• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.19.1-19.4
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• 2020

Background: The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society. Methods: This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation. Results: Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01) Conclusion: The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.616-620
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• 2013

Background Nasal tip support is an essential consideration for rhinoplasty in East Asians. There are many techniques to improve tip projection, and among them, the columellar strut is the most popular technique. However, the conventional design is less supportive for rotating the tip. The amount of harvestable septal cartilage is relatively small in East Asians. For an optimal outcome, we propose an L-shaped design for applying the columellar strut. Methods To evaluate the anthropometric outcomes, the change in nasal tip projection and the columella-labial angle were analyzed by comparing preoperative and postoperative photographs. The anthropometric study group consisted of 25 patients who underwent the same operative technique of an L-shaped strut graft using septal cartilage and were followed up for more than 9 months. Results There were statistically significant differences between the preoperative and postoperative values in the nasal tip projection ratio and columella-labial angle. We did not observe any complications directly related to the L-shaped columellar strut in the anthropometric study group. Conclusions The L-shaped columellar strut has advantages not only in the controlling of tip projection and rotation, but in that it needs a smaller amount of cartilage compared to the conventional septal extension graft. It can therefore be an alternative technique for nasal tip plasty when there is an insufficient amount of harvestable septal cartilage.

• Archives of Plastic Surgery
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• v.41 no.1
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• pp.3-11
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• 2014

Background This study aimed at overcoming the disadvantages of septal extension grafts and keeping the nasal tip as natural as possible by using different forms of the graft and additional supporting methods depending on the case. Methods Among 458 patients who received a septal extension graft from March 2008 to September 2011, 107 patients were selected who underwent at least a 6-month follow-up. Patients were categorized according to the primary objective of the operation; an upturned tip correction or tip lengthening, tip lengthening with tip projection, or retracted columella correction. Each group of patients received a different type of septal extension graft out of 3 different types of grafts based on the purpose of the operation. The evaluation of the results was made from by comparing preoperative and postoperative photographs of the tip angle, projection, and nasolabial angle. Results The average tip angle for the patients in the upturned tip correction group was reduced to 98.3 from 124.9 degrees. For the patients in the tip lengthening with tip projection group, the average tip angle was reduced to 96.8 from 122.4 degrees and the average tip projection was increased to 27.5 from 23.2 mm. The average nasolabial angle for the patients in the retracted columella correction group was increased to 94.6 from 74.8 degrees. Conclusions Sufficient nasal tip lengthening and projection could be achieved by applying a septal extension graft using the graft best suited for the group of patients categorized by surgical objective.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.205-213
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• 2005

There are several characteristics of the nose of orientals. The dorsum of nose is flat and low, the skin is thick with severe tension, the nasal tip is bulbous, the nostril is wide, and the projection of the nose is limited due to a poorly developed alar cartilage with a short columella. In order to improve these untoward characteristics of the nose of Orientals aesthetically, plain augmentation of the dorsum and tip-plasty with conventional methods has been performed by many plastic surgeons. However these conventional rhinoplasty is not enough to obtain satisfactory results when transforming into a more beautiful and aesthetically charming appearance. In order to produce the optimal nasal shape and profile, it is extremely important to consider the aesthetic surgical factors, which are; the position of the nasion, the optimal nasolabial angle(95-100 degree in Orientals), the natural exposure of infra-tip lobule with and columella, the position of the tip defining point in harmony with the dorsal profile and the smooth and natural silhouette of the lateral nasal profile as it descends into the inferior portion of the nose. From April, 2003 to August, 2004, a total of 52 patients underwent open rhinoplasty, adhering to the strict aesthetic principles considered and described priorly. Surgical approach was done through a transcolumella incision and an alar rim incision. The nasal dorsum was augmented with a silicone implant and the shape of the columella and the nasolabial angle were finessed with a silicone strut implant which was placed in between the medial crurae in a manner of a non-visible graft. The nasal tip was corrected by alar cartilage suture technique and onlay graft of shield shaped Alloderm and Gore-Tex. Author obtained the optimal nasal shape and profile aesthetically, and the results, considered satisfactory in all patients without any complications, are as follows; 1. the average increase in nasal length was 2.5 mm, 2. the average decrease in nasal width was 2.1 mm, 3. the average increase in nasal tip projection was 3.2 mm, 4. the changes of nasolabial angles were from 85.5 degree to 94.7 degree, 5. the changes of the angle between the long axis of the external naris was from 101.3 degree to 89.5 degree. In conclusion, this surgical procedure is an effective, reliable and a valuable method in improving the nasal shape, tip projection, nasolabial angle and especially, the lateral facial profile of Orientals aesthetically.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.259-264
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• 2010

Purpose: Most surgeons have used autogenous cartilage for columella strut graft. But the supply of autogenous cartilage is often limited. So, this study is to investigate the usefulness of biodegradable plate as columella strut material. Methods: We studied 19 patients who have secondary cleft nasal deformity. Patients were divided into two groups. Group A patients who were not closed their growth plate underwent columella strut graft only with biodegradable plate through endonasal approach. The biodegradable plate was inserted between nasal tip and anterior nasal spine. Group B patients were closed their growth plate. They had an operation for columella strut graft with biodegradable plate fixed with autogenous conchal cartilage. If nasal tip projection was insufficient, we performed additionally onlay graft on nasal tip with autogenous soft tissue or remnant cartilage. Results: As a result of mean 14 months follow-up, we achieved a good nasal tip projection, narrowing of interalar distance and symmetrical nostril shape. No specific complications were reported except 2 cases, which were the extrusion of biodegradable plate into the nasal cavity and Staphylococcus aureus infection. Conclusion: The columella strut graft using biodegradable plate is simple and effective method. Biodegradable plate can be a good substitute for columella strut in patients who can not use autogenous cartilages.

