Nasal Tip Symmetry Research Articles

Non-surgical (liquid) rhinoplasty

Non-surgical (liquid) rhinoplasty (LR) is a common and expanding cosmetic procedure. The use and safety of in-office injectables, as well as surgeon comfort, has led to substantial growth with the procedure. Knowledge of nasal structural and vascular anatomy, injectable filler properties and in situ behavior, and procedural technique are all required for the application of non-surgical rhinoplasty. There is consensus regarding common indications for the procedure, including dorsal augmentation, correction of post-surgical deformities, and improvement of nasal tip symmetry. However, there is substantial variability in filler usage, technique, and patient selection. As with surgical rhinoplasty, the risk of patient dissatisfaction with LR remains high. It is of utmost importance to consider the rise of non-surgeon providers performing these procedures. A thorough understanding of the risks, benefits, and proper patient selection are key for any facial plastic surgeon utilizing LR.

The Deviated Nasal Tip: A Personal Technique for Correction Using Monolateral Crural Overlay and Monolateral Dome Truncation.

This study aimed to present a novel approach to correct nasal tip deviation with monolateral crural overlay or monolateral dome truncation, presenting as an isolated deformity or in complex nose deviations. Nasal tip deviation can be congenital or posttraumatic, due to a dislocated septum or cartilaginous septal or lower lateral cartilage malformations. Although some treatment strategies have been introduced, appropriate treatment remains a challenge because of the complexity and variability of such deformities. It had been assumed that in most nasal tip deviations, a lower lateral cartilage was longer than the contralateral one. The authors analyzed 158 patients from January 2015 to October 2019 with nasal tip deviation and corrected the deviated tip by using a monolateral interruptive technique (lateral crural overlay or monolateral dome truncation) on the lower lateral cartilage. Photographic comparison between preoperative and at least 1-year follow-up for nasal axis deviation variable was analyzed and a self-assessment questionnaire was administrated to the patients at 1-year follow-up. The mean nasal deviation was 6.59° (±3.1°) preoperatively and 1.56° (±0.26°) postoperatively (p < 0.05). The range of differences between pre and postoperative deviations was 2.7° to 15.1°, and the mean difference was 6.1° (±3.21°). Of the 84 patients, 47 (55.95%) were very satisfied, 33 (39.28%) were satisfied, and 4 (4.76%) were unsatisfied with surgical the results and required revision surgery. In authors' hands, monolateral interruptive techniques (lateral crural overlay or monolateral dome truncation) are a viable and feasible option to restore nasal tip symmetry. These techniques achieved high satisfaction rates among patients and resulted in reliable and reproducible symmetry immediately visible after surgery and stable over time (1-year postsurgery controls).

The Stabilization of Lower Lateral Cartilage in Rhinoplasty: A New Control Suture Technique.

Abstract Objective: Reposition of malpositioned lateral crura to normal position in rhinoplasty is important both functionally and aesthetically. The aim of this study is to describe a lateral cruras reposition suture technique for supplying tip symmetry and avoiding crural displacement. Patient and Method: Sixteen primary rhinoplasty cases with malpositioned lateral crura underwent lateral crural control suture (LCCS) were reported. In this technique dissected and released lateral crura were fixed to cheek skin with a suture. Those cases were assessed with FACE-Q rhinology module both aesthetically and functionally. Result: Intraoperative or postoperative lateral crural displacement can be prevented and nasal tip symmetry can be supplied easily with LCCS. Results were satisfactory both functionally and aesthetically. Conclusion: LCCS is a good alternative to correct lateral crural malposition and obtain a tip symmetry.

Primary Nasal Tip Surgery: A Conservative Approach

Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures. For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1 year. The results at 1 year showed high rates of improvement in tip definition (mean, 7.9±2.4) and nasal tip only evaluation (mean, 6.5±3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2±3.2), nostril symmetry (mean, 4.5±4.1), and tip projection (mean, 5.8±2.9). This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.

Microform Cleft Lip Repair With Intraoral Muscle Interdigitation

With a microform (forme fruste) cleft lip, obtaining an optimal functional and esthetic result is a challenge to a reconstructive surgeon. We describe modifications to existing techniques by Mulliken, Furlow, and Cutting that provides an optimal functional result with correction of the cleft furrow, vermillion notch, and cleft nose deformity. Sequential unilateral microform cleft lip patients underwent our microform cleft lip repair modified from the following 3 techniques: the Mulliken microform cleft lip repair with no cutaneous scar, the Furlow complete cleft lip repair with interdigitating muscle, and the Cutting cleft nose repair (n = 12). From follow-up (1 year) examinations, photographs (and 3-dimensional images), and video, 3 reviewers scored esthetic and functional outcomes using a 0 to 4-point scale. In addition, parental surveys were obtained. For our microform cleft lip repair, there were no infections, bleeding, or other complications. Esthetic outcome score, evaluating the cutaneous scar, symmetry of philtral columns, alignment of lip line and vermillion border, and nasal tip symmetry was a mean of 3.7 (+/-0.3). Thus, the reviewers' scored the cleft lip and nose repair as "Very Good" (minor cleft lip/nose deformity but no need for revision) to "Excellent" (Imperceptible cleft lip or nose deformity). The functional outcome score, based on the ability to smile, pucker their lips, and whistle, was a mean of 3.8 (+/-0.2). The parental survey, including postoperative course, functional, and cosmetic outcome, demonstrated a high level of satisfaction with a score of 3.9 (+/-0.2). The modified microform cleft lip and nose technique provided very good to excellent esthetic and functional results in a series of patients with this rare deformity.

Correction of Intrinsic Nasal Tip Asymmetries in Primary Rhinoplasty; Rod J. Rohrich, M.D., and John R. Griffin, M.D.

