Lower lateral cartilage repositioning

See how lower lateral cartilage repositioning can be used to repair external valve collapse, tip pinching, alar retraction and nasal congestion.

In some people chronic nasal congestion is due to malpositioned lower lateral cartilages (LLCs) which are angled too far upward (cephalic positioning).

Schematic showing LLC cephalic positioning

The schematic above shows how this upward positioning leads to less support of the external nasal valve and nasal sidewall. A secondary effect of the cephalic positioning of the LLCs is alar retraction in which the nostril margins are higher than normal or the tip looks quite bulbous (parantheses deformity).

What is lower lateral crural repositioning?

The problem of lower lateral cartilage malpositioning is ideally suited to an advanced rhinoplasty maneuver called LLC repositioning. This technique involves dissecting the lower lateral cartilages away from the underlying internal skin lining. Once this is done cartilage strut grafts are placed under the LLCs to strength and flatten them. The LLCs are then mobilized into new pockets situated lower down toward the nostrils.

There are a few benefits of LLC repositioning. This includes improved support of the nasal sidewalls and external nasal valves. Repositioning of the lower lateral cartilages can also improve the overall nasal contour as the tip can appear pinched and isolated when there is not a normal transition from the tip defining points to the nasal alae. Since LLC repositioning includes placement of a LLC strut graft we gain all of the benefits of this technique as well.

This patient had LLC repositioning on both side of his nose to treat severe pinching of his nasal tip:

LLC repositioning to treat external valve collapse photos

This patient had a prior rhinoplasty which resulted in significant retraction and collapse of her lower lateral cartilages. Dr. Lamperti performed revision rhinoplasty to reconstruct her tip and treat her pinching and alar retraction:

External valve collapse and alar retraction before and after revision rhinoplasty

You can see how the severe supra-alar pinching and alar retraction is vastly improved thanks to this LLC repositioning technique.