Horizontal Reduction Using a Cephalic Hinged Flap of the Lateral Crura: A Method to Treat the Bulbous Nasal Tip

Background The term “bulbous nose” is used to describe a large or boxy nasal tip. Typically, correction of the bulbous tip has been achieved through a variety of cartilage-modifying maneuvers based on incision or excision of the lower lateral cartilage. Methods Horizontal reduction with a cephalic hinged flap of the lateral crura was used for 28 patients during open rhinoplasty. Effort was made to preserve the structural integrity of alar cartilage as much as possible with this technique. Results The average follow-up period was 14 months. Satisfactory results were achieved. External nasal valve collapse and pinch deformity were not observed during the postoperative period. Conclusions The described technique improves nasal tip reduction while maintaining nasal tip support and strength. The hinged flap used with this technique can both prevent weakness of the lateral crura and support it.