Mean Nasolabial Angle Research Articles

Quantification of Gravitational Effects on Nasal Tip Geometry

Introduction: It is widely accepted in plastic surgery that patient positioning can affect the geometry of the nasal tip due to downward gravitational forces. However, empirical data supporting this principle is lacking. The primary objective of this study is to quantify gravitational effects on nasal tip geometry by calculating changes in tip rotation and projection between the supine and upright positions. This analysis will help further assess whether gravity affects the actual positional rotation of the nasal tip or if its impact is solely relative to neighboring landmarks. Methods: This study is a prospective case series that obtains upright and supine nasal measurements in 20 subjects. The nasolabial, nasofrontal, and columellar-facial angles, as well as the Goode, Crumley, Simon, and Powell ratios are used to calculate nasal tip rotation and projection changes. Results: Mean nasolabial angle demonstrated a statistically significant tip derotation of 3.2° in the upright position relative to supine. Mean nasofrontal angle and mean columellar-facial angle did not significantly differ between positions. The nasal tip appeared relatively less projected in the upright position using the Simon and Crumley methods, whereas no significant difference was seen with the Powell and Goode methods. Conclusion: Gravity can influence the apparent nasal tip geometry by altering lip position and length, but it does not impact the true nasal tip geometry when the upper lip is excluded as a reference point.

Internal mucosal resection and LLC suspension: a new method to establish a stable tip rotation angle and reduce the nasal bridge length.

Herein, we describe a new technique to obtain both the appropriate degree of rotation angle and the ideal nasal bridge length. The aim of this study is to investigate the long-term results of this new technique with regard to these two variables. A total of 76 (27 males, 49 females) patients were operated in accordance with the presented technique. Internal caudal mucosal excision and lower lateral cartilage (LLC) suspension were applied to all the patients included in this prospective study. Preoperative, immediate postoperative, and postoperative 1st-year photographs were taken. NOSE scores were obtained in the postoperative 1st year. The mean nasolabial angle values of the patients preoperatively, at the end of the surgery (immediate postoperative), and at the end of the first year were 94.13° ± 5.1, 113.1° ± 5.3, and 109.6° ± 5.2, respectively. The patients had an average gain of 19° at the nasolabial angle at the end of the surgery and experienced a 3.5° (3.1%) loss at the end of the first year. For the nasal bridge length (n-prn) values; the preoperative, immediate postoperative, and first year mean values were 5.1 ± 0.55 cm, 3.98 ± 0.41 cm, and 4.29 ± 0.39 cm, respectively. The noses of the patients were shortened by 1.11 cm on average at the end of the surgery. Internal caudal mucosal resection with a suspension of the LLC to the caudal edge of the upper lateral cartilages (ULC) offers a reliable method to control the nasal tip rotation and shorten the long noses. This technique's effect is more obvious in long noses compared to the short ones.

Nasal profile changes after orthodontic tooth extraction in Class II, Division 1 malocclusion patients: A retrospective study

IntroductionThis study aimed to investigate changes in the facial soft-tissue profile, especially the nose, following fixed orthodontic treatment, with or without tooth extraction, in individuals diagnosed with dental Class II malocclusion. Materials and methodsCephalometric images of 81 individuals with dental Class II malocclusion who underwent fixed orthodontic treatment were assessed before and after treatment. The participants were categorized into three groups: non-extraction; upper first premolar extraction; and four first premolar extractions. The parameters measured were: upper lip height, upper lip to E-plane, lower lip to E-plane, lower lip height, nasolabial angle, nasomental angle, facial convexity, lower anterior face height, soft-tissue facial convexity, nasal tip angle, nasal bridge length, N′-nasal bridge point, nasal bone length, nasal bone angle, nasal depth, columella convexity, and nose height. ResultsWithin the upper two extraction group, there were significant increases at the start and end periods in nasolabial angle (P = 0.023), nasal depth Pr to Ac (P = 0.027), and nasal depth Pr to N-Prn (P = 0.040); and decreases in columella convexity (P = 0.010), upper lip to E-plane (P = 0.009), and nasomental angle (P = 0.009). There were significant results in comparisons between measurements based on the extraction status in the mean nasolabial angle (P = 0.011), mean columella convexity (P = 0.028), and mean lower lip to E-plane (P = 0.045). ConclusionOrthodontic treatment involving tooth extraction may potentially affect the nasolabial angle and nasal depth. During treatment planning, it is crucial to consider the potential changes that may occur to the nose and any alterations that may be needed to achieve the desired esthetic outcome.

