Introduction & Objective: In most anatomic references, the shape of the lower lateral cartilage (LLC) is described as a two-dimensional structure. However, the authors have found different forms of LLC in at least 40% of their open rhinoplasty cases in the last 20 years. We found this cartilage to have a threedimensional hemispheric appearance that was connected to the upper lateral cartilage (ULC) at scroll area by an inward limb of this hemisphere. This inward limb may have an important role in producing asymmetry and flare of the nostril.
Materials & Methods: The LLC of 286 patients was evaluated during open rhinoplasty over a two-year period, with the main focus on the shape of this structure, especially at the LLC-ULC junction (scroll area). Results: A dome-shaped appearance of the LLC was noted in 40.9% of cases, and 11.5% of cases had bilateral LLC variation. This different anatomic form was seen mostly in patients with a strong bulbous TIP, although it was observed less frequently in narrow nasal TIPs as well.Conclusions: At least one-third of the LLCs that were analyzed had a medial wall in addition to the lateral wall, which significantly increased the flare and recoil force of this structure. This makes this cartilage more redundant to reshaping procedures (straightening); thus, special attention must sometimes be paid to this common anatomic variation in order to produce symmetric nostrils and obtain a more aesthetically acceptable alar TIP.