Semra, MD*

doi: 10.1097/SAP.0000000000001780
Aesthetic Surgery

Background Middle crura support deficiency and short middle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip.

Methods Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created from the excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps.

Results There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21 months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34) mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for the middle crura and increased definition, projection, and stability to the domal area.

Conclusions The tip reinforcement flap technique offers advantages for tip plasty in those cases with middle crural deficiency, short middle crura, and middle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

From the *Department of Plastic and Reconstructive Surgery, Sisli Etfal Training and Research Hospital, University of Health Sciences; and

Department of Plastic and Reconstructive Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Received July 16, 2018, and accepted for publication, after revision October 28, 2018.

I.K. is in private practice in plastic, reconstructive, and aesthetic surgery in Istanbul, Turkey.

Conflicts of interest and sources of funding: none declared.

Reprints: Merdan Serin, MD, Department of Plastic Surgery, Istanbul Training and Research Hospital, Org. Abdurrahman Nafiz Gürman Cd, 34098 Samatya, Fatih, İstanbul, Turkey. E-mail:

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