Nasal Base Research Articles

Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction.

A new technique for dorsal preservation rhinoplasty that minimizes recurrent hump deformity is introduced. The authors sought to present a novel dorsal roof flap (DRF) technique for modifying the nasal hump and dorsum while reducing morbidity. Twenty-two primary and 3 secondary rhinoplasty patients had 1 of 2 types of nasal DRF depending on hump composition. A triangular roof flap was created utilizing 2 incisions from W-point to lateral Keystone junction in cartilaginous humps (cartilaginous DRF) and to the nasion in osseocartilaginous humps (osseocartilaginous DRF). Then, septal strip excisions were conducted to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height trimmed, and the DRF sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial and nasoglabellar angles were measured on the photos. Mean follow-up was 10.3 (standard deviation, 4.41) months (range, 6-20 months). A total 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A cartilaginous DRF was utilized for the 5 cases with a cartilaginous hump and osseocartilaginous DRF was employed in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions. The DRF technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence.

Application of a Novel Nasal Clip for Nostril Retention After Primary Unilateral Cleft Rhinoplasty.

This study aimed to investigate the outcomes of using a novel nasal clip designed for nostril retention after primary unilateral cleft rhinoplasty. This is a retrospective study. Department of Cleft Lip and Palate in a stomatological hospital. A retrospective study was conducted on 57 patients who had a unilateral complete cleft lip without cleft palate and underwent primary surgical repair. The patients were categorized into 3 groups: the group in which the conventional nasal retainer was used, that in which the nasal clip was used, and the control group in which no postoperative nasal retainer was used. The nasal retainer or our nasal clip was applied 7 days after primary surgical repair and kept in the nostrils of children from 6 to 12 months. Noses underwent photogrammetry preoperatively, postoperatively, and at follow-up. The nose was also subjectively scored at the follow-up. The nasal retainer and the nasal clip significantly minimized relapse as determined by nasal tip deviation. The nasal clip sustained nasal symmetry, as determined by the postoperative nostril width ratio, better than did the conventional retainer. After 6 to 12 months, the nasal clip achieved better columellar morphology and a more symmetric nasal base than did the conventional nasal retainer. Statistical differences in subjective scores between the control and nostril retention groups were noted. The application of the novel nasal clip after primary unilateral cleft rhinoplasty preserves nasal morphology and reduces postoperative relapse without the need for adhesive tape.

Aesthetic Analysis of Alteration of Eyebrow and Forehead Position After Endoscopic Eyebrow lift.

Some of the surgeons performing endoscopic brow lift believe that this technique does not lead to clinically significant enlargement of the forehead. The goal of this study is to determine the change in eyebrow and forehead height after endoscopic brow lift and to assess the durability of the result over time. The pre- and postoperative photographs of 97 patients who underwent endoscopic brow lift from January 2016 to July 2020 were standardized and analyzed. The distance between median hairline and upper edge of eyebrow, the distance between upper edge of the eyebrow and edge of the lower eyelid and the distance between edge of the lower eyelid and the nasal base were measured, and the change in the upper face proportion was measured and analyzed. There was statistically significant brow elevation after endoscopic brow lift in all three time periods (less than 1 month, 1-6 months and greater than 6 months). Forehead height did not change to a significant degree, while eyebrow height was increased statistically significant. A longitudinal study on 14 patients for whom multiple follow-up data were available showed that the increase in periorbital height appears to be sustained over time, whereas the change in the forehead height is not as readily apparent, resulting in a bigger relative change in the periorbital compared to the forehead height. The brow height increased more than the forehead height, corroborating the fact that most of our patients have not complained about forehead becoming larger. 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 .

Classification of alar abnormalities and the relevant treatments.

At present, nasal abnormalities is often classified from different perspectives, such as the alar-columella relationship, nasal base width, and the condition of alar hyperplasia. However, due to the impact of race and region, different people may be applied to different classification methods, resulting in different clinical diagnosis and treatments. So far, there is no unified standard for alar deformity classification to guide clinical treatment. In alar-columella relationship, the retracted ala and the hanging columella, hanging ala and retracted columella are easily confused. According to the classification of nasal base width, it is easy to confuse the alar flare with wide alar base. Therefore, the accurate preoperative evaluation of the nasal ala and the selection of appropriate clinical treatments for different abnormalities are beneficial for surgeons to achieve perfect rhinoplasty results.

