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 lateral cruras of the alar or lower lateral cartilages are oriented too vertical (instead of their canonically normal wide or even close to 90º square angle with the superior septum or nasal midline), having a too narrow angle with the superior septum or nasal midline above them, severely or mildly (all the possible given combinations might be present) a typical deformity called parenthesis tip is present making the tip is prone to look boxy, there are visible ridges at the cephalic upper edge of the inverted cartilages due to overlapping with the middle vault, the alar support is poor leading to nostril collapse and alar retraction, with frequent association with bulbous tip and bifid tip, being the overall nasal look grotesque and artificial, leading to lack of suitable femininity in women and an unsightly look in men.
Treatment of parenthesis 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 grafting and repositioning, combining either alar cartilages batten, strut or replacement grafting, lateral cruras eversion, lateral cruras cross location, bridging, tongue in groove maneuver, plasties, plications (shaping sutures through the cartilages), nasal tip grafting, with or without reinforcement of tip support with columellar strut.