Advertisement

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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Rhinoplasty Alar cartilage Tip projection Onlay folded flap 

Notes

Conflict of interest

None.

Supplementary material

The OFF surgical technique (MPG 29751 kb)

References

  1. 1.
    Jang TY, Choi YS, Jung YG, Kim KT, Kim KS, Choi JS (2007) Effect of the nasal tip surgery on Asian noses using the transdomal suture technique. Aesthet Plast Surg 31(2):174–178CrossRefGoogle Scholar
  2. 2.
    Chait L, Ritz M (1991) A new approach for the refinement of the very broad nasal tip. Br J Plast Surg 44(8):572–574CrossRefPubMedGoogle Scholar
  3. 3.
    Erdoğan B, Ayan M, Görgü M, Deren O (2002) Umbrella graft of columella tip: 20 years’ experience. Aesthet Plast Surg 26(3):167–171CrossRefGoogle Scholar
  4. 4.
    Sadeghi M, Saedi B, Arvin Sazegar A, Amiri M (2009) The role of columellar struts to gain and maintain tip projection and rotation: A randomized blinded trial. Am J Rhinol Allergy 23(6):47–50CrossRefGoogle Scholar
  5. 5.
    Lee KC, Kwon YS, Park JM, Kim SK, Park SH, Kim JH (2004) Nasal tip plasty using various techniques in rhinoplasty. Aesthet Plast Surg 28(6):445–455CrossRefGoogle Scholar
  6. 6.
    Jones ME, Westreich RW, Lawson W (2008) Augmentation of nasal tip projection using the inferior turbinate: review of technique and evaluation of long-term success. Arch Facial Plast Surg 10(1):34–37CrossRefPubMedGoogle Scholar
  7. 7.
    Beekhuis GJ (1982) Silastic alar-columellar prosthesis in conjunction with rhinoplasty. Arch Otolaryngol 108(7):429–432PubMedGoogle Scholar
  8. 8.
    Von Mangoldt F (1970) Reconstruction of the saddle nose by cartilage overlay. Plast Reconstr Surg 46(5):498–501CrossRefGoogle Scholar
  9. 9.
    Peck GC (1983) The onlay graft for nasal tip projection. Plast Reconstr Surg 71(1):27–39PubMedGoogle Scholar
  10. 10.
    Rohrich RJ, Deuber MA (2002) Nasal tip refinement in primary rhinoplasty: the cephalic trim cap graft. Aesthet Surg J 22(1):39–45CrossRefPubMedGoogle Scholar
  11. 11.
    Foman S, Goldman IB, Neivert H, Schattner A (1951) Management of deformities of the lower cartilaginous vault. Arch Otolaryngol 54(5):467–472Google Scholar
  12. 12.
    Anderson JR (1966) New approach to rhinoplasty. Trans Am Acad Ophthalmol Otolaryngol 70(2):183–192PubMedGoogle Scholar
  13. 13.
    Sheen JH (1975) Achieving more nasal tip projection by use of a small autogenous vomer or septal cartilage graft. Plast Reconstr Surg 56(1):35–40CrossRefPubMedGoogle Scholar
  14. 14.
    Kamer FK, Churukian MM (1984) Shield graft for the nasal tip. Arch Otolaryngol 110(9):608–610PubMedGoogle Scholar
  15. 15.
    Sheen JH (1993) A 20-year retrospective. Plast Reconstr Surg 91(1):48–63CrossRefPubMedGoogle Scholar
  16. 16.
    McCollough ET, English JL (1985) A new twist in nasal tip surgery: an alternative to the Goldman tip for wide or bulbous lobule. Arch Otolaryngol 111(8):524–529PubMedGoogle Scholar
  17. 17.
    Lipsett EM (1959) A new approach to surgery of the lower cartilaginous vault. Arch Otolaryngol 70(1):42–47Google Scholar
  18. 18.
    Micheli-Pellegrini V, Ponti L, Ponti G, Guidarelli P (1996) Interrupted and continuous strip technique for tip surgery during traditional rhinoplasty. Facial Plast Surg 12(4):347–355CrossRefPubMedGoogle Scholar
  19. 19.
    Hong-Ryul J, Tae-Bin W (2009) Nasal tip augmentation in Asians using autogenous cartilage. Otolaryngol Head Neck Surg 140(4):526–530CrossRefGoogle Scholar
  20. 20.
    Papadopulos A, Harada C (1987) Compound implant to project the nasal tip. Aesthet Plast Surg 11(3):181–185CrossRefGoogle Scholar
  21. 21.
    Garcia-Velasco J, Telich Vidal J, Garcia-Casas S (1998) Increasing the length of the middle crura for better tip projection in primary rhinoplasty. Aesthet Plast Surg 22(4):253–258CrossRefGoogle Scholar
  22. 22.
    Millard DR (1965) Adjuncts in augmentation mentoplasty and corrective rhinoplasty. Plast Reconstr Surg 36:48–61CrossRefPubMedGoogle Scholar

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

Personalised recommendations