title: Intermediate crural overlay in rhinoplasty: a deprojection technique that shortens the medial leg of the tripod without lengthening the nose.
abstract: OBJECTIVE
  To review the indications for, surgical techniques of, and results of intermediate crural overlay of the alar cartilages in rhinoplasty.
  
  
  METHODS
  Prospective study of patients undergoing intermediate crural overlay of the lower lateral cartilages. The setting was a facial plastic surgery private practice. Patients included 10 primary rhinoplasty patients and 1 revision rhinoplasty patient who underwent intermediate crural overlay of the lower lateral cartilages. The main outcome measures were postoperative photographs and patient records, which were reviewed for tip projection and rotation, preservation of the double break, bossae, and knuckling.
  
  
  RESULTS
  Intermediate crural overlay decreased projection in all 11 patients and increased the nasolabial angle in 7 patients. One patient had no change in the nasolabial angle, and 3 patients had counterrotation of 1 degrees , 3 degrees , and 4 degrees . A postoperative physical examination revealed that no patient had developed bossae, tip asymmetries, or knuckling. In addition, the double break was maintained in all the study patients.
  
  
  CONCLUSIONS
  Intermedial crural overlay is a reliable technique for achieving tip deprojection. Overall, the nasolabial angle is maintained (although in 3 patients, clinically insignificant counterrotation did occur). In addition, the length of the intermediate crura is reduced, but the double break is preserved. In the group of patients with thin skin and tip overprojection secondary to overdevelopment of the lower lateral cartilages, intermediate crural overlay achieves tip deprojection while controlling the nasolabial angle and preserving the natural curvature of the dome.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Wise
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Becker
authors.forename: Anthony
authors.initials: A
authors.lastname: Sparano
authors.forename: Jacob
authors.initials: J
authors.lastname: Steiger
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000033:anatomy & histology* / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*