Introduction: The Oriental nose differs from the Caucasian nose in terms of size, subunit definition, texture,
and thickness of the skin [1]. Zitelli’s bilobed flap enables aesthetic reconstruction in Caucasian noses but
in smaller Oriental noses the outcomes are less desirable with nasal alar retraction commonly seen [2].
Hence, we describe a modification of Zitelli’s bilobed flap incorporating nasolabial skin for a single stage
nasal reconstruction with reduced nasal alar retraction [3].
Methods: We modified the bilobed flap based on Zitelli’s bilobed flap and the aesthetic subunit principle,
as modified for Orientals by Yotsuyanagi in 2000 [4]. The primary lobe was located between the defect and
the cheek and the second lobe was located on the cheek, above the nasolabial fold. The modification of the
bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect
edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The
length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and
the width of the secondary lobe was two-thirds the width of the primary lobe.
Results: Satisfactory alar reconstruction was achieved from the viewpoint of the patient and surgeon. There
was good nasal contour and appropriate symmetry of the nasal tip with reduced nasal alar retraction.
Conclusion: The modification of Zitelli’s bilobed flap to have a longer primary lobe and include nasolabial
skin, results in reduced nasal alar retraction.
Bilobed Flap Design in Nasal Reconstruction
