Refining vertical lobule division in open septorhinoplasty.

OBJECTIVE To review the indications, surgical techniques, and results of vertical lobule division (VLD) of the alar cartilages as they relate to the M-Arch Model. DESIGN Retrospective study of patients who underwent VLD of the lower lateral cartilages at a private facial plastic surgery practice in a major university teaching hospital. RESULTS Vertical lobule division decreased projection in 34 of 41 patients, narrowed a wide or boxy tip in 25, corrected knuckling or bossae in 20, corrected tip asymmetry in 14, corrected a hanging columella in 14, increased rotation in 12, and decreased rotation in 6. No statistically significant correlation was noted between the location of VLD and the indication for which it was performed. One patient required revision surgery to increase rotation. CONCLUSIONS Vertical lobule division remains a reliable and safe technique with predictable outcomes in tip repositioning. It allows for preservation of a strong tip complex, while adding versatility to tip refinement.