The importance of maintaining the structural integrity of the lateral crus in tip rhinoplasty

Background: A novel technique for maintaining nasal tip support and external nasal valve integrity is proposed. The procedure involves mobilizing the lateral crus to a more cranial position after altering its shape from convexity to a more flat shape. Methods: With the described technique, the lower lateral cartilage is dissected free from the skin in a retrograde fashion after an intercartilaginous incision. The ligament between the lateral crus and the upper lateral cartilage is cut. The vestibular mucosa is not freed. With this maneuver, the lateral crus usually flattens sufficiently. When the convexity flattens, an extra millimeter of cartilage at the cephalic end is gained in the horizontal dimension. When the cut vestibular mucosa is sutured back to its place, the cephalic end of the lateral crus is advanced over the upper lateral cartilage. This technique allows durable support to maintain patency of the nasal valve. No bridges are burned because no cartilage is excised. The surgeon is left with the flexibility to modify the result on the operating table. Results: The technique was successfully used for 48 consecutive patients over a 3-year period. All the operations were primary rhinoplasties performed using a closed technique. The mean age of the patients was 32 years. For 72% of the patients, septoplasty also was performed. None of these patients had to undergo reoperation. Conclusion: The authors emphasize the importance of the lateral crus in rhinoplasty and demonstrate that good results at the tip of the nose can be accomplished without cephalic trimming, averting related complications in selected cases. © 2009 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery.