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Original Investigation
Mar/Apr 2016

An Analysis of Lateral Crural Repositioning and Its Effect on Alar Rim Position

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles
  • 2Lasky Clinic Surgical Center, Beverly Hills, California
JAMA Facial Plast Surg. 2016;18(2):89-94. doi:10.1001/jamafacial.2015.1625

Importance  Cephalically malpositioned lateral crura are a frequent cause of alar rim retraction during both primary and revision rhinoplasty.

Objective  To demonstrate the efficacy of lateral crural repositioning as an isolated maneuver as and combined with adjunctive grafts for lowering the alar rim.

Design, Setting, and Participants  From August through December 2014, we retrospectively reviewed the cases of 54 patients (102 hemi-noses) who had lateral crural repositioning performed by the same surgeon between 2007 and 2013. Only patients with standardized photographs taken preoperatively and at least 6 months postoperatively were included in the study.

Interventions  All primary and revision cases were completed via an open rhinoplasty approach and had lateral crural repositioning performed.

Main Outcomes and Measures  Preoperative and postoperative photographs were compared using Adobe Photoshop CS via a modified Gunter technique to measure the degree of alar rim retraction on lateral views. The change in angle was then calculated, and statistical analysis conducted using a paired t test.

Results  A total of 54 patients (102 hemi-noses) met inclusion criteria; 42 (79%) were women, and the average patient age was 41.3 years. Forty-five (83%) of the cases were revision rhinoplasties, and the average time to obtaining postoperative photographs was 11.3 months. The mean (SD) anterior nostril apex angles preoperatively (31.3° [8.9°]) and postoperatively (24.5° [6.8°]) indicated a net decrease of 6.8° (P < .001). Excluding patients who had other rim-lowering grafts (alar rim and/or composite grafts), we saw a similar result comparing preoperative (31.1° [8.2°]) and postoperative (24.5° [6.7°]) angles, with a net decrease of 6.6° degrees (P < .001). When examining patients who underwent lateral crural repositioning alone compared with those who also had lateral crural strut grafts, we saw a decrease of 6.9° (P < .001) and 6.7° degrees (P < .001), respectively.

Conclusions and Relevance  Repositioning of the lower lateral cartilages results in a statistically significant lowering of the alar rim. Our data suggest that when combined with lateral crural repositioning, the addition of adjunctive grafts does not add significantly to the rim-lowering effect.

Level of Evidence  3.