**3. Tongue in groove**

**2. Cephalic trimming of lower lateral cartilages and**

772 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

These are other modalities that are basically done to increase nasolabial angle. In case basic techniques fail to provide the ideal result, the following techniques may be effectively applied

This is an effective method to increase and hold the nasolabial angle. In this technique a mattress suture is used to anchor lower lateral cartilages to the nasal septum, by incremental tightening of the suture, ideal nasolabial angle is achieved, then with several subsequent ties

Tip rotating suture easily changes the tip position, though it is clear that a single suture suspension may lose its effect gradually and will not lead to permanent results; to achieve stable results, tip support mechanisms should be improved (i.e. application of collumellar strut) and appropriate space be provided for new tip position (i.e. conservative cephalic

**3. Collumellar strut insertion**

this nasolabial angle is fixed and stabilized.

trimming and caudal resection of septum) [17,18]

**4. Tip rotating suture**

**Figure 4.** Transfixion incision

**2.4. Important points**

[14,16]

In this technique two medial crura cartilages are completely separated from each other. Then upper lateral cartilages are stripped off the nasal septum. Medial crural cartilages are pushed back in a way that each medial cru covers the nasal septum on one side. A delicate needle is used to temporarily fix the medial crura cartilages to the septum. Skin flap is turned back to its original position for several times. When the ideal nasolabial angle is achieved, medial crura are fixed to the septum with several PDS sutures. In this method the lower lateral cartilages (nasal tip) are permanently fixed to the nasal septum. [19]
