Nasofrontal Angle Research Articles

Ideal Nasal Preferences: A Quantitative Investigation with 3D Imaging in the Iranian Population.

Background Though in facial plastic surgery, the ideal nasal characteristics are defined by average European-American facial features known as neoclassical cannons, many ethnicities do not perceive these characteristics as suitable. Methods To investigate the preferences for nasofrontal angle, nasolabial angle, dorsal height, alar width, and nasal tip projection, manipulated pictures of one male and one female model were shown to 203 volunteer patients from a tertiary university hospital's facial plastic clinic. Results The most aesthetically preferred nasofrontal angles were 137.64 ± 4.20 degrees for males and 133.55 ± 4.53 degrees for females. Acute nasofrontal angles were more desirable in participants aged 25 to 44. The most preferred nasolabial angles were 107.56 ± 5.20 degrees and 98.92 ± 4.88 degrees, respectively. Volunteers aged 19 to 24 preferred more acute male nasolabial angles. A straight dorsum was the most desirable in both genders (0.03 ± 0.78 and 0.26 ± 0.75 mm, respectively). The ideal male and female alar widths were -0.51 ± 2.26 and -1.09 ± 2.18 mm, respectively. More 45- to 64-year-old volunteers preferred alar widths equal to intercanthal distance. The ideal female and male tip projections were 0.57 ± 0.01 and 0.56 ± 0.01, respectively. Conclusion Results indicate that the general Iranian patients prefer thinner female noses with wider nasofrontal angles for both genders. However, the ideal nasolabial angles, dorsal heights, and tip projections were consistent with the neoclassical cannons. Besides ethnic differences, the trend of nasal beauty is also affected by gender, age, and prior history of aesthetic surgery.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7mm) was significantly improved (35.6±5.7mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3mm preoperatively to 25.3±2.4mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

Lateral Cephalometric Analysis of Nasal Morphology in Patients Visiting Nishtar Institute of Dentistry

Nasal morphology is the keystone of facial aesthetics. Being the most prominent part of the face, the shape and position of the nose greatly influence the facial profile and nasal soft tissue thickness also plays a vital role in orthodontic diagnosis and treatment planning. Objective: To evaluate the soft tissue nasal morphology in individuals presenting with different skeletal patterns such as skeletal class 1 and skeletal class 2 jaw relationship. Methods: It was Comparative Cross-sectional study conducted in Orthodontics Department of Nishtar Institute of Dentistry for the period of six months (5th Mar 2020 to 6th Jun 2021). Study sample consisted of Lateral cephalometric radiographs of 65 subjects. Age range of sampled subjects was 19-26 years (mean age 20.93). The sample was divided into two groups on basis of the Skeletal jaw relationship as class-1 and class-2. An Independent t-test was applied for evaluation of the difference in lateral nasal morphology between both groups. Results: Notable differences were found between skeletal class 1 and skeletal class 2 groups for the prominence of the mandible and Linear distance between soft tissue Pogonion and Pronasale. Considerable differences in measurements of nasal depth, nasofrontal angle, nasal tip projection angle, nasofacial angle and nasomental angle were found. Conclusions: It is concluded that nasal morphology was greatly influenced by not only the underlying skeletal jaw relationship yet other factors e.g., dentition along with soft tissue thickness were also responsible for nasal morphology differences among various skeletal patterns. Gender dimorphism also exists for various nasal features.

107. Facial Feminization Surgery: Region-specific Importance Recognized by Artificial and Human Intelligence Gender Recognition Correlates with Patient Satisfaction

