Effects of the Rhinoplasty Maneuvers on Upper Lip Position and Incisor Show

Impact of Tongue-in-Groove Technique on Smile and Lip Position: A Comparative Analysis with and without Septal Extension Graft

This study was conducted to compare the outcomes of the tongue-in-groove (TIG) technique with and without septal extension graft (SEG) on smile and lip position in rhinoplasty. Fifty-eight rhinoplasty patients, treated at a tertiary referral center between 2020 and 2022, underwent preoperative and 12-month postoperative evaluations, using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and the visual analog scale (VAS). The preoperative and 12-month postoperative photographs were analyzed using Adobe Photoshop to assess changes in lip and smile positions. The study included 38 patients in the TIG with SEG group and 20 patients in the TIG without SEG group. The participants, with an average age of 32.12 ± 7.97 years, comprised 81% females. In terms of surgical outcomes, postoperative evaluations revealed significant improvements in the VAS aesthetic score, SCHNOS-O score, and SCHNOS-C score compared with preoperative scores (p < 0.001) for both groups. Notably, both groups demonstrated significant improvements in the upper lip length, nasolabial angle (NLA), columellar inclination (CI) angle, and smile NLA. Patients in the SEG group exhibited markedly superior SCHNOS-O results, as well as distinctions in smile NLA and smile CI, compared with the group without SEG. The impact of rhinoplasty techniques on lip and smile remains complex requiring further evaluation. Both of the TIG techniques, with and without SEG, resulted in positive outcomes in terms of improving lip and smile positions, with the use of SEG demonstrating greater stability during a smile.

Effect of Tongue-in-Groove Technique on Upper Lip Slope in Rhinoplasty

BACKGROUND

Several surgical techniques used for rhinoplasty can change the upper lip form over the long term. By eliminating the membranous septum and causing dysfunction of the depressor septi nasi muscle and performing other maneuvers, the tongue-in-groove (TIG) technique can exaggerate changes in the upper lip shape, length, and slope.

METHODS

This study was conducted to compare the effects of the TIG technique with and without a septal extension graft (SEG) on lip slope and aesthetic angles on the profile view. A retrospective review was performed on 367 patients who underwent primary rhinoplasty using the TIG technique from 2016 to 2020. The upper lip angle (ULA), the nasolabial angle (NLA), and the columellar facial angle (CFA) were measured for comparison pre-and post-operatively.

RESULTS

Of 367 patients, 209 underwent TIG, while the rest underwent TIG over SEG (TIG+SEG). Comparison of pre-and post-operative ULAs showed significant changes in both groups. Although mean ULAs increased in both groups, some of the patients in each group experienced a decrease in ULA. The percentage of the patients with increased post-operative ULA significantly grow with increase in the pre-operative NLA (p < 0.05). However, no significant correlation was found between pre-operative CFA and post-operative ULA.

CONCLUSION

The present study suggests that TIG with and without SEG can change the lip slope on the profile view, possibly due to the shift of the subnasal point superiorly and posteriorly.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Innovation in Aesthetic Plastic Surgery: An International Collaborative Effort

An overview of the importance of international contributions to the advancement of aesthetic plastic surgery is presented, with emphasis on why, how and where in our specialty does innovation take place. The reason for innovating is clear: to improve on the quality of care patients receive today, through research and education. In order to do so, innovators must be either visionaries, advancers or popularizers of a new technique and they must have an exhaustive knowledge in a specific field, an intrinsic motivation to pursue work in that field and a capacity to solve problems in an original way.  The four areas of advancement in aesthetic plastic surgery are outlined, including better aesthetic results, better and faster patient recovery, increased patient safety and better surgeon experience. The three stages of development of our specialty are described as well, beginning with the creation stage in the late 1870s, in which the correction of evidently altered structures was undertaken; the establishment stage, which began in the late 1960s with the study and correction of surgical stigmata, the detailed analysis of surface aesthetics and later with the rise of minimally invasive procedures; and finally, the refinement stage that we have witnessed over the past few years, in which natural movement and feel are also considered essential in order to achieve successful aesthetic outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Economizing the Septal Cartilage for Grafts During Rhinoplasty, 40 Years' Experience

BACKGROUND

During rhinoplasty, it is typically necessary to use cartilage to shape and support the final nasal construct to provide both form and function to the nose (Tanna et al. in Plast Reconstr Surg 141(1):137e-151e, 2018; Guyuron in Plast Reconstr Surg 105(6):2257-2259, 2000; Kim et al. in Ann Plast Surg 65(6):519-523, 2010). The septal cartilage is the ideal graft both for its ease of access and quality of cartilage. However, this graft is a limited resource, and economy of its use is important as to negate the need to harvest cartilage from the ear or rib.

THE PURPOSE

1. To share the senior author's 40 years' experience with the economy of septal cartilage. 2. To identify the areas of the septal cartilage most suitable for a particular graft. 3. To discuss the common grafts that are used in rhinoplasty. 4. To identify when other sources of cartilage are needed and where to best use those grafts. 5. To present option for preservation of the leftover septal cartilage.

