Medial Crural Overlay

The Problem

• 1.

  Overprojected nasal tip

• 2.

  Overrotated nasal tip

The Background

Precise control of nasal tip position may be one of the most challenging aspects of rhinoplasty. The medial crural overlay (MCO) technique was first described by Soliemanzadeh and Kridel in 2005 after using it for over 15 years. It is a reliable maneuver to retrodisplace and derotate the overprojected and overrotated nose. In 1959, Lipsett described a “sliding flap technique” in which the medial crura are divided after delivering the alar cartilages and repositioning the dome along the septum to change nasal tip projection. The alar setback technique involves excision of a portion of the medial crura and splinting to a strut graft and the intermediate crural overlay. The medial crural overlay does not involve resection of cartilage, which is a critical advantage as compared to other techniques. This chapter will discuss the medial crural overlay technique in decreasing nasal tip rotation and projection.