Nasal Aesthetics Research Articles

Photometric Evaluation of Bilateral Cleft Lip and Palate Patients after Primary Columella Lengthening

To evaluate the results in terms of nasal esthetics of children with bilateral cleft lip and palate, operated with the Cutting primary columella lengthening technique, associated with Grayson orthopedic nasoalveolar molding, and to compare them with the nasal aspects of children with bilateral cleft lip and palate operated with a traditional approach and to an age-matched sample of normal Caucasian children. Normalized photogrammetry. Regional Center for CLP, Department of Maxillo-Facial Surgery, San Paolo Hospital, Milan. Three groups of patients 5 years of age. Cutting group: 18 patients treated with the Grayson-Cutting technique. Delaire group: 18 patients treated with the traditional Delaire technique. Normal children: 40 normal preschool children. With the Cutting-Grayson technique, the columella length, nasal tip angle, and protrusion are greatly improved compared with the previous protocol and are close to normal. On the other hand, the nasolabial angle and interalar distances are still excessively wide in both samples. Although this is not a long-term study, at this time none of the patients operated with this technique have needed secondary columella lengthening. On the other hand, although certainly improved, the nasal anatomy obtained is far from normal.

Use of naso-alveolar moulding appliances in the management of unilateral and bilateral cleft lip and palate—a critical appraisal of the literature

Aims: To evaluate the evidence with regard to infant orthopaedics (IO) – including naso-alveolar moulding (NAM) – in improving nasal aesthetics, influencing favourable maxillary arch development and preventing maxillary arch segment collapse.

Correlation between Facial Morphology and Esthetics in Patients with Repaired Complete Unilateral Cleft Lip and Palate

The purpose of this study was to determine if there were correlations between anthropometric nasolabial measurements and subjective assessments of nasal esthetics in individuals with repaired complete unilateral cleft lip and palate (CUCLP). The sample consisted of 28 individuals with repaired CUCLP and 20 age- and gender-matched individuals without clefts. Nasolabial morphology was assessed using 2D and 3D measurements made on frontal photographs, lateral cephalometric radiographs, and plaster nose casts. A panel of orthodontists rated nasal esthetics from frontal, lateral, three-quarter, and basal view photographs and plaster nose casts using visual analog scales, and they also order ranked the nose casts. Based on the nasal esthetics ratings and rankings, two groups that had the best and the worst esthetics representing the extremes of nasolabial esthetics were statistically identified. Measurements were compared between the cleft and noncleft and the best and worst groups using t tests and analysis of variance. Differences in anthropometric measurements between the groups were identified. The columellar width and nose base and nasolabial angles significantly differed between the best and worst groups (p < .05). Differences in panel ratings of nasolabial esthetics between the best and worst groups were statistically detected using lateral and three-quarter view photographs (p < .05). Although morphologic differences between the cleft and noncleft and between the best and worst groups were identified, the slight morphologic differences noted were not sufficient to explain the subjective esthetic evaluation by the panel.

Prevention and Correction of Airway Compromise in Rhinoplasty

Recognition of patients who are at high risk for developing postrhinoplasty airway obstruction is essential. These patients may be at risk because of certain anatomic characteristics or may have a preexisting degree of airway obstruction from previous nasal surgery. Every surgeon who performs esthetic or reconstructive rhinoplasty procedures should be familiar with anatomic variants predisposing to airway obstruction and surgical techniques for airway improvement. The author presents case examples illustrating these principles and his methodology for recognizing and correcting airway compromise in primary and secondary rhinoplasty procedures. The use of spreader grafts, columellar graft, batten grafts, and piriform aperture widening are discussed. The author advocates incorporating these techniques to enhance nasal esthetics and function.

Modified Tip Grafts and Tip Punch Devices

Nasal tip aesthetics depend on the graceful synergism between soft tissue and the underlying frame. Nasal projection and the nasal tip width are the two most important components of nasal aesthetics. The cartilage graft, which has a predictable ability to affect several of the anatomical components contributing to nasal tip aesthetics, is one of the most versatile tools used to modify nasal projection. The fundamental shortcoming of the current graft sculpturing technique, namely, the requirement of time to create an optimal tip graft, prompted the design of a tool for the precise and rapid sculpturing of cartilage used for nasal tip onlay and shield grafts. This report describes a modified design of the Peck and Sheen grafts and introduces a new instrument, the tip graft punch. The unique features of the tip graft punch that facilitate the production of a symmetric, precisely proportioned cartilage grafts are highlighted. The tip graft punch has been successfully used on 49 patients over the past 2 years. The authors report a modification of nasal tip grafts and a simple and useful device for harvesting these grafts. This modification produces more natural and aesthetically pleasing results. The device saves surgery time, and provides a symmetric and anatomical graft design.

