Repositioning the lateral alar crus.

Malposition of the lateral crus is a normal variant of the nasal alar cartilage as described by Sheen which shows a "parentheses" deformity from the frontal view. The cephalic-positioned lateral crus leaves the alar rims without cartilaginous support, causing deformity and potential destabilization of normal airway competence. The procedure described herein is a modification of the Sheen technique that can be done as either an open or a closed procedure. It is particularly valuable in decreasing the overprojecting nasal tip and preserving the equal height of the alar domes while widening the angle of divergence of the lateral crus. This technique delivers consistently dependable results for an anatomic variant modification frequently overlooked in rhinoplasty surgery.