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Facial Flaps

Design

Authors: Hasan Gökcer Tekin, MD and Magnus Balslev Avnstorp, MD

Learn how to use the skin in the glabella region for a transposition flap.

Blood supply

The glabella flap is based on the dorsal nasal artery (lower part), or the supratrochlear artery (upper part). The muscles of the glabella involve m. procerus, m. frontalis and m. corrugator supercillii

Figure 1 | Facial arterial blood supply

Designing the flap

The glabella flap can be used for reconstructing primary defects on the proximal half of the nose with excessive skin from the glabellar region. The secondary defect is closed primarily with excellent aesthetic result.  Local flaps from the glabella region can be designed as a variety of different geometric shapes such as transposition flaps (fig. 1), bilobed flaps (fig. 2), or as versatile rhombic (Limberg) flaps (Fig. 3).

Key consideration when performing reconstruction on the nasal dorsum with glabella flaps, are aesthetic subunits of the nose, relaxed skin tension lines (RSTL), location of the defect (proximal or distal, central or off-center), the size of the defect and thickness of the flap.

Figure 2 | Transposition flap
Figure 3 | Bilobar flap
Figure 4 | Rhomboic flap

Pearls

  • The optimal location for reconstructing a defect with a glabella flap is on the proximal half of the nose, as the skin on the proximal half of the nose is more similar to glabellar skin and does not contain sebaceous glands.
  • Excess skin and bulk at the basis of the glabella flap is common due to less thinning of subcutaneous tissue and maintaining a stable blood supply. The distal half of the flap can be thinned more aggressively. Secondary debulking can be necessary as a two-step procedure. 

Pitfalls

  • Be cautious when flaps cross RSTL and the borders of different aesthetic subunits (nasal sidewalls, nasal dorsum, medial canthus etc.). Aesthethic units and RSTL represent lines where incision lines can be made and scars should be placed.

Acknowledgements

Illustrations: Christian Kaare Paaskesen, med.stud and Anne Mosebo, med.stud.

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