Vertical transection of the alar cartilages in unilateral cleft noses

Nasal deformities in unilateral cleft patients require more-or-less modifications of the nasal tip. The techniques of Goldman and Ponti that have been recommended initially for esthetic rhinoplasties in non-cleft noses include the vertical transection of the alar cartilage on both sides. The first technique is performed in noses that require an extensive modification, especially in large noses with thick seborrheic skin, with a short columella or a distinct asymmetry. The second technique is utilized for slight deformities with thin skin, nearly symmetric and a sufficient columella length. Both techniques have proven to obtain good results, also in cleft nose surgery. The operative steps of the techniques are described and some case reports are presented. Finally, a gradual schedule for the cleft nose repair is discussed and the advantages of the techniques described are pointed out.