An Alternative Rhinoplasty Technique: Rotational Spreader Flap ("Rabbit Flap")

Overview

Septal cartilage is the usual graft material, and running short of it is a common problem. The authors describe an alternative that borrows cartilage from the upper part of the tip cartilage instead, rotating it into position between the septum and the upper lateral cartilage so it acts as a spreader.

Sections of note

• The rabbit flap is created from the cephalic portion of the lower lateral cartilage.
• The key stated requirement is not cutting the connection between the lateral and medial crus of the alar cartilage.
• The flap is rotated between the upper lateral cartilage and the septum for a spreader graft effect, and moved forward or backward to adjust tip rotation.
• Only patients whose lower lateral cartilage was at least 12 mm wide were included.
• 24 patients completed the Rhinoplasty Outcomes Evaluation questionnaire; nasal axis and nasolabial angles were measured before surgery and at 1 year.
• Significant improvement in ROE scores, nasal axis deviation, and nasolabial angle, p below 0.001; no complications observed. Level of evidence IV.

What it means for a patient

• Cartilage can be borrowed from the tip rather than the septum when septal supply is short.
• The same flap addresses tip rotation, mild crookedness, and the middle-of-nose narrowing that causes an inverted V.
• The technique requires cartilage at least 12 mm wide, so it is not available to everyone.
• Limits: 24 patients, one center, no comparison group, no randomization, 1 year of follow-up, and no objective breathing measurement despite the claim of expanding the internal valve.

Why this paper matters

Graft supply is a practical constraint in rhinoplasty, particularly in revision and in patients with small septums. Reusing cartilage that is often simply trimmed away addresses it. Without a comparison group the technique's performance against a conventional spreader graft is unknown.

Terms

• Lower lateral cartilage: The paired cartilage forming the nasal tip and nostril rim.
• Cephalic portion: The upper part, toward the head, often trimmed during tip surgery.
• Spreader graft effect: Widening and supporting the middle of the nose alongside the septum.
• Nasolabial angle: The angle between the base of the nose and the upper lip.
• Inverted V deformity: A visible V-shaped shadow where the nasal bones end and the middle vault has collapsed.