The L-Shaped Lateral Crural Graft: A Single-Graft Technique for the Correction of Alar Concavity and Nasal Valve Insufficiency

Nasal valve insufficiency and alar concavity are challenging sequelae of previous rhinoplasty, often resulting from a weakened or scar-deformed lateral crus. We describe the L-shaped lateral crural graft, a single autologous costal cartilage construct designed to simultaneously address lateral crural weakness, alar concavity, and nasal valve insufficiency in revision rhinoplasty. The graft is shaped into an L configuration: the long limb is positioned along the lateral crus to reinforce the crus and correct concavity, whereas the short limb is directed dorsally to support the lateral nasal wall and internal nasal valve region. In this single-center consecutive case series, 12 patients (7 male and 5 female; aged 18-55 y) underwent bilateral L-shaped lateral crural grafting, with a mean follow-up of 9.5 months. All patients reported improved nasal breathing and expressed satisfaction with the outcome. Clinical examination revealed increased lateral nasal wall support, and photographic assessment demonstrated reduced alar concavity with improved contour and symmetry. No infection, graft exposure, visibility, contour irregularity, asymmetry, warping, resorption, or recurrent collapse was observed. The L-shaped lateral crural graft may be a feasible option for simultaneous functional and aesthetic correction in selected revision cases, although larger comparative studies using validated outcome measures are warranted.