Effects of the Rhinoplasty Maneuvers on Upper Lip Position and Incisor Show

Overview

Smiling pulls the upper lip up and the nasal tip down, so changes at the base of the nose can alter a smile. The authors reviewed charts to measure how much of the upper front teeth showed on matched maximum-smile photographs before and after surgery, and compared this across approaches and individual maneuvers.

Sections of note

• 100 charts reviewed in reverse chronologic order; 76 patients met criteria, 61 female and 15 male.
• Inclusion required at least 6 months of follow-up and professional photographs with matching maximum smile extent and size.
• Mean age 39 years; mean follow-up 16 months.
• Incisor show was the vertical distance from the lower border of the upper lip to the lowest point of the upper central incisors.
• No significant difference between open and closed approaches, p greater than 0.05.
• Decreased incisor show followed columella strut, extended spreader graft, and depressor septi nasi release, p below 0.05.
• No significant change followed nasal spine graft, maxillary augmentation, tip rotation suture, shield graft, columella retraction, or tip suspension suture.
• Footplate approximation and alar base resection showed a significant decrease, which disappeared once depressor septi nasi release was controlled for. Level of evidence IV.

What it means for a patient

• A rhinoplasty can change how much tooth shows when you smile, most often by showing less.
• The muscle running from the nose into the upper lip appears to be the main driver, since effects vanished once its release was accounted for.
• Whether the operation was open or closed made no difference.
• Limits: 76 patients, retrospective chart review, single practice, photographic measurement, and mean follow-up of 16 months.

Why this paper matters

Smile appearance is rarely discussed before rhinoplasty, and this identifies which steps are likely to change it. That makes it a planning issue rather than an unexpected outcome. The study does not report whether patients noticed the change.

Terms

• Maxillary incisor show: How much of the upper front teeth is visible, measured below the upper lip.
• Depressor septi nasi: A small muscle running from the base of the nose into the upper lip.
• Columella strut: A cartilage piece placed between the nostrils to support the tip.
• Extended spreader graft: A long cartilage strip alongside the septum reaching toward the tip.
• Footplate approximation: Bringing together the flared bases of the tip cartilages.