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Facial Plast Surg
DOI: 10.1055/a-2761-1846
Original Article

Advanced Preservation Technique for the Soft Tissue Envelope in Open Approach Rhinoplasty—Cephalic Lateral Crus, Scroll, Pitanguy Flap

Authors

  • Daniel Ben Ner

    1   Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
    2   The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel

  • Adi Busel

    1   Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
    2   The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel

  • Alwyn D'Souza

    3   Institute of Medical Sciences, Canterbury, Canterbury Christ Church University, Kent, United Kingdom

  • Alain Hazan

    1   Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
    2   The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Abstract

Aims and Background

The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip plasty. To avoid adverse outcomes such as pollybeak deformity and nasal valve collapse, these soft tissue structures should be reconstructed. Instead, preservation philosophy aims to preserve rather than reconstruct. The aim of this study is to present a technique that facilitates the preservation of the soft tissue envelope using the cephalic lateral crus–scroll–Pitanguy flap (CLC-SP flap) in open rhinoplasty.

Patient Selection

A retrospective analysis was performed on 22 patients with thick skin who underwent open approach rhinoplasty in the supra-perichondral plane.

Techniques

During the dissection, the cephalic portion of the lateral crus (LC) is elevated as part of the skin, with the LC's attachments to the soft tissues via the scroll and Pitanguy ligaments as a composite flap. In this way, the soft tissues are preserved. Reinsertion of the cephalic LC with its attached soft tissues restores normal anatomy and minimizes dead space.

Post Operative Care

Nineteen patients reported improved nasal breathing, and 21 patients reported aesthetic satisfaction after a mean follow-up of 5.4 months; no pollybeak deformity occurred. Using this technique, we were able to control tip definition by limiting dead space and supporting the nasal valve. Additionally, the cephalic LC was utilized as a caudally advancement flap to reinforce and straighten the caudal LC, improving its position and resting angle.

Conclusion and Clinical Relevance

The CLC-SP flap is a useful technique for controlling and preserving the soft tissue envelope, improving tip definition, supporting the nasal valve, and minimizing dead space, thus preventing pollybeak deformity in thick-skinned patients.

Keywords

preservation - scroll - Pitanguy - cephalic trim - soft tissue envelop


Publication History

Received: 14 November 2025

Accepted: 02 December 2025

Accepted Manuscript online:
03 December 2025

Article published online:
15 December 2025

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