Effects of the Rhinoplasty Maneuvers on Upper Lip Position and Incisor Show
- 277 Downloads
- 1 Citations
Abstract
Background
Smiling involves dynamic movements that include nasal tip descent and upper lip ascent. The effect of rhinoplasty on upper lip position is poorly described.
Methods
One hundred charts were reviewed in reverse chronologic order. Inclusion criteria were receiving one of the rhinoplasty maneuvers of interest, at least 6 months of follow-up, and pre- and postoperative photographs by a professional medical photographer with matching maximum smile extent and size. Maxillary incisor show was measured as the vertical distance between the caudal border of the upper lip and the caudal-most aspect of maxillary central incisors. Pre- and postoperative maxillary incisor show was compared by open versus closed approach and rhinoplasty maneuver with and without controlling for depressor septi nasi (DSN) release.
Results
Sixty-one females and fifteen males with a mean age of 39 years and mean follow-up of 16 months were included. No significant differences were seen between open versus closed approaches (p > 0.05). A decrease in postoperative maxillary incisor show was observed following columella strut, extended spreader graft, and DSN release (p < 0.05). No significant change in maxillary incisor show was seen after nasal spine graft, maxillary augmentation, tip rotation suture, shield graft, columella retraction, or tip suspension suture (p > 0.05). Patients undergoing footplate approximation and alar base resection had a significant decrease in maxillary incisor show (p < 0.05), but this significance was lost upon controlling for DSN release (p > 0.05).
Conclusion
Certain caudal rhinoplasty maneuvers may result in decreased maxillary incisor show, particularly when the DSN muscles are involved. Examination of upper lip position and patient discussion is important for maximizing outcome.
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.
Keywords
Rhinoplasty Depressor septi nasi SmileNotes
Acknowledgements
Bahman Guyuron, MD, is the Chief Executive Officer and Chairman of the Innovative Medical Equipment and receives royalties for three books including the Guyuron Rhinoplasty, Plastic Surgery, Indications and Practice and Aesthetic Surgery Video Atlas.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to declare pertaining this report.
References
- 1.Sabri R (2005) The eight components of a balanced smile. J Clin Orthod 39(3):155–167PubMedGoogle Scholar
- 2.Benlier E, Balta S, Tas S (2014) Depressor septi nasi modifications in rhinoplasty: a review of anatomy and surgical techniques. Fac Plast Surg 30:471–476CrossRefGoogle Scholar
- 3.Rohrich RJ, Huynh B, Muzaffar AR, Adams WP Jr, Robinson JB Jr (2000) Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 105(1):376–383 (discussion 384-388) CrossRefPubMedGoogle Scholar
- 4.Cigna E, Sorvillo V, Stefanizzi G, Fino P, Tarallo M (2013) The use of botulinum toxin in the treatment of plunging nose: cosmetic results and a functional serendipity. Clin Ther 164(2):107–113Google Scholar
- 5.Arregui JS, Elejalde MV, Regalado J, Ezquerra F, Berrazueta M (2000) Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose. Plast Reconstr Surg 106(7):1624–1629CrossRefPubMedGoogle Scholar
- 6.Figallo E (1995) The nasal tip: a new dynamic structure. Plast Reconstr Surg 95(7):1178–1184CrossRefPubMedGoogle Scholar
- 7.Benlier E, Top H, Aygit AC (2005) A new approach to smiling deformity: cutting of the superior part of the orbicularis oris. Aesthet Plast Surg 29(5):373–377 (discussion 378) CrossRefGoogle Scholar
- 8.De Souza Pinto EB (2003) Relationship between tip nasal muscles and the short upper lip. Aesthet Plast Surg 27(5):381–387CrossRefGoogle Scholar
- 9.De Souza Pinto EB, Da Rocha RPİ, Filho WQ, Neto ES, Zacharias KG, Amancio A, de Camargo AB (1998) Anatomy of the median part of the septum depressor muscle in aesthetic surgery. Aesthet Plast Surg 22(2):111–115CrossRefGoogle Scholar
- 10.Rozner L (1981) Lip lifting. Br J Plast Surg 34(4):481–484CrossRefPubMedGoogle Scholar
- 11.Austin HW (1986) The lip lift. Plast Reconstr Surg 77(6):990–994CrossRefPubMedGoogle Scholar
- 12.Felman G (1993) Direct upper-lip lifting: a safe procedure. Aesthet Plast Surg 17(4):291–295CrossRefGoogle Scholar
- 13.Oh SH, Kim DA, Kang NH, Lee SR (2009) The muscular system of the depressor septi nasi: anatomical study and clinical application. Plast Reconstr Surg 124(4S):101Google Scholar
- 14.Kalantar-Hormozi A, Beiraghi-Toosi A (2014) Smile analysis in rhinoplasty: a randomized study for comparing resection and transposition of the depressor septi nasi muscle. Plast Reconstr Surg 133(2):261–268CrossRefPubMedGoogle Scholar
- 15.Shamouelian D, Leary RP, Manuel CT, Harb R, Protsenko DE, Wong BJ (2015) Rethinking nasal tip support: a finite element analysis. Laryngoscope 125(2):326–330CrossRefPubMedGoogle Scholar
- 16.Sajjadian A, Guyuron B (2009) An algorithm for treatment of the drooping nose. Aesthet Surg J 29(3):199–206CrossRefPubMedGoogle Scholar
- 17.Guyuron B (1998) Footplates of the medial crura. Plast Reconstr Surg 101(5):1359–1363CrossRefPubMedGoogle Scholar