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ORIGINAL ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 3  |  Page : 162-165

The effectiveness of rein flap technique in the cosmetic outcomes of rhinoplasty


Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

Date of Submission29-Nov-2020
Date of Acceptance19-Mar-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Omid Etemad
Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_122_20

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  Abstract 


Background: The beauty of nasal tip is very important in septorhinoplasty surgeries. Unstable tip rotation may lead some problems in the outcome of this surgery or performing a repair surgery. Hence, using an appropriate method to save the tip rotation for the long term is considered. Materials and Methods: We studied 30 patients who underwent rhinoplasty in Imam Khomeini Hospital Complex of Tehran and Razi Hospital of Tehran and divided them equally into two groups of rein (case) and septocolumellar (control), randomly. Then, we evaluated the rotation and projection of the nasal tip (nasolabial, columellar-labial, and nasofacial angles) after 2 weeks and 6 months of the surgery. Results: In both groups, 80% and 20% of the patients were female and male, respectively. The reduction of the nasal projection (columellar-labial and nasofacial angles) and nasal rotation (nasolabial angle) was significant in both groups during 6 months after the surgery (P > 0.001) that showed reduction in the nasal projection and rotation after 6 months in both group. This reduction was not significant in the nasofacial and columellar-labial angles (nasal projection) among two groups. However, in the case of nasolabial, we found less reduction in the case group that explains significant relation (P = 0.03). Discussion: Using rein flap can be used as a proper way to save the tip rotation in the long term and could be used in the patients with droopy tip noses. Conclusion: Using rein flap in nasal tissue seems to be effective in providing a stable rotation and projection. This method can be considered as a good option for providing proper projection and rotation.

Keywords: Nasal tip, rein flap, rhinoplasty


How to cite this article:
Rahmati J, Yavari A, Etemad O. The effectiveness of rein flap technique in the cosmetic outcomes of rhinoplasty. Turk J Plast Surg 2021;29:162-5

How to cite this URL:
Rahmati J, Yavari A, Etemad O. The effectiveness of rein flap technique in the cosmetic outcomes of rhinoplasty. Turk J Plast Surg [serial online] 2021 [cited 2021 Oct 26];29:162-5. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/3/162/322672




  Introduction Top


In rhinoplasty surgeries, manipulation and stability of the nasal tip are two key points to achieve a proper cosmetic result. Although there are various methods to control the rotation of the nasal tip, such as cartilage grafting, cartilage-modifying sutures in which the columellar strut graft, tip graft, septal extension, and shield graft are deployed, the stability of it in the long term is still very important for us. Some other methods include lateral crural overlap, lateral crural suture, and tongue-in-groove which are being used to control the nasal tip.[1],[2],[3]

Although the tip rotation can be provided during the surgery, it may be lost in the long-term, and improper results will be achieved that leads dissatisfaction among the patients and they may need repair surgeries. Hence, the best method is the safer one with the lower cost, more accuracy, more stability, and easier to be performed.

In this study, we evaluated the outcomes of rhinoplasty using lateral crural rein flap in 15 patients as the case group and compared the results with 15 other patients who underwent the rhinoplasty using the method of septocolumellar suturing to provide desired tip rotation.

In this method, we used the lower lateral cartilage (LLC) cephalic as the flap after the excision of cephalic trim with the minimum width of 2 mm and it was fixed to the septum along the rotation just like the spreader graft. Using this technique allows the surgeon to provide the proper rotation with the desired amount of tension and fixation area. This method seems to create long-term stability due to the use of the patient's own cartilage flap that is fixed to the medial part.

We have several studies that measured the efficacy of different methods (septal extension graft, septocolumellar suturing, and tongue-in-groove) for stability of nasal tip rotation and projection, but all studies on rein flap were subjectively and affirmed the efficacy of rein flap method for long-term stability of nasal tip after rhinoplasty but they did not measure anything and just they released they experiences, subjectively.

Dr Esmail Kuran in 2014 published the results of 11 patients of rhinoplasty and lateral crural rein flap. He believes this method an efficient method to achieve long-term stability of the nasal tip.[4]


  Materials and Methods Top


We chose 30 patients among those who referred to Imam Khomeini Hospital Complex and Razi Hospital of Tehran plastic and reconstruction surgery clinics. The inclusion criteria were the appropriate width of the LLC so that the flap was 2 mm and the remaining part was 7 mm, and the consent from the patients. The exclusion criteria were defined as any problem that may not allow us to perform rein flap or usual techniques, the lack of tracking during the follow-up, cases with the thin width of the middle part of the LLC, and the patients who had the history of rhinoplasty before.