PURPOSE: Facial Feminization Surgery (FFS) has emerged as an important aspect of social gender confirmation for trans women through modifications to the facial hard and soft tissues. However, there is limited information about which of the many FFS procedures are the most important. To determine this, individual FFS procedures or regional changes were compared preoperatively and postoperatively using gender typing from both artificial intelligence (neural networks trained on facial features) and public opinion (online crowdsourcing survey). METHODS: For both studies, standardized frontal and lateral view preoperative and postoperative images were used; in addition, unoperated control cis-gender males and cis-gender females were included. Part I: The outcome of 12 different individual FFS procedures (eg. osseous genioplasty vs rhinoplasty) or facial regions (eg. forehead vs chin) (n=303 patients) was comparatively analyzed using four neural networks (AI which have been trained to recognize facial images to assess gender) and crowdsourcing public opinion of gender type (n=917) to measure changes in correct gender-typing, improvement in gender typing (preop vs postop), and confidence in femininity. Part II: The nasofrontal region (frontal sinus setback/rhinoplasty) was separated into subtypes based on morphologic typing of the preoperative severity (Types 1-3) and change was compared for success in FFS using neural networking and crowdsourcing. In addition, FACE-Q surveys were used to assess patient-reported facial aesthetic outcome. RESULTS: All four neural network platforms provided a gender. For all four neural networks, cis-male and cis-female control images were gendered correctly 98% and 99% of the time respectively. Preoperative FFS patient images were recognized as female only 52% of the time. With postoperative FFS, a combination of all the procedures followed by correction of the nasofrontal region had superior outcomes (98%, 96% correct gendering) compared to other facial regions (range 68-86%). With public opinion, similar results were recorded, with a combination of all the procedures followed by correction of the nasofrontal region having superior outcomes (97%, 95% correct gendering with improved confidence levels of 8.9+1.2 and 8.1+2). For the nasofrontal region, improved outcome in correct gendering was seen with a more severe preoperative state (Type 3 brow/dorsal hump) and increased change in measured nasofrontal angle (from 90o to 135o). Finally, FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1+8.1) and quality of life (82.4+8.3). There was a positive correlation between less AI and public misgendering and patient reported FACE-Q scores for appearance, quality of life, and overall satisfaction. CONCLUSION: The success of FFS (patients more likely to be correctly identified as female) was demonstrated by both artificial and human intelligence methods. For FFS feature changes, both all and nasofrontal regions should be considered the most important for less misgendering by artificial and human intelligence; these outcomes positively correlated with patient satisfaction.

24. Facial Feminization Surgery: Region-specific Importance Recognized by Artificial and Human Intelligence Gender Recognition Correlates with Patient Satisfaction

PURPOSE: Facial Feminization Surgery (FFS) has emerged as an important aspect of social gender confirmation for trans-women; however, it is not known which of the many FFS procedures are the most important. To determine this, individual FFS procedures or regional changes were compared using gender typing from artificial intelligence and public opinion. METHODS: The outcome of 12 different individual FFS procedures or regions (n=303 patients) was compared based on four neural networks and crowd sourcing public opinion of gender type (n=917). The nasofrontal region preoperative severity and change was compared for success in FFS. FACE-Q surveys were used to measure patient-reported facial aesthetic outcome. RESULTS: For all four neural networks, cis-male, cis-female gendered correctly (98%, 99%); Preoperative FFS misgendered 52%. With postoperative FFS, a combination of all the procedures followed by the nasofrontal region had superior outcomes (98%, 96% correct gendering) compared to other regions (range 68-86%). With public opinion, similar results were recorded with a combination of all the procedures followed by the nasofrontal region having superior outcomes (97%, 95% correct gendering with improved confidence level 8.9 + 1.2 and 8.1 + 2). For the nasofrontal region, improved outcome was seen with a more severe preoperative state and increased change in measured nasofrontal angle. FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1 + 8.1) and quality of life (82.4 + 8.3). CONCLUSION: For FFS feature changes, both all and nasofrontal regions should be considered the most important for less misgendering by artificial and human intelligence; these outcomes positively correlated with patient satisfaction.

