nasolabial flap: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drcosmetic

Definition (What it is) of nasolabial flap

A nasolabial flap is a piece of nearby facial skin and soft tissue moved to repair another area.
It is taken from the nasolabial fold region (the natural crease running from the side of the nose toward the corner of the mouth).
It is a surgical technique used most often in reconstructive plastic surgery and sometimes in select cosmetic contexts.
Its goal is to restore coverage, contour, and sometimes internal lining using tissue that closely matches the face.

Why nasolabial flap used (Purpose / benefits)

A nasolabial flap is used when a nearby facial defect needs durable, well-matched tissue for repair. In reconstructive terms, a “flap” differs from a skin graft because it is transferred with its own blood supply (maintained through a pedicle or specific vascular pattern), which can improve reliability for certain wounds and surgical defects.

Common goals include:

Restoring appearance and symmetry: The cheek and nasolabial skin often matches the color, texture, and thickness of the nose and perioral (around-the-mouth) region better than distant donor sites.
Rebuilding contour: By moving a block of skin and underlying soft tissue, the surgeon can recreate three-dimensional shape (for example, the curved rim of the nostril).
Supporting function: In areas like the nostril margin, lip, or inside the mouth, reconstruction is not only cosmetic—function can matter for breathing, oral competence, speech, and comfort.
Using a concealed donor site: Incisions can often be designed along natural facial creases (particularly the nasolabial fold), which may help scars blend in over time. Scar appearance still varies by anatomy, technique, and healing.
Providing lining when needed: Some variations can be folded or inset to replace internal lining in small, selected defects (for example, nasal vestibular lining), depending on case planning.

Overall benefits depend on the defect size, depth, location, and the clinician’s reconstructive plan. Not every defect is a good match for a nasolabial flap, and results vary by clinician and case.

Indications (When clinicians use it)

Clinicians may consider a nasolabial flap in scenarios such as:

Reconstruction of nasal ala (nostril rim) and alar crease defects
Repair of nasal sidewall or nasal tip-adjacent soft-tissue defects (case-dependent)
Selected upper lip or perioral soft-tissue defects
Some intraoral reconstructions requiring local tissue (for example, small lining needs), depending on defect characteristics
Coverage of defects after skin cancer excision (commonly after Mohs surgery) in appropriate patients
Revisions of scars or contour deformities where local tissue rearrangement is suitable
Situations where tissue match and local blood supply are prioritized over more distant donor sites

Contraindications / when it’s NOT ideal

A nasolabial flap may be less suitable, or another approach may be preferred, in situations such as:

Inadequate local tissue laxity or unfavorable anatomy that would create excessive tension or distortion
Very large or complex defects where local tissue would be insufficient (regional or free flaps may be considered instead)
Compromised local blood supply (for example, significant scarring from prior surgery, radiation changes, or vascular compromise), depending on clinician assessment
Active infection or poorly controlled inflammation at or near the surgical sites
High risk of poor wound healing (varies by patient health factors; clinicians assess risks individually)
Cases where a nasolabial flap might cause unacceptable donor-site changes, such as noticeable pulling of the lip or nostril, depending on flap design and patient anatomy
Situations where a skin graft or a different local flap would provide a better contour or simpler reconstruction (varies by clinician and case)

How nasolabial flap works (Technique / mechanism)

A nasolabial flap is a surgical reconstruction technique, not a minimally invasive or non-surgical procedure. It works by repositioning living tissue with an existing blood supply from the cheek/nasolabial area to a nearby defect.

At a high level:

General approach: Surgical flap design, elevation, and transfer into the defect.
Primary mechanism:
Reposition and replace missing tissue (skin and sometimes subcutaneous tissue) to restore coverage and contour.
In some designs, the flap can be folded or turned in to provide internal lining for small, selected defects.
Typical tools/modalities used:
Incisions placed along planned lines (often aligned with the nasolabial fold when feasible)
Dissection instruments to elevate the flap in the appropriate tissue plane
Sutures for inset (attaching the flap into the defect) and closing the donor site
Dressings to protect the repair
Adjunctive grafts may be used in some nasal cases (for example, cartilage support), but that depends on the defect and surgeon’s plan

Energy-based devices and injectables are not part of the nasolabial flap itself. If a patient is also receiving scar management or aesthetic refinement later, those are separate considerations and vary by clinician and case.

nasolabial flap Procedure overview (How it’s performed)

Below is a simplified workflow that reflects common steps, recognizing that details vary by clinician and case.

