A review of the bilobed flap's design with particular emphasis on the minimization of alar displacement.

BACKGROUND: The bilobed flap excels in the surgical reconstruction of the distal nose. Unfortunately the aesthetic success of the flap is occasionally limited by the production of distracting alar displacement.

OBJECTIVE: To review elements of the bilobed flap's design with a particular emphasis on understanding techniques to minimize distortion of the alar margins.

CONCLUSION: With a proper understanding of the bilobed flap's intricate design, the surgeon can anticipate those factors that are most likely to produce temporary or permanent alar asymmetry. Appropriate prospective flap design and meticulous surgical technique can significantly minimize the risk of a poor surgical outcome.