Patient Selection and Diagnosis

Rhinoplasty continues to be one of the most demanding procedures performed by cosmetic surgeons. A thorough knowledge of the anatomic structures involved is mandatory. The nose is an osteocartilaginous vault lined by mucous membranes on the inside and covered externally by skin. External landmarks are important for their relationship to underlying functional structures. Nasal aesthetics are an important part of determining facial balance and proportion. Rhinoplastic surgery must be performed in conjunction with maintaining the respiratory function of the nose.

Technical Advances in the Correction of Septal Perforation Associated With Closed Rhinoplasty

To demonstrate technical advances for closing septal perforations that allow the perforation repair to be performed with primary or revisional closed rhinoplasty during the same operation. We used this technique with closed rhinoseptoplasty in 258 cases of perforations in which the perforation ranged from 1.0 to 3.5 cm in diameter. We repaired the perforation using bilateral intranasal submucoperichondrial and submucoperiosteal advancement flaps with a sandwich graft interposition between. We prepared the sandwich graft using the auricular or septal cartilage and 2 layers of deep temporoparietal fascia. In every case, the septal perforation was corrected along with the closed rhinoseptoplasty and, because this is a conservative approach, the vascularization of the columella and anterior septum was preserved, with an excellent view of all the structures involved. Perforation repair represents a challenge to most surgeons owing to the low rates of successful correction with some techniques. Some of these techniques not only fail to rectify nasal aesthetics and the perforation during the same surgery but also cause undesired aesthetic alterations due to the retraction and rotation of tissues to close the perforation. We have performed this repair since 1989, allowing for closure of the perforation in 257 of 258 patients.

Nasal Deformities Associated With Orthognathic Surgery

Any surgical procedure undertaken to correct or change facial features will have a resultant effect on nasal aesthetics. Orthognathic surgery is frequently performed to correct congenital and acquired dentofacial anomalies. The resultant changes in the maxillomandibular skeleton have consequences for the overlying soft tissue envelope of the face. This article will review the concepts of nasal analysis and aesthetics. It will then discuss the expected changes to the nasal appearance with orthognathic surgery, primarily LeFort I osteotomies, including a review of the literature that has attempted to quantify and predict these changes. A discussion of surgical techniques to control these changes as well as a discussion of adjunctive rhinoplasty will follow. Surgeons performing these procedures must be aware of the potential changes that can occur to the nasal structure so that they may appropriately plan adjunctive procedures and counsel their patients on both the expected aesthetic outcome and the possible need for subsequent surgeries.

Changes in nasal aesthetics following nasal bone manipulation

Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35 degrees pre-manipulation to an average of 9 degrees post-manipulation.

Combined use of triple cartilage grafts in secondary rhinoplasty

Secondary rhinoplasty on a patient with a middle vault deformity is one of the most challenging procedures for a plastic surgeon. In order to achieve proper nasal aesthetics and airway function, a surgeon most commonly chooses to engraft the nose with a spreader, dorsal onlay, or columellar graft. This paper examines the aforementioned techniques in the management of 25 patients who presented with a severe middle nasal vault deformity. During the last 5 years, 25 patients received secondary rhinoplasty using triple cartilage grafts to repair severe middle vault deformities. Patients were then questioned at least 3 months postoperatively about both airway problems and cosmetic satisfaction. All the 25 patients indicated cosmetic satisfaction with 23 of the patients also achieving complete nasal airway function. Only two patients persisted to have an insufficient nasal airway. An endonasal examination revealed a slight nasal synechiae in one patient, while no anatomic problem was identified in the second patient. From a cosmetic standpoint, a straight dorsum with improved dorsal aesthetic lines and nasal profile, along with nasal-facial balance were achieved. When indicated, secondary rhinoplasty to repair a middle vault deformity using the combination of spreader, dorsal onlay, and columellar grafts to augment the nose has shown to have both functional and cosmetic benefits.

