Lateral Crural Steal (LCS)

The Problem

• 1.

  Underprojected nasal tip

• 2.

  Ptotic nasal tip

The Background

Underprojection of the nasal tip can be secondary to short medial crura. Goldman first described vertical division of the alar cartilage and underlying vestibular skin to increase the height of the medical crura and increase projection. The degree of tip projection varies based on the location of the cartilaginous incision. The Goldman technique is dome-disrupting and violates nasal tip support structures resulting in complications such as a “tent pole” appearance and over-narrowing of the nose. The lateral crural steal (LCS) technique was initially described by Kridel in 1989. In the LCS technique, the lateral crura are advanced onto the medial crura, thus increasing the medial crural height and nasal tip projection and rotation. The vestibular skin and domal cartilages are preserved to maintain the integrity of the lobular cartilage complex. The LCS with a cephalic trim also allows refinement of wide, bulbous, or amorphous tips while creating stability in the lower third of the nose. One of the main advantages of the LCS technique is that the sutures can be removed and repositioned as needed until the desired nasal tip position is achieved. No “bridges are burned” with this technique. This chapter will discuss the LCS technique in nasal tip repositioning, refinement, and projection.