Surgery of the naso-frontal angle

Rhinoplasty with Fillers and Fat Grafting

Nonsurgical rhinoplasty is one choice for cases in which open surgery may be harmful, the deformity is not indicated to correct with open surgery, or in patients who have phobia of general anesthesia or any type of surgery. Autologous fat injection or fillers are most common materials currently available in the market. In this article, we explain the indications, contraindications, methods, and complications of this treatment.

Fat Grafting to the Forehead/Glabella/Radix Complex and Pyriform Aperture: Aesthetic and Anti-Aging Implications

BACKGROUND

Optimal aesthetic outcomes from rhinoplasty are heavily influenced by structures adjacent to the nose. Although the importance of the chin has been emphasized since the inception of rhinoplasty, little attention has been given to the forehead. The forehead/glabella/radix complex represents a vital triad in rhinoplasty, from which the nasofrontal angle is derived. In the present study, the authors sought to determine whether fat grafting to the forehead/glabella/radix complex and pyriform aperture can favorably impact the nasofrontal and nasolabial angles, respectively.

METHODS

The authors reviewed pre- and postoperative images (obtained by an independent professional photographer) of patients who underwent autologous fat grafting to the forehead/glabella/radix region and the pyriform aperture, with or without concurrent rhinoplasty. Nasofrontal and nasolabial angles were measured on lateral images. Mean pre- and postoperative values were calculated and compared. A Wilcoxon rank-sum test was used for statistical analysis.

RESULTS

Twenty-six patients underwent fat grafting alone (FG group; mean follow-up, 3.3 years), and 19 had fat grafting plus rhinoplasty (FG + R group; mean follow-up, 5.2 years). The mean nasofrontal angle in the FG group decreased by 2.0° (P = 0.005), and the mean nasolabial angle increased by 2.3° (P = 0.006). The mean nasofrontal angle in the FG + R group decreased by 2.0° (P = 0.011), and the mean nasolabial angle increased by 6.0° (P = 0.026).

CONCLUSIONS

Autologous fat grafting to the forehead/glabella/radix complex and pyriform aperture is a reliable method to favorably influence the nasofrontal and nasolabial angles, respectively. Such treatment optimizes the interplay between the nose and the adjacent facial features, enhancing overall aesthetics.

Analysis of the midface, focusing on the nose: an anthropometric study in young Koreans

Improvements in both living standards and incomes have meant that many more people are now able to undergo elective plastic surgery for facial improvement. The nose and midface are the most frequent surgical target in Korea. However, the lack of reliable and precise anthropological data is a hindrance for effective surgical applications in this area. In the current study, 21 different lengths and angles of the midface and nose were measured in 2065 volunteers. The data were analyzed to establish sex and racial differences. Most of the measurements obtained from male volunteers were 5% to 10% greater than for the females, exceptions being the nasofrontal, nasolabial, and nasal tip angles. The biggest sex difference was found for depth of pupil, and the smallest difference was for intercanthal distance. For each measurement, the ratio of proportional differences was similar to that for whites. Many Koreans exhibited a columella protrusion of 4 to 5 mm; that parameter measures 2 to 3 mm in whites. The prevention of a hanging columella is important in nasal tip surgery. The intercanthal distance was also relatively large compared with the facial width. In females, the intercanthal distance was similar to the length of the nasal dorsum and the width of the nose. Surgeons may find this analysis useful for surgical planning. The present study provides basic clues for planning and practice in reconstructive and aesthetic facial surgery.