title: The lateral crural rein flap: a novel technique for management of tip rotation in primary rhinoplasty.
abstract: BACKGROUND
  An important consideration in rhinoplasty is maintenance of the applied tip rotation. Different techniques have been proposed to accomplish this. Loss of rotation after surgery not only results in a derotated tip but also can create a supratip deformity.
  
  
  OBJECTIVE
  As a supplement to dorsal reconstruction, the authors introduced and applied the lateral crural rein flap technique, whereby cartilage flaps are created from the cephalic portion of the lateral crura to control and stabilize tip rotation.
  
  
  METHODS
  Eleven patients underwent primary open-approach rhinoplasty that included the lateral crural rein technique; the mean follow-up time was 18 months. Excess cephalic portions of the lateral crura were prepared as medial crura-based cartilaginous flaps and were incorporated into the nasal dorsum (similar to spreader grafts) and stabilized to achieve the desired tip rotation.
  
  
  RESULTS
  The lateral crural rein flap technique provided stability to the nasal tip while minimizing derotation in the postoperative period. Long-term follow-up revealed maintenance of the nasal tip rotation and symmetric dorsal aesthetic lines.
  
  
  CONCLUSIONS
  The lateral crural rein flap technique is effective for controlling nasal tip rotation while reducing lateral crural cephalic excess. Longevity of the applied tip rotation is reinforced by secure attachment of the lower nasal cartilage complex to the midvault structures.
  
  
  METHODS
  4.
authors.affiliation: Drs Kuran and Efendioğlu are plastic surgeons in private practice in Istanbul, TurkeyDr Öreroğlu is a consulting plastic surgeon in the Plastic, Reconstructive and Aesthetic Surgery Department at Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, TurkeyDrs Kuran & Öreroğlu are members of the Turkish Society of Plastic Reconstructive and Aesthetic Surgery and the Turkish Aesthetic Plastic Surgery SocietyDr Efendioğlu is the member of the the Turkish Aesthetic Plastic Surgery Society only ismailkuran@gmail.com.
authors.forename: Ismail
authors.initials: I
authors.lastname: Kuran
authors.affiliation: Drs Kuran and Efendioğlu are plastic surgeons in private practice in Istanbul, TurkeyDr Öreroğlu is a consulting plastic surgeon in the Plastic, Reconstructive and Aesthetic Surgery Department at Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, TurkeyDrs Kuran & Öreroğlu are members of the Turkish Society of Plastic Reconstructive and Aesthetic Surgery and the Turkish Aesthetic Plastic Surgery SocietyDr Efendioğlu is the member of the the Turkish Aesthetic Plastic Surgery Society only.
authors.forename: Ali Rıza
authors.initials: AR
authors.lastname: Öreroğlu
authors.affiliation: Drs Kuran and Efendioğlu are plastic surgeons in private practice in Istanbul, TurkeyDr Öreroğlu is a consulting plastic surgeon in the Plastic, Reconstructive and Aesthetic Surgery Department at Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, TurkeyDrs Kuran & Öreroğlu are members of the Turkish Society of Plastic Reconstructive and Aesthetic Surgery and the Turkish Aesthetic Plastic Surgery SocietyDr Efendioğlu is the member of the the Turkish Aesthetic Plastic Surgery Society only.
authors.forename: Kamran
authors.initials: K
authors.lastname: Efendioğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: cephalic resection; lateral crura; rein flap; rhinoplasty; tip rotation