Reliability of cone beam CT for morphometry of nasolabial soft tissue in patients with skeletal class III malocclusion: A qualitative and quantitative analysis.

To assess reliability of cone-beam CT (CBCT) for nasolabial soft tissue measurements in patients with skeletal class III malocclusion based on 3-dimensional (3D) facial scanner results. CBCT and 3D facial scan images of 20 orthognathic patients are used in this study. Eleven soft tissue landmarks and 15 linear and angular measurements are identified and performed. For qualitative evaluation, Shapiro-Wilk test and Bland-Altman plots are applied to analyze the equivalence of the measurements derived from these two kinds of images. To quantify specific deviation of CBCT measurements from facial scanner, the latter is set as a benchmark, and mean absolute difference (MAD) and relative error magnitude (REM) for each variable are also calculated. Statistically significant differences are observed in regions of nasal base and lower lip vermilion between two methods. MAD value for all length measurements are less than 2 mm and for angular variables < 8°. The average MAD and REM for length measurements are 0.94 mm and 5.64%, and for angular measurements are 2.27° and 3.78%, respectively. The soft tissue results measured by CBCT show relatively good reliability and can be used for 3D measurement of soft tissue in the nasolabial region clinically.

Correction of the Nasal Ala

The alar-columellar relationship is an important concept for the rhinoplasty surgeon to master. The alar rim in particular is a critical component of the nasal tip, contributing to both overall symmetry and proportion of the nasal base. The retracted ala creates a displeasing aesthetic to the tip complex, distorts the nostril openings, and may have functional implications of the external nasal valve. While alar retraction can occur naturally or as the result of trauma, the majority of cases are post-surgical in nature. Many techniques have been described for correction of alar retraction, most of which require open rhinoplasty and many fail to add the soft tissue within the vestibule necessary to properly lower the alar margin. Herein, we present our experience with the auricular chondrocutaneous composite graft-a simple, reliable, and effective technique to correct moderate to severe alar retraction via either open or endonasal rhinoplasty.

Quantitative analysis of facial proportions and facial attractiveness among Asians and Caucasians.

It has been proposed that the proportions of the human face are crucial for facial aesthetics. If this is the case, we should describe the relationship among proportions of face components quantitatively. This study aims to develop a mathematical model of facial proportions to provide a quantitative description of facial attractiveness. Furthermore, we expect that plastic surgeons can use models in clinical work to enhance communication efficiency between doctors and patients. Face alignment technique was used to analyse 5500 frontal faces with diverse properties (male/female, Asian/Caucasian, ages) to obtain the ratios among the nose length ($ {N}_{L} $), the nasal base width ($ N $), and the inner canthus width ($ {E}_{I} $). A mathematical model ($ {N}_{L}^{2} = a{E}_{I}\mathrm{*}{N}_{L}+b{E}_{I}\mathrm{*}N+cN\mathrm{*}{N}_{L} $) was developed to describe the relationship among these proportions. To validate the effectiveness of this approach, we simulated the post-operative photos using Adobe Photoshop. Our findings show that the ratio of nose length to nose width, the ratio of inner canthus width to nose length and the ratio of inner canthus to nose width play a significant role in determining facial attractiveness. These results provide a possible strategy to quantitatively describe the relationship among human face proportions.

Commentary: Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity.

