Angulated Cephalic Strip Flap in Lateral Crura Reduction: A Scroll Area Preservation Technique in Rhinoplasty

Generalow A, Kovacevic M, Stigger T, Kofler B.

What this paper says

In 138 patients with bulbous tips, folding the upper edge of the tip cartilage under itself instead of cutting it off gave satisfactory tips with no valve narrowing and no technique-related revisions.

Overview

The standard cephalic trim removes the upper strip of the lower lateral cartilage to slim a bulbous tip, but can cause alar retraction and weaken the internal nasal valve. The authors describe a modification, the angulated cephalic strip flap (ACSF), used during open septorhinoplasty in 138 patients. The strip is incised but not detached, a small triangle is removed, and the flap is folded down and sutured.

Sections of note

138 patients with bulbous tips, all via open septorhinoplasty.
The cephalic portion is superficially incised without separation, preserving the scroll area.
The anterior-cephalic triangle is resected so tip sutures are easier and cartilage does not double up at the new dome.
The folded flap is anchored with a single suture plus a scroll-area suture to prevent displacement and warping, "particularly in thin-skin patients."
All 138 had satisfactory results; no revisions related to the technique; no internal valve narrowing observed.

What it means for a patient

Tip-slimming can be done by folding rather than removing cartilage, keeping support for the side wall.
In this series the method avoided the alar retraction and breathing problems linked to aggressive trims.
Results are from a single group's assessment without a comparison group.

Why this paper matters

It refines the cephalic hinged flap, part of a broader shift toward preserving tip cartilage. Limits: no control group, no validated outcome scores in the abstract, and unstated follow-up.

Terms

Lower lateral cartilage (LLC): the paired cartilages that shape the tip and nostrils.
Cephalic trim: removing the upper edge of the LLC to refine the tip.
Scroll area: the junction where the tip cartilages overlap the upper lateral cartilages, a key support for the valve.
Internal nasal valve: the narrowest part of the airway, between the septum and upper lateral cartilage.
Alar retraction: the nostril rim pulling upward, showing too much nostril.

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

From the abstract

“In nasal tip surgery, achieving both functional and aesthetic results is crucial. Several complications, such as alar retraction or weakening of the internal nasal valve (INV), are associated with the "classical" cephalic trim. To prevent complications in nasal tip surgery a horizontal reduction of the lateral crus…”

Excerpt; the full abstract is on PubMed.