Overresection of the lower lateral cartilages: a common conceptual mistake with functional and aesthetic consequences.

BACKGROUND: Overresection of the lower lateral cartilages to narrow the tip in individuals with thick skin is a common mistake with functional and aesthetic consequences. The most frequent deformities are external valve dysfunction, alar retraction, alar pinch, tip asymmetry, lack of tip definition, and parrot beak deformity resulting from drooping of the tip.

METHODS: In 82 patients who underwent revision surgery from 1998 to 2007 the lower lateral cartilages were missing. To restore function of the external nasal valve and correct aesthetic deformities it is essential to rebuild the anatomical structure. Tip deformities were analyzed pre- and postoperatively based on clinical evaluation and standardized photographs. Patient satisfaction was evaluated subjectively.

RESULTS: Improvement of the poorly defined tip, the underprojected tip, the overrotated tip, and alar pinch was accomplished in all patients (100%). The function of the external nasal valve was restored in all patients (100%). The postoperative results showed a clear improvement in tip asymmetry (95.0%), tip deviation (76.5%), alar retraction (87.0%), and tip ptosis (85.7%). The average follow-up period was 13.8 months. Forty-eight patients (59.8%) rated the result as "excellent," 27 (32.9%) as "very good," 5 (6.1%) as "good," 1 as "not satisfied" (1.2%).

CONCLUSION: Overresection of the lower lateral cartilages to narrow the tip in individuals with thick skin is frequently followed by dysfunction of the external nasal valve and aesthetic deformities. We completely rebuild the structure of the nasal tip. Only an anatomically correct configuration correlates with ideal aesthetics and physiologic function.