Flag technique an alternative in tip-plasty for Asian patients with insufficient septal cartilage

Recently published study findings demonstrated that a new “flag technique” was a suitable alternative method for tip-plasty in Asian rhinoplasty patients with insufficient septal cartilage.

“The technique uses a tip-strut complex in a flag-like shape, using only the septal cartilage as an elongated columellar septal graft, a shield graft and bilateral mini-spreader grafts of the upper part of the elongated columellar septal graft without the septal extension grafts or extended spreader grafts,” researcher Cheol Hwan Kim, MD, wrote in the study.

The retrospective analysis involved 161 patients who underwent open rhinoplasty with the flag technique, 137 of whom were undergoing primary rhinoplasty and 24 of whom were undergoing secondary rhinoplasty. Postoperatively, Kim reviewed patient photographs and medical charts to track increasing tip projection and lengthening of the nose. Mean follow-up was 357.3 days.

Postoperative complications included one patient with tip deviation and one patient with suboptimal outcome. To correct tip deviation caused by a weak columellar septal strut graft, the surgeon replaced the columellar Medpor-septal complex strut graft (Orthovita).

Of the six parameters used to measure tip projection, no significant differences were observed in the tip-to-nostril ratio, columellar-labial angle, columellar-lobular angle or nasofrontal angle, according to Kim. However, a significant difference was discovered in the tip projection-to-nasal-length ratio, tip to vertical line of upper lip-to-tip projection ratio and tip-defining point-to-alar base width ratio.

Kim reported that the differences could be a result of the varying anatomy between Asians and Westerners. Additionally, Kim recommends this technique in Asian patients to improve greater than 3 mm of tip projection without the septal extension grafts or extender grafts. - by Abigail Sutton

Disclosure: Kim reports no relevant financial disclosures.