Redefining tip surgery: LLC malposition as a structural, not volumetric problem
目标: To present a practical approach for diagnosing and correcting alar cartilage malposition, restoring both nasal valve function and natural tip aesthetics while minimizing postoperative complications.
介绍: Since the pioneering work of Jack Sheen, alar cartilage malposition has been recognized as an important cause of nasal valve insufficiency and tip deformity. Later, surgeons such as John Tebbetts and Jack Gunter corrected this problem through open rhinoplasty, improving structural support but sometimes producing an over-structured or heavy nasal tip. In closed rhinoplasty, correction remains technically demanding, and many surgeons rely on onlay or batten grafts rather than true cartilage repositioning. Mark Constantian further refined the concept by emphasizing anatomical relocation of theALC
材料 / 方法: A prospective series of 50 consecutive patients, independently audited by a notary, underwent alar cartilage relocation using either an open or closed approach according to the deformity. Cartilage orientation was assessed using:
* Nasal axis
* Canthal axis
* Sheen’s and Constantian’s anatomical principle
结果: Relocation of the lateral crura restored a more physiological cartilage orientation, improved external nasal valve support, and produced a lighter, more natural tip contour than reinforcement alone. Both open and closed techniques were effective when correctly indicated. Careful postoperative management during the critical healing phase significantly reduced displacement and other unexpected postoperative situations.
总结: Understanding cephalically rotated lateral crura.
* Recognizing true alar cartilage malposition.
* Choosing between open and closed correction.
* Preventing postoperative displacement during the critical healing period.
* Achieving functional improvement without compromising tip aesthetics
