Vertical Alar Folding (VAF): A Useful Technique for Correction of Long and Concave Lateral Crura in Rhinoplasty

Şeneldir S, Kırgezen T.

What this paper says

Across 83 patients followed a mean of 26.7 months, folding the tip cartilage vertically to shorten and stiffen it required no technique-related revision, and 90.3 percent reported satisfaction with the result.

Overview

The outer arm of the tip cartilage can be too long or bowed inward, producing a hollowed nostril wall that both looks wrong and collapses on breathing in. This technique folds that cartilage vertically to shorten it and remove the concavity, while also controlling how far the tip rotates.

Sections of note

83 patients, 59 women and 24 men, operated by the senior author between 2013 and 2018.
Mean age 26.3 years, range 18 to 47.
Mean postoperative follow-up 26.7 months, range 12 to 64.
Patients completing 1 year after surgery filled in the Rhinoplasty Outcome Evaluation questionnaire.
Outcomes were assessed at examination and by analysis of before and after photographs.
No revision surgery was required for technique-specific reasons across the 5 years.
90.3 percent, 75 of 83 patients, were content with aesthetic and functional results. Level of evidence IV.

What it means for a patient

The technique shortens the tip cartilage by folding rather than by cutting a piece out, which preserves the tissue as support.
It addresses a hollowed nostril wall, which is both an appearance and a breathing problem.
Roughly 1 in 10 patients were not content with the result.
Limits: 83 patients, one surgeon, no comparison group, no objective breathing measurement, and the abstract reports functional improvement in descriptive terms only.

Why this paper matters

Long or concave tip cartilages are a common cause of both a bulbous tip and nostril collapse, and cutting them out removes support. Folding keeps the cartilage in place while changing its shape and stiffness. Without a comparison group the technique's advantage over alternatives is not demonstrated.

Terms

Lateral crus: The outer arm of the tip cartilage running toward the cheek.
Concavity: An inward curve, here producing a hollow in the nostril wall.
Alar collapse: The nostril wall falling inward when breathing in.
Tripod theory: A model treating the tip cartilages and columella as a three-legged support.
Tip rotation: How far the tip is turned upward.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“The tripod theory explains the dynamics of the nasal tip, where surgery is difficult because of anatomic variations and pathologies and the various surgical possibilities. Abnormalities or weaknesses of the lateral crura can result in concavity in ala or alar collapse and cause aesthetic and functional impairments of…”

Excerpt; the full abstract is on PubMed.