Symmetrization in primary tip rhinoplasty after resection of the cephalic portion of the lower-lateral cartilage

Background: The cephalic trim allows the remodeling of the alar cartilages by removing the cranial portion of the lower-lateral carti- lages; this resection determines raising the tip of the nose through its rotation. The objective of this study is to demonstrate how a greater symmetry of the lower-lateral cartilages after resection of the cephalic portion is obtainable by introducing a specific addi- tional surgical time into the procedure. Methods: Between June 2016 and December 2021, forty-six pa- tients underwent primary rhinoplasty with the cephalic portion of the alar cartilage resection. After the cephalic trim symmetry of the nose tip was then assessed through a specific additional sur- gical maneuver in 23 patients (Group A), whereas in 23 patients, the evaluation of symmetry was performed according only to the surgeon’s personal judgment (Group B). Preoperative and postoper- ative pictures were evaluated in the symmetry of the two sides of the faces considering anthropometric measurements and the judg- ment by ten plastic surgeons uninvolved in this study. Results: None of the patients had completely symmetric values. Objectively, the degree of asymmetry in Frankfurt’s plane, consid- ering RMLLA (midline-lateral alar margin ratio), was significantly decreased in Group A. Subjectively, more patients in Group A who were judged with asymmetrical face before rhinoplasty were eval- uated with a symmetrical face after rhinoplasty than those in Group B. Conclusions: We believe that in closed rhinoplasty, the symmetry of the postoperative sides of the face is increased by performing an easily replicable intraoperative maneuver as described.