Nasolabial Flap Variations and Alternatives in Nasal Ala Reconstruction

Various nasolabial flap types, including 2-stage and single-stage flaps, have been advocated for alar reconstruction. When to choose which method remains unclear. In this study, the performance of nasolabial flap variations was analyzed and compared with other reconstructive options.

Consecutive alar reconstructions performed over a 10-year period (2012 through 2022) were studied retrospectively. Patient charts were reviewed for defect size, reconstructive technique, cartilage grafts, surgical complications, and secondary procedures. Patients were followed up clinically at 3, 6, and 12 months. Aesthetic outcomes were evaluated using standard digital photographs.

A total of 148 alar reconstructions were performed in 84 women and 64 men (mean age, 69 years). The average defect diameter was 1.6 cm (range, 0.5 through 4.5 cm). A total of 110 reconstructions (74%) were performed with nasolabial flaps (90 single-stage and 20 2-stage), including 68 nasolabial cheek flaps, 32 nasolabial island flaps, and 10 nasolabial transposition flaps. A total of 38 reconstructions (26%) were performed using other flaps ( n = 20), skin-fat grafts ( n = 14), or direct closure ( n = 4). Alar rim grafts (95 primary and 5 secondary) were used in 100 patients. Complications occurred in 43 patients (29%), including hematoma, delayed wound healing, flap necrosis, vestibular stenosis, and alar crease obliteration. Planned secondary procedures were performed in 20 nasolabial island flaps and 12 paramedian forehead flaps. Unplanned secondary procedures were performed in 40 single-stage (44%) and two 2-stage (10%) nasolabial flaps. None of the other single-stage flaps or skin-fat grafts were revised.

Single-stage nasolabial flaps produce aesthetically pleasing results and compare favorably to other techniques. However, unplanned secondary surgery is frequent.