Association of Increasing Nasal Tip Projection With Lip Position in Primary Rhinoplasty

Cerrati EW, Dayan SH.

PubMed 28418453 Publisher (DOI)Free full text (PMC)

What this paper says

In 20 patients whose nasal tip projection was increased, 18 (90%) showed a measurable increase in upper lip projection, with the Z angle decreasing by 2.7 degrees.

Overview

Changes at the base of the nose can move the upper lip, since the two are structurally linked. This case series measured what happened to the lip when the tip was pushed forward during a first rhinoplasty, using before and after photographs and standard profile measurements.

Sections of note

Case series of 20 patients undergoing primary rhinoplasty to increase tip projection, between October 1, 2014, and September 25, 2015.
19 females and 1 male; mean age 26.8 years, SD 10.2, range 16 to 52.
Increased projection was verified using the Goode ratio.
Upper lip projection was calculated by the Z angle, based on the intersection of the Frankfort horizontal plane and the profile line; vermilion height was also assessed.
18 of 20 (90%) showed increased upper lip projection, achieved by either a columellar strut or a tongue-in-groove maneuver.
The Z angle decreased by 2.7 degrees, 95% CI 1.5 to 3.9, P below .001.
Vermilion height did not change significantly, with a trend toward a mean increase of 0.051, P .09. Level of evidence 4.

What it means for a patient

Raising the tip also pushes the upper lip forward, so the lip changes even though it was not operated on.
The change was measurable but small, under 3 degrees on average.
The authors state they applied this association to filler injection as an alternative route to a fuller looking upper lip.
Limits: 20 patients, almost all female, single practice, photographic measurement, no comparison group, and no reported follow-up interval.

Why this paper matters

Adjacent facial features shift when the nose changes, and few studies measure that. This gives a number for the lip effect and a reason to mention it during consultation. The sample is small and the durability of the lip change is not reported.

Terms

Tip projection: How far the nasal tip stands out from the face.
Goode ratio: A standard measurement of tip projection taken from a profile photograph.
Z angle: A profile angle used to express how far the upper lip projects.
Frankfort horizontal plane: A standard reference line across the head used to orient profile measurements.
Vermilion: The red part of the lip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: The effects of rhinoplasty maneuvers on adjacent facial features are an important component in preoperative planning and patient counseling. Tip projection modifications are commonly performed in both cosmetic and reconstructive rhinoplasty.

Objective: To evaluate the subsequent change in lip projection that results from increasing nasal tip projection.

Design, Setting, And Participants: In this case series, 20 patients underwent primary rhinoplasty with the objective of increasing tip projection during the period from October 1, 2014, to September 25, 2015. Preoperative and postoperative photographs were evaluated.

Main Outcomes And Measures: The increased tip projection was verified using the Goode ratio. Upper lip projection was calculated by the Z angle, which is based on the intersection between the Frankfort horizontal plane and the profile line. Vermilion height was also assessed.

Results: Of the 20 patients in the study (19 females and 1 male; mean [SD] age, 26.8 [10.2] years; range, 16-52 years) 18 (90%) demonstrated an increase in upper lip projection when the tip projection was increased by either a columellar strut or tongue-in-groove maneuver. The Z angle demonstrated a statistically significant decrease of 2.7° (95% CI, 1.5°-3.9°; P < .001). Although the vermilion height did not change a significant amount, there was a trend toward an increase in mean height of 0.051 (95% CI, -0.00515 to -0.10685; P = .09).

Conclusions And Relevance: Increasing nasal tip projection causes a measurable increase in upper lip projection. This new causal association has been applied to our filler injection armamentarium as an alternative way to achieve the desired result of a more youthful upper lip.

Level Of Evidence: 4.

Abstract as indexed by PubMed; the article is open access (PubMed Central).