Angulated Cephalic Strip Flap in Lateral Crura Reduction: A Scroll Area Preservation Technique in Rhinoplasty

In nasal tip surgery, achieving both functional and aesthetic results is crucial. Several complications, such as alar retraction or weakening of the internal nasal valve (INV), are associated with the "classical" cephalic trim. To prevent complications in nasal tip surgery a horizontal reduction of the lateral crus (LC) using a cephalic hinged flap while preserving the scroll area is described. In 138 patients with bulbous tips, a modification of the hinged flap, the angulated cephalic strip flap (ACSF), was performed during open septorhinoplasty. The cephalic portion of the lower lateral cartilage was superficially incised without separation, preserving the scroll area. The anterior-cephalic triangle of the cephalic portion was resected to facilitate tip sutures and avoid cartilage duplication in the new dome area and hereby creation of additional, undesired volume. The cephalic part was folded inferiorly and anchored with a single fixation suture. Additionally, a fixation with a suture in the scroll area should be performed to strengthen the cranial border of the LC to prevent flap displacement and warping of lower lateral cartilage, particularly in thin-skin patients where the healing forces are significantly stronger. In all 138 patients, a satisfactory postoperative result was achieved, with improved aesthetic and functional outcomes for the nasal tip. The ACSF facilitated tip suturing in all patients after resection of the anterior-cephalic triangle. No revision related to this technique was required, and no narrowing of the INV was observed.