See how lower lateral cartilage repositioning can be used to repair external valve collapse, tip pinching, alar retraction and nasal congestion.
I last wrote about what rhinoplasty surgery methods we have to create a Breathe Right Strip effect and correct external and internal nasal valve collapse. Just as I promised, today we'll go over an example of one of these techniques in action.
How To Fix Static External Valve Collapse
This patient is a great example of someone with baseline external valve collapse causing a reduction in nasal airflow.
You can see how he has significant supra-alar tip pinching in the area of his external nasal valves. In his case this is due the upward (aka cephalic) positioning and internal curvature of his lower lateral cartilages (LLCs). This schematic shows how this upward positioning leads to less support of the external nasal valve and nasal sidewall.
A secondary effect of the cephalic positioning of his LLCs is alar retraction in which the nostril margins are higher than normal (his right nostril is higher than the left in the photo) as the lower lateral crural cartilages aren't able to support the nostrils adequately.
What is Lower Lateral Cartilage Repositioning?
This patient's situation was ideally suited to an advanced rhinoplasty maneuver called LLC repositioning. This technique involves dissecting the lower lateral cartilages away from the underlying internal skin lining. Once this is done cartilage grafts are placed under the LLCs to strength and flatten them. The LLCs are then mobilized into new pockets situated lower down toward the nostrils. 
As you can see in the before and after photos above, the benefits of this technique are that the tip pinching is improved as the lower lateral cartilages are now in a proper position and are now straight. The shadowing that resulted from the concave crural cartilages has been effaced given a more natural tip contour. The underlying strut grafts provide improved strength and stability to the nasal sidewall further improving nasal airflow.
This set of oblique before and after photos further illustrates the improvement in alar retraction and supra-alar tip pinching.
Check back again where I'll review some other ways we can treat nasal valve collapse.