The Utilization of Fresh Frozen Cartilage in Asian Rhinoplasty: A New Approach

Asian rhinoplasty generally requires augmentation procedures rather than reduction. Alloplastic grafts are fraught with higher complication rates. Autologous cartilage grafts are safer. However, Asian patients typically do not have adequate septal cartilages, and other autologous cartilage grafts may cause surgical site morbidities, prolonged surgical time, and complications, including warping and infection. Asian rhinoplasties were performed using fresh frozen cartilage by the senior author. Patients' demographics and medical histories were recorded. Anthropometric measurements (nasofrontal angle, nasofacial angle, nasolabial angle, and Goode ratio) were taken on two-dimensional photographs. FACE-Q scales were used to assess patient-reported outcomes. Five Asian patients underwent rhinoplasty using the fresh frozen cartilage and were followed up for an average period of 14.2 ± 3.35 months. There was no resorption, warping, or infection. Anthropometric measurements showed no significant changes 2-4 months or 8-20 months after surgery. At the time of the 1-year follow-up, mean FACE-Q Satisfaction with Nose, and Satisfaction with Nostrils scores improved from 35.2 ± 10.06 to 60 ± 15.48 (P = 0.0002), and 42.6 ± 20.31 to 59.8 ± 38.21 (P = 0.12), respectively. Fresh frozen cadaveric cartilage is a novel option for Asian rhinoplasty. Our study demonstrated its safety and satisfying surgical outcomes.

Cosmetic Open Rhinoplasty in Acute Nasal Bone Fracture With Pre-Existing Deformity.

The simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty is a challenging procedure, because of fracture severity and skeletal instability. Our aim was to investigate the surgical strategy and outcomes of cosmetic rhinoplasty according to the pre-existing nasal deformity when performing simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty. In total, 71 patients who underwent cosmetic rhinoplasty were included. All patients were categorized according to pre-existing deformity, dorsal hump and irregularities, and deviation of the nose, wide nose, and flat nasal dorsum. The authors performed individual maneuvers to correct each deformity. Autologous tissue was used in all maneuvers for graft. Photoanalysis was performed to measure the deviation, nasal length, radix height, dorsal height, tip projection, nasofrontal angle, and nasolabial angle. Subjective evaluation of the functional and esthetic problems was confirmed through rhinoplasty outcome evaluation. In the analysis of the photographs, most patients presented improved scores ( P <0.05). The scores of satisfaction were significantly higher in the postoperative state ( P <0.05). As a postoperative complication, 2 cases of deviated tip occurred due to septal instability and were successfully revised with septoplasty and columellar strut graft. The authors created a harmonious face by evaluating, categorizing, and treating each deformity of the nose in patients with nasal fractures according to our algorithm.

Assessment of Cranial Sexual Dimorphism Using 3D Reconstruction: Implications for Gender-Affirming Surgery.

As more centers offer gender-affirming procedures, dissemination of best practices is critical to ensuring quality care. This study is the first to use advanced 3-dimensional visualization software to characterize cranial differences between natal males and females, as they relate to planning for facial gender-affirming operations. A retrospective analysis was conducted on randomly selected patients with facial computed tomography imaging performed at a single institution between February 2020 and July 2021. Patients with acquired bony deformity on computed tomography or documented history of hormone replacement therapy were excluded. The images were retrieved and analyzed using advanced 3-dimensional visualization software (Vitrea). Independent sample t tests were performed to analyze variation in typically sexually dimorphic facial features between natal males and females. We identified 50 patients (25 natal males and 25 natal females) who met the inclusion criteria. Ages ranged from 19 to 91. Natal males were found to have significantly greater frontosellar distances (difference between means, SEM: 2.7±1.2; P =0.03) and mandible volumes (difference between means, SEM: 14.0±4.2; P =0.002) than natal females. Statistical analysis revealed no significant differences in gonial angle, chin width, nasofrontal angle, or nasolabial angle between natal males and females. In this diverse sample of natal males and females, statistical analysis revealed that the sexually dimorphic facial characteristics most relevant to the planning of facial gender-affirming surgery are frontosellar distance and mandible volume. When planning facial gender-affirming surgery, we recommend that these characteristics be considered to achieve optimum results.

Application of a Modified Costal Cartilaginous Framework in Correction of Severe Saddle Nose Deformity.

