Video 4.4: Correction of Medial Crus Malposition and the Hanging Footplate

What this video shows

The medial crura normally follow a caudal arc of about 10–30 degrees from the footplate to the dome; when this arc is wider, the footplate hangs and needs to be corrected. Video 4.4 shows the correction: the medial crura are separated from their adhesion to the footplate, shortened if necessary, re-fixed on the mucosa in a more correct position and angle, and then the strut is fixed to the septal extension graft or caudal septum.

The book warns not to confuse medial crus malposition with a long medial crus, whose treatment is much simpler, a medial overlapping suffices.

Key points

• Diagnosis: medial crural arc wider than 10–30 degrees with a hanging footplate.

• Medial crura are released, shortened and re-fixed at a corrected angle.

• Not to be confused with a long medial crus (treated by medial overlapping).

In the book: Chapter 4 – Nasal Tip Surgery, section 4.2.5 Medial Crus Malposition, pp. 79–80 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.