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Lower Lateral Crural Turnover Flap in Open Rhinoplasty

Janis, Jeffrey E. M.D.; Trussler, Andrew M.D.; Ghavami, Ashkan M.D.; Marin, Vincent M.D.; Rohrich, Rod J. M.D.; Gunter, Jack P. M.D.

Plastic and Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - p 1830-1841
doi: 10.1097/PRS.0b013e3181a65ba2
Cosmetic: Original Article

Background: Lower lateral crural deformities are common problems in rhinoplasty. The shape and position of the lower lateral crura directly influence the alar contour and external valve function. This study reviews an extensive experience with the lower lateral crural turnover flap, which represents a versatile and reproducible technique for correction of lower lateral crural deformities and improvement of external valve function.

Methods: A retrospective review of our experience with the lateral crural turnover flap in consecutive primary (n = 21), secondary (n = 2), and tertiary (n = 1) open rhinoplasties was conducted to evaluate the indications, contraindications, and long-term outcomes of this technique. Patient case examples are used to illustrate this technique and its results.

Results: The lower lateral crural turnover flap is beneficial for deformities, weakness, and collapse of the lower lateral crura. It can also be used to improve lower lateral crural strength during tip reshaping. It is contraindicated when there is insufficient width of the lower lateral crura. A lower lateral crural turnover flap can complement other external valve and alar arch supporting techniques, such as placement of alar contour grafts and/or alar batten grafts. The shape and position of the lower lateral crural turnover flaps have had long-lasting results (>1 year) after open rhinoplasty.

Conclusions: The lower lateral crural turnover flap is a useful and reproducible technique in rhinoplasty with enduring results. The use of adjacent cartilage provides a local source of viable tissue to correct and support the lower lateral crura in both primary and revision rhinoplasty.


Dallas, Texas

From the Department of Plastic Surgery, The University of Texas Southwestern Medical Center.

Received for publication December 31, 2007; accepted December 2, 2008.

Disclosures: Dr. Gunter has financial relationships with Canfield, Ethicon, and Quality Medical Publishing. None of the other authors has any financial interest to declare in relation to the content of this article.

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Jeffrey E. Janis, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2009American Society of Plastic Surgeons