Based on the blocking of four numbers and by the method of allocation of 4, the patients were divided into two groups of case and control, equally. The control group underwent rhinoplasty with the technique of septorhinoplasty. For these patients, we used columellar strut for achieving the appropriate rotation and projection which it was the only difference between two groups. In the case group, the lateral crural rein flap technique was used to provide proper rotation and projection.

All the surgeries were performed by one surgeon and the photograph of each patient's frontal and lateral facial was taken after 2 weeks and 6 months of the surgery. In both groups, the nasofacial angle and the tip-columellar angle compared to evaluate the projection and angle of nose-lip and nasal tip rotation, respectively. [Figure 1] shows the different angles of the nasal which are evaluated in this study.
Figure 1: The angles of the nasal

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  Results Top


Each group included 15 patients who 3 and 12 of them were male (20%) and female (80%), respectively. The mean age in case and control group was 29.3 and 31.4 years, respectively, and the results of the surgery were evaluated after 2 weeks and 6 months following the surgery.

The mean angle of nasolabial was 103° and 106.9° after 2 weeks and 100.6° and 102° after 6 months of the surgery in the case and control group [Table 1], respectively (P = 0.003). These quantities after 2 weeks and 6 months of the surgery had significant relationship without considering the groups (P < 0.001); and also, they had significant relationship among both groups after 2 weeks and 6 months of the surgery (P < 0.001).
Table 1: Nasolabial angle

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The mean angle of columellar labial was 104.1° and 108° after 2 weeks and 100.53° and 102.6° after 6 months of the surgery in the case and control group [Table 2], respectively. After 6 months, the reduction of tip rotation in the control group was larger than it in the case group with no significant relationship (P = 0.2). This parameter had a significant relationship after 2 weeks and 6 months of the surgery without considering the groups (P < 0.001).
Table 2: Columellar labial angle

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The mean angle of nasofacial was 37° and 36.2° after 2 weeks and 33.9° and 31.5° after 6 months of the surgery in the case and control group [Table 3], respectively. After 6 months, the reduction of tip projection in the control group was larger than it in the case group with significant relationship (P < 0.001). This parameter had a significant relationship after 2 weeks and 6 months of the surgery without considering the groups (P < 0.001) [Table 4].
Table 3: Nasofacial angle

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Table 4: Projection

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The parameters of the long-term evaluation during 2 weeks and 6 months of the surgery are also tabulated in [Table 5] and [Table 6]. Furthermore, we provided three patients photographs in [Figure 2], [Figure 3], [Figure 4] in which you can find the changes of the nasal during the follow-up period.
Table 5: The evaluation of parameters after 6 months in case group

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Table 6: The evaluation of parameters after 6 months in control group

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Figure 2: Patient (1): before the surgery (Left), 2 weeks of the surgery (middle), 6 months of the surgery (right)

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Figure 3: Patient (2): before the surgery (left), 2 weeks of the surgery (middle), 6 months of the surgery (right)

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Figure 4: Patient (3): before the surgery (left), 2 weeks of the surgery (middle), 6 months of the surgery (right)

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  Discussion Top


In a study by Dr. Kuran in 2014, 11 patients underwent the rhinoplasty using the lateral crural rein flap technique.[4] The cartilage flaps were created from the cephalic portion of the lateral crural to stabilize the tip rotation. It was reported that this method was very effective in providing stability of the nasal tip and minimized the postoperative period. No columellar or medial crural retraction was observed by the author of this study.

Another study by Dr. Kuran et al. on 18 patients who underwent the rhinoplasty was performed in 2005.[5] In this research, the patients were divided into two equal groups which include the tip-binding suture group and cartilaginous graft group. The changes in all parameters except crural length were significant in the tip-binding suture group. The author statement introduced the effectiveness of this technique when minor dimensional changes with more rotational alternations are planned.

Dr. Rohrich also reported the results of using columellar strut technique on 100 patients, and after 1 year, about 65% of patients experienced reduction in the nasal projection.[6] Tip translation was decreased in 23% of them, and the nasolabial angle increased in 46%, decrease in 34%, and unchanged in 20% of the patients.