Insufficient support of the nasal septum due to congenital or secondary deficiency leads to severe saddle nose deformity, which presents an unpleasant appearance. The purpose of this study is to present our approach to constructing a costal cartilaginous framework with autologous costal cartilage for correction of severe saddle nose deformities. A retrospective analysis was conducted of patients who underwent correction of severe saddle nose deformity (type 2 to type 4) by a senior surgeon from January 2018 to January 2022. Preoperative and postoperative measurements were conducted to evaluate the surgical outcomes. A total of 41 patients ages 15 to 50 years completed the study. The average follow-up time was 20.6 months. No short-term complications were observed. Revisional operations were performed on 3 patients. All patients were satisfied with the aesthetic results. Analysis of objective measurements showed that the nasofrontal angle, columellar-labial angle, and tip projection improved significantly in type 2 cases, the nasofrontal angle and tip projection improved significantly in type 3 cases, and tip projection improved significantly in type 4 cases. Application of this modified costal cartilaginous framework, which consists of a fairly stable foundation layer and an aesthetic contour layer of block costal cartilage, has achieved satisfactory results over the long term.

Objective Photoanalysis of Feminizing Frontal Cranioplasty Outcomes.

Retrospective analysis at a tertiary care center. This study describes a method of analyzing postoperative results using lateral view clinical photographs to create normalized projection ratios of the glabella and radix. We reviewed preoperative and postoperative photographs of 15 patients. All photographs were in the lateral view Frankfort horizontal plane. We calculated the distances between the (a) tragus and cornea, (b) cornea and radix, (c) cornea and glabella, and the (θ) nasofrontal angle. Fifteen sets of patient photographs were analyzed and found that there was a favorable 14% reduction at the radix and an even greater reduction (78.9%) at the glabella. The nasofrontal angle was improved to a more feminine range from 131.84° preoperatively to 145.86° postoperatively. Normalized projection ratios of the glabella and radix, along with the nasofrontal angle, can be used to objectively measure outcomes of frontal feminizing cranioplasty.

Use of nasal septal bone to straighten septal L-Strut in correction of east Asian short nose: A retrospective study.

The perpendicular plate of ethmoid (PPE) was used to correct short noses in rhinoplasty in Asians, but the safe harvest of the plate and the assessment of its clinical application has been perplexing to plastic surgeons. To explore how to safely cut the perpendicular plate of ethmoid bone and evaluate its application effect. A finite element model was established to guide the clinical operation. A total of 30 patients with short noses were selected. Among them, 15 patients used autologous septal cartilage to lengthen the nasal tip, and 15 patients used the PPE to strengthen the L-shape nasal septum. The differences in the esthetic parameters of the nose, complications, and patients' satisfaction were compared between the two groups. Significant differences were noted in the nasal dorsal length (p=0.001), Goode's ratio (p=0.001), and nasofrontal angle (p=0.003) after rhinoplasty, and no significant differences were noted in any of the esthetic parameters between the two groups. The symptoms of nasal obstruction in the experimental group were significantly lighter than those in the control group (p=0.04). There was no statistically significant difference in the doctors' assessment of outcomes between the two groups (p=0.48). The safest region to harvest the PPE is in the middle and lower third. Rhinoplasty improves the esthetics of the patient's nose. The PPE used to strengthen the L-shape nasal septum structure has a smaller probability of nasal septal deviation with the time in Asian short noses.

Quantitative Analysis of Morphometric Changes in Feminization Rhinoplasty Utilizing a Standardized Forehead-Rhinoplasty Technique

