Digital anthropometric shape analysis of 110 rhinoplasty patients in the Black Sea Region in Turkey

Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis

AIM

This study aimed to describe gender-specific three-dimensional morphology of the soft-tissue nose in Lebanese young adults and to explore the associations between nasal morphology with age and body mass index (BMI).

MATERIALS AND METHODS

Three-dimensional photographs were captured for 176 young healthy Lebanese adults (75 males and 101 females) aged 18.1-37.68 years. Linear and angular nasal measurements were computed and compared between genders, in addition to other established norms. Associations with age and BMI were also assessed.

RESULTS

All linear measurements were greater in males than in females, and only the nasolabial angle was significantly larger in females by 2.97 degrees on average. Most of the measurements were found to be larger than the Caucasian norms. A few significant correlations were found between the measurements and age or BMI.

CONCLUSION

This study is the first to present the sex-specific norms for nasal morphology in the Lebanese population and highlights the presence of gender dimorphism in the majority of measurements. Additional studies are needed to validate our data and expand the associations with age and BMI.

CLINICAL SIGNIFICANCE

The data offered in this study could help enhance the accuracy of facial reconstructive surgery and aid in personalized treatment planning for both medical and cosmetic nasal interventions. How to cite this article: Saadeh M, Shamseddine L, Fayyad-Kazan H, et al. Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis. J Contemp Dent Pract 2024;25(3):199-206.

Relationship between the nasal profile and craniofacial structures: does part of the nasal profile reflect some craniofacial structures?

This study aims to evaluate the relationship between the nasal profile and other craniofacial structures. Lateral cephalometric images of 124 adults were collected for this purpose. Statistical analyses such as regression analysis and canonical correlation analysis (CCA) were conducted on nasal and craniofacial anatomical parameters and their relationships. The regression analysis revealed that nasal length was related to maxillary height; nasal depth was related to the position of the maxilla and anterior cranial base length; and nasal base angle was related to upper dentoalveolar height. CCA revealed that nasal parameters (nasal length, depth, and hump) correlated more strongly with craniofacial parameters (maxillary height, anterior-posterior position of the maxilla, and maxillary length). Individuals with maxillary development curved anteriorly upwards had a straighter and smaller nasal profile, while those with maxillary development curved posteriorly downwards had a more arched and large nasal profile. The shape of the nasal dorsum was affected by the maxillomandibular rotation, while the increase in nasal base inclination was accompanied by an upward rotation of the maxillary plane, an increase in the upper dentoalveolar height, and an increase in the lower facial height. While it was observed that each nasal parameter was correlated with the underlying craniofacial structures to some extent, it was also observed that it would be more useful to evaluate the cumulative effects posed by craniofacial parameters. Various combinations of skeletal and dental structures are related to the nasal profile in varying forms and knowing these relationships will help reshape the face and provide aesthetic harmony.

Nasal Anthropometric Analysis in Turkish Rhinoplasty Patients

This study aimed to determine the mean values of the nasal anthropometric measurements through 2-dimensional photogrammetry in for rhinoplasty patients. The study group included 72 healthy individuals, 36 men, and 36 women. The patients were aged 18 to 42 years. All patients had undergone primary rhinoplasty in our clinic between 2013 and 2020. Seven landmarks were identified from the preoperative photographs taken with the patient's head in neutral position in the frontal and lateral planes. Five distances (total nasal length, nasal bridge length, morphological nose width, alar length, and nasal tip protrusion) and 2 angles (nasofrontal and nasolabial) measurements were calculated. We noted a statistically significant difference between the male and female sexes in terms of total nasal length and morphological nose width (P<0.05). The results were compared with the nasal anthropometric measurements reported in the literature for the Turkish population as well as other ethnic groups. We believe results of this study may facilitate preoperative planning in Turkish patients who request rhinoplasty and improve the success rate of the surgery.

Classification of Alar Dynamic Aesthetic in an Asian Female Population: Experts or Automatic Algorithms?

AIM

To provide referenced classifications of alar dynamic aesthetics from both subjective and objective perspectives for determining proper surgical strategies in alarplasty.

