Updated Dynamics of Rhinoplasty: A Review of the Literature and Comprehensive List of the Findings

Overview

The authors argue rhinoplasty is complex because every maneuver produces effects beyond the one intended. This review searched PubMed for rhinoplasty dynamics and for each specific maneuver, covering publications from 1991 to 2019, and compiled what each step does.

Sections of note

• PubMed searches covered rhinoplasty dynamics and keywords for each specific maneuver, 1991 to 2019; article types included case series, cohort studies and reviews.
• Radix reduction apparently elongates the nose and widens the space between the eyes; radix augmentation creates the opposite illusions.
• Dorsal hump reduction widens both the nose and the intercanthal space.
• Resection of the upper lateral cartilages can rotate the tip upward and reduce tip width.
• Manipulating the footplates of the medial crura primarily affects the columella but can also change tip projection.
• Placement of a columellar strut firmly establishes tip position.
• Alar rim grafts move the nostril rim downward, widen the nostrils, and lengthen a short nostril; alar base reduction creates the illusion of increased tip projection; changes to the anterior nasal spine affect tip projection, upper lip length and the nasolabial angle. Level of evidence III.

What it means for a patient

• Changing one part of the nose changes how other parts appear, sometimes without any tissue being touched there.
• Several of the listed effects are illusions of perception rather than actual measured changes.
• Lowering a hump makes the nose look wider, which is why bone cuts usually follow.
• Limits: this compiles findings from studies of varying design and quality rather than measuring anything directly.

Why this paper matters

Unintended effects are what make rhinoplasty results diverge from the plan, and having them catalogued in one place supports better preoperative prediction. The review updates an established concept with two decades of literature. It does not grade the strength of evidence behind each listed effect.

Terms

• Radix: The root of the nose, the deepest point between the eyes.
• Intercanthal space: The distance between the inner corners of the eyes.
• Medial crura footplates: The flared bases of the inner arms of the tip cartilages.
• Alar rim graft: A small cartilage strip placed along the nostril edge.
• Anterior nasal spine: The small bony projection at the base of the nose.