A Technique for Recreation of the Naso-labial Skin Fold and Alar Skin Crease Following Naso-Labial Flap Reconstruction of the Nose

Purpose

The nasolabial flap is a common local flap used for reconstruction of nasal defects. Unfortunately, the final cosmetic outcome may be suboptimal due to a loss of such important facial aesthetic landmarks such as the nasolabial fold (NLF) or the alar skin fold (ASF). There are very few options available to recreate these landmarks successfully. We propose a simple and consistent technique for late recreation of the NLF and ASF following nasolabial flap reconstruction by combining a simple local flap with the technique of “opposing triangles”.

Methods

Three consecutive patients who underwent this new technique were evaluated.  All patients previously underwent a superiorly based naso-labial flap for reconstruction of a nasal alar defect following local cancer excision. All three patients complained of loss of the NLF, and or the ASF as well as a bothersome unaesthetic “webbing” that occurs from the ala onto the cheek. Correction was achieved utilizing a simple medially based local flap from the nasal ala, and opposing triangles on the cheek. (See diagram) 

Results

All patients achieved complete correction and restoration of the ASF and NLF.  Representative photos of all three cases will be presented.

Conclusions

We propose a novel secondary revisional surgical technique that allows simple and reliable recreation of important facial aesthetic transition landmarks such as the ASF and NLF that may be lost as a result of nasolabial flap reconstruction of the nose.

Learning Objectives

1) The audience will understand how the use of a NL flap for reconstruction of the nose can lead to undesirable loss of the ASF and NLF aesthetic landmarks.

2) The audience will learn a simple and quick technique to restore these landmarks.