Smile Analysis in Rhinoplasty

Kalantar-Hormozi, Abdoljalil; Beiraghi-Toosi, Arash

doi:10.1097/01.prs.0000436850.86785.24

Cited by 19 publications

(5 citation statements)

References 16 publications

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“…Previous postrhinoplasty studies attributed the dynamic nasal tip droop to the persistent hyperactivity of the NTDs, which was overlooked during surgery. 19,20 In the current study, we believe that hyperactive NTDs can favor the scarring forces, which act in a less projecting vector causing deterioration of the initial postoperative NTP even in static pause. Most of the scar remodeling phase occurs during the first 1 to 2 years postoperatively.…”

Section: Discussionmentioning

confidence: 64%

“…This outcome supported the previous studies, which presented the NTDs as a major cause behind the delayed deterioration of the aesthetic outcome in patients with hyperactive NTDs. 19,20,21 These previous studies used the changes in the NTP 19,21 and the NLA 20 as an objective tool to evaluate the aesthetic outcome after closed rhinoplasty. Certainly, measuring both parameters in an animated pause would represent a more objective evaluation tool.…”

Section: Discussionmentioning

confidence: 99%

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Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties

Elgazzar

Elshahat

Lashin

2022

Plastic and Reconstructive Surgery - Global Open

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Background: During smiling, the prominent action of nasal tip depressors (NTDs) antagonizes the rhinoplasty nasal tip support maneuvers and favors scarring forces‚ pulling the nasal tip in a less projecting vector. The NTDs' disinsertion is feasible through the open rhinoplasty approach. Yet, the reliability of the open approach to manipulate all NTD attachments is still questionable. The upper buccal sulcus approach (UBSA) is a reliable approach to manipulate variable anatomy of the NTDs. Methods: Thirty-two patients had primary open rhinoplasty between 2016 and 2020. All patients showed hyperactive NTDs during smile preoperatively. Through UBSA, disruption of NTDs was done. Aesthetic outcome was evaluated by comparing the pre/postoperative nasal tip projection (NTP) and nasolabial angle (NLA) in lateral views. Results:The sample included 28 women and four men, and the mean age was 30.7 years. The mean follow-up period was 23.8 months. Preoperatively, 53% (n = 17) of patients showed normal NTP measurements; this percentage increased to 87.5% (n = 28) postoperatively. The mean NLA for the 32 patients was 91.0 degrees pre-operatively‚ which was increased to 102.5 degrees postoperatively. These aesthetic results were maintained throughout the follow-up period‚ with no significant increase in the incidence of complications. Conclusions:The combination of the UBSA with open rhinoplasty resulted in objective visualization and manipulation of the NTDs. This was proven by the maintained NTP and NLA in aesthetic optimum values throughout the follow-up period. We believe that UBSA can be safely combined with open rhinoplasty as a reliable hidden approach to manipulate hyperactive NTD cases.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties

Elgazzar

Elshahat

Lashin

2022

Plastic and Reconstructive Surgery - Global Open

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“…Since the depressor septi is responsible for smiling deformity, correction of the same helps to improve both it and the tip-lip relationship. 19 An intranasal or open approach resection of this muscle is effective in correcting a drooping nasal tip because it prevents the inferior pull of the tip during smiling. Dissecting free from the accessories and sectioning the muscle and, if necessary, the accessory cartilages of the lower laterals has also been suggested because it benefits the ''tense nose'' aspect and smiling deformity.…”

Section: Discussionmentioning

confidence: 99%

“…The depressor septi muscle originates from the alveolar bone and inserts the footplates of the medial crus and caudal septum and interdigitates with the medial fascicles and orbicularis. Since the depressor septi is responsible for smiling deformity, correction of the same helps to improve both it and the tip-lip relationship 19 . An intranasal or open approach resection of this muscle is effective in correcting a drooping nasal tip because it prevents the inferior pull of the tip during smiling.…”

Section: Discussionmentioning

confidence: 99%

Cartilage Remodeling in Nasal Tip Rhinoplasty Using “Lateral Crural Steal” and “Tongue in Groove” Strategies: A Randomized Controlled Trial

