Management of Lateral Crura Deformity in Functional and Aesthetic Rhinoplasty: Classification, Surgical Algorithm, and Outcome-Based Approach

INTRODUCTION: The lateral crura of the lower lateral cartilages are crucial in tip rhinoplasty. Their deformity or malposition causes aesthetic imbalance, alar insufficiency, and functional airway compromise. Objectives & Hypotheses: To describe a classification system for lateral crura deformity and evaluate the outcomes of a structured surgical management algorithm Study Design: Retrospective-prospective Methods: This study included patients undergoing primary or revision rhinoplasty involving lateral crural intervention between 2022 and 2025. Outcomes were assessed using standardized photographic analysis, a 5-point Likert scale for patient satisfaction, and the Nasal Obstruction Symptom Evaluation (NOSE) scale for valve stability. RESULTS: This study included 50 patients (primary: 80%, revision: 20%). The mean follow-up was 14.2 months (range: 6-24 months). The mean preoperative NOSE score improved. Patient satisfaction scores were high, 90% of patients reported significant improvement in both aesthetic and functional outcomes, and two patients (4%) required revision surgery for minor asymmetry correction. CONCLUSION: Lateral crural deformity management should prioritize preservation and restoration over excessive excision. An algorithmic, preservation-based approach improves predictability, airway stability, and long-term nasal tip support. Modern management should focus on repositioning, reinforcement, and reconstruction.