Use of a Space Graft in Rhinoplasty.

Construction of the nasal tip strut is an important part of rhinoplasty; the incidence of postoperative complications is closely related to the type of graft and the approach to cartilaginous framework construction. To introduce a supplementary graft to support the cartilaginous framework. Forty patients (37 female and 3 male), aged from 18 to 40 years (average 29), received a rhinoplasty using a spacer graft. Of these, 12 were primary cases and the other 28 had a previous rhinoplasty procedure. Postoperatively, all patients were photographed and asked to complete a satisfaction survey. Complications were collected retrospectively. Postoperatively, the mean nasofrontal angle was 141.92±1.26 degrees for the primary cases and 140.75±2.22 degrees for the repeat procedures; the mean nasolabial angle was 88.69±0.95 degrees for primary cases and 89.14±0.93 degrees for the repeat procedures; mean nasal length was 4.78±0.05cm for primary cases and 4.79±0.07cm for the repeat procedures; mean tip projection was 4.68±6.35cm for primary cases and 2.24±0.07cm for the repeat procedures. Self-report of the overall improvements showed a high satisfaction rate. One case (2.5%) had a postoperative complication involving a mildly deviated columellar. The spacer graft can be used as an effective supplement to the traditional methods for reconstructing the nasal tip framework; it can prevent the occurrence of postoperative complications such as the exposure of the nasal prosthesis, the downward rotation of the nasal tip, the depression of the supratip regions of the nose, and the deviation of the nasal columella.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty.

Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values ( p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001). Moreover, this method had a significant favorable effect on nasal obstruction ( p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p &lt; 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p &lt; 0.0001; p &lt; 0.001). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Unlocking nasal angle anthropometry and nasolabial angle preferences: a key to achieve the perfect rhinoplasty

Objectives: Determining the ideal nasolabial angle is very important for setting aesthetic goals in rhinoplasty. By knowing the demographic data of the three main nasal angles, which are the key to facial balance, indications, planning and peroperative evaluations of surgery can be better applied. The aim of this study was not only to measure nasal angles but also to find out the nasolabial angle preferences of the Anatolian population. Methods: 142 participants had their nasal angles (nasolabial, nasofrontal, nasofacial angles) measured both digitally and manually and a questionnaire was administered. Each participant was asked about their ideal nasolabial angle preferences and their propensity for rhinoplasty. The results were then compared between each other, age and gender. Results: According to digital measurements, the mean nasolabial angle was 99.51±9.51° in men and 100.49±9.37° in women. The mean nasofacial angle was 32.35±3.44° mm in men and 32.54±3.17° in women. The mean nasofrontal angle was 138.49± 9.29° in men and 141.64±8.10° in women. Manual measurements were similar. The mean ideal nasolabial angle in women (91.32±6.11°) was lower than the mean ideal nasolabial angle in men (94.78±4.47°). It was observed that the aesthetic perception of the participants was similar whether they had rhinoplasty or not. Participants aged less than 24 years were more likely to prefer higher nasolabial angles. Conclusion: The nasal angles and preferred nasolabial angle results presented in this study may be useful in planning and evaluating rhinoplasty operations.