• Archives of Craniofacial Surgery
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• v.25 no.3
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• pp.123-132
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• 2024

Background: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. Methods: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. Results: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). Conclusion: Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.671-675
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• 2010

Purpose: In order to maintain corrected nasal tip projection, strong support is important. Authors used calvarial bone graft method for this purpose. Patients were followed up about permanency of the bone graft for a long time. Methods: From 1995 to 1998, author performed calvarial bone graft on 30 adult patients with secondary cleft lip and nose deformity. Patients were observed for 34 months. There were no specific complications, and results were satisfactory. We could confirm the permanence of the calvarial bone graft in 3 patients by photography and radiologic studies for 10 years follow-up. Results: None of the patients showed size change or displacement. But the portion of graft facing the tip was absorbed resulting in loss of tip projection and short nose in two patients. One patient had fracture on the middle of the graft. This caused depression from lower portion of the dorsum to the tip. Conclusion: Despite of autogenous grafts such as calvarial bone, absorption of the bone may occur when compressed with tension for a long period. And the graft in the nasal tip not having any contact with the nasal bone may cause absorption of the graft.

• Journal of Yeungnam Medical Science
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• v.37 no.1
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• pp.32-39
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• 2020

Background: Rhinoplasty is one of the most commonly performed cosmetic surgery procedures. Most Asians desire elevation of their relatively flat nasal dorsum and tip to make them appear more prominent. This study introduces a simple method of nasal tip plasty using three-dimensional (3D)-printed polycaprolactone (PCL) (Smart Ball^®), which provides the required length and volume for this purpose and enables the creation of a nasal tip of the desired shape in a safe and simple manner. Methods: Between September 2014 and May 2017, 22 patients participated in a survey to assess postoperative satisfaction levels. Additionally, three plastic surgeons compared patients' pre- and 1-year postoperative photographs to evaluate the results. All patients underwent 2- to 4-year postoperative follow-up. Results: Levels of subjective satisfaction among patients were 3.59, 3.50, 3.82, 3.73, 3.55, and 3.82 for each of the 6 categories evaluated, with a mean of 3.67/4 points, indicating high satisfaction levels. The mean plastic surgeon-reported score for the 22 patients was 4.47/5 points, which also indicates highly successful outcomes. Postoperative nasal tip rotation and tip projection were ideal in most patients. Conclusion: Our novel method using 3D-printed PCL (Smart Ball^®) provides the optimal length and volume required for nasal tip plasty and enables the creation of a nasal tip of the desired shape, in a safe and simple manner. An advantage of our method is that it retains the original nasal structure in contrast to structural changes observed with the use of conventional methods.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.49-56
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• 2010

Objective: To evaluate nasal and upper lip changes after Le Fort I surgery by means of images taken with a three-dimensional computed tomography (3D-CT). Methods: Fifteen patients (9 female and 6 male, mean age 21.9 years) with preoperative and postoperative 3D-CT were studied. The patients underwent maxillary movement with impaction or elongation, and advancement or setback. With the 3D-CT which presents reconstructive soft tissue images, preoperative and postoperative measurement and analysis were performed for nasal tip projection angle, columellar angle, supratip break angle, nasolabial angle, interalar width, internostril width, columella length and nasal tip projection. Results: Postoperative interalar and internostril widening was significant for all categories of maxillary movement. However, there was little significant relation in all parameters between the amount and direction of maxillary movement. Interestingly, movement of the maxilla with upward did show a little decrease in the columellar angle, supra tip break angle and nasolabial angle. Also movement of the maxilla with forward did show a little advancement in the upper lip position. Conclusion: Changes to the nose clearly occur after orthognathic surgery. There was a significant increase in postoperative interalar width and internostril width with maxillary movement. However, no clear correlation could be determined between amount of change and maxillary movement. Interestingly, maxillary impaction did show a little decrease in the columellar angle, supra tip break angle and nasolabial angle. In addition, we used 3D-CT for more precise analysis as a useful tool.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.681-687
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• 2006

Purpose: The nose of most Koreans is characterized as a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a modified septal extension graft, along with augmentation rhinoplasty has been developed. Methods: With this technique, a septal extension graft is fixed on the entire caudal margin of the septum (the cephalic-caudal axis) and at the same time, it is placed above the anterior nasal spine, in the membranous portion of the septum and at the base of the columella(the anterior-posterior axis). The present report describes the results obtained in 13 patients and offers an analysis of the results as judged by the columella-labial angle and 4 proportional indices(nose height index, nasal bridge length index, nasal tip projection index, columella length index), measured by photogrammetry. Results: The postoperative values obtained in these 5 categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally and lengthened. Moreover, these positive outcomes were still maintained during the follow-up period, and no side effects, such as saddle nose deformity, were reported. Conclusion: A modified septal extension graft can be considered as an effective method for the surgical correction of the nasal tip and columella in Koreans.