fig1

Figure 1. Historical guidance was to leave a minimum of 6 mm of width (orange lines) to the lateral crus after performing a cephalic trim. This type of trim can leave a structural void between the upper and lower lateral cartilages, leading to alar retraction. It can also sufficiently weaken the cartilage longitudinally, predisposing to buckling of the cartilage and bossa formation. The senior author prefers a more medially placed cephalic trim, which preserves most of the structural integrity of the lateral crura (blue lines). This type of trim will permit reorienting the short axis of the lateral crus, flattening its shape and decreasing the volume in the supratip, moving the supratip break closer to the tip defining point.