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Page 10 of 14 Sciegienka et al. Plast Aesthet Res 2022;9:1 https://dx.doi.org/10.20517/2347-9264.2021.76

Figure 6. Dorsal nasal flap. The dorsal nasal flap, or Rieger flap, is most useful for lateral defects but can be used for tip defects in select
patients.

Minor complications of the Rieger flap include small periorbital hematoma, nasal deformity due to scar
contracture, and skin color mismatches. Hematomas, when formed, self-resolve over the following days to
weeks. Nasal deformity can be avoided with proper planning and tension-free closure. Lastly, color
mismatches or scars can be improved with secondary treatment modalities such as dermabrasion, laser
therapy, and steroid injection .
[28]

The major advantages of this flap are that in a one-stage procedure, like skin is brought into the defect, and
incisions can be designed around cosmetic subunit boundary lines.

Bilobed flap
The bilobed flap is a random pattern, double transposition flap, and is a technique used for small to
medium nasal sidewall and nasal tip defects [Figure 7]. Although typically nasal subunits are reconstructed
as entire units, some small defects are more appropriately reconstructed with the bilobed flap. It can also be
[30]
used to reconstruct other areas of the face, such as the cheek . The typical bilobed flap is designed with 90
degrees of total rotation for the primary and secondary flaps. Two flaps are used to redistribute tension over
a larger area. The midline of the primary flap is designed about 45 degrees away from the midline of the
defect and is usually described as the same size of the primary defect. However, in practice, the primary flap
in nasal sidewall reconstruction can be slightly smaller, allowing tissue elasticity to make up the difference in
size. When reconstructing the nasal tip, the primary flap and defect sizes should match because of the tight
adherence of nasal tip skin to underlying anatomy. When planning local flaps, care should be taken to avoid
crossing the cheek-nose border. The secondary flap is oriented 45 degrees from the midline of the defect
created by raising the primary flap. It is typically half the size of the primary defect, but in areas where there
is more skin elasticity and opportunity to undermine, the size and angle can be adjusted to allow for optimal
tissue use and scar placement. Bilobed flaps are advantageous because their excellent color and texture
match to nasal defects; however, as with any U- or V-shaped scar, they can be prone to trapdoor
[27]
deformities .

Melolabial flap
The melolabial flap is a random pattern flap and is a workhorse flap in the reconstruction of the nasal
sidewall and lips. It can be based superiorly or inferiorly because of its rich dual blood supply from direct
branches of the angular artery and arterial perforators from surrounding muscles. Generally, the angular
artery is not incorporated into the flap as a true pedicled flap. Superiorly based flaps are best for large