Advanced Preservation Technique for the Soft Tissue Envelope in Open Approach Rhinoplasty-Cephalic Lateral Crus, Scroll, Pitanguy Flap

Ben Ner D, Busel A, D'Souza A, Hazan A.

What this paper says

In 22 thick-skinned patients, lifting the upper part of the tip cartilage together with its scroll and Pitanguy ligament attachments as one flap during open rhinoplasty, then reinserting it, prevented pollybeak deformity and improved breathing in 19 and satisfaction in 21 at a mean 5.4 months.

Overview

Open rhinoplasty and tip work disrupt the soft-tissue envelope, and reconstructing it afterwards is imperfect. The authors describe a preservation alternative: during dissection in the supra-perichondrial plane, the cephalic lateral crus is elevated as part of the skin flap with its scroll and Pitanguy ligament attachments, forming a composite flap (CLC-SP flap) that is later reinserted. They reviewed 22 thick-skinned patients.

Sections of note

22 patients with thick skin, open approach.
19 reported improved breathing; 21 reported aesthetic satisfaction.
No pollybeak deformity at a mean follow-up of 5.4 months.
The reinserted flap limits dead space and supports the nasal valve.
The cephalic lateral crus was also used as an advancement flap to straighten and reinforce the caudal lateral crus.

What it means for a patient

Thick skin tends to fill the space above the tip with scar (pollybeak); keeping tissue attached rather than cutting and rebuilding is meant to prevent that.
Early results in 22 patients were good, but 5.4 months is too short to judge scar behaviour fully.
The method is for open surgery, showing preservation ideas are not limited to closed approaches.

Why this paper matters

It applies ligament preservation to the open approach in the patient group most at risk of pollybeak. Limits: 22 patients, short follow-up, no comparison group.

Terms

Pollybeak deformity: a rounded fullness above the tip that makes the nose look like a parrot's beak.
Cephalic lateral crus: the upper portion of the tip cartilage's side arm.
Scroll ligament: the fibrous junction between tip and upper lateral cartilages.
Pitanguy ligament: the midline soft-tissue band from bridge skin to tip.
Supra-perichondrial plane: a dissection layer just above the cartilage covering.

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

From the abstract

“The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip plasty. To avoid adverse outcomes such as pollybeak deformity and nasal valve collapse, these soft tissue structures should be reconstructed. Instead, preservation philosophy aims to preserve rather than…”

Excerpt; the full abstract is on PubMed.