Abstract Background Rhinoplasty is one of the most commonly performed facial gender-affirming surgeries (FGASs) for transgender females, but well-established morphometric parameters describing feminizing nasal changes do not exist. Objectives Describe the author's technique for feminization rhinoplasty, analyze the changes in 3-dimensional nasal anthropomorphic parameters, and describe patient-reported outcomes. Methods Three-dimensional photogrammetric evaluation was performed both preoperatively and postoperatively in transgender female patients who underwent FGAS. Measurements assessed included the nasofrontal angle, nasolabial angle, dorsal height, mid-dorsal width, alar width, nasal tip width, and tip projection. Patients were surveyed preoperatively and postoperatively using the FACE-Q Nose module. Paired t-tests were utilized to assess changes in postoperative measurements and FACE-Q Nose satisfaction scores. Results Twenty patients underwent FGAS during the study period. The average time between surgery and postoperative 3-dimensional images was 13.6 ± 6.8 months. The nasofrontal angle increased by 8.2° (148.0 ± 7.4° to 156.1 ± 6.7°, P &amp;lt; .001) and tip projection increased by 0.017 (0.58 ± 0.03 to 0.60 ± 0.04, P &amp;lt; .01). Dorsal height, mid-dorsal width, and tip width all decreased significantly (P &amp;lt; .05). There were significant improvements in patients’ “Satisfaction with Nose,” “Satisfaction with Facial Appearance Overall,” “Psychological Function,” and “Social Function” on FACE-Q. One revision rhinoplasty was performed, and no documented surgical complications were reported. Conclusions There were statistically significant changes in the nasofrontal angle, tip projection, dorsal height, mid-dorsal width, and tip width in patients receiving feminization rhinoplasty. These data may help surgeons with preoperative planning and intraoperative decision making. Level of Evidence: 4

Perinatal lethal Gaucher disease due to compound heterozygosity of the splicing mutations in GBA gene

ObjectiveIn order to figure out the cause for two consecutive fetuses with nonimmune hydrops fetalis (NIHF) in a Taiwanese couple, whole-Exome Sequencing and Sanger Sequencing were applied for the family. Case reportThe two fetuses developed NIHF at gestation age of 19 and 21 weeks, respectively. The clinical features included ascites and pleural effusion, flattened nasofrontal angle, skin edema, clenched hands, ambiguous genitalia, hepatosplenomegaly and fetal thrombocytopenia. Magnetic resonance imaging of the brain showed cerebellar hypoplasia and delayed cortical maturation. The GBA deleterious variants c.1505+5G > C and c.308-1G > A were both detected in the two fetuses. ConclusionThe report provided the precious experience of the clinical presentation of perinatal lethal Gaucher disease (PLGD) and advice on reproductive medicine for the next pregnancy in a couple. The novel genetic mutations identified in the study also contribute to the known spectrum of PLGD-related mutations.

An Innovative Approach for Nasal Reshaping using Hyaluronic Acid Intradermal Injections.

Nasal reshaping using hyaluronic acid (HA) filler has become a widespread technique and injections are usually performed in deep layers. As an alternative, we propose an innovative approach where HA is injected into the dermis, the so called MesoRhinoFiller. The aim of this study was to describe our injection technique using a smooth, cohesive, and slightly viscous HA filler injected in the dermis. A retrospective review of the author's clinical experience from March 2017 to March 2020 was presented. A total of 280 consecutive patients were treated with HA injections to improve their nasal appearance. The mean volume was 0.5 cc HA filler/treatment. An average increase of 4.9 ± 3.4° was obtained for the nasofrontal angle, and of 7.0 ± 4.5° for the columella labial angle. Asymmetries in the nasal profile and alar rim were also corrected. All the patients were satisfied with the results and no complications occurred. Injecting HA fillers in the dermal plane is a versatile approach that provides very satisfactory results. This technique allows one to better correct aesthetical, post-traumatic, and post-surgical defects compared with the usual injection rhinoplasty procedures where the filler is injected deep onto the bone/cartilage in the midline of the nose.

Outcomes of Open Rhinoplasty for Unilateral Cleft Patients using Photogrammetric Analysis - An Evaluative Study.

