Extended open-tip rhinoplasty with three V-flaps for secondary correction of bilateral cleft lip nasal deformity

Many procedures have been developed to correct the secondary cleft lip nasal deformity, including the depressed nasal tip, flaring nasal aperture, and a very short columella. The forked flap, cartilage graft, or strut and bony graft have been applied for many years. We propose the extended open- tip rhinoplasty with three V-flaps, which we have performed on 12 patients during the past 3 years. An extended incision for the nasal skin flap exposes all deformities to direct vision, makes the advancement and rotation of the nasal skin flap complete, and makes the corrective procedures easy and accurate. A large V-flap (with V-Y advancement for columellar lengthening) and two small V-flaps (with back-cut incisions on the nasal lining) are used to elevate and suspend the alar domes and cartilage to create two symmetrical and piriform apertures, and to ensure adequate columellar length. Columellar lengthening averaged from 2.5 mm preoperatively to 10 mm postoperatively. A protruded nasal tip with two delicate and small dimples over the alar rims, and a piriform aperture of the nasal nares were achieved in our series. No hypertrophic scar, nasal obstruction, or exposure of hairy nares were noted. No cartilage graft or strut and bone graft were required.