Lateral crural steal and lateral crural overlay: an objective evaluation.

OBJECTIVE To assess objectively the effect of 2 cartilage-modifying techniques, lateral crural steal (LCS) and lateral crural overlay (LCO), on the degree of nasal tip projection and rotation. DESIGN A prospective trial using computer imaging techniques for assessment. SETTINGS Half of the patients were seen at a university hospital and the other half at a private practice. PATIENTS A selected series of 30 patients seeking rhinoplasty mainly for nasal tip repositioning. Only patients with no history of previous nasal operations were included. INTERVENTION All patients were operated on using an external rhinoplasty approach. Only 1 of the 2 techniques was adopted for each patient. The technique selected depended purely on clinical judgment. MAIN OUTCOME MEASURES The nasofacial angle and the Goode ratio were used to assess tip projection, and the nasolabial angle and rotation angle were used to assess tip rotation. RESULTS The use of the LCS technique resulted in an increase in both nasal tip projection and rotation, but the use of the LCO technique resulted in an increase in tip rotation and a decrease in tip projection (P<.001). Additionally, the LCO technique resulted in significantly higher degrees of rotation than the LCS technique (P<.001). CONCLUSIONS The LCS procedure is indicated when a moderate increase in nasal tip projection and rotation is desired. The LCO technique is useful in patients where severe underrotation is associated with overprojection.