Consultation
The clinician reviews the concern (often a post-excision defect, trauma, or deformity), health history, and goals. Photos and documentation may be taken.
Assessment / planning
The defect is assessed for size, depth, location, and functional needs (for example, nostril support or oral lining). The surgeon plans flap orientation and the donor-site closure strategy, balancing tissue match with the risk of distortion.
Prep / anesthesia
The surgical area is cleansed and marked. Anesthesia may be local anesthesia, local with sedation, or general anesthesia, depending on complexity, patient factors, and setting.
Procedure (flap design and transfer)
The flap is outlined near the nasolabial fold and carefully elevated while preserving blood supply. It is then moved (advanced, rotated, or transposed) into the defect and shaped to match the needed contour.
Closure / dressing
The flap is secured with sutures. The donor site is closed, often along the nasolabial fold to help camouflage the incision when possible. Dressings may be applied to support healing and protect the area.
Recovery
Early recovery focuses on swelling control, wound monitoring, and protecting the repair. Follow-up visits are typically used to evaluate healing, remove or adjust sutures when appropriate, and discuss scar maturation expectations.

Types / variations

Nasolabial flap design is not one single technique; it is a category of local flaps with multiple variations. Surgeons choose based on anatomy, defect location, and reconstructive needs.

Common distinctions include:

Based on blood supply pattern
Random-pattern nasolabial flap: Relies on the subdermal plexus and careful design proportions (selection varies by clinician and case).
Facial artery–based (axial or perforator-based) designs: May be planned to leverage more specific vascular anatomy in certain reconstructions.
Based on orientation
Superiorly based nasolabial flap: Often oriented to reach areas higher on the face (selection depends on defect location).
Inferiorly based nasolabial flap: Commonly oriented to reach nasal ala and lower nasal regions, depending on surgeon preference and defect needs.
Based on movement pattern
Transposition flap: Tissue is lifted and moved over adjacent skin into the defect.
Advancement or rotation elements: Some designs incorporate advancement/rotation principles to reduce tension and improve contour.
One-stage vs staged (interpolated) approaches
Single-stage flap: The flap is transferred and inset in one operation when geometry and blood supply allow.
Two-stage (interpolated) nasolabial flap: The flap may remain attached by a pedicle initially and then be divided later once it has established sufficient circulation at the recipient site. Staging depends on defect complexity and surgeon strategy.
Lining and contour variations
Folded or “turn-in” components: In selected cases, the flap can help reconstruct internal lining (for example, small nasal lining needs).
Combined reconstructions: A flap may be paired with structural support (such as cartilage grafting) when contour or airway stability is part of the goal; this is case-dependent.
Anesthesia choices
Local anesthesia: Often feasible for smaller defects and straightforward transfers.
Local with sedation or general anesthesia: May be chosen for patient comfort, longer cases, staged reconstructions, or combined procedures.

Pros and cons of nasolabial flap

Pros:

Uses nearby tissue with similar color and texture to the nose and perioral region
Transfers tissue with a blood supply, which can be advantageous compared with grafts in certain settings
Can often place donor-site scars along a natural facial crease (scar visibility still varies)
Can restore three-dimensional contour better than flat coverage options for some defects
Flexible design with multiple orientations and staging options
May address functional needs in select reconstructions (for example, nostril margin integrity), depending on defect and technique

Cons:

It is a surgical procedure, with associated downtime and healing variability
Scarring occurs at both donor and recipient sites, even when well placed
Risk of distortion (for example, pulling on the lip, nostril, or cheek) depending on tension and design
Potential for bulkiness or contour irregularity that may require refinement in some cases
Some cases require a staged approach, meaning more than one procedure
As with all flaps, there is a risk of wound-healing complications (for example, partial tissue compromise), with risk level varying by patient and case

Aftercare & longevity

Aftercare and durability are closely tied to surgical planning, tissue quality, and how the reconstruction heals over time. While specific instructions must come from the treating clinical team, general concepts that influence outcomes include:

Technique and flap design: Tension, thickness, and inset accuracy can affect contour, scar position, and long-term stability.
Skin quality and anatomy: Thicker skin, thin skin, and differences in cheek laxity can change how the flap settles and how scars mature.
Scar maturation: Scars typically evolve over months. Their final appearance varies with genetics, incision placement, wound care practices, and sun exposure.
Swelling and contour settling: Early swelling can temporarily make the repair look fuller or uneven. Long-term contour depends on how tissues heal and contract.
Lifestyle factors: Smoking/nicotine exposure, uncontrolled sun exposure, and inconsistent follow-up can negatively affect healing and scar quality. The impact varies by individual.
Medical factors: Conditions that affect circulation or wound healing may influence outcomes; clinicians usually evaluate these risks during planning.
Follow-up and maintenance: Some patients may undergo scar treatments or contour refinements, but this is individualized and varies by clinician and case.

