Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 175–183 | Cite as

The Relation Between the Lower Lateral Cartilages and the Function of the External Nasal Valve

  • Eduardo Nascimento SilvaEmail author
Original Article Rhinoplasty



The position of the lower lateral cartilages (LLC) is closely related to the function of the external nasal valve (ENV). When there is a cephalic malposition of these cartilages, the nasal alae have inadequate support, which leads to ENV insufficiency during deep inspiration.


Retrospective study with 60 patients evaluated: the positioning of the LLC and the occurrence of ENV insufficiency; the effectiveness of structuring the medial and lateral walls of the ENV; and the frequency of the grafts used for structuring it.


Of the 60 operated cases, 37 patients (62%) had ENV insufficiency, in 23 cases there was cephalic malposition of the LLC, and in the latter group 17 patients (74%) presented this insufficiency. A structured ENV was effective in the treatment of this insufficiency (p = 0.001). A lateral crural strut graft was performed in 24 cases (40%) of 60 patients operated. The alar contour graft was performed from 2013 to 2015 in 4 patients (22%) of 18 cases operated, and between 2016 and 2018 it was performed in 29 patients (69%) out of 42 cases. The columellar strut was routinely used from 2013 to mid-2016 in 33 cases (100%), and after that period until the present day the tongue-in-groove technique was performed in 11 cases (41%) and in the remaining 16 cases (59%) the caudal septal extension graft was performed.


Cephalic malposition of the LLC is an important red flag of ENV insufficiency. This insufficiency should be treated by structuring the walls of the ENV.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Nose Nasal cartilage Nasal obstruction Rhinoplasty 



The author declares that he has no conflict of interest to disclose.

Supplementary material

266_2018_1195_MOESM1_ESM.mp4 (9.4 mb)
Video 1: Evaluation of nasal alae collapse during deep inspiration. Pre- and 1.5 year postoperative (MP4 9631 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Medicine DepartmentState University of Ponta GrossaPonta GrossaBrazil
  2. 2.Ponta GrossaBrazil

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