Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series.

Shaping the nasal tip is one of the most complex and challenging components of rhinoplasty surgery. There has been a gradual progression away from cartilage splitting and morselization techniques tomore conservativemethods that rely on suturing or structural grafting to reshape and reinforce native tissue geometry. In parallel with these changes and the broad adoption of the open structure rhinoplasty approach, more emphasis has been placed on maintaining native cartilage structure. From the standpoint of structural dynamics and mechanics, rhinoplasty has further transitioned toward a paradigm where tensile and compressive forces are balanced to achieve stable structure, rather than relying upon structural grafting alone to alter tissue curvature or achieve stability. Correction of the broad nasal tip due to convexity of the lateral crura has remained a challenge, and multiple techniques have been developed to address excessive curvature in this region.1 Contemporary methods include the use of lateral crural mattress sutures,2,3 lateral crural turn-in and turn-over flaps,4–7 lateral crural strut grafts,8,9 lateral crural splitting,10 and lateral crural repositioning.11,12 Excisional techniques, such as cephalic trim, weaken structural support mechanisms and can lead to retraction and collapse.13 In contrast, suturing techniques preserve structure and are in principal adjustable and reversible, which is particularly important as rhinoplasty has a historically high revision rate. Davis has recently published an innovative approach for correcting convexity of the lateral crus, referred to as lateral crural tensioning (LCT).13–15 This technique involves performing an aggressive lateral crural steal maneuver16–19 in tandem with using a caudal septal extension graft (CSEG).