Alolateropexy for management of droopy nose
& Michel, J.*
*Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique, H
opitaux de Marseille, La Conception
Aix-Marseille University, Marseille Cedex, France
Accepted for publication 5 January 2017
Clin. Otolaryngol. 2018, 43, 774–776
The surgical management of droopy nose remains problem-
atic. Corrective techniques described in the literature
be difﬁcult to perform or sometimes lead to unsatisfactory
results. Dome sutures or grafts such as columellar strut often
give good initial results but may deteriorate over time.
rhinoplasty, predictable results and stability over time are
features that deﬁne a good surgical technique. Silver et al.
reported the possibility of suturing the superior part of the
lateral cartilages to the lower upper lateral cartilages.
According to the authors, this technique, called LUCS
(Lower lateral cartilage to Upper lateral Cartilage Suspen-
sion), provides good, stable results and spares cartilage. The
main causes of droopy tip include inferiorly oriented alar
cartilages (85%), overdeveloped scrolls of upper lateral
cartilages (73%), a high anterior septal angle (65%) and thick
skin at the nasal lobule (56%).
The association between
droopy nose and dorsal hump and overdeveloped cartilages
is quite frequent in our area of France. In our department, we
perform a technique we called alolateropexy that reduces and
rotates the droopy tip.
The purpose of this study was to describe how we perform
this alolateropexy technique in droopy nose management.
We performed alolateropexy in patients with a droopy nose
deﬁned by a nasolabial angle less than 90° for men (Fig. 1a)
and 100° for women (Fig. 2a).
Surgical technique: The three-step procedure is performed
after correction of osseous nose abnormalities such as nasal
dorsum convexity or bony deviation.
Step 1: Cephalic lateral crura excision preserving at least
5 mm of lateral crura. (Fig. 1b)
Step 2: Resection of the caudal portion of the upper lateral
cartilage (Fig. 1c).
Step 3: Alolateropexy: Three different sutures are per-
formed (Fig. 1d) as follows:
1 Suture of the lower lateral cartilages by an interdomal
suture is important to allow symmetrical vertical
traction when the alolateropexy is performed. As
usual, a transdomal suture can be associated if needed.
2 Suture of both upper lateral cartilages to the nasal
septum (in case of paraseptal vertical cuts on either
side of the septum) to ensure the position of the upper
3 Suture of the lower lateral cartilages to the upper
lateral cartilages with a non-absorbable colourless
monoﬁlament suture (Prolene 5/0, Ethicon
con Inc., Somerville, New Jersey, United States).
Sutures are ﬁxed between the free edge of the lower
lateral cartilage (cephalic portion of the lateral crura)
and the upper lateral cartilage. Suture tension must be
controlled by inspecting the rise of the lower lateral
cartilages, especially in men, to avoid an excessive
nasolabial angle. The effect of this suture is perma-
nent; no over-corrected rotation is needed.
The external approach is recommended for this surgery. It
allows perfect control of resections as well as a perfectly
symmetrical suture. This approach is simpler and more
accurate to achieve the required sutures. Finally, it allows tip
management using transdomal and/or interdomal sutures,
or by ﬁxation of a columellar strut.
Alolateropexy must always be the ﬁnal surgical stage and is
performed after correction of any osseous abnormalities.
At step 1, it is necessary to preserve at least 5 mm width
on the lateral crura of the lower lateral cartilages to avoid a
pinched nose effect. Resection enablescephalicrotationofthe
tip without weakening the tripod supporting the nasal tip.
At step 2, resection of the caudal portion of the upper
lateral cartilage must be moderate and carried out on
demand. This allows greater cephalic rotation of the tip but is
At step 3, the sutures between lower and upper lateral
cartilages must be perfectly symmetrical.
Correspondence: T. Radulesco, Department of Oto-Rhino-Laryngology and
Head and Neck Surgery, Assistance Publique, H
opitaux de Marseille, La
Conception University Hospital, 147 Bvd Baille, 13005 Marseille, France.
Tel.: +33491435858; fax: +33491435810; e-mail: Thomas.radulesco@
© 2017 John Wiley & Sons Ltd
Clinical Otolaryngology 43, 774–776