Reverse nasal SMAS-perichondrium flap to avoid supratip deformity in rhinoplasty

Overview

A supratip deformity, or parrot beak, is a bulge just above the tip that appears after rhinoplasty. A leading explanation is that too much of the lower bridge is removed, leaving a gap that scar tissue fills. The authors designed a flap of the soft tissue layer (SMAS) and cartilage lining, based toward the tip and turned downward, to occupy that gap in a controlled way.

Sections of note

• Flap raised from the lower third of the nose and the lower third of the middle third, including perichondrium and SMAS, with a reverse base.
• Used in 42 primary rhinoplasty patients between December 2008 and July 2010.
• Follow-up 3 to 18 months.
• No early or late complications such as infection, excessive bleeding or prolonged swelling.
• Minor revisions in 2 patients to smooth the dorsum.
• The authors advise avoiding the flap, or using it cautiously, in thin skin; in thick skin they call it very safe.

What it means for a patient

• The bulge above the tip that can follow hump removal may be prevented by managing the soft tissue, not only the cartilage.
• Suits thick-skinned noses; thin skin may show the flap.
• Short follow-up, no comparison group and no count of supratip deformity avoided; the authors themselves call the results preliminary.

Why this paper matters

Supratip fullness is a frequent cause of revision. This is a new soft tissue maneuver aimed at its cause, from a period when most solutions addressed cartilage. Larger and longer studies, which the authors call for, have not been reported in the abstract.

Terms

• Supratip deformity: a bulge on the bridge just above the tip after rhinoplasty; also called parrot beak or pollybeak.
• SMAS: the superficial musculoaponeurotic system, the sheet of muscle and fibrous tissue under the skin.
• Perichondrium: the thin membrane covering cartilage.
• Flap: a piece of tissue moved while still attached at one edge to keep its blood supply.
• Caudal dorsum: the lower part of the bridge, near the tip.
• Primary rhinoplasty: a first-time nose operation.