Resting angle correction beyond aesthetics: a retrospective cohort study demonstrating its role in nasal valve repair.

Introduction: The resting angle forms between the lateral crus of the lower lateral cartilage (LLC) and the upper lateral cartilage. While conventional nasal valve repair relies on cartilage grafting for reinforcement of these structures, the functional significance of resting angle adjustment remains underexplored. Objectives & Hypotheses: We describe a technique to reposition the LLC, adjusting the resting angle to support the lateral nasal wall and restore external nasal valve (ENV) function without grafts, with the hypothesis that this approach improves functional and aesthetic outcomes. Study Design: Retrospective cohort study. Methods: We retrospectively identified patients with ENV collapse-related nasal obstruction who underwent the described surgery. Pre- and postoperative Peak Nasal Inspiratory Flow (PNIF) measurements and FACE-Q scores were compared to evaluate functional and aesthetic improvement, respectively. Results: Thirty patients (22 female, 8 male) were included. Postoperatively, median PNIF increased from 74.0 L/min (IQR: 73.0-76.0; 95% CI: 72.5-75.5) to 96.0 L/min (IQR: 93.0-97.0; 95% CI: 94.0-97.5), and median FACE-Q Satisfaction with nose scores from 17 (IQR: 16.0-18.0; 95% CI: 16.0-17.5) to 37 (IQR: 35.0-38.0; 95% CI: 36.5-37.5); both improvements were statistically significant (p<0.001). Conclusions: Resting angle correction may not only improve aesthetics, but also stabilize the lateral nasal wall to prevent or repair ENV collapse.