Lateral Crura Strut Grafts and Alar Batten Grafts in Pinched Nose
I typically rely on the lateral crural strut graft technique when too much native cartilage has been resected. Strut grafts are placed under the remaining native cartilage (underlay) and often possess a mechanical advantage over the alar batten graft, which is placed on top of the native cartilage (overlay). However, both types of grafts can be used to correct pinching and collapse, especially when they are made to overlap onto the maxillary bone or pyriform aperture. The choice of underlay or overlay graft, as well as the size of the graft, depends on anatomic need and the preference of the surgeon. If available, I prefer septal cartilage because it is strong yet thin, and not prone to warping. Secondary choices include rib cartilage and ear cartilage. Ear cartilage can be weak and fragile, while rib cartilage becomes calcified in older patients and is prone to warping. Best wishes.
Which cartilage is best for post operative pinched nasal tip
Autologous septal or rib cartilage is alway best for lateral crural replacement.
Properly screened and preserved homografts can also be used, good luck.
The best cartilage would be septal or rib cartilage. Best of luck with your decision to move forward with your surgery.
Reconstructing lateral crura
In my experience, the best cartilage for this is either the nasal septum (if it is thick enough) or rib cartilage. Rib cartilage is much stronger, can be shaped and carved to suit the purpose and is accepted very well in the nose. You should only see a surgeon who has extensive experience in revision/reconstruction rhinoplasty as this type of procedure is complex.
Revision rhinoplasty for pinched tip etc.
A revision rhinoplasty can be done to correct your pinched tip For 35 years I have used both batten graftss and full cartilage replacement of lateral course. See a very experienced revision rhinoplasty surgeon for this.
It sounds like your lateral crura were over-resected and now there is a lack of support to the nasal tip. Even if you have just a small amount of lateral crura present, placing a lateral crural strut graft is the most appropriate treatment to restore the strength and support to this region. The areas that cartilage can be harvested are septum, ear, or costal rib cartilage. Where the cartilage is harvested from will depend on if you have sufficient septal cartilage present. If not, the other sites will have to be considered. Hope this helps. Best of luck.