Application of the two-flap method for nasal alar contracture

Reconstruction of the contracted nasal ala has been a very difficult problem for plastic surgeons. Numerous surgical procedures have been reported. However, most operations require multiple stages and leave conspicuous facial scarring and a thick, asymmetrical nostril rim. We have used the two-flap method introduced by Thomson and Sleightholm for isolated naso-ocular clefts, but we have added some modifications to this method: making a deeper backcut into the dome on the mesial side of the contracture and using thinner flaps than were originally used. As a result, we have achieved reasonable symmetry, good color match, appropriate thickness, and no conspicuous facial scarring in every patient.