Foda evaluated five hundred consecutive rhinoplasty cases in 2003.[7] These patients underwent the rhinoplasty by three methods which include the lateral crural steal, the lateral crural overlay, and the tongue-in-groove techniques. The nasal tip rotation was increased in all groups, while the projection was increased in the first group, decreased in the second group, and in the third group, no significant changes were seen. Highest degrees of rotation were observed in the second group followed by the first and third group. The author indicated the lateral crural steal as the best technique in cases with droopy under projected nasal tip, and the lateral crural overlay as the best method in cases of droopy overprojected nasal tip, and the tongue-in-grooves in cases where the droopy nasal is associated with an adequate amount of projection.

In our study, the angles of nasolabial, columellar labial, and nasofacial and the projection of the nasal tip in the control group were larger in the case group after 2 weeks of surgery that showed no significant relationship among them except in nanolabial angle. It was shown that using the rein flap was more effective for maintaining the tip rotation in long term. The mean of all the calculated angles, regardless of the groups, 2 weeks after the operation is significantly different from them after 6 months of the operation; this showed that we have some degrees of sagging in nasal tip after the rhinoplasty.

By performing a pairwise test on each variable, to compare 2 weeks with 6 months after the surgery, all variables calculated in both groups were significantly reduced after 6 months. This finding indicated reduction of the projection and rotation of the nasal tip after 6 months, independent of the method used.

Due to the possibility of using nasal self-adhesive tissue, using the rein flap initially seemed to be very effective in providing stability and desirability in rotation and projection of the nasal tip. We found that all patients who underwent the rhinoplasty had some degrees of failure. The rate of reduction in the projection and rotation of the nasal tip is independent of the method which was used. The rate of reduction of the projection and rotation in the control group was higher, but it was significant only in the case of nasolabial angle.

Therefore, it seems that this method can be more successful in maintaining the tip rotation in compare with the conventional method, and this method can be used as an option to create a suitable projection and rotation in this area. According to the findings of this study, it is recommended to use this method in patients who need a big change the tip rotation and their nose has a suitable length, because with small changes in the fixation of the flap on the septum, there is a significant change in the tip rotation and the length of the nose. There is the risk of short nose in people with short nose.


  Conclusion Top


Using rein flap in nasal tissue seems to be effective in providing a stable rotation and projection. The decrease in projection and rotation was more in control group and it only had significant relation with nasolabial angle. On the other hands, using this method helps us to make. Hence, it seems that this technique is more successful in saving the postoperative rotation than other methods and can be considered as a good option for providing proper projection and rotation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guyuron B, Behmand RA. Nasal tip sutures part II: The interplays. Plast Reconstr Surg 2003;112:1130-45.  Back to cited text no. 1
    
2.
Castro-Govea Y, del Campo AF, Chacón-Martínez H, Pérez-Porras S, Vallejo-Estrella RO, Cervantes-Kardasch V. A procedure to prevent cephalic rotation of cartilage grafts in the nasal tip. Aesthet Surg J 2009;29:98-105.  Back to cited text no. 2
    
3.
Daniel RK. Rhinoplasty: open tip suture techniques: A 25-year experience. Facial Plast Surg 2011;27:213-24.  Back to cited text no. 3
    
4.
Kuran I, Öreroğlu AR, Efendioğlu K. The lateral crural rein flap: A novel technique for management of tip rotation in primary rhinoplasty. Aesthet Surg J 2014;34:1008-17.  Back to cited text no. 4
    
5.
Kuran I, Tümerdem B, Tosun U, Yildiz K. Evaluation of the effects of tip-binding sutures and cartilaginous grafts on tip projection and rotation. Plast Reconstr Surg 2005;116:282-8.  Back to cited text no. 5
    
6.
Rohrich RJ, Kurkjian TJ, Hoxworth RE, Stephan PJ, Mojallal A. The effect of the columellar strut graft on nasal tip position in primary rhinoplasty. Plast Reconstr Surg 2012;130:926-32.  Back to cited text no. 6
    
7.
Foda HM. Management of the droopy tip: A comparison of three alar cartilage-modifying techniques. Plast Reconstr Surg 2003;112:1408-17.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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