Rhinoplasty and facial asymmetry: Analysis of subjective and anthropometric factors in the Caucasian nose

The Isosceles Nasal Tip-Laser-Assisted Midline Assessment in Rhinoplasty

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Anthropometry of the nose pre- and post-photogrammetric adjustments in a sample of Syrian medical students. A cross-sectional study

Background and Aims

The individual's perceived beauty, sense of identity, and general well-being are all influenced by the social implications of the esthetics of their facial appearance. One of the major indicators of one's facial beauty is anthropometric proportions. This study was conducted to measure and evaluate the anthropometric proportions in a Syrian population, and to determine their desired nasal shape.

Methods

A cross-sectional study was conducted on Syrian university students. Lateral and frontal pictures of the participants were taken using Canon EOS 250D from a standard distance of 100 cm. These pictures were analyzed, then nasal measurements were adjusted according to the participants' desire using Adobe Photoshop 2020. All anthropometric measurements were conducted on AutoCAD® 2019 software before and after the adjustments. Data was analyzed using the SPSS-25 using paired samples T test to compare the means.

Results

The study included 53 females and 47 males. The mean age was 22.25. The mean unadjusted nasofrontal angle, nasolabial angle, nasomental angle, nasofacial angle, nasal index, Byrd and Hobar ratio, and Powell-modified Baum ratio were 141.80, 102.18, 129.21, 34.60, 71.71, 0.62, and 3.08 in the rhinoplasty-negative participants, and 145.89, 102.03, 130.20, 32.44, 67.96, 0.64, and 3.06 in the rhinoplasty-positive participants, respectively. While the mean of the adjusted previously mentioned angles were 144.59, 106.32, 131.19, 31.15, 62.91, 0.60, and 3.19 in the rhinoplasty-negative participants, and 146.31, 102, 130.20, 31, 62.55, 0.62, and 3.08 in the rhinoplasty-positive participants, respectively.

Conclusion

In contrast to other populations, our study concluded that Syrians had unique anthropometric measurements and facial esthetics preferences. Moreover, the local plastic surgeons were able to identify most of the preferred nasal measurements for rhinoplasty in this ethnic group. It is advisable to use photogrammetry before rhinoplasty to identify the preferred nasal measurements of each individual to ensure the patient's satisfaction with the outcome of the surgery.

Level of Evidence

Level IV, cross-sectional study.

Effect of Rhinoplasty on Various Angles of Nose on Ideal Position and Alignment in Indian Population

Study of anthropometric measurements of the nose makes possible a qualitative and quantitative analysis of surgical results. Analysis of pre- and post-operative changes in nasal tip projection, rotation and nasofrontal angle may also emphasize the fact of over correction or under correction of deformed nose to surgeon. Aim of our study to compare preoperative and postoperative nasal tip projection, rotation and nasofrontal angle after rhinoplasty. The present study was a 1.5 years prospective interventional study conducted at SMS Medical College, Jaipur, India from January 2021 to July 2022. Total 51 patients with external nasal deformity were included in our study. Pre-operative, immediate post-operative and 6 months follow-up nasofrontal, projection and nasolabial angle were recorded, compared and analyzed objectively. In our study significant improvements were observed in the nasolabial angle from 92.9 ± 16.4 to 101.6 ± 10.4 and 110.3 ± 9.8 and nasal tip projection from 0.74 ± 0.17 to 0.58 ± 0.11 and 0.52 ± 0.09 immediate post-op and at 6-months follow up respectively. Mean Nasofrontal angle at pre-op, intra-op and post-op 6 months was 132.5 ± 11.9, 135.4 ± 9.6 and 134.8 ± 9.4 and this difference was not found to be statistically significant. We would like to conclude that Indian noses which are predominantly small and shorter, our surgical procedure aimed at making them more prominent aesthetically on the face, so in the present study results were satisfactory in term of anthropometric parameter.

Ideal Reference Lines for Assessment of Facial Asymmetry in Rhinoplasty Patients

BACKGROUND

Assessing facial asymmetry is important to prevent unsatisfactory results in rhinoplasty. There has yet to be a consensus on reference lines for determining asymmetry. This study aimed to determine ideal reference lines to assess facial asymmetry and identify predictors of subjective perceptions of facial asymmetry.

