Description: The preservation of the intercrural ligament during open technique rhinoplasty allows its re-fixation of to the medial crural complex, providing a fine tool to control tip rotation and projection in the long term after rhinoplasty, while avoiding rigidity of the tip complex. The author aims to illustrate this technique with a video presentation from multiple rhinoplasty cases with differing tip characteristics.

Outcome objectives: To suggest an effective alternative to nasal tip fixation that is closer to natural anatomy

Background: Septal extension grafting and alar cartilage fixation with rigid tongue-in-groove techniques has been widely used to ascertain long-term preservation of tip rotation and projection. In order to achieve a more natural, flexible but robust tip structure that withstands skin contracture, fixation of the medial crura to the intercrural ligament may be a sound alternative.