Sir: We would like to congratulate the authors on an important study that clarifies dogma regarding the unilateral cleft lip nasal deformity.1 A common misperception is that the cleft-side alar base is displaced lateral, and that correction requires medial advancement (Fig. 1A). Just as we have, the authors provide objective evidence of the reverse2: relative to facial midline, the non-cleft alar base is displaced laterally and needs to be centralized (Fig. 1B). Mulliken has proposed that surrounding regional contours may lead to optical illusions of alar base position.3 We feel that the misperception may be due to human cognitive tendencies to reference the more natural appearing non-cleft side when explaining the less-familiar cleft-side contours. Regardless, a clear understanding of the deformity is critical to improving treatment and avoiding iatrogenic anomalies.Fig. 1.: A, Optical illusion. In the absence of facial regions outside the nasolabial region it may seem that correction of the deformity involves downward rotation of the medial lip philtrum and medial advancement of the lateral lip and alar base. B, Context. Facial features and reference lines make the actual displacements readily perceived. The non-cleft alar base and columella need to be centralized, and the cleft alar base needs to be advanced anteriorly. If the lateral lip and alar base were advanced medially, it would produce further imbalance, aggravate the nasal twist, and introduce iatrogenic deformity. Modified with permission from Plast Reconstr Surg 2020:145;185–199.Sakamoto et al analyzed a large sample of photographs and suggested that the cleft alar base is displaced medial relative to age-matched controls.1 Their findings differed from ours in that we found the cleft alar base to be retruded, but normal in medial-lateral position.2 Although they attributed the discrepancy to their larger sample size,1 there are several other explanations to consider. First, whereas our study examined standardized 3D images, they used 2D photographs that involve considerable error from lens distortions, parallax, and uncontrolled head rotation. The appearance of depth from a retruded cleft alar base on 2D images could be extrapolated as variation in medial-lateral position, and error from parallax may be magnified when images are tilted to normalize head position. Second, whereas we measured alar base position using calibrated images with accuracy to within 1 mm, they normalized dimensions on non-standardized photographs using inter-endocantion distance expressed as ratios. These ratios don’t account for the fact that the inter-endocanthion distance widens with increasing cleft severity.2 The findings that Sakamoto et al report may therefore simply be a changing denominator rather than true alteration of cleft alar base position. Although further analysis of well-controlled 3D images would be helpful, the medial position of cleft alar base relative to controls that they report is minimal and may not be of clinical relevance. Most figures depicting unilateral cleft lip nasal deformity crop out facial features beyond the nasolabial region and some research studies advocate that doing so reduces bias when rating esthetic outcomes.4 We are glad to see that Figure 4 in Sakamoto’s article1 is identical to Figure 1 in ours.2 The midline and the endocanthion verticals illustrate the medial-lateral displacements, whereas the alar base horizontals illustrate the relative vertical disparities. Visualization of the whole face allows balance to be judged, and the reference lines guide us to correct perceptions (Fig. 1). We propose that those references should be standard and caution against future research that crops out non-nasolabial regions without providing a mechanism to judge balance. Finally, based on Sakamoto’s,1 Fisher’s,5 and our2 studies, we propose that centralizing the columella and rebalancing the nasal base elements should be the fundamental principle in the correction of the unilateral cleft lip nasal deformity. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Effect of Modified Septal Extension Grafts on the Nasal Tip in Rhinoplasty.

Background:One of the faced difficulties of nasal tip surgery is progressive loss of nasal tip projection and rotation postoperatively. Nasal base stabilization by septal extension grafts has shown to improve this loss over time. The aim of this study was to demonstrate that a modified septal extension graft can provide the required tip rotation/derotation by changing the angle of the graft’s insertion. In addition, it maintains nasal tip projection without creating a rigid tip. Other than that it avoids the requirement of a large amount of cartilage.Materials/Methods:This study involves a retrospective review of 37 patients who underwent open rhinoplasty for primary or secondary cases over a period of 12 months. The average age of the patients was 28 years (range = 20–43 years), and all patients were of Middle Eastern origin. Subjective evaluation based on photographic analysis was used pre and postoperatively.Results:All cases included in this study maintained their operative results of tip rotation. Two cases showed a minimal decrease in tip projection documented upon review 6–12 months postoperatively. No patient needed secondary revision surgery due to changes in tip projection or rotation. The objective pre and postoperative findings were satisfying for the patients and surgeons.Conclusions:The modified septal extension graft is an effective tool for rotation of the nasal tip as well as derotation of an over rotated tip. It is also capable of maintaining nasal tip projection.

Rejuvenating the Aging Upper Lip: The Longevity of the Subnasal Lip Lift Procedure.

Objective: This study sought to retrospectively analyze the longevity of the subnasal lip lift procedure on the aging upper lip by determining if the amount of skin resected was maintained. Methods: Patients who underwent subnasal upper lip lift procedure of 5-mm resection with the senior author (S.W.P.) from 2006 to 2020 were identified for a total of 52 patients who met inclusion criteria. Pre- and postoperative measurements of nasal base to upper lip vermillion border and vermillion height were taken. Longevity of results were measured through percentage retention of 5-mm lift and percentage improvements of lip show. Results: The percentage retention of the 5-mm lift and percentage improvement of lip measurements were maintained over time with a slow decline. The average percentage improvement of lip show was 48.2%. Patients <5 years out from surgery had 50.1% improvement compared with 40.3% for those ≥5 years out (p = 0.569). Conclusions: The subnasal lip lift procedure shortens the vertical height of the elongated upper lip and gives increased vermillion show with predictable results.

