Superior-Based Transposition Flap: A Novel Technique in Rhinoplasty

Abstract

Background: The cephalic trimming of the lower lateral cartilage (LLC) is an attempt to reduce tip bulbosity; unfortunately, it has the potential to cause a pinched nose deformity and valve collapse. Objectives: The author sought to use the superior-based transposition (ST) flap to reshape, relocalize, and reinforce the LLC as a support material for both internal and external valves with aesthetic corrections, leaving the scroll area untouched. Methods: A total of 367 patients (female, 215; male, 152) were operated with the presented technique. The ST flap was simply used to prepare a cartilage flap based on the scroll area in the cephalic portion of the LLC, and then this flap was advanced over the remaining LLC. The data were evaluated retrospectively. Results: Functionally, the ST flap was used to reshape and support the LLC and the internal valve by keeping the scroll intact and increasing the internal valve angle. The support and suspension of the LLC with this novel technique improve the functional results and prevent complications such as stenosis of both the external and internal valve angles. Aesthetically, the convexity and concavity of the LLC could be fixed with the adaptation of these two surfaces in different angles, thereby achieving a narrower, refined, and aesthetically pleasing tip. Conclusions: This study demonstrates that the ST flap can be one of the main maneuvers performed during rhinoplasty for many purposes, such as reshaping and supporting the LLC, increasing the tip rotation, achieving more aesthetically pleasing tips, suspending the internal and external valves, and protecting the scroll area.