Ann Plast Reconstr Surg | Volume 4, Issue 3 | Review Article | Open Access

Lateral Crura Control in Nasal Tip Plasty: Cephalic Oblique Domal Suture, 7X Suture and ANSA Banner

Jose Carlos Neves1 and Diego Arancibia Tagle2*

1Department of Facial Plastic Surgery, “MyFace, Clinics and Academy”, Facial Plastic Clinic, Lisbon, Portugal
2Department of Otorhinolaryngology - Head and Neck Surgery, The European Academy of Facial Plastic Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, Spain

*Correspondance to: Diego Arancibia Tagle 

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For many years the nasal tip has been the main task for rhinoplasty surgeons, who have developed many surgical strategies to refine its complex anatomy and obtain a durable aesthetic and functional result over time. We present a surgical sequence where new techniques are introduced based on the elliptical vestibular ring. The goal is to conservatively control the two arms of this ring, with limited cartilage resections, new configuration of the cartilaginous framework using sutures and the use of a minimal amount of cartilage for grafting. We aim to achieve elegant and functional longstanding tips without the stigma of a “frozen nose”. We present our technical sequence, with some innovations, to treat the lower lateral crura anatomical variations obtaining a flat structure and the use of an Anterior Nasal Septal Angle (ANSA) extension graft that gives support to the lateral crura tensioning, gives projection, and avoids the rigid tip side effect of the septal extension grafts. The cephalic oblique domal suture and the 7X suture control the lateral crura anatomy, and the ANSA Banner gives it support. These techniques will be explained in detail in the following paragraphs of this article.


Elliptical vestibular ring; Lateral crura control; Cephalic oblique dome suture; 7X suture; ANSA banner


Neves JC, Tagle DA. Lateral Crura Control in Nasal Tip Plasty: Cephalic Oblique Domal Suture, 7X Suture and ANSA Banner. Ann Plast Reconstr Surg. 2020;4(3):1059..

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