Freed Lower Lateral Cartilages with Intact Lateral Attachments: A Versatile Approach in Tip Plasty.

Abstract

Tip plasty is an important procedure that contributes much to obtaining an aesthetically pleasant nose. To increase precision during the tip plasty procedure, control over the lower lateral cartilages should be maximized. This can be accomplished by extending the exposure of the cartilage framework. We present our "Freed Lower Lateral Cartilages With Intact Lateral Attachments" approach through which inferior lateral cartilages are being dissected free from their attachments, while only their lateral bases (lateral crural parts) are left intact. A total of 1752 consecutive patients operated on with this approach were included. All patients were cosmetic rhinoplasty patients operated on between the years 1999 and 2014. During tip plasty, the lower lateral cartilages of all patients were totally dissected from all their attachments, while the lateral bases were left intact. The suture and graft techniques for the tip plasty procedure were then applied to reconfigure the tip region. The approach was used successfully in 1752 patients in a 15-year period. The mean age of patients was 33.5years. The complication rate was 6.4% and the revision rate was 4.7% for the patients. Only 1.2% of patients needed a revision surgery for tip and/or alar region. None of these patients needed further revision. The aesthetic and functional outcomes revealed high satisfaction rates. The "Freed Lower Lateral Cartilages With Intact Lateral Attachments" approach in tip plasty facilitates manipulation of the tip region while maintaining precise control to provide definition in terms of symmetry and three-dimensional configuration. Furthermore, it constitutes an autologous and practical platform on which nondestructive techniques can be performed in a combined and synergistic fashion. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .