Pivot point of the rotation arc is placed at distance of 1x radius from the lateral border of the defect. Lobe 1 is placed at approx. 45 degrees and lobe 2 at 90 degrees following the arc from the tip of the defect.

• Lobe 1 width equals the defect, while the height extends beyond the arc with a few millimeters
• Lobe 2 width is slightly smaller than lobe 1, while the height is 1,5x lobe 1

The tumor has been excised with free histologic margins. A circular excision defect of 11x12mm is to be reconstructed. The bilobe flap is raised in the sub-fascial plane and transposed into the defect.

• Further sub-fascial undermining of nasal skin is often necessary
• Avoid tension on lobe 1 on the nasal tip

Closure is performed using a few absorbable vicryl 5-0 sutures and then nylon 5-0 sutures. First, the lobe 2 donor site on the proximal nose is closed. Thereafter the lobe 1 donor site defect and at last the primary defect are closed.

• Skin correction by excision of redundant skin by a burrows triangle is often necessary
• Nylon sutures are removed after 7-8 days