Tip Projection Research Articles

Indications, Stability, and Surgical Outcomes of Using Osteochondral Nasal Septal Graft as a Septal Extension Graft in Rhinoplasty Patients: A Prospective Cohort Study.

Septal extension graft (SEG) is an adaptable tool that controls, supports, and stabilizes the nasal tip projection, rotation, length, and shape. Recent studies comparing SEGs to more conventional columellar strut grafts found that SEGs provided improved results. This prospective cohort study included 66 patients divided into 2 groups based on their indications. Group 1 was patients who underwent septorhinoplasty using osteochondral septal extension graft (OSEG), and group 2 underwent septorhinoplasty using cartilaginous SEG. The main reason for undergoing OSEG was insufficient septal cartilage (P<0.001). The outcomes were not significantly different between both groups, with the % of patients who experienced positive outcomes ranging from 78.8% to 97%. The OSEG is a safe, valid, and effective option in septorhinoplasty that can be used in patients with insufficient cartilaginous septum.

Comparison of Anthropometric and Cephalometric Measurements Obtained by Stereophotogrammetry and 3D Computed Tomography of the Nose Before Septorhinoplasty.

Computed tomography (CT) is normally used in evaluation of patients with esthetic and functional nasal deformities. Stereophotogrammetry (SPG) is a measurement device that is an alternative to CT and does not harm human health. In this single-center retrospective study, we aimed to evaluate measurements obtained with CT and SPG. The measurements of 18 patients who applied to our clinic between January 2022 and August 2022 and planned for septorhinoplasty were performed on both 3D images obtained with paranasal sinus CT and SPG device (SLR type Vectra H1 system). Measurements included that dorsocolumellar length, columella-filtral length, nasal tip projection ratio (dorsocolumellar length/columella-filtral length), columella-labial angle, nasofrontal angle, tip deviation direction, tip deviation angle, tip deviation distance and dorsal nasal hump. Most of patients were male (61.1%). Mean age was 24.5 years. Only columella-labial angle measurements showed a low level of significant difference (p<0.05). However, there was no significance difference in other measurements (p>0.05). A significant strong correlation was observed between all Vectra and CT measurements (p=0.000). SPG device can be applied quickly in polyclinic without giving radiation to patient. Measurements can be taken automatically using a software. Its use in postoperative period does not carry any risk. Disadvantage of SPG is lack of information about internal nasal passage. However, there is a strong correlation between measurements obtained from both measurement devices. Therefore, SPG can be considered as an alternative to CT imaging in operation planning. 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 .

Use of Auricular Composite graft in Rib-Cartilage based Rhinoplasty for Contracted Nose Correction.

This study investigated the effects of combining an auricular composite graft with rib cartilage-based rhinoplasty to correct contracted noses in Asian patients with a history of multiple previous operations. A total of 43 patients were included in the retrospective analysis of secondary rhinoplasty procedures. The surgical approach involved short-nose correction, utilizing rib cartilage for septal extension grafts and chondrocutaneous composite grafts harvested from the conchal part of the ear for internal nasal lining reconstruction. Our assessment encompassed clinical outcomes, the occurrence of complications, and the utilization of three-dimensional (3D) photography for nasal measurements at the preoperative, 3-month, and 1-year postoperative stages. Regarding graft survival, 12 (27.9%) patients showed >80% graft engraftment, followed by 29 (67.4%) patients with 50%-80% graft engraftment, and 2 (4.6%) patients with 20%-50% graft engraftment. Two of these patients required wound irrigation for infection control and additional repair and were finally discharged without significant nasal deformity. At 3 months postoperatively, 3D anthropometry showed significant differences in nasal dorsum length (4.46 ± 1.79 mm), nasal height (1.25 ± 1.25 mm), nasal tip projection (4.06 ± 1.76 mm), and columellar-labial angle (22.75° ± 14.19°). No significant relapse of nasal parameters was noted 1 year postoperatively. Auricular composite graft combined with rib cartilage-based rhinoplasty enables the comprehensive restoration of nasal structures, addressing the inner, intermediate, and outer layers. This approach can serve as an effective and sustainable option for correcting contracted noses in Asian patients who have undergone multiple operations.

