The sandwiched lateral crural reinforcement graft: A novel technique for lateral crus reinforcement in rhinoplasty

Abstract

Background: Misshapen or weak lateral crura can cause an inward collapse of the lateral crus observed on deep inspiration. The lateral crural strut graft is a popular technique for reinforcing lateral crura. Failure to stabilize the graft properly can, however, result in graft displacement postoperatively and an accompanying aesthetic deformity. Objectives: The authors discuss lateral crus reinforcement with the sandwiched lateral crural reinforcement (SLCR) graft. Methods: An SLCR graft was placed in 30 nonconsecutive primary open-approach rhinoplasty procedures by the senior author (I.K.) between February 2010 and May 2012. Cephalic excess of the lateral crura was incised and placed under the lateral crura; the lateral crural strut grafts were placed between the 2 cartilages, and the cephalic edges of both the superior and inferior lateral crura segments were sutured together. Results: Of the 30 patients, there were 5 men and 25 women ranging in age from 22 to 45 years (median, 35 years). Half (50%) of the patients received the SLCR graft for external valve collapse; in 30% of the patients, it was placed to support the lateral crura after correcting cephalic malpositioning; and 20% had an SLCR graft placed for lateral crural reinforcement after deformity secondary to dome-shaping sutures. No graft displacement or tip disfigurement was observed in the follow-up period (mean, 24 months). Conclusions: The SLCR graft technique represents a powerful tool for reinforcing lateral crura without discarding the cephalic portion of the cartilage, thus securing a stable graft pocket while minimizing any postoperative structural dislocation. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.