Neglected Nasal Foreign body discovered by Nasal Deformity: A Case Report and Review of the Literature

Foreign bodies of the nose are mostly common in paediatric population. In teenagers and adults, they are predominately seen in patients with mental disturbances. Usually with acute presentation, they also can remain in place for a long time. The main clinical presentation is unilateral purulent rhinorrhea possibly associated, in chronic cases, to nasal deformities, nasomaxillary abnormalities or rhinolithes. The removal can require a surgical procedure under general anaesthesia specifically in front of neglected foreign bodies covered by mucosa or previous multiple failed attempts. We report the case of a 14-years-old girl, with mental retardation, who consulted in our structure for a swelling in the left nasal alar base evolving progressively since 4 months, with intermittent purulent rhinorrhea not improved after medical treatment. No incident of nasal foreign body insertion was reported or witnessed by the patient and its family. The facial CT scan confirmed the diagnosis and the removal required surgical procedure. The diagnosis of neglected nasal foreign body should always be considered in front of unilateral nasal obstruction and discharge specifically in children and mentally disabled patients. Its removal should be rapid in order to avoid the constitution of rhinolithes and nasal deformities.

Application of autologous costal cartilage-based open rhinoplasty in secondary unilateral cleft lip nasal deformity

To evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity. Between January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio). The incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients' nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference ( t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively ( P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients' nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness. Autologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.

How Deviation of Nasal Septum Affects Nasal Appearance in Unilateral Cleft Patients: A Study Using Cone-Beam Computed Tomography.

To quantitatively evaluate the relationship between nasal appearance and nasal septum deviation in unilateral complete cleft patients using cone-beam computed tomography.Method: Cone-beam computed tomography images of 180 patients with unilateral cleft lip/palate from June 2014 to June 2017 were used in the study. None of the subjects had undergone septoplasty. The data were compared between the 2 groups to elucidate the relationship between nasal appearance and deviated nasal septum in unilateral complete cleft patients. The mean age of a total of 180 patients (126 males and 54 females) was 14.58 years, with a standard deviation of 7.10 years, ranged from 6 years old to 49 years old. Columella nasi symmetry parameters show slight positive significant association with angle of nasal septal deviation on transerve plan (r = 0.250, P < 0.001), TRSD (r = 0.323, P < 0.001) and coronal range of nasal septal deviation (r = 0.294, P < 0.001), and moderate positive significant association with coronal angle about septal deviation (r = 0.404, P < 0.001). Columella nasi symmetry affected by septal deviation, whereas there is lack of evidence to say symmetry of nasal tip and base affected by septal deviation. The symmetry of nasal tip and alar base are not just determined by nasal septum deviation. The nasal septum deviation show difference in different cleft type.

Tilted implantation technique for edentulous patients.

The tilted implantation technique is characterized by placing the implant at an angle of more than 15° and less than 45° from the horizontal plane. This technique can avoid damaging the maxillary sinus, inferior alveolar nerve, nasal base, and other anatomical structures when the height of the upper and lower jaw available bone is insufficient, to maximize the use of available bone and avoid a large range of bone increment. The tilted implantation technique can reduce the trauma of the surgery, increase the possibility of immediate restoration and shorten the treatment cycle, which has been widely used clinically. In this review, the scope of application, design elements, design scheme and complications of the tilted implantation technique for edentulous patients will be described.

Effect of Dichotomous Conchal Cartilage Transplantation on Correction of Unilateral Cleft Lip Nasal Deformity.

