Medial cruras custom made grafting is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties, whenever the medial cruras of the lower lateral cartilages are totally or subtotally missing or, alternatively, need to be completely redesigned and replaced, providing the location, prominence, shape, size, angle or specific custom look desired by the patient or deemed technically required by the surgeon, from an ambitious change up to a totally brand new custom made medial crura; common indications are the columella deformities, medial crura buckling, asymmetries, ethnic noses, revision of poor results, feminization cases, etc, being the ideal donor sites the nasal septum, ear concha and the rib.
The medial cruras custom made graft technique is indicated when it is deemed unsafe, unstable, unpredictable or unlikely successful letting the lower lateral cartilage, its medial crura and the tip and the columella 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 medial cruras custom made graft, in those noses with undoubted an undisputable requirement of extraordinarily firm support of the medial 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.