Effect of depressor septi resection in rhinoplasty on upper lip length

Overview

Cutting the depressor septi muscle is a standard step for correcting a drooping tip and a smile deformity, but its effect on the resting upper lip is not well defined. The authors reviewed records and photographs from patients operated on by two of the investigators at an academic centre and a private practice. They measured whether the lip got longer or shorter in repose.

Sections of note

• Retrospective record review and photographic analysis of 36 patients operated on between 2010 and 2013.
• Patients were 22 men and 14 women; all steps performed during each operation were recorded.
• Photographs before and after were compared in Adobe Photoshop, using the ratio of upper lip length to intercanthal distance.
• Postoperative photographs were taken a mean of 7.06 months after surgery, range 7 days to 2 years.
• Mean change was a 1.74 percent decrease in upper lip length.
• Twenty-four patients (67 percent) had a decrease, mean 5.89 percent and maximum 21.22 percent; 12 patients (33 percent) had an increase, mean 6.55 percent and maximum 12.68 percent.
• Postoperative lip length was 100.09 percent of baseline in women against 95.37 percent in men, P equal to .07.
• No factor predicted which direction an individual patient would go. Level of evidence 3.

What it means for a patient

• On average this manoeuvre barely changes the resting length of the upper lip.
• The individual result varies in both direction and size, and the surgeon cannot say in advance which way it will go.
• The study is retrospective, with photographs taken at widely different intervals, from one week to two years.
• Smiling was not measured here, so this says nothing about the smile deformity the operation targets.

Why this paper matters

It gives counselling numbers for a common step whose lip effects were previously assumed rather than measured. Unanswered is why individuals differ and whether the changes are visible to patients.

Terms

• Depressor septi: a small muscle that pulls the nasal tip down when you smile.
• Resection: surgical removal of tissue.
• Repose: the face at rest, not smiling or moving.
• Intercanthal distance: the span between the inner corners of the eyes, used as a scale reference.
• Ptotic tip: a nasal tip that hangs downward.