Autologous conchal cartilage is becoming increasingly popular as a source of material for secondary reconstruction. The aim of this study was to verify the effect of dichotomous autologous conchal cartilage transplantation in the treatment of unilateral cleft lip nasal deformity. Eighteen patients (10 males and 8 females) with unilateral cleft lip nasal deformity treated from August 2018 to August 2019 were selected for the study. The cut C-shaped conchal cartilage was trimmed into a strip shape and a shield shape and transplanted into the alar cartilage and the tip of the nose, respectively. The effect of the operation was evaluated in terms of patient satisfaction, two-dimensional linear quantitative results, and three-dimensional spatial differences after the operation. During follow-up from 6 months to 2 years, the nasal appearance of 18 patients was significantly improved. The postoperative patient satisfaction survey revealed more than 93% satisfaction for each research index. Two-dimensional linear quantitative analysis revealed that the height of the nasal columella and nostril was significantly increased and that the nasal base and breadth were significantly decreased after the operation. Evaluation of the three-dimensional spatial difference between the unaffected side and the affected side before and after the operation revealed a significant decrease in the difference in the soft tissue volume between the unaffected side and the affected side (P < 0.05). Dichotomous autologous conchal cartilage transplantation is an ideal method for the treatment of unilateral cleft lip nasal deformity.

Effect of Cleft Width on the Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate.

The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.

Lateral Domal Translocation and Medial Crural Transection: A Reliable Method for Nasal Tip Deprojection.

Nasal tip deprojection is a common goal in rhinoplasty. Several techniques have been described, many of which require destructive techniques that compromise the intrinsic integrity and morphology of the lateral crura. Through lateral translocation of the domes and shortening of the medial crura, nasal tip deprojection can be achieved without disrupting the integrity of the lateral crura. The domes are recreated lateral to the intrinsic domes with a standard transdomal suture, and excess length of the middle and medial crura is managed through transection and shortening of the medial crura. This technique preserves the morphology of the nasal base without altering the position of the medial crural footplates. Deprojection of 4 to 5 mm can be readily achieved with this technique.

Evaluation of facial soft tissues by stereophotogrammetry method in patients with obstructive sleep apnoea: a morphological study.

We aimed to use the "SomnoMed MAS" device, which brings the mandible forward in obstructive sleep apnoea syndrome patients due to mandibular retrognathia, and to examine its effects on facial soft tissues by stereophotogrammetry (3dMD) method. Thirty-one patients with a mean age of 44 years and 6 months were included in the study. SomnoMed MAS, one of the splint appliances that position the mandible in front, was applied to all patients and the changes in facial soft tissues were examined by overlapping the images taken at different times with the 3dMD face system. The obtained data were analysed statistically and the level of statistical significance was determined as p ≤ 0.05. Mouth width decreased statistically during T0-T1 period. In T0-T2 period, while crista philtri and labiale inferius points moved backwards, Mouth width, nose width decreased and nasal base width increased. In the T0-T3 period, nasal base width increased statistically, the philtrum width and the mouth width decreased, and the soft tissue nasion point came to the fore. Splint treatment, which positions the mandible in front in adult obstructive sleep apnoea syndrome patients, affected the middle and lower facial soft tissues with the forward and downward translational movement of the lower jaw.

Midfacial Degloving Technique for Free Flap Reconstruction of Nasal and Anterior Skull Base Defects.

Traditionally, surgical access for extirpation and reconstruction of midfacial tumors requires external incisions that can cause a myriad of complications, especially in irradiated patients. The modern midfacial degloving approach involves hidden, sublabial and intranasal incisions that provide reliable access for free flap reconstruction of nasal and maxillofacial tumors. Seven patients with a history of radiation therapy underwent free flap reconstruction of the midface. Five patients underwent the technique in a delayed manner, and the remaining two underwent reconstruction immediately at the time of resection. Five patients underwent free radial forearm fasciocutaneous free flaps and two underwent reconstruction with anterolateral thigh perforator flaps. Bone and/or rib cartilage grafting was used in all patients. All patients underwent successful free flap reconstruction of the midface without external incisions. The most common complication was postoperative infection requiring oral or intravenous antibiotics. No patients sustained loss of their grafts or hardware in the postoperative period. The midfacial degloving technique provides satisfactory exposure to the nasal cavity, midface, orbits, and skull base for free flap reconstruction, without disrupting the external soft tissue. The authors describe a novel use of the midfacial degloving technique to provide safe and reliable results with improved cosmetic outcome.

Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip

We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery. Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019. We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P=.012, r=0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P=.00074, r=0.57); thus, the shorter the red lip, the higher was the oral commissure. The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.