Correction of Various Nasal Tip Deformities #4: Triangular Nostril (Revision Rhinoplasty)

Triangular Nostril (Nostril Notching, Alar Retraction)

A distinctive feature of our clinic is that many patients, after a first surgery at another clinic went wrong,

come to us for revision surgery.

Patients therefore come with a wide range of problems, and among them “nasal tip deformity” is, within rhinoplasty,

the most demanding area, and one in which good results are not easy to achieve.

The reason is that “nasal tip deformity”

i) takes many different forms and is complex because the deformity appears in 3 dimensions.

ii) also has a complex course of development and causes, including “contracture,” “damage to and deformation of the tip cartilage from repeated surgery,” and “inflammation,” 

among others, which makes the surgery very demanding and difficult.

01 Upturned Tip (Upturned Nose)

02 Twisted Tip

03 Pinched Tip

04 Triangular Nostril (Nostril Notching, Alar Retraction)

05 Asymmetric Nostrils, Deviated Columella

06 External Valve Insufficiency

From here, we turn to a demanding and highly difficult area of rhinoplasty,

“nasal tip deformity,” and examine it in detail.

This case study continues as a series of 6 parts in total; we hope you will follow along.

“Contracture” or “surgical manipulation”

That is, it arises when contracture caused by a silicone implant has deformed the tip,

or when the tip cartilages were sutured together in a previous surgery in order to narrow the tip.

“Pinching” and “Notching” share the same cause, so they often occur together.

It can be corrected with tip cartilage repositioning (lateral crural repositioning) or

a lateral crural strut graft (LCSG).

(Materials Used)

Septal cartilage / Costal cartilage / Ear cartilage

PH

Several years ago, underwent tip plasty and augmentation rhinoplasty with ear cartilage and autologous dermis.

CC

The patient was dissatisfied that the nostrils were highly visible and looked pulled upward.

P/E

Triangular nostrils (nostril notching) on both sides.

Corrected with a lateral crural strut graft using ear cartilage.

This technique improves notching by reinforcing the alar cartilage with costal cartilage;

its formal medical name is the lateral crural strut graft,

and it is quite powerful in its effect.

​

In this patient as well, a lateral crural strut graft (LCSG) was performed,

correcting the triangular nostrils into a rounded, natural shape.

Near the apex of the nostril, the rim had been pulled up into a triangular shape,

but it was corrected to an even contour after surgery.