[Overresection of the lower lateral cartilage. A frequent cause for revision rhinoplasty].
BACKGROUND
Overresection of the lower lateral cartilages to narrow the tip may give rise to a dysfunction of the external nasal valve and aesthetic deformities like alar pinching, alar retraction, tip asymmetry, lack of tip definition and projection, leading to parrot beak deformities resulting from drooping of the tip.


METHODS
Between 1998 and March 2008 we performed 1670 secondary rhinoplasties on patients who had undergone previous surgery elsewhere. The lower lateral cartilages where found to be missing in 89 patients intraoperatively. It was necessary to rebuild the structure of the nasal framework in order to resolve the deformities. We prefer to use septal cartilage or, if unavailable, costal or auricular cartilage. The deformities were analysed pre- and postoperatively by the operator based on clinical evaluation and standardised photographs. Patient satisfaction was evaluated subjectively.


RESULTS
The postoperative results as judged by the surgeon showed a clear improvement in tip definition (100%) and projection (100%), alar pinching (100%), tip deformities (95.2%), tip deviation (77.8%) alar retraction (87.5%) and tip ptosis (85.7%). The function of the external nasal valve as evaluated by the surgeon was completely restored in all cases (100%). The average follow-up period was 13 months. In all, 50 patients (59.6%) stated that the result was "excellent", 28 (33.3%) as "very good", five (5.9%) as "good" and one as "not satisfied" (1.2%).


CONCLUSIONS
In the case of destroyed anatomical structures we completely rebuild the structure of the nasal tip, since only a correct anatomical configuration correlates with ideal aesthetics and physiological function.
Eichhorn-Sens
J
J
Klinik für Plastische Gesichtschirurgie, Marienhospital Stuttgart, 70199 Stuttgart. info@dr-eichhorn-sens.de
Gubisch
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D002356:Cartilage / Q000637:transplantation; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods; D013536:Suture Techniques; D055815:Young Adult