CONCLUSION

Overall consideration should focus on the size, thickness, and curvature of the graft contemplating the structural and functional needs of the rhinoplasty maneuvers.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

Examining the upper lip position is a key indicator of facial beauty. This study aimed to examine the upper lip position following cosmetic rhinoplasty at the frontal and profile views. The medical records of 67 patients who underwent rhinoplasty with no history of any facial skeletal surgery were obtained from archives. Complete preoperative and postoperative photos including the profile view at rest and the frontal view at rest, were prepared and analysed using Adobe Photoshop CC 2015 software. Interpupillary distances of two eyes in frontal views and Glabella to Pogonion (POG) distance in profile views were considered as fixed landmarks to calibrate the preoperative and postoperative photos. Upper lip length, subnasal area, and vermilion points were marked and compared between preoperative and postoperative photos. Data analysis was carried out using one-sample t-test and p<0.05% was considered as the significant level. Lip length (frontal view) was increased in 46 subjects. There were changes in the profile view of vermilion and subnasal positions in 56 patients and 53 patients, respectively. In surgical procedures on columella strut, maxillary augment, alar resection, spreader graft, columella retraction, and depressor septi muscle release, vermilion and subnasal protrusion in the profile view was statistically significant and lip length increased significantly in the frontal view. In tip rotation surgery techniques, the vermilion and subnasal position showed also significant protrusion. The depressor septi muscle cutting methods had only led to a significant protrusion of the vermilion position and upper lip length. Despite all covariants interfering in rhinoplasty, this cosmetic surgery most often may increases maxillary lip length and helps that maxilla look more protruded.

Subnasal Lip Lift and Its Effect on Nasal Esthetics

BACKGROUND

The subnasal lip lift has emerged as a standard procedure for the treatment of an elongated upper lip. Despite its popularity, limited literature has studied its effect on nasolabial esthetics. The purpose of this study is to describe the effect of the subnasal lip lift on nasal and labial esthetic parameters.

METHODS

The authors conducted a retrospective case review of patients who underwent a subnasal lip lift procedure without concurrent rhinoplasty between January 1, 2008, and December 31, 2019. The outcome variables were lip length, tooth show, vermillion display, alar width, nasolabial angle, columellar-lobular angle, Crumley analysis, and Simons analysis. Preoperative and postoperative values were compared and analyzed using paired sample t-tests.

RESULTS

Overall, 55 female patients with an average age of 52 years and a mean follow-up of 14 months were included in the study. Subnasal lip lift resulted in a statistically significant 21.5% reduction in lip length, 31.5% increase in the vermilion show, and a 1.52 mm increase in tooth show (P < .0001). In relationship to nasal esthetics, there was a statistically significant decrease in nasolabial angle of 4.56° (P < .0001), a 2.2% increase in alar width (P < .001), and a 26.3% increase in nasal projection per Simons analysis (P < .0001). The study did not demonstrate a significant change in columellar-lobular angle or Crumley projection analysis.

CONCLUSIONS

Subnasal lip lift procedure can significantly impact lower nasal esthetics, specifically by decreasing the nasolabial angle and potentially contribute to pseudo-overprojection of the nasal tip, as shown by the results of this study.

Effects of Rhinoplasty on Smile Esthetic and Gingival Appearance

Rhinoplasty alone or combined with septoplasty is one of the cornerstone management techniques in facial esthetic surgery. The aim of the current study was to evaluate the effects of rhinoplasty maneuvers on facial and smile esthetics. The study included a total of 27 adult patients. Measurements of gingival length (GL), right and left maxillary incisor-upper lip distance (MIULD), right and left inter-lip distance (ILD), and right and left gingival pocket depth (GPD) were performed and rounded to the nearest millimeter in full smile and at rest. All measurements were obtained at baseline and at the postoperative 1st and 6th months by the same clinician. As compared with the baseline values, significant decreases were determined in the left and right GLs in full smile, left and right MIULD, and left ILD at the postoperative 1st month and in the GL, left and right MIULD, and left and right ILD at the postoperative 6th month. In conclusion, rhinoplasty maneuvers can improve smile esthetics by changing the GL thereby increase patient satisfaction.

Evidence-based Nasal Analysis for Rhinoplasty: The 10-7-5 Method

Rhinoplasty is one of the top 5 aesthetic surgical procedures performed in plastic surgery. A methodical evaluation based on solid and up-to-date scientific evidence in different key areas of nasal and facial analysis is presented, the 10-7-5 method. This represents the most important preoperative step for a successful rhinoplasty. The 10-7-5 method for nasal analysis is a useful instrument that provides the rhinoplasty surgeon a deep comprehension of nasal anatomy. Understanding the nasal structures’ main relationships and consequences of each surgical maneuver on nasal framework assists on establishing the appropriate surgical goals for each patient, both in primary and secondary rhinoplasty cases. This systematic analysis of patient’s frontal, lateral, and basal nasal views provides a background to identify changes to ideal aesthetic proportions and how to surgically restore them while maintaining gender and ethnic congruency.

Transection of the Nasal Base Muscles for the Correction of Plunging Tip: An Outcome Analysis

BACKGROUND

The plunging-tip deformity has been attributed to the combined actions of nasal base muscles. However, there are no quantitative data in the literature to discuss the effect of muscle transections on the clinical outcome.

OBJECTIVES

This study was designed to assess the actions of the nasal tip, nasal base, and upper lip in patients with plunging-tip deformity and to compare their preoperative and postoperative activities following multiple myotomies.

METHODS

Patients were treated for nasal base animation deformity by the transection of the depressor septi nasalis, myrtiformis, nasalis, and levator labii superior alaeque nasi muscles. The profile views of preoperative and 12 months postoperative photographs were selected for measurements. Rest and smile images were overlaid to achieve alignment, and movements were measured with reference to the Frankfurt horizontal plane.

RESULTS

Twenty-seven (27) patients were included in the study. Movements of the nasal tip and nasal base were significantly reduced postoperatively. The upper lip shortened significantly in smile poses postoperatively compared with preoperative measurements. The change in the tip angle during animation significantly decreased in the postoperative measurements.

CONCLUSIONS

Movements of the nasal tip and the alar base contributed significantly to the hyperdynamic nasal tip deformity. Transection of the nasal base muscles is an effective treatment method with a weaker recovery of the muscle function in the long term. Dynamic upper lip shortening is an unexpected finding following surgery and should be investigated further.

LEVEL OF EVIDENCE 4