The periosteoperichondrial flap in external rhinoplasty

A technique for raising a laterally based periosteoperichondrial flap over the nasal bones and the upper lateral cartilages has been used successfully. The patient's nasal skin is temporarily elevated, as in standard external rhinoplasty, and then the periosteum is incised on the right side of the frontal process of the maxilla just caudal from the synostosis of the maxilla and the frontal bone. The incision is extended caudally, gently curving over the upper lateral cartilage, ending at the septal tip. The periosteoperichondrial flap is then elevated, using Cottle's knife, over the midline to a corresponding line on the other side. After all rhinoplastic maneuvers are completed, the periosteoperichondrial flap is replaced and sutured in its original position. The periosteoperichondrial flap provides excellent covering for the reconstructed bony and cartilaginous nasal pyramid, smoothens the new nasal dorsum, stabilizes the medial osteotomies, and prevents supratip protrusion.