The Long-Term Results Of Suture And Graft Techniques Used To Increase Tip Projection and Rotation In Open Technique Septorhinoplasty

Background: In this study, we aimed to evaluate the long-term results of suture and graft techniques used to increase tip projection and rotation in Open Technique Septorhinoplasty.&#x0D; Methods: In this study, the data of 89 patients who underwent Open Technique Septorhinoplasty were analysed retrospectively. The patients were divided into groups 1,2,3,4 and 5 according to the suture and graft techniques used. Preoperative and postoperative photographs of all patients included in the study at the 1st, 3rd, 6th, 12th, 36th and 60th months were analyzed. To measure and compare these techniques, tip projection and rotation losses were measured on all photographs using a computer program called Imagej.&#x0D; Results: A statistically significant increase was found between the preoperative mean Nasolabial Angle (NLA), Type Angle (TA), Byrd–Hobar Method (BHM) and Nasofacial Angle (NFsA) measurement values and the measurement values at 36th months postoperatively in Groups 1 and 4 (p &lt; 0.05). In Group 2, a statistically significant increase was found between preoperative mean NLA, TA and BHM measurement values and postoperative 36th month measurement values (p &lt; 0.05). In group 1 only, there was a statistically significant difference between the preoperative mean TA, BHM, Simons Method (SM), Goode Method (GM) and Powell-Modified Baum Method (PMBM) measurement values and the postoperative measurement values at 60th months (p &lt; 0.05).&#x0D; Conclusions: Our results showed that suture techniques were more effective on projection and rotation than graft techniques in the long term.

The Effect of the Vertical Alar Resection (VAR) Technique on Tip Stability; Long-Term Results.

Main properties of nasal tip are the nasal tip projection (NTP), the nasal tip rotation (NTR), and the definition. Its surgery is difficult due to anatomic variations, pathologies, and various surgery possibilities. The ideal technique must also provide good results in long-term. The aim of the study was to analyze long-term results of vertical alar resection (VAR) technique in rhinoplasty. Forty-eight patients who underwent rhinoplasty operations that VAR method was used by senior author between 2001 and 2017 were included into the study (42 women and six men). The mean age of patients was 35.5 years (range 18-56 years). Mean post-operative follow-up period was 86.8 months (range 25-225 months). We analyzed pre=operative, early, and late post-operative photographs of patients. NTP and NTR changes in years were objectively evaluated. Patients also completed Rhinoplasty Outcome Evaluation questionnaire in their last control visit. Mean NTP (through Goode Method) was changed from 0.60 in early to 0.59 in late post-operative control, mean nasofacial angle from 29.4 in early to 28.7 in late post-operative control. Mean nasolabial angle (NLA) changed from 97.3 to 94.5 and Tip rotation angle (TRA) from 35.2 to 35.4 between early and late post-operative control. Differences between early and late post-operative measures of NTP and NLA were significant (p<0.001 for all), but TRA did not changed significantly (p>0.001). VAR is a useful method for modifications of lateral crura and nasal tip. With VAR, we can control NTP and NTR, length of lateral crus and nose; get satisfying and long lasting results.

A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty.

Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft). Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery. Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05). It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Comparative Study of Three-Dimensional Simulation in Nonsurgical Rhinoplasty With Hyaluronic Acid Fillers.

The use of 3-dimensional computer imaging has grown steadily over the past decade, especially with cosmetic facial surgery. The technological advance has influenced how we counsel patients, perform procedures, and assess outcomes. The purpose of this study was to analyze the feasibility of quantifying simulated versus actual outcomes for nonsurgical rhinoplasty with hyaluronic acid. A retrospective review of 3-dimensional images (LifeViz Inc, France) for rhinoplasty patients was performed. Randomized preoperative, simulated, and actual images were rated by a blinded panel of physicians (1 = poor, 5 = excellent). In addition, a quantitative assessment of nasofrontal angle and nasolabial angle was conducted where paired and 2-sample t tests were performed (P < 0.05 as significant). Twenty-five patients were included in this comparison study. Fifty-six percent of preoperative images were rated as poor (mean, 1.7). The simulation received a mean score of 3.4 (good in 60% of cases), and 80% of actual cases were rated good to excellent (mean, 3.7). Mean nasofrontal angle decreased from 147.1 ± 1.2° preinjection to 143.3 ± 1.6° posttreatment, a mean change of 3.8 ± 2.0°. The mean nasolabial angle decreased from 125.5 ± 1.6° pretreatment to 117.5 ± 1.5° posttreatment. Average volume of actual dosage was 1.74 ± 0.18 mL. Three-dimensional simulation for patients undergoing nonsurgical rhinoplasty is helpful for surgical planning and patient communications. It provides a mechanism for critical self-evaluation and helps set patients with realistic expectations about rhinoplasty.

