What is the minimum amount of cartilage that should be preserved during cephalic trim?

Question

Is there any reason or case where a surgeon would go under that threshold? If too much cartilage was removed, what revisions can correct it?

Andrew Miller, MD · Answer

Usually at least 6 mm of lower lateral cartilage should be left after cephalic trim. Removing too much can lead to deformities after some time. We often leave more to keep good support of the sidewall of the nose. The key is to straighten the lateral crus, which created a less bulbous, more defined tip. Correcting an over resection involves using cartilage grafts to reestablish the lateral cartilage to the proper size. Be sure you see a rhinoplasty expert for consultation.

Jeffrey M. Darrow, MD · Answer

The cartilage you refer to is the lower lateral cartilage.  The shape of this cartilage partially determines the shape of the nasal tip and the support of the alar rim of the nose.  Trimming the upper (cephalic) portion of this cartilage helps to reduce nasal tip fullness and to narrow the nasal tip.  As this cartilage is part of the nasal tip and alar rim support, enough cartilage must be left to provide that support.  For noses with “normal” skin thickness, 6-7 mm of the cartilage should be preserved.  Patients with thicker nasal tip tissues may benefit from more support so more of the cartilage should be preserved.  If too much cartilage is removed and support of the nasal tip and alar rim is compromised, cartilage grafting can improve that support.  Best wishes.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.

I'm impressed with the specificity of your question.  A cephalic trim involves resected a portion of your lower lateral cartilages and the amount removed varies based on your anatomy and the specific location on your lower lateral cartilages where the cartilage was removed.  In my experience, any tip modification (such as a cephalic trim) is oftentimes reinforced with cartilage grafts or other tissue grafts to reduce the risk of any nasal rim collapse, alar retraction or other cosmetic or functional deformities.  If this wasn't done in your original surgery, those components would like be an integral part of your revision surgery if pursued.

Without any pictures, I am unable to help further.  However, I would recommend that your next step should be to pursue the right aesthetic plastic surgeon to address your (revision) rhinoplasty questions in person.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  I also think a key component of your consultation is to establish a good connection with your plastic surgeon.  This is difficulty to do without seeing your surgeon in the office, in person.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Generally speaking, at least six millimeters of lower lateral cartilage should be left after cephalic trim. There are many maneuvers which can be performed during a revision to correct this depending on your anatomy. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Zoran Potparic, MD · Answer

Although there are some rules about preservation of lateral cartilages to maintain good airway support (5-6 mm) decision about how much to trim and how to use trimmed cartilage is in the scope of surgeons intraoperative decision. I hope this may help. Good luck.

Sean Fisher, MD · Answer

As rhinoplasty surgeons, we have long used the cut off of 6 mm as a minimum amount of cartilage to leave to avoid causing issues with external valve collapse and breathing related issues or long-term issues with tip contour. However, many surgeons would now agree that trying to preserve the cartilage structures of the nose is advantageous when it can be done by using a variety of techniques such as suture methods to reshape the cartilages of the nose, or special means of treating the lower lateral cartilages to preserve their strength while trimming the width. If a patient's nose has been overly resected, this can often lead to a pinched tip, external valve collapse, or poor aesthetics. Correcting this often requires cartilage grafts to support the weakened cartilage and repositioning them to improve contour. There are a variety of techniques that are used, which vary significantly based on a patient's anatomy. I would recommend having a consultation with a well- trained rhinoplasty specialist who can evaluate your nose and come up with a comprehensive surgical plan to address your concerns.
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

What is the minimum amount of cartilage that should be preserved during cephalic trim?

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