A bilobed flap moves two joined lobes of skin at once. The first lobe fills the wound, the second fills the space left by the first, and the last small area is closed directly, which shares the movement across a wider area.
A bilobed flap is a double transposition. Two lobes of skin share one base, and both pivot together. The first lobe swings into the defect, the second lobe swings into the gap the first has left, and the smaller space remaining is stitched closed. Sharing the movement in two steps means each step is small, which is what allows tight skin such as the nose to be closed.
The lower part of the nose presents a real problem. Skin there is thick, oily and firmly attached, so it will not slide or stretch far, and a graft in that position rarely matches the surrounding surface. What the nose does have is looser skin higher up, closer to the bridge. A bilobed flap is the bridge between those two facts.
Two lobes are drawn side by side, sharing a single base, and they rotate together. The first lobe drops into the wound. The second lobe, which comes from the looser upper area, moves into the gap the first lobe vacated. What remains is a smaller space that closes directly. Splitting the movement in two means no single step demands much from the tissue.
Careful planning matters more here than in a simple flap. The lobes must be sized so each one fills its target without stretching, and the pivot must be placed so nothing pulls on the nostril rim. When the geometry is right, the nose keeps its shape and the scars follow its natural borders. When it is wrong, the rim lifts, and that is far harder to correct afterwards.
This flap suits defects on tight, thick skin where a single flap could not reach and a graft would look obvious. Nasal wounds are the classic example.
The wound is measured and its position judged against the nostril rim. How much skin can be borrowed from higher up the nose is tested by pinching the tissue.
Two lobes are then marked, sharing one base and pivoting around a common point. Sizes are chosen so each lobe fills its target without being stretched to reach it.
Both lobes are lifted together with the layer beneath, keeping the base attached and the blood supply intact. Thinning is done cautiously, since the tip depends on that supply.
The first lobe is turned into the defect and the second follows into the space it leaves. Both are inset with deep stitches, then closed neatly at the surface.
The remaining space is closed directly and any small fold at the pivot is trimmed. A light dressing supports the nose, and the flap is reviewed within a few days.
Swelling and bruising around the nose and under the eyes are common. Rest, a raised head position and simple pain relief help through this stage.
Stitches come out early on the face. The lobes usually look pink, firm and slightly puffy once the dressing is removed.
Most swelling has settled and the scar lines start to pale. Glasses and masks can usually be worn again by now if they were restricted.
The flap continues to soften and flatten. Any persistent puffiness or a small fold at the pivot can be reviewed and adjusted at this point.
When the design is right, the nose keeps its shape and the repaired area matches its surroundings closely. Expect several curved scar lines that stay pink for months, and puffiness in the lobes that can take longer to settle than patients anticipate. A small raised area at the pivot is common. Minor asymmetry between the two sides of the nose may remain, and a small adjustment is sometimes offered once healing is complete.
Two lobes mean two areas depending on one blood supply, and the nose leaves little room for error in the design.
The lobes and the lines they came from all sit on the nose, so protecting the whole area matters. Pressure is the main thing to keep off it.
Dividing the movement actually lowers tension at each step. The design is more complex to plan, but each individual step asks less of the tissue.
On the lower nose a graft often heals as a visible patch of different colour and texture. Local skin matches because it comes from the same area.
Puffiness in the lobes commonly takes months to settle. Judging the shape too early gives a misleading impression of the final result.
Lines are placed along natural borders wherever possible, but a curved pattern remains. It fades with time rather than disappearing.
At Elegance Clinic in Surat, nasal reconstruction is planned with the nostril rim in mind first, because protecting that edge decides how natural the nose looks afterwards.
Technique pages do not carry their own price, because the cost depends on the treatment the technique is used within. The same flap may close a small nasal defect after skin cancer surgery or form part of a wider facial reconstruction.
Before admission you receive a written estimate covering surgery, anaesthesia, dressings and planned review visits. For bands, please see the relevant treatment page or the costs section.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →This page covers a technique rather than a treatment, so no price sits with it. Cost depends on the defect, the anaesthetic used and the reviews needed. A written estimate is issued before the surgery date is confirmed.
Most are day case repairs, often under local anaesthetic. The recognised concerns are loss of part of a lobe, bleeding under the flap and lifting of the nostril rim, which is why the design is planned carefully beforehand.
On the lower nose a graft frequently heals as a visible patch, because that skin is thick and oily and hard to match. Moving local tissue keeps the colour, thickness and texture of the nose itself.
Bruising settles within a couple of weeks, but puffiness in the lobes commonly persists for months. That is the part patients find most surprising, and it usually improves steadily rather than suddenly.
Some difference between the two sides can remain, especially in the early months while the flap is firm. Most settles as scar tissue matures, and a small adjustment can be discussed once healing is complete.
Anyone with a large defect, a wound involving the nostril lining, or a nose with little movable skin after earlier surgery or radiotherapy. Continued smoking also counts strongly against a flap with two pivoting lobes.
The defect is measured against the nostril rim, the skin is tested for looseness, and the design is drawn directly on the nose. Alternatives are compared, smoking and medicines reviewed, and a written estimate is provided.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
