Related Experiment Video
Updated: Jun 10, 2025
Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants
Published on: May 23, 2020
Improving the Supraalar Groove Aesthetic Subunit and Lateral Crura Convex-Concave Deformity
Background:
Lateral crura surface problems are one of the most difficult challenges in nose tip surgery. Closed preservation rhinoplasty (CPR) is a revolutionary concept that keeps nose tip flexibility and elasticity. By solving lateral crura surface problems and keeping tip flexibility the surgeon will accomplish a sharper supraalar groove transition between the dorsum and the tip.
Objectives:
The convex-concave lateral crura deformity (CCLCD) or S-shaped lateral crura is one of the biggest constraints to accomplishing a beautiful tip and dorsum-tip transition (DTT). This deformity is the reason for the commonly called parenthesis deformity of cephalic malposition. This LLC convex-concave shape creates a C-shaped shadow. This DTT is one of the key areas for accomplishing natural results, and it depends on different nose structures, not just the lower lateral cartilages (LLC).
Methods:
A total of 560 rhinoplasty cases were studied retrospectively between September and December 2023. Three hundred and twenty patients had at least 1 year of follow-up. Patients had follow-up at 2 weeks, 1 month, 3 months, 6 months, and 1 year after surgery. No secondary rhinoplasty was included. Only 2 secondary septoplasty cases were included, without any nose skin undermining in the previous surgery. Surgical details were documented, including the 6 fundamental steps of this technique: (1) mucosal lower lateral incision, (2) dorsum subperichondral dissection and vertical scroll release, (3) lateral crura tail caudal release, lateral crura steal and slide-under flap lateralization, (4) upper lateral caudal resection, (5) vertical scroll reconstruction, and (6) turning point extension graft.
Results:
Three hundred and twenty patients had at least 1 year of follow-up. In total, 516 patients underwent a closed approach and 47 patients an open approach. All patients had subperichondral dissection of the hump envelope. All patients who underwent a closed approach had a low-strip letdown dorsal preservation technique. All patients who underwent an open approach had a structural technique with spreader flaps or grafts at the keystone area. All the patients underwent osteotomies with a piezoelectric device. Twenty-three revisional surgeries were necessary.
Conclusions:
CPR taught us how important ligament and soft tissue preservation are. We learned that the less damage you do to the nose soft tissues and scaffold, the less support you need for it. Surgeons have been overgrafting the lateral crura to solve postoperative problems mainly because of dissection problems and lack of lateral crura support. This paper describes how to solve lateral crura surface problems, keeping the tip flexible and elastic, and also creating a nice and natural supraalar groove transition, by applying 6 surgical maneuvers.
Related Concept Videos
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...