title: Elliptical horizontal excision and repair of alar cartilage in open-approach rhinoplasty to correct cartilaginous tip deformities.
abstract: Correction of nasal tip deformities, especially bulbous tip deformities, has improved greatly with the advancement of open-approach rhinoplasty. Bulbous and double-dome deformities of the nasal tip are more often cartilaginous, rather than fibrous, in nature. Therefore, direct alterations of the cartilage are necessary to achieve the desired effect. In the past, these alterations were accomplished by resection of the cephalic part of the lateral crura of the lower lateral cartilage and, less commonly, by resection of the caudal ends of the lateral crura. For the past several years, we have used elliptical excision of the central segment of the lower lateral cartilage in a horizontal direction. The upper and lower edges of the remaining cartilage are repaired with 5-0 nylon sutures. This procedure removes the most protruding and bulbous portion of the lateral crura, and the cephalic and caudal portions that remain are sutured together to form a flatter and more narrow lateral crura. It changes the bulge of the dome where a change is necessary, at the top. It also preserves the anatomically intricate relationship of the junctions of the upper and lower lateral cartilage. There are no free or loose edges of cartilage to warp or deform during the healing process. Satisfactory, long-lasting clinical results can be achieved consistently.
authors.affiliation: Department of Plastic Surgery, East Jefferson General Hospital, New Orleans, La., USA.
authors.forename: H
authors.initials: H
authors.lastname: Massiha
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009300:Nasal Septum / Q000002:abnormalities* / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*