Aesthetic Plastic Surgery

, Volume 35, Issue 1, pp 73–79 | Cite as

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery

  • Hani Abou MayalehEmail author
Original Article



In this article the onlay folded flap (OFF) is introduced as a new technique for reshaping, refining, supporting, and projecting the nasal tip by remodeling the cephalic portions of the lateral crura rather than canceling them. The surgical technique and the long-term outcomes are described. The indications, contraindications, advantages, and disadvantages are defined.


Forty patients were operated on for hypoprojected nasal tips. They had been followed for from 6 to 35 months (average = 13 months). None of the patients had thin skin, and none of them had previously undergone a rhinoplasty. Two symmetric lateral flaps are taken from the cephalic portions of the lateral crura and attached to the domal segments. The flaps’ internal edges are carefully sutured together to form one flap. This is then rotated anteriorly over the original domes and fixed to them, before its distal portion is turned posteriorly over the first layer and fixed to it. The nasal tip projection was calculated for all patients before and 6 months after surgery using a personal method as a means of evaluating the gain in nasal tip projection in the postoperative period.


Revision was necessary in only one patient to fix an unpleasant columellar scar. The average nasal tip projection gain 6 months after surgery was approximately 4 mm (range = 3–5 mm). The nasal tips were fine and stable in all patients.


The OFF technique is recommended in primary rhinoplasty for reshaping, refining, and supporting the nasal tip and for increasing nasal tip projection (from 3 to 5 mm maximum) but only for people with normal or thick skin. It has many advantages and good postoperative results.


Rhinoplasty Alar cartilage Tip projection Onlay folded flap 


Conflict of interest


Supplementary material

The OFF surgical technique (MPG 29751 kb)


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Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2010

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology Head and Neck SurgeryCentre Hospitalier Robert BissonLisieuxFrance

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