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Figure 3. (A, B) Patient with a history of prior nasal trauma and severe right-sided nasal obstruction due to caudal septal deviation and
nasal collapse. (C) The severely deviated caudal septum required excision. (D) Septal cartilage and the perpendicular plate of the
ethmoid bone were used for L-strut reconstruction in vivo. (E) Additional lateral crural strut grafting was performed for external nasal
[16]
valve support. Image courtesy: Oliver et al. .

Lateral crural strut grafts
A technique often utilized to correct lower lateral cartilage asymmetry is lateral crural strut grafting [
Figure 5] . This can be particularly helpful when there is a significant discrepancy between the two sides in
[24]
contour, shape, or size. First, a dissection plane is created between the lateral crura and its vestibular lining
with hydrodissection using local anesthetic. A precise pocket is then bluntly dissected laterally within the
alar soft tissue or under the alar crease for placement of the graft laterally. A more caudal placement of this
graft can correct alar retraction. This graft is secured to the overlying lower lateral cartilage with horizontal