Closed Rhinoplasty with a Mushroom-Shaped Costal Cartilage Graft in East Asian Patients.

The most challenging part of rhinoplasty is nasal tip management. For East Asian patients with a bulbous under projected nasal tip with thick skin, autologous cartilage is considered the gold-standard graft material to provide strong support to the nasal tip and effectively increase tip projection. The present study aimed to evaluate the outcomes of closed rhinoplasty with a mushroom-shaped costal cartilage graft in East Asian patients. From February 2018 to May 2019, 52 patients underwent rhinoplasty with a mushroom-shaped costal cartilage graft in our institution. Rhinoplasty was performed through a bilateral endonasal incision. Postoperatively, all patients were photographed and asked to complete a satisfaction survey online or by telephone. The mean follow-up period was 15.8months (range 12-21months). Twenty-four of 52 patients agreed to participate in this study. Postoperatively, the mean nasofrontal angle was 137.7 ± 3.7°, mean nasolabial angle was 94.1 ± 6.2°, mean nasal tip angle was 79.4 ± 5.2°, and mean columellar/lobular angle was 44.7 ± 2.4°. The mean tip projection/nasal length index was 0.53 ± 0.07, and the mean columellar/lobular length index was 1.21 ± 0.22. There were no prolonged functional complications. Most patients (23/24; 95.8%) were satisfied with the aesthetic results. The present results suggest that the mushroom-shaped costal cartilage graft in closed rhinoplasty is a good choice for the correction of a bulbous under projected nasal tip. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Non-surgical Rhinoplasty with Hyaluronic acid Fillers: Predictable Results Using Software for the Evaluation of Nasal Angles.

There is a relative lack of evidence on optimal products and techniques for nose treatment with hyaluronic acid (HA) fillers. This study assessed the efficacy and safety of nasal reshaping with Vycross HA fillers, using a free software (Face Master) to measure facial parameters. This was a prospective, open-label, single-center study of consecutive adult patients treated in the nose (bony and cartilaginous dorsum and/or columella) with VYC-20 or VYC-17.5. A maximum of 1mL of filler was used. All patients (except one) had at least 12months of follow-up. Sixty-two patients were enrolled (57 females; 5 males) with a mean age of 29.0 ± 9.2years. A mean of 0.55 ± 0.22mL of filler (range 0.2-1.0mL) was injected during initial treatment; 12 patients required touch-up with 0.15 ± 0.08mL of filler (range 0.1-0.3mL). Using Face Master, mean nasofrontal angle increased from 143.6 ± 6.3° pre-treatment to 147.3 ± 6.7° post-treatment (mean change 3.7 ± 2.8°), and mean nasolabial angle increased from 85.3 ± 6.1° to 88.5 ± 6.1° (mean change 3.2 ± 2.6°). Mean patient satisfaction (0-10 scale) increased from 2.4 ± 1.7 pre-treatment to 9.4 ± 0.8 post-treatment (mean improvement 7.1 ± 2.1). Complications were minor and transient: pain, n = 3 (4.8%); edema, n = 3 (4.8%); hematoma, n = 2 (3.2%). Non-surgical nasal reshaping with VYC-20 or VYC-17.5 appeared to be efficacious and safe; Face Master objectively demonstrated meaningful changes in key nasal angles. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Soft tissue changes after anterior maxillary osteotomy by using 3D CBCT scanning.