Secondary cleft rhinoplasty is a challenge due to the complex anatomy of the nose, with structural deformity and difficulty in surgical management. This study aimed to evaluate the effect of an anatomical-based approach on enhancing tip and alar symmetry in secondary unilateral cleft rhinoplasty using photogrammetric evaluation. The study was conducted on 57 adult patients seeking rhinoplasty after primary repair of congenital unilateral cleft lip deformity. All patients were operated upon using an external open rhinoplasty approach using an anatomical-based surgical technique. The cases were periodically followed up at three, six, 12 and 18 months for both aesthetic and functional outcomes with photogrammetric analysis of facial profile using the software Mirror Suite programme to compare before and after the surgical procedure. The photogrammetric analysis showed a significant improvement of facial angles (P = 0.05). The nasofrontal angle changed from a median of 146° to 132.5°, nasolabial angle of 73° to 95°, nasofacial angle of 21.5° to 32° and nasomental angle of 105° to 130°. The rotation angle of the nasal tip showed a significant cephalic rotation with a mean increase of the tip elongation of 1.8 cm achieved per lateralised millimetre. Secondary rhinoplasty in unilateral cleft deformities needs accurate evaluation of the anatomical and pathological abnormalities. Open approach is preferred with using costal cartilage graft allowing adequate columellar lengthening, maxillary enhancement and alar repositioning which leads to optimise the definition, projection and cephalic rotation with better stabilisation and symmetry of the nasal tip.

Analysis of Imperative Facial Angles for Rhinoplasty: An Endowment to the Surgeon.

To study the nasal framework of patients in relation to CT scan and observe the Nasofrontal angle and Nasofacial angle in patients. This study is a prospective observational study. It was done from January 2020 to December 2020. It involved selection of patients with nasal complaints and external nasal deformity followed by their CT scan evaluation. It included a 3D analysis of the CT scan using a computer software. Preoperative photographic evaluation of the patient was done in frontal, lateral and basal view for a better understanding and correlation. Thirty patients were evaluated and their 3D reconstructed CT scans were observed. The mean Nasofrontal angle was 116.69°. The mean was 110.43° in males and 126.08° in females. The mean Nasofacial Angle was 37.68. The mean was 43.05° in males and 29.62° in females. There was a significant statistical difference seen. The demand for rhinoplasty in India is on rise. The studies done in the past have evaluated patients using plain 2D CT films. In this study, 3D reconstruction of CT scan has been done. There are meagre studies which describe the aesthetics of Indian population. It aids in preoperative evaluation and plan of surgery, enables a good doctor-patient communication. Also, it can be used for clinical learning of resident doctors.

Comparison of Nasal Analysis by Photographs (2D) against Low-cost Surface Laser Imaging (3D) and against Computed Axial Tomography Imaging.

Introduction In aesthetic surgery, we have a few evaluation tools that numerically and objectively measure the changes we make in patients. This article aimed to evaluate the nasal systematic analysis and compare findings between the three systems of nasal evaluation: photographs 2D, 3D surface imaging with the Kinect system, and 3D CT scan imaging. Methods We designed a longitudinal and descriptive prospective study with simple non-blind randomization. To compare the systematic nasal analysis between the three methods. If the findings are similar, all three methods would be useful in independent clinical scenarios. Results A total of 42 observations were included finding a minimum age of 21 with a mean of 28 years old. Also, 64% were female, 93% had adequate facial proportions, and 50% were Fitzpatrick III. For outcome statistics, we found differential nasal deviation between 3D images with a mean of 6.53 mm. While when comparing the nasal dorsum length, we found a statistical significance of p = 0.051. When comparing the nasal dorsum length index, we found no significant difference p = 0.32. Also, we did not find statistical significance when comparing the nasofrontal angle and tip rotation angle p = 1 for both. Conclusion We found that the population we serve has characteristics of Hispanic mestizo nose. The three methods seem to evaluate systematic nasal analysis in a very similar way, and any of them can be used depending on the scenario and the needs of plastic surgeons.

3-dimensional analysis of nasal soft tissue alterations following maxillary Lefort I advancement with and without impaction using 3D photogrammetry scanner.