Gentile

Cervelli

2021

Journal of Craniofacial Surgery

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Background: The authors present their experience using ''Lateral Crural Steal'' (LCS) and ''Tongue in Groove'' (TING) techniques in nasal tip remodeling. Objectives: The paper aimed to evaluate the efficacy and safety of the use of LCS and TING in nasal tip remodeling for aesthetic improvement. Methods: A randomized controlled trial was conducted. Thirty-five patients affected by low and boxy nasal tips were treated with LCS and TINGs (study group [SG]), comparing results with the control group (CG) (n ¼ 30) treated with cartilage grafts. The preoperative analysis has been performed with an accurate clinical evaluation, a photographic assessment, and a computed tomography scan. Postoperative follow-up took place at 1, 2, and 4 weeks, 3, 6, and 12 months, and then annually. Results: A total of 82.9% (n ¼ 29) of SG patients showed excellent cosmetic and functional results after 1 year compared with the CG patients, who showed the same results in only 40% (n ¼ 12) of cases. The tip projection maintenance and contour restoring in the SG were higher than that in the CG (P < 0.0001 versus CG). Conclusions: The use of LCS and TING was safe and effective in this series of cases performed.

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“…The depressor septi muscle originates from the alveolar bone and inserts the footplates of the medial crus and caudal septum and interdigitates with the medial fascicles and orbicularis oris 3 . Since the depressor septi is responsible for smiling deformity, correction of the same helps to improve both it and the tip-lip relationship 13 . An intranasal or open approach resection of this muscle has been shown to be effective in correcting a drooping nasal tip because it prevents the inferior pull of the tip during smiling 1 3 ; in our series this was the case in 4/41 patients (9.7%).…”

Section: Discussionmentioning

confidence: 99%

Approach to the correction of drooping tip: common problems and solutions

Giacomini

Rubino

Mocella³

et al. 2017

Acta Otorhinolaryngol Ital

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La punta cadente è una fastidiosa deformità estetica e funzionale del naso. Laspetto della punta è influenzato da aspetti sia statici che dinamici. Per questo motivo, appare logico tenere in considerazione questi fattori nel pianificare la correzione chirurgica di questa deformità. Molti studi hanno affrontato questo argomento, ma il trattamento resta controverso. Per rendere efficace la chirurgia della punta appare indispensabile identificare le caratteristiche anatomiche fondamentali della punta stessa. Diversi angoli e misure possono essere calcolati per definire la posizione della punta tra cui: langolo nasolabiale, lasse della narice, langolo di rotazione della punta in rapporto al piano di Francoforte, langolo columellare-facciale. Lobiettivo di questo studio è focalizzare lattenzione sulla nostra esperienza personale sulle alterazioni anatomiche del naso che meritano una correzione e sulle procedure chirurgiche necessarie per ottenere risultati soddisfacenti nel trattamento della punta cadente. Nel presente studio sono stati presi in considerazione la proiezione e la rotazione della punta pre e post-operatorie. La correzione della punta cadente è stata ottenuta mediante settorinoplastica aperta o chiusa a seconda dei casi. La tecnica prevalentemente usata per riposizionare la punta è risultata essere il raddrizzamento del setto (41/41 casi) e la tecnica Tongue-in-groove (36/41 casi) (87,6%). Lo strut columellare è stato impiegato in 8/41 pazienti (19,51%). Resezioni cefaliche delle cartilagini alari sono state applicate in 29/41 pazienti (70,73%). Suture per ri-orientare le cartilagini alari sono state impiegate in 18/41 casi (43,9%). Il Lateral crural overlay è stato necessario in 2/41 casi (4,8%). Il presente articolo rivaluta le principali varianti anatomiche del naso che meritano correzione e le tecniche chirurgiche utilizzabili per semplificare il processo decisionale preoperatorio.

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Smile Analysis in Rhinoplasty

Abstract: Therapeutic, II.

Cited by 19 publications

References 16 publications

Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties

Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties

Cartilage Remodeling in Nasal Tip Rhinoplasty Using “Lateral Crural Steal” and “Tongue in Groove” Strategies: A Randomized Controlled Trial

Approach to the correction of drooping tip: common problems and solutions

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