The objective of this study was to evaluate the soft tissue changes after anterior maxillary osteotomy using cone beam computed tomography. The study included twelve patients diagnosed as suffering from an excess of the anterior part of maxilla and required surgical correction by anterior maxillary osteotomy. Assessment of Cone beam computed tomography in evaluation the soft tissue changes. All cases subjected to anterior maxillary osteotomy using modified Cuper technique. Follow up of cases was does clinically and radio- graphically by cone beam computed tomography. The results of the study proved that the statistically significant increase in mean Nasolabial angle after 6 months was 5.2 degrees, the mean value of nasal width after 6 months was 0,9mm. The mean value of Philtrum length was 3.3mm. In conclusion, Cone Beam Computed Tomography can be used to obtain dimensionally accurate linear and angular measurement from bony maxillofacial structure and landmarks and allows accurate, three-dimensional imaging of hard and soft tissues.

Application of a Porous Polyethylene Spreader Graft for Nasal Lengthening in Asian Patients.

Rhinoplasty maneuvers to lengthen the nose include placing an alloplastic implant, caudally rotating the lower lateral cartilage (LLC), and stretching the soft tissue skin envelope (STSE) downward. Tissue tension associated with these procedures can result in implant extrusion or tip retraction. The authors performed rhinoplasty with implantation of porous polyethylene (Medpor). The Medpor device enabled transfer of tension from the LLC and STSE to the juncture of the septal cartilage and upper lateral cartilage (ULC), thereby stabilizing the nasal structures. Twenty-six patients who underwent rhinoplasty with nasal augmentation and lengthening were evaluated in a prospective study. Two pieces of Medpor were placed as a spreader graft, and a third piece was inserted as a columellar strut. The released LLC was rotated caudally, and the domal segments were wrapped over the caudally projected tip of the implant. Surgical outcomes were assessed with a patient satisfaction questionnaire and by photogrammetry. Patients were monitored for an average of 9.6 months. The patients' mean nasolabial angle (NLA) was 106.2° ± 4.7° preoperatively and 94.3° ± 3.7° postoperatively (t < 0.0001). Most patients were fairly or completely satisfied with the operative outcome. One patient had impending implant extrusion and underwent explanation. Medpor material is easy to shape and is sufficiently strong to function as a spreader graft and withstand the tension associated with repositioning of the LLC and STSE.

Clinical features and treatment of patients with class III malocclusion combined with and increase and lengthening of the nose

The aim of the study was to study the effect of orthognathic surgery using the developed method of correction of dentoalveolar anomalies on the shape of the nose in patients with Class III tooth-jaw anomalies, according to Engle's classification, combined with an increase and lengthening of the nose. In the period from 2014-2017 on the basis of FGBBO VO 'PIMU' of the Ministry of Health of Russia treated 45 patients with maxillofacial anomalies, among them 31 people diagnosed with upper retro microburnia, lower macrognathia, Engle III class, skeletal type. All patients were between the ages of 21 and 45, without severe co-morbidities. We evaluated the nasolabial angle (ÐCm-Sn-UL) characterizing the projection of the tip of the nose in patients with a skeletal form of mesial occlusion and an increase and extension of the tip of the nose before and after surgical treatment. According to the data of various authors, the value of the nasolabial angle in the norm varies from 97 to 110°. The mean nasolabial angle before the operation was 83.52±2.02°, which is much less than the recommended value, which indicates a pronounced elongation and 'droop' of the tip of the nose. The average value after the operation was 94, 90±1.88°, which on the average is 11° more than the initial data. These data indicate a change in the projection of the tip of the nose and an increase in the angle of Sm-Sn-UL, thereby improving the appearance of the patient.

Concomitant Overlap Steal Tip-plasty: A Versatile Technique to Simultaneously Adjust the Rotation, Definition, Projection, and Symmetry of the Nasal Tip.

