Change in Columellar-Philtral and Nasolabial Angles Over Time Following Rhinoplasty

Overview

Two angles are used to assess how far the nasal tip is rotated: the columellar philtral angle and the nasolabial angle. This prospective study compared how each changed over time after rhinoplasty and looked for maneuvers or patient characteristics affecting rotation, in 111 consecutive patients of one surgeon.

Sections of note

• Prospective analysis of 111 patients, measured before surgery, immediately after, and at 1 week, 1 month, 6 months and 1 year.
• Subgroup analyses were performed by surgical maneuver and other factors.
• The greatest change came at 1 week: 11.8 degrees of elevation in the columellar philtral angle, and 9.3 degrees in the nasolabial angle, both P less than 0.001.
• By 6 months the mean columellar philtral angle was not significantly different from before surgery.
• The nasolabial angle remained 4.94 degrees elevated, 95 percent confidence interval 2.1 to 8.4, P equals 0.001.
• Women showed roughly 10 degrees more elevated columellar philtral angle than men before and after surgery, while the nasolabial angle did not differ by sex.
• Transfixion incisions appeared to cause a significant decrease in the postoperative nasolabial angle.
• The authors state a standardized measurement for tip rotation is warranted.

What it means for a patient

• The tip appears most rotated a week after surgery, from swelling, and then settles over months.
• One year later the nose remained measurably rotated by one measure but not the other, so the two are not interchangeable.
• A transfixion incision, which separates the septum from the tip, was associated with less lasting rotation.
• This is one surgeon's consecutive series with no comparison group.

Why this paper matters

Tip rotation is a central goal of rhinoplasty but is measured inconsistently across the literature, making studies hard to compare. This study shows two standard measures disagree about the same operations. It supports standardizing which angle is used before results can be pooled.

Terms

• Columellar philtral angle: the angle between the strip below the nostrils and the groove above the lip.
• Nasolabial angle: the angle between the base of the nose and the upper lip.
• Tip rotation: how far upward the nasal tip is angled.
• Transfixion incision: a cut separating the septum from the tip structures.
• Confidence interval: the range within which the true value is likely to lie.