Superior-Based Transposition Flap: A Novel Technique in Rhinoplasty

Overview

Trimming the upper edge of the tip cartilage is the standard way to reduce a bulbous tip, but it removes support and can leave the nose pinched or the valve collapsed. This technique converts that trimmed portion into a flap that is advanced over the remaining cartilage instead.

Sections of note

• 367 patients were operated with the technique: 215 female, 152 male. Data were evaluated retrospectively.
• The flap is prepared from the cephalic portion of the lower lateral cartilage, based on the scroll area, and advanced over the remaining cartilage.
• Functionally, the flap is described as reshaping and supporting the cartilage and the internal valve while keeping the scroll intact and increasing the internal valve angle.
• The author states the support and suspension provided prevent narrowing of both the external and internal valve angles.
• Aesthetically, the convexity and concavity of the cartilage are corrected by adapting the two surfaces at different angles, producing a narrower, refined tip.
• Stated additional uses include increasing tip rotation and suspending the internal and external valves.
• The abstract gives no numeric outcomes, complication rates, satisfaction scores, or follow-up duration.

What it means for a patient

• Cartilage that would normally be discarded is reused as support, so narrowing the tip does not cost structure.
• The scroll area, the junction between the middle and lower thirds, is preserved rather than disrupted.
• Limits: 367 patients but one surgeon, retrospective, no comparison group, no objective breathing measurement, and no stated follow-up.
• The functional claims about valve angle are described rather than measured.

Why this paper matters

Cephalic trim is one of the most commonly performed tip maneuvers and one of the most common causes of a pinched nose and valve collapse years later. Repurposing the trimmed cartilage addresses that directly. The absence of measurement or a control group means the claimed benefits remain unverified.

Terms

• Lower lateral cartilage: The paired cartilage forming the nasal tip and nostril rim.
• Cephalic trim: Removing the upper edge of that cartilage to narrow the tip.
• Scroll area: The junction where the upper and lower lateral cartilages overlap.
• Internal nasal valve: The narrowest part of the nasal airway.
• Transposition flap: Tissue moved from one position to another while staying attached at its base.