Increased nasal tip projection with “pseudo-flaps” using excess lateral cephalic alar cartilage

ABSTRACT

Introduction:

An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of “pseudo-flaps” is proposed.

Methods:

In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce “pseudo-flaps”. The cartilages were folded over themselves in the form of a “French soldier’s suspender” over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by “pseudo-flaps” of the alar cartilages sutured there or covering the columella’s structural graft. Thirty-six patients underwent surgery using this technique.

Results:

Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The “pseudo-flaps” method is relatively simple for those performing nasal surgery.

Conclusion:

The nasal tip can be projected discretely using the excess of alar cartilage “pedicled” in the domus.

Keywords:
Nose; Rhinoplasty; Surgical flaps; Nasal cartilages; Nasal mucosa