Lateral cruras strut grafting is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties, whenever the lateral cruras of the lower lateral cartilages show an insufficient length, under support, under projection, buckling, inversion, concavity, convexity, asymmetries, deformities, pinching, retraction, collapse, malpositioning, etc.
This kind of lateral cruras strut grafting is inserted between cartilage and vestibular skin and along the inner side of the lateral cruras and then the assembly is secured by means of suturing them both en bloc to act as a firm lateral crura reinforcement element, with or without combination with alar rim graft, tip graft, columella strut graft, etc, being the ideal donor sites the nasal septum, ear concha and the rib.
The lateral cruras strut graft technique is indicated when it is deemed unsafe, unstable, unpredictable or unlikely successful letting the lower lateral cartilage, its lateral crura and the ala float free to acquire their shape, position, projection and angle or alternatively when other less interventionist maneuvers with the same purpose are unreliable, unfeasible or have already failed; it is one of the most powerful and versatile maneuvers which can be performed on a nose.
With that said there are clear and necessary indications of the lateral cruras strut graft, in those noses with undoubted an undisputable requirement of extraordinarily firm support of the lateral cruras, as long as they are managed by highly experienced surgeons.
It is considered a highly demanding technique of high difficulty, long time consuming in the operating room and pretty much artistic in terms of its versatility, allowing full deployment of creativity reshaping noses.
This gesture can be done by either closed or open approach rhinoplasties, notwithstanding the open approach is a must of safety, reliability and precision for its execution.
Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed and open approach structure and non structure rhinoplasties should execute high end rhinoplasty cases, should they feel capable and comfortable with the challenge.