Tip-plasty is a particularly challenging stage of aesthetic nose surgery. The diversity of nasal tip deformities has necessitated the development of numerous surgical techniques that can be difficult to master and may yield unpredictable surgical results when combined. The authors describe how concomitant overlap steal tip-plasty (COST) can enable surgeons to address all of the aesthetic characteristics of the nasal tip simultaneously. COST involves lateral crural steal followed by medial crural overlap. The medical records of 1617 patients who underwent primary open septorhinoplasty with COST were evaluated in a retrospective study. Pre- and postoperative patient photographs were compared for nasal length, nasolabial angle, tip projection, and deviation of the nasal axis. Pre- and postoperative mean nasal lengths were 5.66 cm and 5.17 cm, respectively (P < .05). The mean nasolabial angle was 86.95° preoperatively and 101.8° postoperatively (P < .05). The projection of the nasal tip was reduced from 3.09 cm to 2.53 cm, and tip symmetry was achieved by decreasing the nasal axis deviation from 7.76° to 1.71° (both P < .05). COST does not obviate all other tip-plasty techniques for specific situations. Once mastered, however, COST can become the only procedure needed to achieve all of the aesthetic goals of the nasal tip in most cases. LEVEL OF EVIDENCE 4: Therapeutic.

Fat Grafting to the Forehead/Glabella/Radix Complex and Pyriform Aperture: Aesthetic and Anti-Aging Implications.

Background:Optimal aesthetic outcomes from rhinoplasty are heavily influenced by structures adjacent to the nose. Although the importance of the chin has been emphasized since the inception of rhinoplasty, little attention has been given to the forehead. The forehead/glabella/radix complex represents a vital triad in rhinoplasty, from which the nasofrontal angle is derived. In the present study, the authors sought to determine whether fat grafting to the forehead/glabella/radix complex and pyriform aperture can favorably impact the nasofrontal and nasolabial angles, respectively.Methods:The authors reviewed pre- and postoperative images (obtained by an independent professional photographer) of patients who underwent autologous fat grafting to the forehead/glabella/radix region and the pyriform aperture, with or without concurrent rhinoplasty. Nasofrontal and nasolabial angles were measured on lateral images. Mean pre- and postoperative values were calculated and compared. A Wilcoxon rank-sum test was used for statistical analysis.Results:Twenty-six patients underwent fat grafting alone (FG group; mean follow-up, 3.3 years), and 19 had fat grafting plus rhinoplasty (FG + R group; mean follow-up, 5.2 years). The mean nasofrontal angle in the FG group decreased by 2.0° (P = 0.005), and the mean nasolabial angle increased by 2.3° (P = 0.006). The mean nasofrontal angle in the FG + R group decreased by 2.0° (P = 0.011), and the mean nasolabial angle increased by 6.0° (P = 0.026).Conclusions:Autologous fat grafting to the forehead/glabella/radix complex and pyriform aperture is a reliable method to favorably influence the nasofrontal and nasolabial angles, respectively. Such treatment optimizes the interplay between the nose and the adjacent facial features, enhancing overall aesthetics.

Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients.

BackgroundOrthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery).MethodsTwenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared.ResultsThe mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'.ConclusionsPatients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

Does Correction of Caudal Septal Deflection Affect Nasal Angle Parameters?

Objectives: Verify whether one’s external appearance may change after correction of caudal septal deflection by estimating nasal angle parameters. Methods: Correction of caudal septal deflection was performed by first releasing the caudal septal cartilage along the maxillary crest and excising excessive portions. The incised cartilage was sutured, and the detached ventral cartilage of caudal septum was fixed at the midline. Preoperative and postoperative photographs (lateral view) were taken at postoperative 6 months. Nasolabial angle (NLA) and nasal tip angle (NTA), as well as the angle between the columella and a perpendicular line to the Frankfort line (CFL), were evaluated. The visual analogue score (VAS) for nasal obstruction was evaluated at pre- and post-operation. Results: A total of 35 patients per protocol were included in this study. The mean preoperative NLA was 98.67±9.17° and the mean NLA at postoperative 6 months was 98.64±9.27°; the NTA changed from 84.41±6.96° to 84.33±7.07°; the CFL changed from 80.06±7.91° to 80.08±8.02°. All parameters showed no significant change between pre- and post-operation. Subjective saddle nose or other external deformities were not reported. VAS score of subjective nasal obstruction decreased significantly from 7.89±1.37 to 1.80±1.05. Conclusions: After correction of caudal septal deflection, nasal angle parameters were not changed and VAS score was significantly improved. Therefore, caudal septal deflection can be safely and satisfactorily corrected through proper surgical methods.