Advanced Preservation technique for the soft tissue envelope in open approach rhinoplasty – Cephalic lateral crus, scroll, Pitanguy flap

Aims and Background: The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip-plasty. To avoid adverse outcomes such as polly-beak deformity and nasal valve collapse, these soft tissue structures should be reconstructed. Instead, preservation philosophy aims to preserve rather than reconstruct. The aim of this study is to present a technique that facilitates the preservation of the soft tissue envelope using the cephalic lateral crus-scroll-Pitanguy flap (CLC-SP flap) in open rhinoplasty. Patient Selection: A retrospective analysis was performed on 22 patients with thick skin who underwent open approach rhinoplasty in the supra perichondral plane. Technique: During the dissection, the cephalic portion of the lateral crus (LC) is elevated as part of the skin, with the LC’s attachments to the soft tissues via the scroll and Pitanguy ligaments as a composite flap. In this way, the soft tissues are preserved. Reinsertion of the cephalic LC with its attached soft tissues restores normal anatomy and minimizes dead space. Post Operative care: Nineteen patients reported improved nasal breathing, and twenty-one patients reported aesthetic satisfaction after a mean follow up of 5.4 months, no polly-beak deformity occurred. Using this technique, we were able to control tip definition by limiting dead space and support the nasal valve. Additionally, the cephalic LC was utilized as a caudally advancement flap to reinforce and straighten the caudal LC improving its position and resting angle. Conclusion and clinical relevance: The CLC-SP flap is a useful technique for controlling and preserving the soft tissue envelope, improving tip definition, supporting the nasal valve and minimizing dead space, thus preventing polly-beak deformity in thick skin patients.