Septal Advancement Flap: Preserving, Restructuring, and Reshaping the Nasal Tip Contour with a Novel Flap

Tip support and the tip's exact final position-rotation and projection-remain a main concern among rhinoplasty surgeons. The available options can be classified into two groups: septal extension graft (variations including tongue-in-groove) and columellar strut (with all its variations). There is still the possibility of nasal tip ligament(s) preservation-namely the interdomal ligament, when anchoraged cephalically to the anterior septal angle preserving the tip support. Including this panoply of solutions, the author has identified some challenges with insufficient outcome. Based on engineering concepts, a novel septal flap was developed to facilitate a preferred tip position and shape. The septal advancement flap (SAF) is a rotational-advancement flap of the superior and caudal aspects of the cartilaginous septum that enables the surgeon to create stable and accurate tip shape and position. This flap was designed following the spare roof technique B sequence, although it can be completed along with any technique of structure or preservation rhinoplasty.