The Lateral Turn-In Flap in Rhinoplasty

This audio podcast has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

The world of rhinoplasty is so very complicated in discussing how to perform various parts of the procedure and it’s amazing how one small tool or one small trick can really change the way that rhinoplasty is safer more structurally improved. So for me, the biggest one is the lateral cartilages extension graft. I actually did, excuse me, a caudle septal extension graft. I did a podcast on the caudal septal extension graft many months ago. I encourage you to listen to that but to me, that’s the single most important development in rhinoplasty over the last 10 years. Essentially what that is it’s a graft place the tip of the nose anchored to the septum so that the tip of the nose does not fall downwards over time. So there’s very predictable tip outcomes that over the ones lifetime does not alter a shift or start to fall and that is a huge thing. A new one for me over the last couple of years that I’ve been doing that I’ve really loved is what’s called the lateral canthal turn-in flap. I’m sorry. I just did a podcast on lateral canthus the lateral turning flap. So what this is very hard to describe and so I may not actually do it full justice here without you now visuals here, but the lateral crus CR U s– defines the outer portion of the nostril REM made of cartilage. That’s the outer nostril It’s the area that when you look at your nose it can look bulbous, boxy or wide and so often times you want to reduce that and you want to actually shrink that shape down so that the nose looks more refined and that can be in almost any ethnicity. The problem with the traditional way which is called a cephalic trim. Which is the way I’ve been I was doing it for many, many years over, you know, maybe 15 years is I would just look at that excess cartilage and cut it out and throw it away and so that was the old technique in my opinion of doing this where essentially you looked at. Okay. This part is just, you know, too much cartilage. You just don’t need that much. So we’re just going to discard it. And then of course what the key is we’re going to preserve the cartilage below so that your nose isn’t collapse inward. However, the problem with that is essentially you are weakening that cartilage that you essentially are making that nose weaker. In in support and yes, there’s a chance that you could over reduce it and make the nose too weak. So, this is a very preserving way of reducing that and has other positive attributes. So, essentially what I do here is instead of cutting away that excess I just score it like I cut the cartilage just almost through but not completely and I release the mucosa or the lighting and the inside so that it’s now just a free-floating cartilage and I flip that upper portion inside. And so what that does is now I hide that cartilage inside the other cartilage instead of just cutting it away. So this is a lateral turn in flap where I’m actually flipping that cartilage downwards you said well, would that not make the nose too thick. Actually number one it it really doesn’t it’s so thin that it doesn’t really make the cartilage to thick which is always a concern. But one thing really cool that it adds incredible stability to that cartilage so that there is very little risk of that nose being collapsing inwards over time and that helps with the airway. The other really interesting thing about this and it’s going to be really hard to describe again without actually having visual here. But usually the shape of that cartilage is convex and other words a sort of bulging outwards and then and that causes the fullness as well. And so what I do is when I flip that in the lateral turn in flap, I flip it in that actually flattens the cartilage out. So it no longer looks convex. It’s a really interesting feature. It is that once you hinge that graft you don’t actually cut through the cartilage entirely just score it and you flip it in actually the two convex side sewn together creates one flat straight cartilage and then of course with the caudal septal extension graft, which is what I briefly mentioned before anchoring that forward and hold. Position further flattens that that cartilage down so it’s an amazing reshaping of the cartilage adding further strength without weakening the cartilage at and at the same time also making the tip look much more refined. This is something that probably 99% of surgeons rhinoplasty surgeons out there don’t do they still trim it away. But the best of the best this is what we do because it’s just so much better in terms of structure and also aesthetics.

    Contact Us

    I agree to the Terms of Use