METHODS

A total of 150 healthy Asian female participants were instructed to perform two standardized facial movements including a resting pose and a maximum smile while taking care not to show their teeth. The participants were recorded using a dynamic three-dimensional surface imaging system. Frames depicting the resting position and the alar maximum enlargement during the smile were exported separately for anthropometric analysis and classification. The alar dynamic aesthetic was assessed through measurement of the anthropomorphic changes comparing the resting and maximum smile statuses and then transformed into quantitative analysis through the algorithm [Formula: see text]. Subjective classification and evaluation of the subject cosmetic deficiencies and proposals for therapeutic interventions to improve the subjects' alar dynamic aesthetic were performed by three senior plastic surgeons through visualization of the resting and smiling images. The surgeons were asked to divide and classify the subjects into three groups (Class I, Class II and Class III) according to the surgeons' perceptions of degree of the subjects' deficiencies in alar dynamic aesthetic. The more deficiency there was in the aesthetic, the higher the class that the subject was assigned into. The surgeons were presented with the full set of images of the patients on two separate occasions each three months apart, to assess interobserver reliability. Clustering analysis, which is based on machine learning, was applied for objective classification of the images.

RESULTS

According to the senior plastic surgeon experts' subjective classification, the subjects' alar flaring mobility was judged as follows: Class I (6.78 ± 3.84%), Class II (10.35 ± 4.18%), and Class III (18.68 ± 4.15%), while alar base mobility was judged as Class I (12.71 ± 7.57%), Class II (20.06 ± 10.06%), and Class III (30.86 ± 13.20%). By clustering analysis, alar flaring mobility was determined to be Class I (7.01 ± 3.51%), Class II (11.18 ± 4.76%), and Class III (12.72 ± 5.66%), while alar base mobility was Class I (9.07 ± 4.23%), Class II (21.88 ± 4.25%), and Class III (38.59 ± 7.08%). No statistical significance was found in the distribution and assignment of classes between the two methodologies.

CONCLUSION

Classifications of alar dynamic aesthetics could arouse attention to facial dynamic aesthetics and provide referenced quantitative parameters for plastic surgeons to determine appropriate treatments for alarplasty. For patients with Class I mobility, treatments are not recommended, while minimally invasive treatments can be deemed to be optional for patients with Class II alar mobility to potentially improve alar dynamic aesthetics. For patients with Class III alar mobility, surgical treatments are strongly recommended as options. Combing subjective classification with automated algorithms can provide a novel perspective and improve reliability for facial aesthetic classification analysis.

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 .

A Single-Blinded Prospective Study on Using Botulinum Toxin Type A for Reducing Alar Mobility

BACKGROUND

With widespread utilization of instant social media, people desire a minimally invasive treatment to improve alar dynamic aesthetic, but few practical procedures on reducing alar mobility have been conducted.

OBJECTIVES

This study aimed to verify the effects of botulinum toxin on reducing nasal alar mobility and provide a supplemental treatment of rhinoplasty.

METHODS

This single-blind prospective study included a cohort of 20 participants with the desire to improve their alar dynamic aesthetic. The experimental group was injected with 3U botulinum toxin type A at dilator naris anterior, dilator naris vestibularis, levator labii superioris alaeque nasi, and dilator naris, and the control group received the equivalent of saline. Standardized facial movement (from rest to maximum smile without revealing teeth) was recorded with a 3-dimensional imaging system. The changes between rest and maximum smile statuses represented alar mobility and were generated by MOBILITY=WIDTHsmile-WIDTHrestWIDTHrest×100 % . Alar mobility and root mean square analysis were employed for postoperative evaluations.

RESULTS

In the experimental group, alar flaring mobility decreased from 10.05% ± 6.40% to 4.91% ± 3.48%(P < 0.05), and alar base mobility decreased from 16.83% ± 5.69% to 12.50% ± 4.89% (P < 0.05), whereas no significant changes in alar mobility were found in the control group. In root mean square analysis, changes in the experimental group were significantly higher than in the control group (P < 0.05).

CONCLUSIONS

Botulinum toxin type A can effectively restrain alar mobility without any significant adverse events and improve alar dynamic esthetic, which can serve as a minimally invasive method or supplemental treatment for rhinoplasty.

LEVEL OF EVIDENCE: 2

A Novel Study on Alar Mobility of HAN Female by 3dMD Dynamic Surface Imaging System

AIM

The aim of this study is to conduct a quantitative analysis on alar mobility of HAN females and provided referenced materials for alar dynamic aesthetic.