Power Instrumentation for Shaping the Nasal Cartilages

The cartilaginous structures of the nose play an important role in nasal esthetics and function. The handling of these structures has always been very treacherous, and long-term follow-up quite often has shown unexpected results. Based on Gibson's studies, we propose the use of abrasion treatment of the nasal cartilages with the burr power drill. This device can produce controlled weakening on determined regions of the nasal cartilages. If this weakening is done on just one side, the cartilage will bend to the opposite side. On the septal cartilage, this method can be used to straighten it by abrasion on its concave portion. To correct the alar cartilages, the burring is done either to enhance curvatures or to change the conformation of the alar cartilage itself. This method was used in 67 patients with satisfactory results, permitting corrections of septal deviations with very little resections of the septal cartilages and corrections of various tip deformities, with almost no resections at all of the alar cartilages.

Le lambeau nasogénien en reconstruction de la columelle

We report three cases of squamous cell carcinoma of the columella invading the sub-partitions. Wide resection raised the problem of several nasal esthetics sub-units. A chronological review of columella reconstruction procedures explained why the nasolabial fragment rarely used for partial rhinopoiesis, was appropriate in these three patients.

Assessing outcome in aesthetic rhinoplasty.

In the measurement of outcome, rhinoplasty surgery suffers from the lack of easily calculable data such as recurrence rates or survival figures, which are inherent in other branches of the speciality and surgical practice in general. We have reviewed methods utilized for the assessment of outcome following aesthetic rhinoplasty, and have developed an instrument by which a pre- and postoperative assessment of nasal and facial appearance can be made from standard frontal, lateral, basal and oblique photographs, the Rhinoplasty Assessment Scale (Photographic) (RASP). It is our intention that this will act as a template for methodical and standardized photographic assessment of the nose prior to rhinoplasty. This will highlight the changes required and provide a quantitative measure of nasal aesthetics, which will be complimentary to existing measures of subjective patient benefit.

Facial analysis and nasal aesthetics.

Facial analysis and nasal aesthetics.

Long-term outcome of autogenous rib graft nasal reconstruction.

Whereas reconstruction of the hypoplastic nose with rib grafting is common, the long-term outcomes of nasal growth and aesthetics are unknown. This study assessed nasal morphometrics, patient satisfaction, and the perception of nasal appearance by others up to 15 years after nasal reconstruction using cantilevered autogenous chondro-osseous rib grafting with rigid internal fixation in children. Records of all patients who received nasal rib grafts between 1983 and 1998 by one senior surgeon were reviewed. Patients in this study were operated on before their late teens and had greater than 1-year follow-up including serial photographic documentation. Nasal growth was determined by comparing anthropometric measurements preoperatively, perioperatively, and postoperatively. Patient satisfaction was determined through a questionnaire that addressed memory, donor-site morbidity, and nasal perception. Independent, blinded skilled observers who reviewed frontal and lateral photographs of the preoperative, perioperative, and postoperative intervals assessed nasal aesthetics. Thirty-two patients who underwent 38 rib graft reconstructions of the nasal dorsum and tip at an average age of 8.8 years constitute the study population. Six patients underwent secondary augmentation. The average interval between initial nasal reconstruction and evaluation for this study was 7.9 years. Comparative anthropometric measurements before and after surgery documented increases in both tip projection (2.3 percent) and nasal length (3.0 percent) and a decrease in nasolabial angle (1.9 percent). Patient satisfaction interview response rate was 100 percent of those whom we were able to contact (28 of 32). The average age at interview was 17.2 years. Most patients recalled the operation and denied recollection of pain. Donor-site long-term morbidity was not an issue for 86 percent of patients. Sixty-four percent of patients remembered their preoperative nasal appearance and 89 percent of these preferred the postoperative change and were not concerned with nasal scars or texture. Almost two-thirds of the patients had fixation screws removed from the nasal dorsum because of skin erosion, easy palpability, or visibility. Although several patients expressed a desire to make minor additional changes to their nose, only one of these elected offered presurgical consultation and none have had such surgery. The postoperative nasal appearance compared with that preoperatively was rated as improved for 66.3 percent of responses, 26.5 percent as unchanged, and 7.2 percent as deteriorated. Cantilevered autogenous chondro-osseous rib graft reconstruction of the nasal dorsum is an effective means of reconstruction for the hypoplastic nose in childhood with respect to morphometric measurements, patient self-perception, and the assessment of nasal appearance by others.

Vertical lobule division in rhinoplasty: maintaining an intact strip.

