Use of the Interalar Ligament Flap for Tip and Supratip Contouring in Primary Open Structural Rhinoplasty

Marianetti TM, Segreto F, Iademarco A, Rossi C, Persichetti P.

What this paper says

Among 147 primary rhinoplasty patients, those whose interalar ligament was preserved and repositioned as a flap had less tip swelling and better definition above the tip at 2, 6 and 12 months.

Overview

Precise shaping of the tip determines much of the cosmetic result, and the area just above the tip is prone to fullness and long lasting swelling. The authors describe using the interalar ligament, a fibrous band between the tip cartilages, as a flap rather than discarding it, and compared that against conventional tip dissection in a two group study.

Sections of note

Design: comparative study of 147 primary open structural rhinoplasty patients. Level of evidence therapeutic III. Group 1 had the interalar ligament harvested and repositioned as a flap; group 2 had conventional tip dissection.
Supratip definition, scored blindly at 2, 6 and 12 months, was significantly better in group 1 at all three points, p less than 0.05 at 2 months and p less than 0.01 at 6 and 12 months.
Tip swelling and supratip fullness were significantly lower in group 1 at every time point, p less than 0.01.
The nasolabial angle, and its change between 2 and 12 months, did not differ between groups.
Findings held after multivariable regression. The abstract does not state how patients were allocated.

What it means for a patient

Persistent fullness above the tip is a common source of dissatisfaction, and this technique reduced it out to a year.
The flap uses tissue that would otherwise be removed, so no graft or donor site is involved.
Tip rotation was unaffected, meaning the flap changed the contour without altering the angle of the tip.
Limits: the abstract does not report randomization, and outcomes were scored on appearance ratings rather than patient questionnaires.

Why this paper matters

Structural rhinoplasty routinely divides the soft tissue between the tip cartilages, and preserving it fits the broader move toward keeping native structures. Blinded scoring across three time points with a comparison group is stronger than most technique reports. Whether the benefit persists past a year is unanswered.

Terms

Interalar ligament: the fibrous band connecting the two lower tip cartilages.
Supratip fullness: excess bulk just above the tip, sometimes called pollybeak deformity.
Flap: tissue moved to a new position while staying attached to its blood supply.
Nasolabial angle: the angle between the base of the nose and the upper lip.
Blinded scoring: rating by evaluators who do not know which technique was used.

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

From the abstract

“Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supratip deformities, and long-lasting edema may jeopardize the outcome and lead to patient dissatisfaction or to reintervention. Several approaches have been reported, sometimes with…”

Excerpt; the full abstract is on PubMed.