Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity

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Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, “bulbous pinch” LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen.


The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face.


We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups.


There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally.


Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60–70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration.

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Correspondence to Farhad Hafezi.

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Hafezi, F., Naghibzadeh, B. & Kazemi Ashtiani, A. Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity. Aesth Plast Surg 42, 867–876 (2018) doi:10.1007/s00266-018-1136-8

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  • Nasal tip
  • LLC cephalic malposition
  • Bulbous pinch