A nasolabial flap is generally intended as a durable reconstructive solution because it transfers living tissue. However, the long-term appearance can change with normal aging, weight changes, sun damage, and scar remodeling.

Alternatives / comparisons

The “best” alternative depends on the defect’s location, size, depth, and whether internal lining or structural support is needed. Common comparisons include:

Skin grafts (split-thickness or full-thickness) vs nasolabial flap
Skin grafts can be simpler for some superficial defects but do not bring their own blood supply and may have different color/texture match and contour behavior.
A nasolabial flap may better recreate contour for certain nasal or perioral defects, but it is more involved surgically.
Other local flaps vs nasolabial flap
Bilobed flap, dorsal nasal flap, or cheek advancement flaps may be used for nasal/cheek defects depending on location and skin characteristics.
Each flap pattern trades off scar placement, tissue match, risk of distortion, and contour control.
Forehead flap vs nasolabial flap (nasal reconstruction)
A forehead flap can provide substantial tissue for larger or more complex nasal defects and is commonly staged.
A nasolabial flap may be suitable for smaller, localized defects (often near the ala), but suitability varies by clinician and case.
Free flap reconstruction vs nasolabial flap
Free tissue transfer may be considered for extensive defects requiring large volume replacement or complex lining/structure reconstruction.
Nasolabial flaps are local options and generally used for smaller, adjacent reconstructions.
Injectables or energy-based treatments (cosmetic) vs nasolabial flap
Dermal fillers and energy-based devices are used for wrinkles, volume loss, or skin texture changes, not for replacing missing tissue after excision.
A nasolabial flap is reconstructive surgery and is not a substitute for non-surgical “nasolabial fold” treatments.

Common questions (FAQ) of nasolabial flap

Q: Is a nasolabial flap the same thing as treating nasolabial folds with filler?
No. A nasolabial flap is a surgical reconstruction using tissue from the nasolabial area to repair a defect elsewhere. Filler in the nasolabial folds is a non-surgical cosmetic treatment aimed at softening a crease, not replacing missing tissue.

Q: Will it be painful?
Discomfort is possible, especially in the first days of healing, but the experience varies widely. Pain control methods depend on the setting, anesthesia, and the clinician’s routine protocols. Sensations like tightness or pulling can also occur during early healing.

Q: What type of anesthesia is used?
Nasolabial flap surgery may be performed under local anesthesia, local with sedation, or general anesthesia. The choice depends on defect complexity, patient comfort needs, and whether the reconstruction is staged. Your treating team determines the most appropriate option for the specific case.

Q: Will there be visible scarring?
Scars are expected at both the donor site and the reconstruction site. Surgeons often try to place donor-site incisions along the nasolabial fold to help the scar blend with a natural crease, but visibility varies by skin type, healing tendency, and scar care practices.

Q: How long is the downtime and recovery?
Recovery timelines vary by clinician and case, including whether the procedure is single-stage or staged. Swelling and bruising are common early on, and scar maturation typically takes longer than initial wound healing. Many patients need follow-up visits to monitor healing and plan any refinements if needed.

Q: How long do results last?
A nasolabial flap transfers living tissue and is generally intended to be durable. That said, long-term appearance can evolve with scar remodeling, normal aging, sun exposure, and changes in facial volume. Longevity and final contour vary by clinician and case.

Q: What are common risks or complications?
As with many surgeries, risks can include bleeding, infection, delayed healing, noticeable scarring, contour irregularity, and asymmetry. Flaps also carry a risk of partial tissue compromise if blood supply is affected, though risk level depends on multiple factors assessed by the surgical team. The overall risk profile varies by patient health and surgical details.

Q: Is a two-stage procedure always required?
Not always. Some nasolabial flap reconstructions can be completed in one stage, while others are planned in stages to protect blood supply and optimize shaping. Whether staging is used depends on flap design, defect location, and surgeon preference.

Q: Will it change my smile or facial expression?
It can, especially temporarily, because the donor site is near the mouth and cheek. Tightness, swelling, and scar contraction can influence movement during healing, and in some cases there can be longer-lasting changes. The likelihood and degree vary by anatomy, flap size, and closure technique.

Q: What affects the cost?
Cost depends on many factors, including the size and complexity of the defect, whether staging is required, anesthesia type, facility fees, and whether the procedure is reconstructive (often related to medical necessity) or elective. Pricing and coverage vary by region, system, and individual circumstances.