3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial.

Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. Randomised clinical trial. Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). Changes in facial and nasolabial morphology. Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

Quantification of Gravitational Effects on Nasal Tip Geometry

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

The comparison of 1-year results for mini and wide-size cap grafts applied to nasal tips.

In the present study, we evaluated patient satisfaction with cap grafts by Rhinoplasty Outcomes Evaluation (ROE) scores. Mini cap and wide cap grafts were applied. A total of 80 patients who underwent a rhinoplasty operation with cap graft application to the tip region were included in the study. According to the cap graft size, there were two groups: Group 1 consisted of 40 patients with cap graft size ≤7 cm (mini cap group). Group 2 comprised 40 patients with cap grafts ≥8 cm (wide cap group). Patients in groups 1 and 2 underwent evaluations based on the following criteria at preoperative, postoperative-1st month, and postoperative-1st year intervals: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. Postoperative 1st-month and 1st-year ROE scores of the wide cap group were significantly higher than those in the mini cap group (p<0.05). Preoperative tip projection ratio (Goode) values of the wide cap group were considerably higher than those in the mini cap group (p<0.05). There were no significant differences between tip projection, nasal dorsum length, nasofrontal angle, and nasolabial angle values of the mini cap and wide cap groups (p>0.05). Correlation tests showed that as preoperative ROE scores decreased, postoperative-1st month and 1st-year ROE scores increased (p<0.05). Postoperative 1st-month and postoperative 1st-year's ROE scores increased together (p<0.05). In the wide cap group, postoperative 1st-month and postoperative 1st-year's ROE scores increased compared to the mini cap group (p<0.05). As postoperative 1st-year nasolabial angle values increased, postoperative 1st-year ROE scores also increased (p<0.05). We found that patients who received wide-cap rhinoplasty had increased postoperative ROE scores and higher satisfaction rates during the first month and first year. Postoperative higher nasolabial angle values were related to higher ROE scores and patient satisfaction in the postoperative 1st year.

New Concept for Articulated Alar Rim Graft Positioning.

The articulated alar rim graft (AARG) proposed by Davis is a simple and effective method for avoiding and correcting most alar rim deformities in rhinoplasty. In addition to its benefit for the nasal ala, the position suggested herein allows for a precise definition of the facet polygon and infratip lobule. A retrospective series of 317 patients surgically treated with the modified AARG positioning were evaluated. The height of the septal extension graft was always a few millimeters above the new dome, without demanding excessive lateral crural tensioning (LCT), and the AARG itself was fixed more on the facet polygon and infratip than in the standard procedure. The results were favorable after 1 year of follow-up. The proposed AARG modification yielded good nasal tip projection and definition without excess LCT, enhanced the facet polygon and supra-alar sulcus, and stretched the skin downward. Functional gain was reported by most patients. Few minor and common complications were reported. The use of this modified AARG position can avoid and correct most alar deformities, with the added benefit of providing better control over tip definition without the need for excessive LCT or overprojection of the nose.

Secondary Bilateral Cleft Rhinoplasty: Achieving an Aesthetic Result.

Secondary rhinoplasty in patients with bilateral cleft lip poses ongoing challenges and requires a reliable method for achieving optimal outcomes. The purpose of this study was to establish a safe and effective method for secondary bilateral cleft rhinoplasty. A consecutive series of 92 skeletally matured patients with bilateral cleft lip and nasal deformity were included. All had undergone secondary open rhinoplasty, performed by a single surgeon with a bilateral reverse-U flap and septal extension graft, between 2013 and 2021. Medical records of these 92 patients were reviewed to assess the clinical course. A 3-dimensional (3D) anthropometric analysis and panel assessment of 32 patients were performed to evaluate the aesthetic improvement, with an age-, sex-, and ethnicity-matched normal control group for comparisons. The methods showed statistically significant improvement in addressing a short columella (columellar height), short nasal bridge (nasal bridge length), de-projected nasal tip (nasal tip projection, nasal dorsum angle), poorly defined nasal tip (nasal tip angle, dome height, and panel assessment), and transversely oriented nostrils (columellar height, alar width, nostril type). Importantly, these improvements were accompanied by a low complication rate of 4%. However, upper lip deficiency over the upper lip angle and labial-columellar angle remained without significant improvement. In this study we described effective secondary rhinoplasty, which was composed of a bilateral reverse-U flap and septal extension graft, with acceptable outcome. The 3D anthropometric analysis and panel assessment clarified that our rhinoplasty procedure could bring the nasal morphology in these patients closer to the normal data.

Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture.

The optimal timing of rhinoplasty for patients with nasal bone fractures remains controversial. We investigated whether the timing of rhinoplasty after nasal trauma affects the aesthetic outcome of the procedure. A total of 41 adult patients with nasal bone fractures who underwent rhinoplasty between 2006 and 2021 were enrolled in this study. A visual analog scale (VAS) was used to indicate the assessor's satisfaction with the surgical outcome after a comparison of the pre- and postoperative facial photographs of each patient. Of the 41 patients, 28 underwent rhinoplasty within 14 days after nasal trauma (early rhinoplasty group), whereas 13 underwent rhinoplasty more than 14 days after nasal trauma (late rhinoplasty group). The rate of receiving spreader and shield graft was higher in the late rhinoplasty group (p = 0.043 and 0.018, respectively). Patients with type IV or V nasal bone fracture and patients with preoperative saddle noses had higher VAS scores than those with types I to III fractures and those without preoperative saddle nose (p = 0.003 and 0.020, respectively). There was no significant difference in overall aesthetic outcome between the early and late rhinoplasty groups. Both groups achieved significantly better radix height, dorsal height, and tip projection after rhinoplasty. The aesthetic outcome of rhinoplasty performed in the early posttrauma period is comparable with that of rhinoplasty performed more than 2 weeks after nasal bone fracture. Rhinoplasty can be considered a safe surgical treatment option for nasal bone fracture, even in the early posttrauma period. LEVEL OF EVIDENCE: : 4.

Decreased Tip Projection and Tip Stiffness Due to A Calcified Septal Extension Graft.

A septal extension graft is frequently applied in esthetic rhinoplasty in Asia. Autologous cartilage is usually selected for the graft material, and nasal septal cartilage is the most commonly used in septal extension grafts. Although the complication rate is reported to be very low, the authors recently encountered a patient who complained of decreased nasal tip projection and stiffness of the nasal tip. The patient had previously undergone a rhinoplasty, including dorsal augmentation with silicone implant and septal extension graft with septal cartilage. Based on the images, the authors hypothesized that the septal extension graft was calcified, and the intraoperative findings confirmed severe calcification of the previously inserted septal cartilage graft. Herein, the authors report the case of a patient with decreased tip projection and stiffness due to calcification of a previous septal extension graft that used septal cartilage and share the lessons the authors learned from this case.

Cog graft, a new septal extension graft for designing nasal tip rotation and projection in rhinoplasty

BackgroundAdjusting the nasal tip rotation and tip projection according to the patient's face and wishes is a very important stage in rhinoplasty with the use of a cog graft positioning the tip point in the appropriate place is possible by adjusting the nose length, tip projection and tip rotation together. ObjectiveThe aim of this study is to facilitate positioning the tip rotation and projection in the appropriate place according to the patient's needs in rhinoplasty with Cog graft. Materials and methodsCog graft was applied in 32 patients who underwent rhinoplasty. Cog graft was prepared from costal cartilage in 10 patients and from septal cartilage in 22 patients. Cog graft was prepared by shaping the superior edge of the septal extension graft like a gear wheel. It is fixed to provide desired projection to the caudal septum. In the position where rotation and projection are evaluated adequately, the graft is fixed with sutures. They were followed in average 18 months (between 6 and 24 months). ResultsTwenty of the patients were primary cases and 12 were revision cases. The targeted rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. ConclusionsCog graft is a useful graft with which we can adjust the nose length, projection and rotation appropriately and in a short time with a single graft.

