Either telescoping the rim strip with flap or excising a small portion of the flap to create a void into which the LLC would telescope can affect retrodisplacement. Kridel and Konior,13 later introduced a lateral crural overlay technique. In

this technique the lateral crus was cut vertically at its middle portion. Then the cut ends were overlapped and sutured to shorten the total length of the lateral crus.11 Other procedures such as medial crura shortening SB203580 molecular weight techniques have also been employed for deprojection. Lipsett,10 advocated splitting the LLC medial to the dome, resecting a length of the cartilage Inhibitors,research,lifescience,medical just lateral to the incision, and reshaping the lateral crus remnant, using multiple scoring incisions on the cartilage to recreate a new dome. This was performed using a rim incision and a cartilage delivery technique. Other experts have made some modifications in the Lipsett’s Inhibitors,research,lifescience,medical technique. For example, they preserved the underlying vestibular skin, delivered the cartilage with a marginal incision and morselized the cartilage. The excision of medial crura foot pods to deproject the nasal

tip was also suggested by Guyuron and colleagues.6 The lateral and medial crura need to be equally shortened in order to deproject the nasal tip without Inhibitors,research,lifescience,medical altering tip rotation. Joseph and Safian,15 favored excising the lateral and medial crura elements to achieve deprojection. Close, et al,16 removed a calculated length of the medial and lateral crura. The remnants would be sutured together end to end. Later, medial and lateral crura overlay and suturing techniques were combined by Foda et al,17 for deprojection. Vertical Dome Division is a versatile mean of nasal tip alteration. The hockey-stick,11 approach is a technique among the vertical division Inhibitors,research,lifescience,medical techniques, which includes the Goldman procedure and the Simon’s modification. We believe our technique is suitable for three main objectives: (1) nasal tip deprojection, (2) increasing tip rotation, and (3) decreasing tip rotation especially in revision cases with over-rotated tips. In fact, Inhibitors,research,lifescience,medical by changing

the site of cartilage removal, we can achieve different from goals depending on the deformity. The most frequent complication of our technique is widening of the tip since the dome area is the narrowest part of the lower lateral cartilage removed in this technique. This area, in fact, is replaced by a much wider part of LLC. Reasonably, this causes widening of tip area. To avoid this, we did narrow the new tip area as much as possible by removing cartilage from the cephalic part of LLC and inserted a tip graft in most patients. Using the tip graft helps to minimize this complication, define the tip area, and camouflage suture knots and visible cartilage cut ends, which are the second most common complications of this technique especially in thin-skinned patients. No other major complications were observed in our patients.