Propeller Modification of Tapia's Flap

The aim of this manuscript was to describe a surgical technique to modify Tapia's flap for malar volume enhancement, to describe the results of an anatomical study of the transverse facial artery, and to present the results of a retrospective analysis of 42 clinical cases who received this flap as part of their facelift procedure. Tapia et al originally described a flap from the superior part of the superficial muscular aponeurotic system (SMAS) for malar enhancement during facelifting procedures. The flap remained attached at its base (random-type vascularization) and was folded to the malar area. This report presents a modification of this technique, raising the flap as an island, irrigated by the perforator of the transverse facial artery (which is consistently present at the inferolateral border of the zygoma). The flap is completely isolated as an island and is rotated 180° as a propeller to be placed in the prezygomatic space. The donor area is closed directly by advancement of the subcutaneous-SMAS during the facelifting procedure. The immediate postoperative period was uneventful in all patients. Flap viability was proved intraoperatively by indocyanine green staining. A series of 42 patients underwent this procedure from 2022 to 2024. Long-term results-evaluated clinically and with ultrasonography at 1 month and 1 year postoperatively-revealed that the volume remained permanent without reabsorption. Patient satisfaction evaluated with a satisfaction scale indicated in a high rate of excellent results. An anatomical study was performed in 14 fresh cadaveric specimens (28 hemifaces). The cutaneous branches of the transverse facial artery were dissected from their origin. These branches were consistently present in all the specimens, giving branches to the subcutaneous-SMAS system. This modification of the original Tapia flap reinforces its vascularization. It allows better flap placement and a longer medial reach in the tear trough area. Complete flap survival and long-term volume preservation was observed. Level of Evidence: 4 (Therapeutic).