Reconstruction of Scroll and Pitanguy's Ligaments in Open Rhinoplasty: A Controlled Randomized Study.

In the preservation rhinoplasty era, ligament management represents a hot topic. The aim of this study is to analyze the role of ligaments as indispensable elements of support of the nasal tip to have an adequate, safe, and predictable aesthetic and functional result. Patients meeting the following criteria were included in the study: primary rhinoplasty, minimum 2-year follow-up, proficiency in Italian language, signed consent, and standardized pre- and postoperative photographic documentation. The study was performed with a double-blinded randomized design; both the patients and two of the authors measuring outcomes were blinded to the treatment methods. All patients were asked to answer the FACE-Q satisfaction with the nose postoperative scale. Two plastic surgeons reviewed all postoperative photographs, rating the outcome on a 1-5 VAS scale. One hundred and twelve patients were enrolled, 47 males and 65 females, aged between 20 and 50years. Patients were randomly divided in three groups: group 1, ligament reconstruction and grafts; group 2, only grafts (shield, single and double onlay, umbrella); and group 3, only ligament reconstruction with columellar strut. All rhinoplasties were performed with an open approach. Both the FACE-Q and VAS scores were in groups 1 and 2, which were also the ones undergoing fewer secondary procedures compared to group 3. The best surgical option appears to be the combination of ligament repair and grafts. It reduces dead space and enables a better redraping of soft tissues, obtaining a better control of tip projection, position, and rotation. 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 .

Use of a Space Graft in Rhinoplasty.

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

Essential Role of Columellar Strut Graft on Projection and Rotation of Nasal Tip in Open Rhinoplasty

Essential Role of Columellar Strut Graft on Projection and Rotation of Nasal Tip in Open Rhinoplasty

Effect of Nasal Tip Reshaping on Tip Projection in Primary Rhinoplasty without Cartilage Grafting from a Second Donor Site in an Asian Population

Objectives: Many Asian patients with nasal aesthetic surgery desire a sharper, more defined nasal tip. In many cases, their nasal cartilage is not abundant enough, necessitating cartilage transplantation from an extranasal location. We investigated which patients would qualify for a method of reshaping the nasal tip without needing donor cartilage by reshaping the lower cartilage using the transdomal suture technique and local cartilage grafting.Methods: We performed a single-center retrospective cohort study of patients undergoing nasal tip surgery. We divided patients into two groups. Group 1 comprised 13 patients with nasal tips with thin skin and soft tissue and relatively abundant cartilage. Group 2 included 31 patients with nasal tips with thicker, firmer skin and soft tissue and a smaller amount of cartilage. No patients had prior nasal surgery, and all patients were followed up for at least 3 months. Patients in both groups underwent the transdomal suture technique and local cartilage grafting. Five patients in Group 2 underwent alar reduction. Preoperative and postoperative lateral view photographs were superimposed and analyzed to measure changes in tip projection.Results: Patients in Group 1 showed a mean increase in tip projection of 3.9%. Patients in Group 2 demonstrated a mean decrease in tip projection of −1.5% without alar reduction and −5.6% with alar reduction.Conclusions: If the nasal tip is predominantly cartilaginous, patients may undergo surgery that does not involve donor cartilage from another site with good results. However, most patients, who have a relatively small amount of nasal tip cartilage, are not good candidates for this procedure.

Discussion: Controlling Supratip Break and Tip Rotation and Projection with Preservation of the Pitanguy Ligament.

Discussion: Controlling Supratip Break and Tip Rotation and Projection with Preservation of the Pitanguy Ligament.