Preoperative nasal analysis for the rhinoplasty patient is not complete without recognition and characterization of asymmetries. A simplified classification of columellar and intrinsic nasal tip asymmetries has evolved from 15 years' experience with rhinoplasty. Nasal tip asymmetries have vertical and horizontal dimensions. The vertical, or cephalocaudal, causes of tip asymmetry are primarily extrinsic factors. Elements that contribute to tip asymmetry and are extrinsic to the lower lateral cartilages are the bony and cartilaginous septum, the nasal bones, the upper lateral cartilages, and the maxilla. Horizontal or side-to-side asymmetries can be the result of intrinsic lower lateral cartilage abnormalities. The importance of this distinction is to differentiate the patient with a deviated nose and concomitant tip asymmetry from the patient with an isolated, intrinsic deformity of the nasal tip cartilages. A simplified classification system for nasal tip asymmetries is presented along with proposed methods for surgical correction. Case examples are analyzed also. A description of nondestructive suturing techniques and cartilage grafts to restore nasal tip symmetry is provided for each deformity. An open rhinoplasty approach is advocated in all cases.

Correction of intrinsic nasal tip asymmetries in primary rhinoplasty.

Preoperative nasal analysis for the rhinoplasty patient is not complete without recognition and characterization of asymmetries. A simplified classification of columellar and intrinsic nasal tip asymmetries has evolved from 15 years' experience with rhinoplasty. Nasal tip asymmetries have vertical and horizontal dimensions. The vertical, or cephalocaudal, causes of tip asymmetry are primarily extrinsic factors. Elements that contribute to tip asymmetry and are extrinsic to the lower lateral cartilages are the bony and cartilaginous septum, the nasal bones, the upper lateral cartilages, and the maxilla. Horizontal or side-to-side asymmetries can be the result of intrinsic lower lateral cartilage abnormalities. The importance of this distinction is to differentiate the patient with a deviated nose and concomitant tip asymmetry from the patient with an isolated, intrinsic deformity of the nasal tip cartilages. A simplified classification system for nasal tip asymmetries is presented along with proposed methods for surgical correction. Case examples are analyzed also. A description of nondestructive suturing techniques and cartilage grafts to restore nasal tip symmetry is provided for each deformity. An open rhinoplasty approach is advocated in all cases.

Correction of the cleft-lip nasal deformity.

Correction of the cleft-lip nasal deformity is a difficult task that requires a clear understanding of the associated complex anatomic abnormalities. These deformities tend to accentuate as nasal growth continues. Primary tip rhinoplasty in the unilateral deformity improves nasal tip symmetry and decreases the need for intermediate surgery. Intermediate rhinoplasty in the bilateral deformity is performed when nasal tip projection is markedly diminished. In both the unilateral and bilateral deformity, definitive rhinoplasty utilizing the open-structure rhinoplasty approach allows maximum exposure for placement of structural grafts to improve tip projection, definition, support, and function. In this article, the pathologic anatomy of the unilateral and bilateral cleft nasal deformity is described. The philosophy and timing of repair are discussed. Finally, the techniques used by the authors to address both the aesthetic and functional problems are outlined.

A 20 year audit of nose-tip symmetry in patients with unilateral cleft lip and palate

The purpose of this study was to audit the process and outcome in terms of nasal-tip symmetry of the first 20 patients with unilateral complete cleft lip and palate treated by the Pigott alar leapfrog primary nasal correction in the early 1970s and followed for 20 years. Symmetry was assessed using the Coghlan computer-based analysis of frontal and basal views to determine the stability of the correction. The Åbyholm technique of alveolar bone grafting was performed in 12 of the 20 patients. Various other secondary procedures have been performed on the nose tip and septum to improve the airway or appearance. Photographs were taken within one year of ages 5, 10, 15 and 20 years, and the lower border of the nose, the alar domes and the nostrils were assessed. To assess the overall change from5 years to 20 years, both views were available for 17 patients. No significant change was found in the lower border or nostril symmetry, but significant deterioration at the P< 0.01 level was found on the basal view. We assessed the 10, 15 and 20 year views of all 12 patients who had undergone alveolar bone grafting to determine early and late changes. No significant benefit was found from alveolar bone grafting or minor secondary procedures for appearance. Consequently, our criteria for undertaking minor adjustments to improve appearance have become more stringent. We consider that objective reporting of appearance should become essential in peer-reviewed journals.

The asymmetrical nasal tip in primary rhinoplasty

An analysis of nasal tip asymmetry is proposed that focuses on intrinsic deformities of the lower lateral cartilages. Three types of intrinsic deformities of the lower lateral cartilages are recognized that result in asymmetrical domal projection and lateral domal deviation. The most common deformity involves ipsilateral middle crural convexity and contralateral concavity. The second problem is caused by different lengths of paired medial crura. The third form of tip asymmetry is caused by a unilateral splayed lower lateral cartilage that is further from the anatomic midline than the opposite lower lateral cartilage. The use of suturing techniques and occasional grafts to restore nasal tip symmetry is described in each of the three scenarios.

A more precise technique of tip rhinoplasty with a cartilage-splitting incision.

• One of the possible disadvantages of tip rhinoplasty with the use of a cartilagesplitting incision technique is the inability to attain nasal tip symmetry in a few patients. Surgeons occasionally make an error in judgment on the amount of lateral crura to be removed and the amount of lateral crura to remain. A technique of marking the desired positions of the lateral crura on the external nose and viewing those positions in the nasal vestibule has been developed. This technique provides greater consistency in attaining better results of tip rhinoplasty with good symmetry when the surgeon chooses to use this cartilage-splitting technique. ( Arch Otolaryngol 1981;107:425-427)