The lateral crural rein flap: a novel technique for management of tip rotation in primary rhinoplasty

Kuran I, Öreroğlu AR, Efendioğlu K.

What this paper says

In 11 primary rhinoplasty patients followed a mean 18 months, cartilage flaps cut from the upper edge of the tip cartilage and anchored to the bridge held the tip rotation that surgery had set.

Overview

Tips tend to drop back down after surgery, which undoes the intended rotation and can leave fullness just above the tip. The authors describe using the excess upper portion of the lateral crura as flaps that stay attached at the inner end and are fixed into the nasal dorsum. The aim is to tether the tip so it keeps its position.

Sections of note

Eleven patients underwent primary open approach rhinoplasty including this technique; mean follow-up was 18 months.
Excess cephalic portions of the lateral crura were prepared as medial crura based cartilage flaps.
The flaps were incorporated into the nasal dorsum in a manner the authors compare to spreader grafts, then stabilised at the desired rotation.
The technique is presented as a supplement to dorsal reconstruction.
Reported results were stability of the tip with minimal derotation after surgery.
Long term follow-up showed maintained tip rotation and symmetric dorsal aesthetic lines.
The paper is graded level of evidence 4.

What it means for a patient

Tip rotation set during surgery can relax afterward, and this method is one way of anchoring it.
Only 11 patients were treated, with no comparison group and no numeric measurement of rotation before and after.
Results were judged by the operating team rather than by independent assessors or patient scores.
The technique reuses cartilage that would otherwise be discarded, so no extra graft is harvested.

Why this paper matters

Loss of rotation is one of the recurring disappointments of tip surgery, and structural fixation to the midvault is the current line of attack. Whether the rein flap holds better than established methods, and in larger numbers, is unanswered.

Terms

Tip rotation: the upward or downward angle of the nasal tip.
Derotation: the tip dropping back down after surgery.
Lateral crus: the outer arm of the lower tip cartilage.
Medial crus: the inner arm of the lower tip cartilage, running toward the nostril base.
Spreader graft: a strip of cartilage placed alongside the septum to widen and support the middle vault.
Supratip deformity: fullness just above the tip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“An important consideration in rhinoplasty is maintenance of the applied tip rotation. Different techniques have been proposed to accomplish this. Loss of rotation after surgery not only results in a derotated tip but also can create a supratip deformity. Objectives: As a supplement to dorsal reconstruction, the…”

Excerpt; the full abstract is on PubMed.