The comparison between two different combinations of alar cartilage-modifying techniques: is lateral crural steal the choice?

To assess the effect of two different combinations of alar cartilage-modifying techniques on the degree of nasal tip projection and rotation, a prospective trial was performed using preoperative and postoperative photos. The patients were seen in private practice. Sixty patients who had underprojected with/without underrotated nasal tips, primarily due to alar cartilage malformities, were randomly divided into two equal groups (A, B). All patients were operated using an external rhinoplasty approach. The techniques of narrowing transdomal sutures and placing a collumellar strut were used in both groups; in addition, lateral crural steal (LCS) was used only in group B. The patients were reevaluated after a minimum period of 6 months. The nasofacial angle and the Goode ratio were measured to assess tip projection and the nasolabial angle was used to assess tip rotation. The patients of both groups showed significant increase in tip projection and rotation (P < 0.001). Additionally, the use of LCS in patients of group B resulted in significantly more increase in tip projection and rotation in comparison with group A (P < 0.05). The LCS along with placement of a columellar strut and a transdomal suture is more beneficial in patients suffering from underprojection with/without underrotated nasal tips.