The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal tip and the alae are structured by the so called alar or lower lateral horseshoe shaped cartilages with their lateral and medial crura or crus and accessory cartilages, the domes between lateral and medial cruras, the interdomal fibrofatty pad, the caudal or lower septum and the skin of the alae.
Both halves of the nasal tip join with each other in the center of the tip to form a tripod in which the lateral legs are the lateral cruras of the alar or lower lateral cartilages and the central leg the union of both medial cruras of the alar or lower lateral cartilages.
When the alar or lower lateral cartilages are oversized the tip of the nose is prone to be bulbous, bifid, boxy, too large, overprojected, even droopy or downturned, the columella show too much and the nose be long and hooked.
Treatment of large alar or lower lateral cartilages has to be customized to each individual situation, being the main pillar the techniques of alar or lower lateral cartilages trimming, deprojection, plasties, plications (shaping sutures through the cartilages), combining either alar or lower lateral cartilages medial or lateral cruras shortening, septal shortening, defatting, tongue in groove maneuver, etc.