Preoperative Facial Analysis

Abstract

A successful tip rhinoplasty depends on careful preoperative preparations, including a thorough examination of the nasal tip and surrounding facial features. Several important variables should be considered, including skin quality (e.g., cartilage strength and presence of scars) and patient characteristics (e.g., age, sex, and ethnicity). In addition, the patient's concerns and expectations should be carefully considered prior to the surgery. An important part of preoperative rhinoplasty screening includes imaging of the nose. There are 6 commonly used views, including basal, frontal, right oblique, left oblique, right lateral, and left lateral. The Frankfort horizontal position, in which the upper ear and lower orbital rim are horizontal, is used to take the frontal, oblique, and lateral views.It is important that the lighting is bright enough to give a detailed view of the nose, but should not obscure skin quality or make shadows. A proper frontal view can be obtained with the patient in the Frankfort position; both pinnae should be symmetric. The most prominent features of the nasal profile include the dorsal nasal contour and the nasal tip' s rotation and projection. ln general, nasal tip projection is defined by measuring the distance between the nasal tip and the anterior facial plane. To determine the facial plane, a vertical line can be imagined over the face, which connects the nasion (most posterior bony point at the top of the nose) and the area where the nasolabial fold is intersected by the alar groove. When the contralateral malar eminence is tangent to the tip of the nose, there is proper orientation of the right and left oblique images, which are useful for determining the esthetic lines of the ipsilateral brow tip. Using these images, the nasal dorsum can be further evaluated. The nasal base should be assessed while the patient’s head is tilted back so that the surgeon can see the nasal tip projected between the eyebrows.