METHODS

One hundred and fifty healthy HAN females without rhinoplasty, nasal injury, nasal deformity and craniofacial deformity were included in this study. 3dMD surface imaging system was used for anthropometric analysis. All participants were instructed to perform the desired dynamic facial expression from rest to maximum smile without reveling teeth and recorded by 3dMD dynamic surface imaging system simultaneously. Two frames of rest status and alar maximum enlargement were selected for measuring alar width, alar base width and inner-canthal distance. The difference between two status represented alar mobility, which was generated through equation: [Formula: see text].

RESULTS

Alar mobility consisted of alar flaring mobility and alar base mobility. The alar flaring mobility was (9.49 ± 4.90)%, reference range was(1.45, 17.53)% and regression equation between rest and maximum smile was Y = 7.953 + 0.886X (R² = 0.641, p = 0.000); the alar base mobility was (17.94 ± 10.44)%, reference range was (0.88, 35.00)% and regression equation between rest and maximum smile was Y = 4.481 + 0.966X (R² = 0.528, p = 0.000.

CONCLUSION

Asian alar anatomy has great distinction from Caucasian, processing conspicuous alar movement and damaging alar aesthetic dynamically. This study novelly defined alar mobility by three-dimensional anthropometric analysis, providing objective references for alar dynamic aesthetic and arousing plastic surgeons' attention on keeping balance of static and dynamic aesthetic in rhinoplasty.

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 .

Photographic Nasal Soft Tissue Analysis From Preadolescence to Young Adulthood: Anthropometric Measurements

ABSTRACT

The nose has a tremendous effect on facial esthetics and overall facial harmony, accordingly it contributes to the physical appearance of individuals. The aim of this study is to establish sex-related nasal soft tissue norms for preadolescents, adolescents, and young adults in Anatolian population. A total of 300 volunteers (150 males and 150 females) with ages varying from 10 to 24 years were divided into 6 subgroups according to gender and educational status. The anthropometric measurements of the nose in preadolescent, adolescent, and young adult males and females were performed on digital photographs. A total of 16 nasal parameters, 13 linear and 3 angular measurements, were analyzed for sex-related variations. A significant sexual dimorphism was observed for nasofrontal and nasolabial angles in adolescent and young adult groups (P < 0.001, P = 0.011, and P = 0.007, respectively). All linear measurements of the nose were larger in males as compared to females, except for left alar thickness, which were similar between males and females in young adult group. Of the 16 nasal measurements, 13 were found to be sexually dimorphic in certain age groups (P < 0.05). In Anatolian population, the nasal shape and dimensions displayed significant sexual dimorphism in preadolescents, adolescents, and young adults. The average values of nasal soft tissue in this population could serve as a database for the planning of cosmetic and reconstructive rhinoplasty in the pediatric and adult population and obtaining the desired outcomes.

The Expanding Role of Geometric Morphometrics in Craniofacial Surgery

INTRODUCTION

Geometric morphometrics (GM) is an advanced landmark-based quantitative method used to study biological shape and form. Historically, GM has been limited to non-biomedical fields such as comparative biology; however, this technique confers advantages over traditional cephalometric methods, warranting a review of current applications of GM to human craniofacial disorders.

METHODS

The RISmed package was used to extract metadata associated with PubMed publications referencing GM analysis techniques in craniofacial and reconstructive surgery. PubMed search terms included "geometric AND morphometric AND craniofacial;" and "geometric AND morphometric AND reconstructive surgery." Duplicate search results were eliminated.

RESULTS

Search yielded 139 studies between 2005 and 2020, of which 27 met inclusion criteria. Human craniofacial studies constituted 2% of all queried GM studies. Among these, cleft lip and palate were the most commonly studied craniofacial conditions (7 studies, 26%), followed by sagittal craniosynostosis (4 studies, 15%). Seventeen studies (63%) used GM to assess skeletal structures, seven studies (26%) examined both skeletal and soft tissues, and three studies (11%) analyzed soft tissues only. Eleven studies (40.1%) employed a GM approach to evaluate postoperative changes in craniofacial morphology. Two studies (7%) systematically compared GM analysis with conventional shape measurements.

