Abstract
Objective: Lateral Crural Tensioning (LCT) is an important technique to refine the tip. However, a frequent problem that can occur is the weakening of the External Nasal Valve (ENV) and the constant use of Articulated Alar Rim Graft (AARG). The aim of this study is to show the results of the same surgeon (MBJZ) within one year of the Modified LCT, and review of the literature. Methods: We analyzes technical details of 149 patients that underwent rhinoplasty in one year (between July 1, 2018 and June 30, 2019) and had at least 1 year of follow-up. Results: Out of 144 patients, 25 (17.36%) were revision surgery. In 114 cases (79.17%) only the septum was used; and Septal Extension Graft (SEG) was performed in 142 of the 144 patients (98.61%). Of these, 130 (91.55%) were latero-lateral and 12 (8.45%) end-to-end. And we found that the modified LCT was used in 136 (94.44%) of the 144 patients; in these, 73 (53.68%) it was necessary to use Floating Alar Rim Graft (FARG) and 5 (3.68%) AARG. Conclusion: we demonstrate a technique that reduce the need for resection of inferior cartilages, the use of grafts and the improvement of nasal function, with strengthening of the ENV without the need to reconstruct the alar border using contour grafts.
Highlights
Rhinoplasty remains one of the most difficult surgeries, because the nose must have a natural appearance, with good symmetry, projection, length and rotation
Our objective is to present a description of a technique to refine and structure the nasal tip, which is a modification of the Lateral Crural Tensioning (LCT), and we will analyze the surgical technique of patients that have done surgery within one year of the same surgeon
Through the search of the surgical files, we found that 149 patients underwent rhinoplasty between July 1, 2018 and June 30, 2019; 5 records were not recovered due to system problems and, we will analyze the data of 144 patients
Summary
Rhinoplasty remains one of the most difficult surgeries, because the nose must have a natural appearance, with good symmetry, projection, length and rotation. A more refined nasal tip can be created on a slightly concave dorsum that continues with the tip without a visible transition, with the supratip break the more caudal possible. Another important characteristic of the tip is a smooth transition from tip lobule to the alae. Several types of techniques and use of grafts have already been described; many of the deformities observed after rhinoplasty are due to incisions, sutures or exaggerated resections of the lower cartilages, leading to clamping, asymmetries, retractions of the nasal tip and the relationships between lobule, columella and alae. Lateral Crural Tensioning (LCT), described by Davis [2], has gained prominence in contemporary rhinoplasty due to the consistent results; a frequent problem that can occur is the weakening of the soft triangle region and collapse of the External Nasal Valve (ENV). A 1-2mm retraction in this region can lead to a concavity of the alar contour, isolating the tip causing pinching of the region, leading to a globular aspect of the tip, and, possibly, nasal obstruction. [1, 3]
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