Indications for Excision of the Medial Crural Footplate in Rhinoplasty

PURPOSE: The medial crural footplates are known to affect tip projection, columellar symmetry, and structural support during rhinoplasty. Additionally, the footplates are a functional component of the external nasal valve. Direct excision of the footplate has not been well described in the literature. We depict an in depth analysis of this technique particularly focusing on alleviating medial crural flaring and balancing nasal tip aesthethics. As a single step in a multi-faceted approach to controlling nasal tip harmony, nostril shape/function, and columellar symmetry, this study aims to clarify the role of medial crural footplate excision. METHODS: This was a retrospective, single surgeon study that identified patients undergoing rhinoplasty which involved bilateral medial crural footplate excision. The study period spanned 5 years from 2015-2020. Patient demographics, operative indications, surgical technique, structural outcomes, and complications were recorded. Institutional review board approval was obtained. Patient satisfaction and post-operative follow up 3D vectra photos were reviewed. Anatomic landmarks were identified. RESULTS: A total of 441 septorhinoplasties were performed during the 5 year study period, of which 95 underwent medial crural footplate excision and were included. Indications for excision included cosmetic concerns, such as improving nostril diameter/shape, tip projection, and columellar asymmetry. Functional indications included external nasal valve obstruction. Nasal tip balance, projection and functional outcomes were improved with extremely high patient satisfaction. Case Example: A 24-year-old female presented with complaints of nasal obstruction, mouth breathing, snoring, and frequent sinus congestion. She had c-shaped septal deviation, internal and external valve collapse, and slit-like nares. On profile, patients nose was underprojected with a low-hanging columella. Specific operative techniques for her septorhinoplasty included autospreader flaps, high-low-high osteotomies, articular alar rim grafts, septal extension graft, turbinate outfracture, and medial crural footplate excision. She recovered without incident and reported improved nasal breathing as well as being very pleased with nostril shape and columellar positioning on lateral view. There were no complications at one year follow-up. CONCLUSION: Medial crural footplate excision during rhinoplasty can be a useful adjuvant in creating nasal tip harmony, improving nostril shape, alleviating columellar asymmetry and improving functionality of the external nasal valve.