CONCLUSION

The ability to study shape while controlling for variability in structure size and imaging technique make GM a promising tool for understanding growth patterns in complex craniofacial diseases. Furthermore, GM overcomes many limitations of traditional cephalometric techniques, and hence may claim an expanded role in the study of human craniofacial disorders in clinical and research settings.

Prediction of nasal morphology in facial reconstruction: Validation and recalibration of the Rynn method

BACKGROUND

Prediction of the nose from the skull remains an important issue in forensic facial approximation. In 2010, Rynn et al. published a method of predicting nose projection from the skull. With this method, three craniometric measurements (x, y, z) are taken, and these are then used in regression formulae to estimate the nasal dimensions.

AIM

The purpose of this study was to examine and test the accuracy of the Rynn et al. method and if necessary to adapt the formulae for this population.

SUBJECTS AND METHODS

A sample of 90 CT scans of Turkish adults was used in the study. The actual and predicted dimensions were compared using t-test. The age of the individuals ranged from 20 to 40 years by sex.

RESULTS

The descriptive statistics and correlations were calculated, and the actual and predicted measurements were compared. The differences between the actual and predicted values were statistically significant (p < 0.01), with -1 mm for males and -1.5 mm for females. Validation accuracies ranged from 76 to 92% in females and 72 to 82% in males. Recalibration equation accuracies ranged from 88 to 100% in females and 90 to 100% in males.

CONCLUSION

The results showed that the recalibration of the Rynn et al. method and its formulae gave satisfactory results with less error and can be employed in facial approximation cases.

Caucasian Mediterranean patients seeking rhinoplasty-Anthropometric measurements and prevalence of major deformities

OBJECTIVE

To describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities.

DESIGN

Prospective, observational and cross-sectional study.

SETTING

Centro Hospitalar do Porto.

PARTICIPANTS

A 100 Caucasian Mediterranean patients seeking rhinoplasty.

OUTCOMES

Standardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected.

RESULTS

There was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal-hump and nasofrontal-supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%).

CONCLUSION

The present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery.

Anthropometric Analysis of the External Nose of the Egyptian Males

OBJECTIVE

The aim of this study was to describe average nasal anthropometric measurements for young Egyptian males by using the Rhinobase^® software.

MATERIALS AND METHODS

This was a cross-sectional study involving the evaluation of facial photographs. Frontal, right lateral and basal photographs for 300 healthy adult male Egyptian volunteers (n = 300) were taken; then, the photos were edited using Rhinobase^® Software and CorelDraw graphics (2017) software. Twenty anthropometric landmarks were determined. The calculated measurements of the soft tissue of the external nose included ten linear measurements and five angles.

RESULTS

The means of the linear measurements of the external nose in this study were as follows: nasal height (56.12 mm), nasal bridge length (47.0 mm), columella length (9.1 mm), alar length (29.3 mm), morphological nose width (41.0 mm), anatomical nose width (38.0 mm), nasal tip protrusion (21.0 mm), nasal tip projection using 'Goode's method' (29.36 mm), dorsum width (9.6 mm) and nasion height (2.04 mm). The means of the angular measurements of the nose were as follows: nasofacial angle (33.1°), nasofrontal angle (144.0°), nasolabial angle (104.5°), nasomental angle (127.6°) and mentocervical angle (104.7°).

CONCLUSIONS

Racial differences of the external nasal anthropometric values exist; hence, it is important to establish the average anthropometric measures for several races and ethnic groups. Measurements collected in this study can serve as a database for anthropometric average values of the external nose in healthy adult Egyptian males. Moreover, these measurements can aid in planning prior to nasal reconstruction and esthetic rhinoplasty by serving as a reference standard. Although the Rhinobase^® software is an easy, reliable and safe indirect method for nasal analysis, we should be cautious during interpretation of some edited landmarks on Rhinobase^® software pictures. In addition, inserting two rulers (in the horizontal and vertical dimension) allows accurate assessment of the linear anthropometric measurements.

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 .

Anthropometric analysis of the nose in young Turkish men and women

PURPOSE

The aim of the study was to describe and compare values for nasal anthropometric measurements using the landmark-based geometric morphometric technique in young healthy Turkish men and women.

