Lateral crural tensioning for refinement of the wide and underprojected nasal tip: rethinking the lateral crural steal.

Refinement of the wide, ptotic, under protected tip is one of the most difficult challenges in cosmetic nasal surgery yet also among the most common. Although excisional techniques can produce reductions in lobular width, long-term contour alterations are unpredictable and subject to stigmatic tip deformity. Preservation of natural tip support is a fundamental requirement of a successful rhinoplasty. The traditional lateral crural steal is a useful technique for tip refinement, but, when combined with a sturdy septal extension graft, the modified lateral crural steal (lateral crural tensioning) becomes a more potent and versatile rhinoplasty technique that can improve tip contour without jeopardizing function or structural stability.