Aesthetic Plastic Surgery

, Volume 40, Issue 4, pp 475–481 | Cite as

Freed Lower Lateral Cartilages with Intact Lateral Attachments: A Versatile Approach in Tip Plasty

  • Hayati Akbaş
  • Caglayan YagmurEmail author
Multimedia Manuscript Aesthetic



Tip plasty is an important procedure that contributes much to obtaining an aesthetically pleasant nose. To increase precision during the tip plasty procedure, control over the lower lateral cartilages should be maximized. This can be accomplished by extending the exposure of the cartilage framework. We present our “Freed Lower Lateral Cartilages With Intact Lateral Attachments” approach through which inferior lateral cartilages are being dissected free from their attachments, while only their lateral bases (lateral crural parts) are left intact.

Patients and Method

A total of 1752 consecutive patients operated on with this approach were included. All patients were cosmetic rhinoplasty patients operated on between the years 1999 and 2014. During tip plasty, the lower lateral cartilages of all patients were totally dissected from all their attachments, while the lateral bases were left intact. The suture and graft techniques for the tip plasty procedure were then applied to reconfigure the tip region.


The approach was used successfully in 1752 patients in a 15-year period. The mean age of patients was 33.5 years. The complication rate was 6.4 % and the revision rate was 4.7 % for the patients. Only 1.2 % of patients needed a revision surgery for tip and/or alar region. None of these patients needed further revision. The aesthetic and functional outcomes revealed high satisfaction rates.


The “Freed Lower Lateral Cartilages With Intact Lateral Attachments” approach in tip plasty facilitates manipulation of the tip region while maintaining precise control to provide definition in terms of symmetry and three-dimensional configuration. Furthermore, it constitutes an autologous and practical platform on which nondestructive techniques can be performed in a combined and synergistic fashion.

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


Rhinoplasty Tip plasty Alar cartilage Medial crura Rhinoplasty technique Dissection 



The authors state that they received no funding to assist in the creation of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors state that they have no conflicts of interest to disclose.

Supplementary material

Supplementary material 1 (MP4 12763 kb)


  1. 1.
    Silver WE, Zuliani GF (2009) Management of the overprojected nose and ptotic nasal tip. Aesthet Surg J 29(3):253–258CrossRefPubMedGoogle Scholar
  2. 2.
    Cakir B, Oreroglu AR, Daniel RK (2014) Surface aesthetics in tip rhinoplasty: a step-by-step guide. Aesthet Surg J 34(6):941–955CrossRefPubMedGoogle Scholar
  3. 3.
    Han SK et al (2005) The effect of releasing tip-supporting structures in short-nose correction. Ann Plast Surg 54(4):375–378CrossRefPubMedGoogle Scholar
  4. 4.
    Behmand RA, Ghavami A, Guyuron B (2003) Nasal tip sutures part I: the evolution. Plast Reconstr Surg 112(4):1125–1129 (discussion 1146–1149) CrossRefPubMedGoogle Scholar
  5. 5.
    Kucuker I et al (2014) Are grafts necessary in rhinoplasty? cartilage flaps with cartilage-saving rhinoplasty concept. Aesthet Plast Surg 38(2):275–281CrossRefGoogle Scholar
  6. 6.
    Keskin M, Tosun Z, Savaci N (2009) The importance of maintaining the structural integrity of the lateral crus in tip rhinoplasty. Aesthet Plast Surg 33(6):803–808CrossRefGoogle Scholar
  7. 7.
    Kridel RW et al (1989) Advances in nasal tip surgery: the lateral crural steal. Arch Otolaryngol Head Neck Surg 115(10):1206–1212CrossRefPubMedGoogle Scholar
  8. 8.
    Ghavami A et al (2008) Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg 122(4):1229–1241CrossRefPubMedGoogle Scholar
  9. 9.
    Neaman KC et al (2013) Cosmetic rhinoplasty: revision rates revisited. Aesthet Surg J 33(1):31–37PubMedGoogle Scholar
  10. 10.
    McKinney P, Cook JQ (1981) A critical evaluation of 200 rhinoplasties. Ann Plast Surg 7(5):357–361CrossRefPubMedGoogle Scholar
  11. 11.
    Byrd HS, Hobar PC (1993) Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 91:642CrossRefPubMedGoogle Scholar
  12. 12.
    Rohrich RJ, Deuber MA, Adams WP Jr (2002) Pragmatic planning and postoperative management. In: Gunter JP, Rohrich RJ, Adams WP Jr (eds) Dallas rhinoplasty: nasal surgery by the masters, vol 1. QualityMedical, St. Louis, pp 72–104Google Scholar
  13. 13.
    Soliemanzadeh P et al (2005) Nasal tip overprojection algorithm of surgical deprojection techniques and introduction of medial crural overlay. Arch Facial Plast Surg 7:374–380CrossRefPubMedGoogle Scholar
  14. 14.
    Yun IS, Rah DK, Kim SM (2010) Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty. J Craniofac Surg 21(6):1922–1925CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2016

Authors and Affiliations

  1. 1.FBM Aesthetic Plastic Surgery ClinicSamsunTurkey
  2. 2.Department of Plastic Reconstructive and Aesthetic SurgeryOndokuz Mayis University Faculty of MedicineSamsunTurkey

Personalised recommendations