The Incidence of Nasal Tip and Upper Lip Malposition in Primary Rhinoplasty

Abstract

Background In order to have an optimal aesthetic plan for correction of nasal tip disharmony, it is crucial to note lip and tip disproportions. Objectives This study sought to investigate the incidence of pre-operative upper lip malposition in primary rhinoplasty patients. Methods 150 consecutive primary rhinoplasty patients were included. The position of the upper lip was measured during smiling relative to the incisors and gum line, and categorized as ideal, inadequate incisor show, or excessive gum show. Nasal length was categorized based on soft tissue cephalometic analysis of lifesize photographs as long, ideal and short. Tip projection was categorized as over-projected, ideal and under-projected. Columella was categorized as hanging, ideal or retracted. Results Standardized photos of 139 primary rhinoplasty patients met inclusion criteria. 49(35%) patients had an ideal upper lip position, 83(60%) inadequate incisor show, and 7(5%) excessive gum show. Sixteen (12%) had a short nose, 45(33%) ideal length and 76(55%) a long nose. 14(10%) had an under-projected tip, 38(28%) an ideal tip projection and 85(62%) an over-projected tip. None of the nasal parameters were predictive of upper lip position. Tip over-projection (OR 3.03, p=0.02) and hanging columella (OR 2.97, p=0.001) were predictive of a long nose. Tip under-projection was predictive of short length (OR 35, p<0.0001). Conclusions There is a high incidence of upper lip malposition in patients undergoing primary rhinoplasty. It is vital for the rhinoplasty surgeon to identify it pre-operatively and plan the surgical maneuvers accordingly to prevent exacerbating an insufficient incisor show or excessive gum show.