Vertical lobule division in rhinoplasty: maintaining an intact strip.

OBJECTIVE To review the indications for, surgical techniques of, and results of vertical lobule division (VLD) of the alar cartilages. DESIGN Prospective study of patients assigned to undergo variations of VLD of the lower lateral cartilages. SETTING Private facial plastic surgery practice in a major university teaching hospital. PATIENTS Twenty-four patients who underwent variations of VLD of the lower lateral cartilages with re-creation of an intact strip, including 4 patients undergoing revision. MAIN OUTCOME MEASURES Postoperative photographs were reviewed for tip projection and rotation, tip symmetry, bossae, knuckles, columellar position and length, and alar retraction. Patients were polled about their overall satisfaction with nasal aesthetics and degree of subjective nasal obstruction preoperatively and postoperatively. RESULTS Vertical lobule division decreased projection in 22 of 22 patients, increased rotation in 12 of 12 patients, decreased rotation in 1 of 2 patients, corrected tip asymmetry in 3 of 4 patients, and shortened a long infratip lobule in 1 patient. Postoperatively, bossae and knuckling developed in 1 patient, and 2 patients demonstrated alar retraction that did not exist preoperatively. One patient undergoing revision noted worsened nasal obstruction not related to VLD. CONCLUSIONS Vertical lobule division is a reliable, safe technique with predictable outcomes in tip repositioning. It allows for preservation of a strong tip complex while adding versatility to tip refinement.