The purpose of this combined prospective and retrospective study was t
o review the abnormalities of the footplates of the medial crura, thei
r surgical correction, and the dynamic changes that result from footpl
ate alteration. Prospectively, measurements of 40 footplates were obta
ined during 20 consecutive primary rhinoplasties. The distance between
the footplates at their most posterocaudal position was measured, alo
ng with the thickness, length, and width of the footplates. The shape
of the nostrils was also observed and correlated to the form of the fo
otplates. The distance between the footplates ranged from 7.5 to 15 mm
, the average being 11.4 mm. The length of the footplates ranged from
4 to 7.5 mm, the average being 5.81 mm. The thickness of the footplate
s averaged 1.06 mm, ranging from 0.80 to 1.5 mm. The width of the foot
plates ranged from 2.5 to 7.0 mm, averaging 4.48 mm. In a retrospectiv
e review of 295 consecutive rhinoplasties, footplates were altered in
76 cases (25.8 percent). Of these cases, 29 procedures (9.8 percent) w
ere performed to narrow the columella base and to advance the subnasal
e: on 24 patients (8.1 percent), the goal of this maneuver was to narr
ow the columella base only; on 5 patients (1.7 percent), the operation
was conducted to aid in increasing the tip projection, provide a bett
er foundation for the tip, advance the subnasale caudally, and narrow
the alar base. Asymmetry of the columella was corrected in 16 patients
(5.4 percent), and footplates were resected primarily to reduce the t
ip projection in 2 patients (0.7 percent). A detailed analysis of the
nasal base will dictate one of the following courses pertaining to foo
tplate alteration. If the patient exhibits an overprojected tip and di
vergent footplates, the lateral portion of the footplates will be rese
cted partially, then approximated. If the tip is under-projected or ha
s normal projection, the divergent footplates will be approximated wit
hout resection. Should the subnasale and the base of tile columella be
protruding, the soft tissue between the footplates will be removed to
avoid excess fullness in this site as a result of the approximation o
f the footplate. However, when the footplates are divergent, the colum
ella base and nasal spine area are often retracted, setting an auspici
ous stage for approximation of the footplates without having to excise
the soft tissue. This maneuver not only narrows the columella base, i
t also advances it caudally. Longstanding caudal deviation of the sept
um may also create asymmetry of tile footplates, which will not respon
d to mere repositioning of the septum, and often requires repositionin
g of the footplates with mobilization and fixation to the contralatera
l footplates.