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
