To create a favorable nose tip contour, the shadows of the nose tip must be positioned in the appropriate place. The favorable contour of the nasal tip should feature a consistently elevated point extending from the domal region to the alar margins on both sides. This elevated point helps eliminate shadows along the lateral edges of the domes, which are responsible for framing the domal structure and contributing to the bulbous or pinched appearance of the tip. Ideally, a seamless elevated ridge should be visible from the domes to the alar lobule, and this should be easily observable in the base view without any signs of pinching around the tip area [1].

To attain a visually appealing outcome, various aspects of the nasal tip, including rotation, projection, definition, and symmetry, must be attended to [2,3]. To achieve this goal, several methods have been outlined for addressing the lower lateral cartilages and caudal septum, which contribute to the definition of the nasal tip. Techniques such as medial overlap, lateral overlap, dome division, vertical alar resection, and vertical alar folding have been employed in the past for the lower lateral cartilages to serve this purpose [4,5]. The lower lateral cartilages are the paired structures that form the framework of the nasal tip and contribute significantly to the overall nasal shape [6].

In this article, we would like to demonstrate how to increase nasal tip definition in primary or revision rhinoplasty cases by positioning the caudal level of the lateral crura of the lower lateral cartilage higher than the cephalic level using an onlay lateral alar caudal graft (LACG).