Management of Lateral Crura Deformity in Functional and Aesthetic Rhinoplasty: Classification, Surgical Algorithm, and Outcome-Based Approach

Abstract

Abstract Introduction The lateral crura of the lower lateral cartilages are crucial in tip rhinoplasty. Their deformity or malposition causes aesthetic imbalance, alar insufficiency, and functional airway compromise. Objectives and Hypotheses The objective of this study is to describe a classification system for lateral crura deformity and evaluate the outcomes of a structured surgical management algorithm. Study Design This is a retrospective–prospective study. Methods This study included patients undergoing primary or revision rhinoplasty involving lateral crural intervention between 2022 and 2025. Outcomes were assessed using standardized photographic analysis, a 5-point Likert scale for patient satisfaction, and the Nasal Obstruction Symptom Evaluation (NOSE) scale for valve stability. Results This study included 50 patients (primary: 80%, revision: 20%). The mean follow-up was 14.2 months (range: 6–24). The mean preoperative NOSE score improved. Patient satisfaction scores were high, 90% of patients reported significant improvement in both aesthetic and functional outcomes, and two patients (4%) required revision surgery for minor asymmetry correction. Conclusion Lateral crural deformity management should prioritize preservation and restoration over excessive excision. An algorithmic, preservation-based approach improves predictability, airway stability, and long-term nasal tip support. Modern management should focus on repositioning, reinforcement, and reconstruction.