The use of inter-alar ligaments flap for tip and supra-tip contouring in primary open structural rhinoplasty

Abstract

Background: Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supra-tip deformities, as well as long-lasting edema, may jeopardize the outcome, thus leading to patient’s dissatisfaction or re-intervention. Several approaches were previously reported, sometimes with considerable drawbacks or conclusions mainly supported by experience. The aim of this study is to describe the inter-alar ligaments flap for tip and supra-tip contouring and to comparatively assess its efficacy and safety. Methods: The study included 147 patients who underwent primary structured open rhinoplasty and divided into 2 groups: group 1 underwent harvesting and repositioning of the inter-alar ligaments flap, group 2 underwent conventional tip dissection. Tip edema, supra-tip definition and fullness were blindly scored at 2-, 6- and 12-month post-operative follow-up. Naso-labial angle was measured at 2 and 12 months post-operatively. Univariate analysis and and multivariable regression model were performed. Results: Supra-tip definition was significantly higher in group 1 at 2-, 6- and 12-months post-operative follow up (p<0.05, p<0.01 and p<0.01, respectively). Tip edema and supratip fullness were significantly lower in group 1 at each time point (p<0.01). Naso-labial angle, as well as its modification between 2- and 12-months post-intervention, did not differ in the 2 groups. All findings were confirmed when controlled for eventual confounders. Conclusions: The inter-alar ligaments flap proved to be versatile, effective and consistently reliable in reducing tip edema and improving supra-tip definition. It may be tailored to the patient, partially folded to improve tip projection or used to camouflage tip grafts.