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Zoumalan et al1 demonstrate a very important design aspect of the bilobed flap: that closure of the secondary defect should be as vertical as possible to avoid distortion of the alar rim. In many published photographs of the bilobed flap, one can see that secondary closures that are not perpendicular to the alar rim will usually result in distortion to either the ipsilateral or contralateral alar rim.
Zitelli JA. Design Aspect of the Bilobed Flap. Arch Facial Plast Surg. 2008;10(3):186. doi:10.1001/archfaci.10.3.186