This study was designed to investigate the changes in nasal soft tissue following maxillary Lefort I advancement with and without impaction in subjects presenting a skeletal class III malocclusion, using a 3D photogrammetry scanner. Patients with class III malocclusion undergoing Lefort I advancement with and without impaction and bilateral sagittal split osteotomy with the standard technique were included in this study. Patients were divided into two groups: maxillary Lefort I advancement alone (group 1) and combined with impaction (group 2). Facial soft tissue landmarks of the nose including nasal height (NH), nasal length (NL), nasal tip projection (NTP), alar width (AW), alar base width (ABW), subalar width (Sbal), nasolabial angle (NLA), nasofrontal angle (NFA), and columella inclination (CI) before and at least 4months after surgery were obtained by a 3D scanner. Twenty-one patients were included in this study (Group 1: 11 and Group 2: 10). NH, NTP, and NL decreased significantly in both groups following surgery. In addition, Sbal decreased only in group 2. On the other hand, NLA and CI increased significantly in group 2. The inter-group comparison revealed a statistically significant difference in the alterations in NH, NL, and CI between the two groups. Changes in the nose soft tissue occurred after both surgeries, but their type and extent were different. Actions taken to reduce unwanted changes need to be further investigated. To evaluate the changes, 3D photogrammetry scan is a feasible imaging technique that can be used, providing numerous benefits.

Application of septal extension grafts with auricular cartilage in rhinoplasty.

Rhinoplasty is one of the most common cosmetic surgeries in China. Septal extension grafts (SEG) have been widely used in rhinoplasty, but there are few reports on SEG derived from ear cartilage. This study aims to explore the effectiveness and stability of auricular cartilage nasal SEG transplantation in Chinese rhinoplasty. A retrospective analysis of 35 rhinoplasty patients admitted from September 2019 to March 2022 has been conducted. Among them, 29 patients underwent rhinoplasty for the first time and 6 patients underwent rhinoplasty with the age of 18-32 (average 22.4) years old. The postoperative follow-up was 3-28 (average 18.5) months. The improvement of the nose shape was observed. The changes of the nose tip angle, nasolabial angle, and nasofrontal angle were compared between before and after the operation, and the complications were recorded. All patients who underwent rhinoplasty with a septal extension grafts constructed from the concha cavity and concha cartilage showed significant improvement in nasal contour. The preoperative nasal tip angle, nasolabial angle, and nasofrontal angle were significantly improved compared with 3 months after operation (all P<0.001), and there was no significant difference between 3 months and 14 months after operation (all P>0.05). The appearance of nasal cavity was satisfactory in 32 patients after operation. Columella deviation occurred in 2 patients and 1 patient complained of downward rotation of the nasal tip, which was satisfied after readjustment of the graft. The simplified SEG derived from auricular cartilage can provide stable support for the nasal tip, the nasal shape is natural after operation, and minimal trauma of unilateral auricle cartilage transplantation remains.

Facial Angles in Arabian Women Seeking Rhinoplasty.

The purpose of this study is to determine the average values of the angular nasal anthropometric variables in Arabian women seeking rhinoplasty and compare them with the normal values. A total of 150 female patients, who underwent rhinoplasty between January 2018 and November 2021, were enrolled in this study. The exclusion criteria were a history of nasal trauma, previous rhinoplasty, and a cleft nose. Data were obtained from standardized digital photographic images. Lateral and basal views were analyzed using landmarks defined by a single observer and measurements were performed using Adobe Photoshop Software SC6. All data were analyzed using SPSS version 21 software (IBM) and compared with the normal values obtained from a previous study. All facial angles, except for the nasofrontal angles, were significantly different between the surgical and nonsurgical normal groups. The values (means±SDs) in the surgical group were as follows: nasofacial angle, 29.7±3.4 degrees; nasofrontal angle, 146.2±2.8 degrees; glabella-nasal angle, 169.8±5.8 degrees; nasolabial angle, 113.5±11 degrees; nasomental angle, 130.6±6 degrees; nasal tip angle, 102.3±8 degrees; ala-slope angle, 95.4±13.6 degrees. The nose characteristics of Arabian women seeking rhinoplasty were as follows: (1) shallow radix, (2) under the projected tip, and (3) normal tip rotation. Surgical planning is important upon consideration of any procedure or modification of the nose among Arabian women.