Total Lower Lateral Cartilage Reconstruction in Multiple Revision Rhinoplasty Patients

Overview

After repeated rhinoplasty the lower lateral cartilages, which form the tip and nostril rims, can be so weakened or removed that nothing usable remains. The authors describe building a complete replacement from rib cartilage grafts. Patients treated with open septorhinoplasty between 2019 and 2023 were included, with partial reconstruction used where only one part of the cartilage was inadequate.

Sections of note

• Design: case series describing a technique, 24 patients. Level of evidence IV.
• 14 patients were female and 10 male. Mean age 23 years.
• Mean follow up: stated as between 6 and 18 months.
• Total reconstruction was used where both the inner and outer arms of the tip cartilage lacked support.
• Where only the inner or only the outer arm was inadequate, only that portion was reconstructed.
• A new lower lateral cartilage was created from costal cartilage grafts.
• No complications were observed from the technique.
• Results are described as satisfactory, with no scoring tool, questionnaire or measurement reported.

What it means for a patient

• This applies to noses that have been operated on several times, where the tip framework has effectively been used up.
• Rib cartilage supplies enough material to build a complete new tip framework, which the septum or ear cannot.
• Using rib means a chest incision and a second surgical site, which the abstract does not discuss.
• Limits: 24 patients, no comparison group, no validated outcome measure, follow up under 18 months, and satisfaction reported as the authors' impression.

Why this paper matters

Multiply revised noses are the hardest cases in rhinoplasty, with scarred skin, missing cartilage and poor blood supply, and few series describe rebuilding the tip entirely. Documenting a total reconstruction approach gives a reference for those cases. Whether the reconstructed framework holds shape over years is unanswered.

Terms

• Lower lateral cartilage: the paired cartilages forming the nasal tip and nostril rims.
• Medial crus: the inner arm of that cartilage, running down toward the nostril base.
• Lateral crus: the outer arm, forming the nostril rim and side wall.
• Costal cartilage: cartilage from the ribs, harvested for use as a graft.
• Revision rhinoplasty: a further operation to correct the result of an earlier one.
• Septorhinoplasty: nose surgery that reshapes the outside and straightens the septum.