Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  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):174–178

    Article  Google Scholar 

  2. Chait L, Ritz M (1991) A new approach for the refinement of the very broad nasal tip. Br J Plast Surg 44(8):572–574

    Article  CAS  PubMed  Google Scholar 

  3. Erdoğan B, Ayan M, Görgü M, Deren O (2002) Umbrella graft of columella tip: 20 years’ experience. Aesthet Plast Surg 26(3):167–171

    Article  Google Scholar 

  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):47–50

    Article  Google Scholar 

  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):445–455

    Article  Google Scholar 

  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):34–37

    Article  PubMed  Google Scholar 

  7. Beekhuis GJ (1982) Silastic alar-columellar prosthesis in conjunction with rhinoplasty. Arch Otolaryngol 108(7):429–432

    CAS  PubMed  Google Scholar 

  8. Von Mangoldt F (1970) Reconstruction of the saddle nose by cartilage overlay. Plast Reconstr Surg 46(5):498–501

    Article  Google Scholar 

  9. Peck GC (1983) The onlay graft for nasal tip projection. Plast Reconstr Surg 71(1):27–39

    CAS  PubMed  Google Scholar 

  10. Rohrich RJ, Deuber MA (2002) Nasal tip refinement in primary rhinoplasty: the cephalic trim cap graft. Aesthet Surg J 22(1):39–45

    Article  PubMed  Google Scholar 

  11. Foman S, Goldman IB, Neivert H, Schattner A (1951) Management of deformities of the lower cartilaginous vault. Arch Otolaryngol 54(5):467–472

    Google Scholar 

  12. Anderson JR (1966) New approach to rhinoplasty. Trans Am Acad Ophthalmol Otolaryngol 70(2):183–192

    CAS  PubMed  Google Scholar 

  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):35–40

    Article  CAS  PubMed  Google Scholar 

  14. Kamer FK, Churukian MM (1984) Shield graft for the nasal tip. Arch Otolaryngol 110(9):608–610

    CAS  PubMed  Google Scholar 

  15. Sheen JH (1993) A 20-year retrospective. Plast Reconstr Surg 91(1):48–63

    Article  CAS  PubMed  Google Scholar 

  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):524–529

    CAS  PubMed  Google Scholar 

  17. Lipsett EM (1959) A new approach to surgery of the lower cartilaginous vault. Arch Otolaryngol 70(1):42–47

    CAS  Google Scholar 

  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):347–355

    Article  CAS  PubMed  Google Scholar 

  19. Hong-Ryul J, Tae-Bin W (2009) Nasal tip augmentation in Asians using autogenous cartilage. Otolaryngol Head Neck Surg 140(4):526–530

    Article  Google Scholar 

  20. Papadopulos A, Harada C (1987) Compound implant to project the nasal tip. Aesthet Plast Surg 11(3):181–185

    Article  CAS  Google Scholar 

  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):253–258

    Article  CAS  Google Scholar 

  22. Millard DR (1965) Adjuncts in augmentation mentoplasty and corrective rhinoplasty. Plast Reconstr Surg 36:48–61

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Robert Bisson, 4, rue Roger Aini, 14100, Lisieux, France

    Hani Abou Mayaleh

Authors
  1. Hani Abou Mayaleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hani Abou Mayaleh.

Electronic supplementary material

Below is the link to the electronic supplementary material.

The OFF surgical technique (MPG 29751 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abou Mayaleh, H. The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery. Aesth Plast Surg 35, 73–79 (2011). https://doi.org/10.1007/s00266-010-9562-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-010-9562-2

Keywords

Search

Navigation