Long-Term Maintenance of Nasal Tip Projection and Rotation with the Columellar Strut Graft

Long-Term Maintenance of Nasal Tip Projection and Rotation with the Columellar Strut Graft

Correction of nasal tip deformity using an island flap of nasal dorsum

Bifid nose is a rare congenital malformation, and few cases have been reported due to its low incidence. Herein, we report a new surgical procedure to treat patients with excess dorsal nasal tissue and an underfilled tip.A total of 22 patients with bifid nose deformities underwent surgery at our institution between 2012 and 2022. They were characterized by broad nasal dorsum and a missing or underdeveloped nasal tip. We designed an innovative island flap of nasal dorsum as a new surgical method for treating this type of bifid nose deformities. Nasal length, tip projection and photographs of nose morphology were obtained before and after the surgery. Outcomes, complications, indications and patient’s satisfaction were analyzed and interviewed.The follow-up time ranges from 6 to 33 months (8.7±5.5 months). The deformity was successfully corrected with improved nasal appearance. Nasal length increased from initially 4.2±0.3mm to 4.6±0.3mm. Tip projection reached to 19.9±4.0mm, which was 15.7±2.9mm before surgery. No serious complications were observed except poor venous reflux within postoperative 72hours in 4 cases. Six patients (27.3%) got moderate healing and acceptable scar, and 14 patients (63.6%) got good healing. Most patients were very satisfied with the outcome (93.9%).The newly designed nasal dorsum island flap is a safe and effective technical approach to correct nose deformity featured by broad nasal dorsum and a missing or underdeveloped nasal tip.

Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial.

The stability of nasal tip rotation and projection, and providing a flexible nasal tip, are important elements in rhinoplasty. Two common options to provide these requirements are the septal extension graft (SEG) and the columellar strut graft (CSG). This study aims to compare nasal tip stability and flexibility between the 2 graft options. A prospective randomized study was carried out in 60 patients operated on with either the CSG or the SEG. Tip rotation and projection stability were analyzed with photographic evaluation at the immediate postoperative period, the first month, and the first year. Nasal tip flexibility was evaluated with a newton meter at the preoperative period and postoperative first, third, and sixth months and the first year. The CSG showed a significant loss of projection and rotation, whereas the SEG showed better preservation of projection and rotation. However, both options showed a greater loss of projection and rotation in the first month and then a slight decrease in the following months. Although the SEG had lesser flexibility compared with the CSG anteroposteriorly, there was no flexibility difference between them in the lateral direction in the long term. The SEG provides better nasal tip stability compared with the CSG. The greatest downside of the SEG is decreased flexibility compared with the CSG. Surgeons should be aware of the loss of projection and rotation with both graft options and adjust their operation plan according to these points. Therapeutic, II.

Septal Extension Graft in Cleft Rhinoplasty: Patients with Secondary Unilateral Cleft Lip Nasal Deformity.

Tip refinement procedures are still controversial in secondary unilateral cleft rhinoplasty. The aim of this study was to assess whether the septal extension graft improved nasal and tip deformity and achieved a normal profile with clinical and three-dimensional morphometric analyses. A consecutive series of 194 skeletally mature patients with unilateral cleft were included and analyzed. All had undergone secondary open rhinoplasty, performed by a single surgeon, with the use of the septal extension graft between 2013 and 2021. Clinical data were collected, and three-dimensional morphometric measurements were performed. An age-, sex-, and ethnicity-matched normal group was included for comparisons. The authors' standard procedures included open approach combining reverse-U incision, septal extension graft, dorsal augmentation, lip revision, and vermilion augmentation. The postoperative outcome showed significantly increased numerical values (nasal bridge length, nasal height, nasal tip projection, nasal dorsum angle, columellar angle, columellar-lobule angle, nostril height ratio, nasal surface area, nasal volume) and decreased numerical values (alar width, tip/middle deviation, nasal tip angle, labial-columellar angle) compared with the preoperative morphology. The postoperative measurement showed significantly higher numerical values (nasal protrusion, tip/middle deviation, nasal dorsum angle) and lower numerical values (columellar-lobule angle, nostril height ratio, alar width ratio) compared with the control group. This study revealed that the authors' secondary cleft rhinoplasty significantly improved the underprojected, up-rotated, deviated, and poorly defined tip and short nasal bridge deformities. The technique could result in the nose of the patients with cleft lip nasal deformity being closer to that of the normative profile. Therapeutic, IV.