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Correcting the Overresected Nose
The Problem
Overresection of the lower lateral cartilages occurring as sequalae of an effort to create decreased tip volume and improved tip contour is a common complication seen in patients seeking revision rhinoplasty. Deformities that arise from aggressive reductive techniques can affect all areas of the nose including the bony and cartilaginous dorsum, as well as the tip, and produce the characteristic stigma of rhinoplasty that leads many patients to seek revision surgery. This chapter will focus on the correction of overresected lateral crura and the resultant functional deficit and esthetic deformity that can occur as a result. Structural grafting in the form of lateral crural strut grafts with or without repositioning can restore tip and alar margin support to improve nasal function and give a natural-appearing nasal tip contour.
The Background
Many conventionally used tip contouring techniques overemphasize cartilage excision with the intent of narrowing the nasal tip and reducing tip volume. Many of these techniques can create an unnatural and poorly supported tip structure, which appears isolated from the surrounding nasal subunits and weakens support for the alar margin. Correcting the overresected nose can be accomplished with the use lateral crural strut grafts with or without repositioning to restore normal nasal architecture and to create a natural appearing tip structure with improved nasal function. Lateral crural strut grafts sutured to the undersurface of remnant lateral crura can flatten round or convex crura, support the alar margin, correct external valve collapse, and restore the natural architecture of the nasal tip in the setting of overly resected lateral crura. Septum may be used, but is often in short supply. Two 28 to 30 mm × 4 to 5 mm grafts are often needed, thus rib cartilage is an excellent option, given its abundance and fortitude, and is our preference when septal cartilage volume is limited.
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