Open rhinoplasty: influence of incisions, alar resection, and columellar strut on final appearance of the tip

Overview

Judging rhinoplasty results is hard because many steps are combined and beauty is subjective. The authors set out to evaluate open rhinoplasty using both measured and self reported criteria. They reviewed patients operated at their hospital between 2004 and 2011, using clinical records, standardised photographs and follow-up consultation.

Sections of note

• 155 patients underwent open septorhinoplasty; after excluding those lost to follow-up and those who had orthognathic surgery, 55 were analysed.
• Measures were the nasolabial angle, the Goode ratio of projection to nose length, and patient satisfaction on the rhinoplasty outcome evaluation form.
• The columella transalar incision tended to close the nasolabial angle, p equal to 0.001, and lowered the Goode ratio, p equal to 0.01, unlike the Rethi incision.
• Resection of the alar cartilages closed the nasolabial angle, p equal to 0.02, and decreased projection, p equal to 0.001.
• Use of a columellar strut increased projection, p equal to 0.01.
• The authors acknowledge unavoidable measurement bias. Level of evidence IV.

What it means for a patient

• The incision itself, not only the reshaping done through it, can shift the final angle and projection of the tip.
• Removing tip cartilage lowers projection and rotates the tip downward, while a supporting strut raises projection, which is what surgeons assume and this study measured.
• The study was retrospective, with 100 of 155 patients excluded, so the analysed group may not represent the whole practice.
• No follow-up length is stated in the abstract, so it is unclear when the postoperative measurements were taken.

Why this paper matters

Much rhinoplasty teaching rests on assumptions about what each manoeuvre does, and this paper tests several of them with numbers. What is unanswered is how large these effects are in visible terms and whether they persist over years.

Terms

• Nasolabial angle: the angle between the base of the nose and the upper lip in side view.
• Goode ratio: a measured ratio of tip projection to nose length.
• Columellar strut: a cartilage post placed between the tip cartilages to support projection.
• Alar resection: removal of part of the lower tip cartilage.
• Rethi incision: an open approach incision extending higher into the columella.
• Septorhinoplasty: surgery addressing both the septum and the outside shape.