Surgical Treatment of the Nasolabial Angle in Balanced Rhinoplasty

Abstract

Aesthetic rhinoplasty is a complex surgical procedure that contains numerous components; when performed harmoniously, it should yield a successful, balanced result. The process begins with a comprehensive nasal analysis and surgical planning. Many surgeons concentrate on altering the nasal dorsum and nasal tip but may ignore potential contributions to overall appearance from the caudal nasal septum and nasal spine. One of the key parameters for evaluation and aesthetic treatment of the nose is the nasolabial angle. The nasal spine, caudal septum, and the medial crura of the lower lateral cartilages provide the framework for this area. Alteration of these structures, as well as nasal tip rotation and projection, may affect the resultant nasolabial angle, length of the upper lip, and overall harmony of the nose. Fullness at the nasolabial junction by a pushing philtrum may also result in an unbalanced appearance. The literature is replete with methods for categorizing the nasal tip and recommended surgical treatments. Treatment of the caudal septum and the nasal spine is often an afterthought that is left to the aesthetic judgment of the surgeon. A chart-with recommended treatment for the caudal septum and nasal spine following appropriate profile analysis-is included in the interest of a more systematic process. The chart takes account of the length of the nose, nasolabial angle, and possible presence of a pushing philtrum with suggested treatments to allow for proper tip placement and aesthetic balance to the nose. Adherence to this process provides a valuable tool for assuring a harmonious result in rhinoplasty.

“Are We Similar to Caucasians”: Orthognathic Surgery for North Indians

“…If Lefort I osteotomy with superior repositioning is planned in these patients, partial resection of anterior nasal spine with or without resection of caudal portion of the septum [22], might have to be considered.…”

Effect of the Depressor Septi Nasi Muscle Modification on Nasal Tip Rotation and Projection

“…2b). Based on the encountered results, we categorized postoperative changes in tip rotation and projection as the following: (1) unchanged (remaining at the same preoperative range), (2) improved (change into the normal range), and (3) worse (become out of the normal range).…”

“…Among these structures are the depressor septi nasi muscles (Fig. 1), which are small, paired muscles located on either side of the caudal septum [2][3][4][5]. Three variations of the depressor septi nasi muscle have been described: type I inserts fully into the orbicularis oris (the most common type), type II inserts into the periosteum and incompletely into the orbicularis oris, and type III is rudimentary or does not exist at all [6].…”

“…The action of this muscle may accentuate a drooping nasal tip and shorten the upper lip in both static and dynamic situations [2,6,7]. Although several surgeons have pointed out modification of the depressor septi nasi muscle during rhinoplasty, controversy still exists over it [2][3][4][6][7][8][9][10][11][12][13][14][15][16][17].…”

Maxillary Advancement Surgery and Nasolabial Soft Tissue Changes

“…Combined orthodontic and surgical procedures are used to correct facial deformities 13 . Improvement in soft tissue appearance is the prime motivating factor for the majority of the patients 13 . Surgical movement of bony segment and orthodontic movement of the teeth both influences overlying soft tissue.…”