The endonasal lateral crural underlay and sandwich grafts.

Background: Previously, the problem created by overly convex, wide, and robust lower lateral cartilages (LLC) required an external or endonasal approach with delivery. Although this method has proven invaluable, it may not be indicated in all patients with large tips, specifically those with overly convex LLC or with thin skin and robust LLC.

Objective: The authors present the results of their straightforward technique for narrowing the bulbous tip through an endonasal nondelivery approach that reinforces the nasal airway while at the same time preventing alar notching, lateral crus recurvature, and bossa formation.

Methods: From August 2008 to February 2010, 29 patients underwent endonasal lateral crural underlay and sandwich graft with the authors' technique. All patients had medium to thin skin and prominent, bulbous, symmetric LLC. Three of the patients presented for secondary rhinoplasty. The authors identified no specific contraindications for this procedure. All patients who remained for follow-up were given a questionnaire that analyzed their nasal tip satisfaction on a five-point categorical scale at seven separate points of follow-up.

Results: Among the 27 patients who remained for follow-up, the results were highly satisfactory, mostly satisfactory, or satisfactory in 25 of the 27 cases (as indicated by patient survey). The two remaining patients requested a thinner nasal tip. No significant complications were noted.

Conclusions: The lateral lower crural underlay sandwich graft is an adjunct to the traditional endonasal approach, further enhancing and expanding the possible outcomes. It appears to equal the predictability and stability identified with traditional tip-narrowing techniques in the external approach but with less operative time, less surgical dissection, and presumably less edema, thereby allowing us to better meet our patients' demands.