Medial Crural Auto-rim Flap in Primary Open Rhinoplasty
Keywords:Aesthetic rhinoplasty, Prospective-observational study, Hanging columella deformity, Nasal tip support, Patient’s follow-up, Sulaimani city
Background: Aging significantly affects the nasal tip and columella; thus, weakening of fibroelastic attachments in the scroll area and intercrural suspensory ligaments results in tip ptosis, separation of the medial crural footplates, and expansion of the membranous septum.
Aim: Thus, we focused on a new technique to maintain tip support without grafting and treat columellar-hanging deformity by folding in the caudal edge of the medial crura as a flap instead of trimming it in patients undergoing open aesthetic rhinoplasty.
Patients and Methods: In this prospective-observational study, 37 patients were enrolled between July 2020 to January 2022 at Sulaimani Plastic, Burn and Reconstructive Surgery Hospital and Royal Private Hospital in Sulaimani, Republic of Iraq. After asking the age of the patients, all participants were appropriately prepared for the surgery and underwent primary open rhinoplasty for columellar hanging deformity correction.
Results: We found that all enrolled patients were satisfied with their nasal shape except one patient who complained about the columellar region's appearance but without the need for revision. Also, the objective assessment of the nasal tip support showed good maintenance upon the follow-up time for patients despite the lack of cartilage graft in the tip area.
Conclusion: In the medial crural auto-rim flap technique, the excess caudal medial crural cartilage could be used as a flap instead of trimming it despite concomitant tip support intercrural augmentation and correction of the columellar hanging deformity.
Rohrich R.J. & Ahmad J. (2011). Rhinoplasty. Plastic and Reconstructive Surgery. 128(2), 49e-73e.
Silver W.E. & Zuliani G.F. (2009). Management of the overprojected nose and ptotic nasal tip. Aesthetic Surgery Journal. 29(3), 253-258.
Daniel R.K. (2018). The preservation rhinoplasty: a new rhinoplasty revolution. Oxford University Press: USA.
Çakır B., Öreroğlu A.R., & Daniel R.K. (2014). Surface aesthetics in tip rhinoplasty: a step-by-step guide. Aesthetic Surgery Journal. 34(6), 941-955.
Moina D.G. & Moina G.M. (2016). Sutures or Resection of the Protruding End of Medial Crura in Miniinvasive Techniques in Rhinoplasty. London: IntechOpen.
Rohrich R.J. & Ahmad J. (2016). A practical approach to rhinoplasty. Plastic and Reconstructive Surgery. 137(4), 725e-746e.
Gerbault O., Daniel R.K., & Kosins A.M. (2016). The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthetic Surgery Journal. 36(1), 21-34.
Rohrich R.J. & Afrooz P.N. (2019). Primary open rhinoplasty. Plastic and Reconstructive Surgery. 144(1), 102e-117e.
Brito Í.M., Avashia Y., & Rohrich R.J. (2020). Evidence-based nasal analysis for rhinoplasty: the 10-7-5 method. Plastic and Reconstructive Surgery Global Open. 8(2), e2632.
Kridel R.W. & Chiu R.J. (2006). The management of alar columellar disproportion in revision rhinoplasty. Facial Plastic Surgery Clinics. 14(4), 313-329.
Rohrich R.J. & Afrooz P.N. (2019). Revisiting the alar-columellar relationship: classification and correction. Plastic and Reconstructive Surgery. 144(2), 340-346.
Antunes M.B. & Quatela V.C. (2018). Effects of the tongue-in-groove maneuver on nasal tip rotation. Aesthetic Surgery Journal. 38(10), 1065-1073.
Serdev N.P. (2013). T-Excision for Nasal Tip Rotation. Miniinvasive Techniques in Rhinoplasty. 3-13. London: IntechOpen.
Unadkat S.N. & Saleh H.A. (2021). Restoring balance and symmetry to the aging nose. Facial Plastic Surgery. 37(02), 205-210.
Helal H.A., Ghanem M.A.M., Al-Badawy A.M., Abdel Haleem M.M., & Mousa M.H. (2019). Histological and anthropometric changes in the aging nose. Aesthetic Surgery Journal. 39(9), 943-952.
Çakır B., Doğan T., Öreroğlu A.R., & Daniel R.K. (2013). Rhinoplasty: surface aesthetics and surgical techniques. Aesthetic Surgery Journal. 33(3), 363-375.
Sazgar A.A. & Most S.P. (2011). Stabilization of nasal tip support in nasal tip reduction surgery. Otolaryngology-Head and Neck Surgery. 145(6), 932-934.
Bucher S., Kunz S., Deggeller M., Holzmann D., & Soyka M. (2020). Open rhinoplasty using a columellar strut: effects of the graft on nasal tip projection and rotation. European Archives of Oto-Rhino-Laryngology. 277(5), 1371-1377.
Ballin A.C., Kim H., Chance E., & Davis R.E. (2016). The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plastic Surgery. 32(04), 384-397.
Rohrich R.J. & Afrooz P.N. (2018). Components of the hanging columella: strategies for refinement. Plastic and Reconstructive Surgery. 141(1), 46e-54e.
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