Tripod Framework Rebuilding in Asian Nose: Tip Plasty Using Alar Advancement Technique

Jeong, Jae Yong

Abstract

In Caucasians, the lateral crural complex is large and long, and the tip plasty is not difficult. In Asians, however, the nasal tissues are insufficient and the nasal tip needs more volume. Therefore, many operators rely on a graft insertion for augmentation effect. Occasionally, if the tip supporting framework is weak, nasal tip drooping is observed by the operators in long period of follow-up. Recently, release and division of tripod structure combined with framework rebuilding has made the correction of various tripod types of tip complexes possible. The main principle of alar advancement technique is that three limbs of the tripod should be properly separated. The nasal tip should be advanced toward upward and forward direction and reinforcement should be done with autologous graft. In other words, scroll ligament, which connects between the alar cartilage and upper lateral cartilage, and nasal hinge complex should be divided freely, inducing the pivot motion and gliding of alar cartilage which leads the V-Y fashioned advancement and projection of alar cartilage. This paper presents an operation method using auricular cartilage after examining the principle of alar advancement in patients who have lack of tip projection, based on my cadaver study and clinical experience.