The role of the upper lateral cartilages in aesthetic rhinoplasty.

Background: Reducing lateral nasal tip width in order to optimize shape while still maintaining function presents a challenge to the operating surgeon. Techniques for the reduction of tip width are typically limited to resection, plication, or medial augmentation of the lower lateral cartilages (LLC).

Objective: This study describes a reduction of both the length and width of the lateral half of the upper lateral cartilages (ULC) to effect a change in nasal tip shape in selected individuals.

Methods: Between January 2003 and February 2005, we reviewed the records of 217 patients undergoing primary rhinoplasty; of these, 43 patients underwent partial resection of the ULC to alter nasal tip shape. In this selected group of patients, resection of a portion of the ULC infralaterally was performed, along with partial resection of the LLC.

Results: No patients noted increased difficulty breathing postoperatively, so nasal valve function was maintained. Reduction of superior lateral tip width was observed in all patients.

Conclusions: Judicious modification of the lateral portion of the ULC--taking care to maintain adequate length and breadth of the medial portion of the cartilage in selected individuals--results in significant improvement in nasal tip width. A specific subset of our patients, approximately 20%, benefited from this approach. Conservative resection of the ULC can enhance nasal tip shape. While clearly not applicable in the majority of patients, the described technique represents a useful addition to the algorithm we may employ in determining the surgical approach in patients seeking aesthetic rhinoplasty.