MATERIALS AND METHODS

A total of 115 young adults (56 men and 59 women) whose ages ranged from 18 to 30 years (mean age 21.22 years) were included in the analysis.

RESULTS

For men the mean nasal bridge length, total length, width and root width were 52.95, 54.38; 35.24 and 17.83 mm, respectively, and in women they were 47.81 and 50.90; 31.59 and 17.36 mm, respectively. The columella length and width were 12.76 and 5.77 mm, respectively, for men, and for women they were 11.88 and 5.60 mm, respectively.

CONCLUSION

Data collected in the present research could serve as a database for the quantitative description of nasal morphology in young Turkish adults. It may also be used in sex based data banks for the Turkish population.

The Sudanese female face: normative craniofacial measurements and comparison with African-American and North American White females

BACKGROUND

Ethnic differences in craniofacial dimensions and proportional relationships means that ethnicity-specific data is required for both diagnosis and treatment planning. This investigation establishes normative craniofacial anthropometric values for the Sudanese female (SF) population, compares with North American White (NAW) and African-American females (AA), and analyses the occurrence of neoclassical norms within the study sample.

METHODS

Standardized frontal and profile facial photographs were taken of 100 female participants. Five vertical and five horizontal anthropometric measurements were determined.

RESULTS

Significant differences were found between the 3 populations. The sample showed very poor compliance with the neoclassical norms. The upper face height of the SF was ∼ 20-mm taller than the AA faces (p < 0.001). Midface, nasal and lower face heights were also significantly taller, by 15-mm, 10-mm and 10-mm respectively (p < 0.001). SF showed significant reduction in bizygomatic width (∼ 30-mm), compared to NAW and AA (p < 0.001). Eye width was ∼ 5-mm less than the AA sample and 3-mm less than the NAW sample (p < 0.001). Mouth width was ∼ 5-mm less in SF than the other two groups (p < 0.001). The SF exhibited a reduced interalar width compared with AA (p < 0.001), but wider than the NAW (p < 0.001).

CONCLUSIONS

The average SF face is significantly taller and narrower than the AA or NAW female face. The neoclassical proportional norms appear to be unreliable guides in relation to the SF face, and should not be used in comparative diagnosis and treatment planning. Use of the normative anthropometric data presented in this article, both linear and proportional values, should be considered in the diagnosis and treatment planning of young adult female patients of Sudanese descent.

Three-dimensional facial distances of Northern Sudanese persons from childhood to young adulthood

No current age- and gender-related normative data exist for the dimensions of facial structures in Northern Sudanese subjects. In the current study information about normal sex- and age-related linear distances is provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4-30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft tissue facial dimensions were significantly larger in men than in women (p < 0.01), except mouth width (ch-ch), upper facial height (n-sn), mandibular body length (pg-go) and width (go-go). All measurements underwent significant modifications as a function of age (p < 0.01), with significant age × sex interactions (p < 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development.

Anthropometric nasal analysis of Han Chinese young adults

BACKGROUND

There are varying degrees of racial differences in the size, shape, proportions of the facial structures.

METHODS

A total of 900 Han Chinese young adults (501 females and 399 males) were included in the analysis. Measurements taken of the soft tissue of the external nose included 12 items of linear distance and 5 angles. Six proportion indices of the soft tissue of the external nose were determined.

RESULTS

In the 12 parameters of linear measurement, females were found to have significantly smaller nasal base width, nasal ala length, nasal ala thickness, columella height, columella width, and nasal tip width in comparison to males (all, P < 0.01). In the five angular measurements, females were found to have a smaller nasal tip angle and nasolabial angle (both, P < 0.05) and a larger nostril tilt angle, nasofrontal angle, and nasal tip angle (all, P < 0.001). Nasal depth-nasal width and columella height-nasal depth were both significantly less in males than females (53.25 ± 8.2 vs. 54.56 ± 9.7 and 51.61 ± 11.92 vs. 53.37 ± 12.56, respectively); whereas nasal ala length-nasal height was significantly less in females than in males (29.41 ± 8.95 vs. 30.9 ± 7.02).

CONCLUSION

Significant differences are present in nasal indices of males and females of Han Chinese ancestry. These data may serve as a reference standard for nasal reconstructive and aesthetic surgery.