In this video, we're going to be demonstrating a cephalic turn-under technique that's often used to help treat bulbous tips. The nasal mucosa is dissected from the undersurface of the lower lateral cartilage by holding it out to length and proceeding from medial to lateral. The lower lateral cartilage is released along its cephalic border, which is at the scroll, and then undermining is allowed for turn-under flap to fit. The axis of the lower lateral cartilage is marked, so we want to preserve at least six to seven millimeters of lower lateral cartilage lateral cruise. We score with a 15 blade and take note that we don't completely cut through the cartilage. The turn-under can then be facilitated by removal of a small wedge of the cartilage from the medial aspect so that it won't block the turn-under. The cephalic half is folded under, the caudal half is shown, and oftentimes additional mucosal undermining may be required to allow it to fit. We then take a 5-0 PDS suture with a tapered needle, horizontal mattress fashion, and it's placed to secure the flaps through and through. The knots are kept on the upper surface of the lower lateral cartilage lateral cruise. After we place the suture, we look underneath the lateral cruise within the nose to make sure that we've not button-holed through. Typically, I'll put two to three of these sutures to secure the turn-under. A cephalic turn-under flap helps to straighten the lower lateral cartilage, and it provides it with more structural rigidity, correcting for any concave or convex deformities.

cephalic turn-under technique

bulbous nasal tips

nasal mucosa dissection

cartilage preservation

structural support