METHODS

Preoperative photographs of 47 patients who underwent rhinoplasty were adjusted according to two reference lines (vertical line from the mid-glabella to Cupid's bow and horizontal interpupillary line). In total, 94 photographs were generated, randomly ordered, and evaluated by two independent observers for anthropometric measurements including six distances (distances from the midline to the medial and lateral canthi, ala, oral commissure, width of midface at maximum distance, and mandible width) and three angles (lateral canthal, lateral alar, and lip margin angles). Photographs were rated by 18 independent observers for subjective perceptions of facial asymmetry.

RESULTS

Observers perceived faces as asymmetric if accompanied by nasal deviation, irrespective of the reference line (p < 0.001). Based on the horizontal reference line, subjective perceptions of asymmetry were correlated with the midline to lateral alar margin distance (r = 0.489, p = 0.003) and sum of the distance ratios (r = 0.354, p = 0.037). None of the objective parameters correlated with subjective perceptions when adopting the vertical reference line. A deviated nose and lateral alar angle were significant predictors of subjective perceptions of facial asymmetry.

CONCLUSION

To assess facial asymmetry, the horizontal reference line should be determined first followed by the perpendicular vertical line. The nose is the most important feature determining overall facial asymmetry. 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 ."

Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient

INTRODUCTION

Rhinoplasty surgeons often find that despite their best efforts to straighten the nose, patients often continue to perceive their nose as deviated, and this perception is particularly prevalent in patients with concurrent facial asymmetry. The aims of this study were to determine whether facial asymmetry influences the satisfaction of rhinoplasty patients and whether there is a difference in postoperative happiness between patients with and without facial asymmetry.

MATERIALS AND METHODS

In this retrospective study, we reviewed the charts and photographs of patients who underwent rhinoplasty between 2016 and 2018. Patient photographs were analysed; 30 patients with facial asymmetry and 30 patients with symmetric faces were randomly selected for the study. The preoperative and postoperative rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scores were compared between the two groups.

RESULTS

The mean preoperative symmetry scores of the group with facial asymmetry were significantly higher than those of the group with symmetric faces. The magnitude of increase in the average ROE score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry. The magnitude of decrease in the mean SCHNOS score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry (p: 0.006).

CONCLUSION

It is important to clearly evaluate patients with facial asymmetries before surgery to increase their postoperative satisfaction and outcomes and make their expectations more realistic.

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 .

Craniofacial anthropometric investigation of relationships between the nose and nasal aperture using 3D computed tomography of Korean subjects

This study investigated the relationships of morphology and locations of the nose and nasal aperture by using major craniofacial landmarks on the human skull and face for craniofacial reconstruction/approximation of Koreans. In the frontal view, the positions of bony landmarks on the skull, including the nasal aperture, were correlated with the positions of nasal landmarks vertical to the transverse plane. In profile, the positions of bony landmarks on the skull were correlated with the positions of nasal landmarks horizontal to the coronal plane. Overall, 26 of the 76 measurements demonstrated significant correlations between the corresponding landmarks on the nose and nasal aperture. Simple regression equations were produced from the results. This study showed that the nose and nasal aperture are significantly related to each other in terms of their morphology and location in Koreans. The prediction guidelines, produced as regression formulas, can be applied to craniofacial reconstruction/approximation and bio-anthropological research of Korean skulls. The study results can also be used clinically in rhinoplasty and nasal reconstruction surgery.

Do Aesthetic Average Nasal Parameters Matter For Rhinoplasty in India?

Nose morphology and facial features depend on ethnicity, gender and environmental conditions. Nasal parameters for rhinoplasty are well defined in the European and American population. Though rhinoplasty is a common cosmetic surgery in India, till now, there is no dedicated study delineating the parameters for the Indian Rhinoplasty. The aim of this study is to determine and delineate the anthropometric measurements of the Indian male and female noses and to propose the nasal parameters for Indian rhinoplasty. To determine the aesthetically pleasing nasal anthropometric parameters in Indian males and females and to put forth the parameters for Indian Rhinoplasty. This anthropometric study included a volunteer sample of 221 young, good-looking Indian males and females aged 18-25 years with Indian parents and no history of previous surgery or trauma to the nose. Standardized frontal, lateral and basal photographs of the noses along with the reference scale were taken, and 11 standard anthropometric measurements of the nose were determined. The sample size selected was such that it included representative population from the north south east and west zones of India. All the nasal measurements for the Indian women and men were found to be significantly different from the other European standards. In our study, we measured the nasal average values of the good looking, young Indian males and females and compared with the results of the nasal parameters of the other populations found in the literature. This study is the first one to propose the aesthetic average nasal parameters for corrective rhinoplasty in Indian population. Level of Evidence IV.