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Surgical Technique |

Lateral Crural Setback With Cephalic Turn-in Flap A Method to Treat the Drooping Nose

Amir A. Sazgar, MD
Arch Facial Plast Surg. 2010;12(6):427-430. doi:10.1001/archfacial.2010.86.
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Herein, I describe lateral crural setback with cephalic turn-in flap as a new technique for management of the drooping nose. I report a technique for reinforcement of the alar cartilage after partial removal of its caudal portion used in 23 patients during open rhinoplasty. An objective assessment, which included measurement of nasal tip rotation and projection, was applied preoperatively and postoperatively. The average follow-up period was 11 months. Satisfactory results were achieved that resulted in an increase in the degree of nasal tip rotation. The mean increase of the nasolabial angle was 12°. This technique allows increasing the nasal tip rotation in an incremental fashion with preservation of nasal valve function and the strength and stability of the tip complex.

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Figure 1.

Schematic diagram of the lateral crural setback with cephalic turn-in flap technique. A, Demarcation of the cephalic portion of the lateral crus. B, Vertical marking of the caudal portion of lateral crus and incising of the cephalic portion (ab = cd). C, Excision of a triangular piece of cartilage from the anterior of the cephalic portion of lateral crus and transecting of the caudal portion. D and E, Secondary movement of the cephalic portion in an opposite direction and fixing of the 2 ends of the caudal portion. F, Turn-in of the cephalic portion and stabilization with 5-0 nonabsorbable mattress sutures.

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Figure 5.

A female patient with a severely drooping nose deformity. Preoperative frontal (A) and lateral (B) views and postoperative frontal (C) and lateral (D) views. The preoperative and postoperative nasolabial angles were 59.6° and 93.7°, respectively.

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Figure 6.

A female patient with drooping nose deformity. Preoperative frontal (A) and lateral (B) views and postoperative frontal (C) and lateral (D) views. The preoperative and postoperative nasolabial angles were 82.4° and 96.3°, respectively.

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Figure 7.

Preoperative (A) and postoperative (B) nasal base views of the patient shown in Figure 5. Minor skin folding over of the vestibule was resolved with preservation of the nasal airway.

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Figure 4.

Fixation of the folded cephalic portion with 3 mattress sutures. Note the turn-in flap.

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Figure 3.

Transection of the caudal portion of lateral crus and excision of the cartilage between 2 cuts.

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Figure 2.

Vertical marking of the caudal portion of lateral crus and incising of the cephalic portion. In addition, a triangular piece of cartilage was also demarcated from the anterior part of the cephalic portion of lateral crus.

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