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Caudal Resection of the Upper Lateral Cartilages and Its Measured Effect on Tip Rotation

Hazani, Ron MD*; Ford, Rachel S. MD; Rao, Arun J. MD; Wilhelmi, Bradon J. MD§

doi: 10.1097/SAP.0b013e3182503af4
Aesthetic Surgery

Background Commonly used maneuvers for upward tip rotation include cephalic trim of the lateral alar cartilages, caudal resection of the septum, and shortening of the upper lateral cartilages (ULCs). Few techniques for surgical manipulation of the ULCs are found in the literature, and none accurately describe the measured effect of the caudal resection on tip rotation. The purpose of this study is to predict the change in upward rotation of the nasal tip for a measured incremental resection of the ULCs.

Methods Ten fresh cadaveric noses were dissected with the aid of loupe magnification via an open rhinoplasty approach. The ULCs were sectioned in 20% increments, and measurements of the nasolabial angle (NLA) were recorded with the use of a goniometer. True lateral photographs were obtained for the photographic analysis of the specimens.

Results The average length of the ULC was 16.8 ± 1.6 mm. Serial reduction of the ULC length by 4 sequential 20% increments resulted in a mean NLA change of 3.6, 2.7, 2.1, and 1.9 degrees, respectively. The average incremental change in NLA for the 4 resections was 2.6 degrees.

Conclusions Caudal resection of the ULC has a measurable effect on the upward rotation of the nasal tip. A 20% resection correlates with an average change in the NLA of 2.6 degrees. Because caudal resection of the ULC is a powerful tool in the armamentarium of the rhinoplasty surgeon that can cause narrowing of the internal nasal valve and hallowing of the lower nasal sidewalls, it should be used with caution in a selected group of patients when attempting to elevate the “droopy” tip.

From the *Massachusetts General Hospital-Harvard Medical School, Boston, MA; †Loma Linda University, Loma Linda, CA; and ‡University of Louisville, and §Division of Plastic Surgery, University of Louisville, Louisville, KY.

Received October 26, 2011, and accepted for publication, after revision, February 13, 2012.

Presented at the Rhinoplasty Society 16th Annual Meeting, Boston, MA, May 6, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Bradon J. Wilhelmi, MD, Division of Plastic Surgery, University of Louisville School of Medicine, 550 S. Jackson St, ACB 2nd floor, Louisville, KY 40292. E-mail:

© 2013 by Lippincott Williams & Wilkins