Lateral Crural Mid-Down Flap Technique in Primary Rhinoplasty

Kaderi S, Ekinci C, Karabağlı Y.

PubMed 40394313 Publisher (DOI)Free full text (PMC)

What this paper says

In 30 randomised patients with bulbous or boxy tips, folding the lateral crus as a "mid-down flap" matched cephalic trimming on overall scores but gave better results on a nasal-pinching questionnaire, where trimming caused deterioration.

Overview

Excessively curved lateral crura produce boxy, bulbous or "parentheses" tips. The standard fix, cephalic excision (CE), removes the upper strip of cartilage. The Turkish authors describe a lateral crural mid-down flap (LCMF) and randomised 30 patients, equal by sex, to CE or LCMF, evaluating with SCHNOS, a nasal pinching questionnaire and VAS.

Sections of note

30 patients randomised, 15 per technique.
SCHNOS and VAS improved significantly in both groups with no between-group difference.
Nasal pinching questionnaire (tip aesthetics and valve function): better after LCMF; worse than baseline after CE.
Level of Evidence IV.

What it means for a patient

Both techniques satisfied patients overall, but the cartilage-removal method showed signs of tip pinching and valve weakening on a targeted questionnaire.
Folding rather than removing cartilage preserved side-wall support in this small trial.
Thirty patients is a small sample; follow-up is not stated.

Why this paper matters

It is a randomised comparison, uncommon for tip techniques, and supports the shift away from cephalic trimming. Limits: small n, unstated follow-up, single centre.

Terms

Lateral crus: the side arm of the tip cartilage along the nostril rim.
Cephalic excision (trim): removing the upper edge of the lateral crus.
Boxy / bulbous / parentheses tip: tip shapes caused by wide, convex or mispositioned lateral crura.
Nasal pinching: a narrowed, pinched tip with side-wall collapse, a known late complication of over-trimming.
SCHNOS: a validated nasal outcome questionnaire.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Nasal tip surgery, especially the correction of deformities of the lateral crura, is perhaps one of the most difficult areas of rhinoplasty, and many different techniques have been described in the literature.

Objectives: The authors describe a new flap technique for the correction of excessive convexity of lateral crura causing boxy, bulbous, and parentheses tip deformities.

Methods: Thirty patients were randomly divided into two groups with equal numbers of male and female patients in each group. In half of the patients, lateral crural correction was performed with the cephalic excision (CE) method, while in the other half, it was performed with the lateral crural mid-down flap (LCMF) technique described by the authors. SCHNOS (standardized cosmetic and health nose outcomes questionnaire), nasal pinching questionnaire, and VAS (visual analog scale) were used to evaluate the results within and between groups.

Results: While significant improvement was observed in both techniques according to SCHNOS and VAS compared to preoperative evaluation, no significant difference was observed between the two groups. On the other hand, in the nasal pinching questionnaire, which includes more specific questions about the nasal tip aesthetics and nasal valve function, better postoperative results were obtained in the LCMF technique, while deterioration was observed in the CE technique according to preoperative findings.

Conclusion: The LCMF technique can be considered as an easy and suitable technique for the correction of lateral crura, especially in patients with excessively convex lateral crura with a bulbous nasal tip.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).