To review the indications for, surgical techniques of, and results of vertical lobule division (VLD) of the alar cartilages. Prospective study of patients assigned to undergo variations of VLD of the lower lateral cartilages. Private facial plastic surgery practice in a major university teaching hospital. Twenty-four patients who underwent variations of VLD of the lower lateral cartilages with re-creation of an intact strip, including 4 patients undergoing revision. Postoperative photographs were reviewed for tip projection and rotation, tip symmetry, bossae, knuckles, columellar position and length, and alar retraction. Patients were polled about their overall satisfaction with nasal aesthetics and degree of subjective nasal obstruction preoperatively and postoperatively. Vertical lobule division decreased projection in 22 of 22 patients, increased rotation in 12 of 12 patients, decreased rotation in 1 of 2 patients, corrected tip asymmetry in 3 of 4 patients, and shortened a long infratip lobule in 1 patient. Postoperatively, bossae and knuckling developed in 1 patient, and 2 patients demonstrated alar retraction that did not exist preoperatively. One patient undergoing revision noted worsened nasal obstruction not related to VLD. Vertical lobule division is a reliable, safe technique with predictable outcomes in tip repositioning. It allows for preservation of a strong tip complex while adding versatility to tip refinement.

Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate.

The purpose of this study was to assess the ability of shape parameters of nasal morphology to predict esthetics in individuals with complete unilateral cleft lip and palate (CUCLP). This retrospective study involved 28 patients with repaired CUCLP. Nostril morphology was analyzed using nose casts and a video-imaging technique. Calculated shape parameters included area, perimeter, centroid, angle of the principal axis, major and minor moments of area, anisometry, bulkiness, lateral offset, and three-dimensional internostril angles. Esthetics was assessed using a panel of six orthodontists who rated nasal esthetics from frontal, lateral, basal, and three-quarters view slides and from nose casts. Correlations between esthetics and the shape parameters were completed using the entire group as well as using two statistically determined subsets: those with the best and those with the worst esthetics. Nasal esthetics was related to only the perimeter and bulkiness parameter ratios. Symmetry of the perimeters between the right and left nostrils positively correlated with better esthetics using the entire sample group while symmetry of bulkiness between the right and left nostrils positively correlated with better esthetics using both the entire sample group and the best and worst subsets. Only perimeter and bulkiness showed positive correlations with nasal esthetics. The group of parameters used to assess nostril morphology had neither significant correlation with-nor predictive power for-esthetics. Thus, an assessment of the entire nasal surface topography in three dimensions needs to be completed and assessed with respect to predictability of nasal esthetics.

Nasal Morphology and Shape Parameters as Predictors of Nasal Esthetics in Individuals With Complete Unilateral Cleft Lip and Palate

Abstract Objective: The purpose of this study was to assess the ability of shape parameters of nasal morphology to predict esthetics in individuals with complete unilateral cleft lip and palate (CUCLP). Methods: This retrospective study involved 28 patients with repaired CUCLP. Nostril morphology was analyzed using nose casts and a video-imaging technique. Calculated shape parameters included area, perimeter, centroid, angle of the principal axis, major and minor moments of area, anisometry, bulkiness, lateral offset, and three-dimensional internostril angles. Esthetics was assessed using a panel of six orthodontists who rated nasal esthetics from frontal, lateral, basal, and three-quarters view slides and from nose casts. Correlations between esthetics and the shape parameters were completed using the entire group as well as using two statistically determined subsets: those with the best and those with the worst esthetics. Results: Nasal esthetics was related to only the perimeter and bulkiness parameter...

Correction of the crooked nose.

Correcting the crooked nose remains one of the most challenging problems in rhinoplasty. When faced with a twisted nose, rhinoplasty surgeons tend to be divided into those who perform an anatomic reconstruction and those who prefer camouflage techniques. Regardless of the approach used, the revision rate remains fairly high. An anatomic correction of the twisted nose through an open approach was performed. The septum was freed from the extrinsic forces of the deformed nasal bones and upper and lower lateral cartilages. The residual true septal injury was then evaluated. The septal deformity was addressed through quadrangular cartilage resection, repositioning of the caudal septum in the anatomic midline, and correction of the dorsal septal deformity with horizontal control sutures. The skeletal support was then reconstructed with the use of a spreader-extension graft on the concave side and a batten graft on the opposite side. The nasal tip was set relative to the dorsum by fixation to the extension grafts. Residual lateral crus deformities were corrected by a combination of lateral crural spanning sutures or alar spreader grafts. With this approach, straightening the crooked nose without compromising skeletal support or nasal aesthetics was successful.

The Relationship of the Root to the Base in Nasal Aesthetics

The Relationship of the Root to the Base in Nasal Aesthetics