Implications of Facial Asymmetry in Rhinoplasty

Overview

Patients who come in complaining that their nose is crooked are often unaware their face is asymmetric underneath. This study tested whether a surgeon's visual assessment of facial asymmetry matches objective measurements, quantified how often asymmetry accompanies nasal deviation, and presents the senior author's method for correcting a deviated nose on an asymmetric face.

Sections of note

• The stated objective was to test whether subjective surgical facial analysis correlates with objective anthropometric measurements.
• A second aim was to quantify how frequently facial asymmetry accompanies nasal deviation.
• Finding: nasal deviation is closely related to facial asymmetry.
• Finding: objective facial analysis closely correlates with anthropometric facial measurements.
• Finding: the wide side of the face corresponds to the short side of the face.
• Finding: the nose tends to deviate away from the wide side of the face.
• Recommended goal in surgery: obtain nasal symmetry and center the nose on a line between the mid glabella and the mid Cupid's bow. Level of evidence IV, diagnostic.
• The abstract states no patient numbers, correlation values, or percentages.

What it means for a patient

• A crooked nose usually sits on an asymmetric face, and the face cannot be straightened by nose surgery.
• The surgical target is centering the nose between two fixed midline landmarks, the middle of the brow area and the middle of the upper lip.
• The authors state this may reduce how much the facial asymmetry is noticed.
• Limits: level IV diagnostic evidence, no patient count or numeric results in the abstract, and satisfaction is asserted rather than measured.

Why this paper matters

Correcting a deviated nose without acknowledging the underlying facial asymmetry sets up disappointment on both sides. Establishing a consistent directional pattern gives surgeons something to check preoperatively. The abstract does not supply the numbers behind the stated correlations.

Terms

• Facial asymmetry: Differences in size or position between the two halves of the face.
• Nasal deviation: A nose that sits off the facial midline.
• Anthropometric measurement: Direct measurement of body or facial dimensions.
• Glabella: The smooth area between the eyebrows.
• Cupid's bow: The double curve of the upper lip's border.