Association of Increasing Nasal Tip Projection With Lip Position in Primary Rhinoplasty

Abstract

ip modification is an integral part of rhinoplasty. It is arguably the most difficult and complex part of the procedure owing to the many variables that can be altered. Besides changing the shape of the nasal tip, several of the maneuvers in rhinoplasty involve changing the tip location, whether that is projection and/or rotation. These alterations are used during both cosmetic and functional rhinoplasty. Although several studies have focused on evaluating how tip modifications affect other regions of the nose along with its overall appearance, the data assessing how these maneuvers affect adjacent facial structures are more limited. 1,2 The 2 most common techniques to increase tip projection are placement of a columellar strut and performing a tongue-in-groove maneuver. The columellar strut graft is a tailored piece of cartilage that is placed between the medial crura of the lower lateral cartilages and spans from the premaxilla to the nasal tip. 3 According to the tripod theory of nasal tip support by Anderson, 4 it can be visualized how this graft pushes the tip outward and how the rest of the nose responds. This maneuver is usually performed when the patient's septal length is within the normal limits. If a patient has a longer septum, however, the medial crura can be set back and sutured onto the septum. In doing so, the placement of this suture will dictate the location of the tip. The technique of suturing the medial crura to the caudal septum is called a tongue-in-groove maneuver. 5 If the patient has a shorter septum, a caudal septal extension graft can be placed, followed by a similar tonguein-groove maneuver. IMPORTANCE The effects of rhinoplasty maneuvers on adjacent facial features are an important component in preoperative planning and patient counseling. Tip projection modifications are commonly performed in both cosmetic and reconstructive rhinoplasty. OBJECTIVE To evaluate the subsequent change in lip projection that results from increasing nasal tip projection. DESIGN, SETTING, AND PARTICIPANTS In this case series, 20 patients underwent primary rhinoplasty with the objective of increasing tip projection during the period from October 1, 2014, to September 25, 2015. Preoperative and postoperative photographs were evaluated. MAIN OUTCOMES AND MEASURES The increased tip projection was verified using the Goode ratio. Upper lip projection was calculated by the Z angle, which is based on the intersection between the Frankfort horizontal plane and the profile line. Vermilion height was also assessed. RESULTS Of the 20 patients in the study (19 females and 1 male; mean [SD] age, 26.8 [10.2] years; range, 16-52 years) 18 (90%) demonstrated an increase in upper lip projection when the tip projection was increased by either a columellar strut or tongue-in-groove maneuver. The Z angle demonstrated a statistically significant decrease of 2.7°(95% CI, 1.5°-3.9°; P < .001). Although the vermilion height did not change a significant amount, there was a trend toward an increase in mean height of 0.051 (95% CI,-0...

Effects of open rhinoplasty on upper lip position in profile and frontal views

“…16 The importance of current study was the assessment of lip position in profile view. Cerrati et al (2017) evaluated the increased nasal tip projection on lip position. 6 They assessed the lip position at the level of vemillion and concluded that upper lip would be more projected as the nasal tip projection is increased.…”

“…Cerrati et al (2017) evaluated the increased nasal tip projection on lip position. 6 They assessed the lip position at the level of vemillion and concluded that upper lip would be more projected as the nasal tip projection is increased. 6 The other anatomical landmark that should be considered in evaluating the lip position in profile view is subnasal area.…”

“…6 They assessed the lip position at the level of vemillion and concluded that upper lip would be more projected as the nasal tip projection is increased. 6 The other anatomical landmark that should be considered in evaluating the lip position in profile view is subnasal area. The changes of upper lip in lateral view are important in camouflage of the premaxilla region in some cases.…”

“…Therefore, examining the upper lip position as an influential indicator of facial and smile beauty as well as factors affecting its position are becoming more important. 6 On the other hand, the patient and, in turn, the surgeons are always worried about the surgical outcomes. 7 Therefore, potential dissatisfaction of the patients following rhinoplasty can be reduced by considering the upper lip position before the surgical procedure and the surgical effects on the lip position as an influential indicator on treatment outcomes.…”

The Effect of Nasal Tip Rotation on Upper Lip Length and Projection

“…Diğer yandan yaptıkları 20 hastayı içeren çalışmada, ÜDP'nin tip cerrahisi menevralarıyla artışı sonucu "Z" açısının azaldığını vurgulamışlardır. 18 Çalışmamızın sonuçları da Cerrati ve Dayan'ın çalışmasıyla aynı paralellikte nazal tip rotasyonu ve projeksiyonunun ÜDP üzerinde artırıcı, Z açısında azaltıcı bir etki oluşturduğunu göstermektedir. Bu bilgilerden yola çıkarak, tip rotasyonu sonucu oluşan üst ÜDP artışının, hastalara daha genç bir görünüm sağlayabileceği sonucu çıkartılabilir.…”