APS Aesthetic Plastic Surgery · 2022

Effect of Tongue-in-Groove Technique on Upper Lip Slope in Rhinoplasty

Sazgar AK, Tavakoli K, Sazgar AA, Saedi B.

PubMed 35348827 Publisher (DOI)Free full text (PMC)

What this paper says

Across 367 rhinoplasty patients, the tongue in groove technique significantly changed the upper lip angle whether or not a septal extension graft was used, with the change more likely in patients whose starting nasolabial angle was larger.

Overview

Several rhinoplasty techniques alter the shape of the upper lip over time. The tongue in groove technique removes the membranous septum and interferes with the muscle that pulls the tip down, which the authors say can exaggerate changes in lip shape, length and slope. This study compared it with and without an added septal extension graft.

Sections of note

Retrospective review of 367 primary rhinoplasty patients, 2016 to 2020; level of evidence IV.
Two hundred and nine patients had the technique alone; the rest had it over a septal extension graft.
Three angles were measured before and after surgery: upper lip, nasolabial and columellar facial.
Upper lip angle changed significantly in both groups.
Mean upper lip angle increased in both groups, though some patients had a decrease.
The proportion with an increased postoperative upper lip angle grew as the preoperative nasolabial angle increased, P less than 0.05.
No significant correlation was found between preoperative columellar facial angle and postoperative upper lip angle.
The authors attribute the change to the point below the nose shifting upward and backward.

What it means for a patient

A technique used to set nasal tip position also changes the slope of the upper lip in profile.
The direction of change was not uniform; some patients moved opposite to the average.
The starting nasolabial angle predicted which way the lip angle would go.
This is a retrospective review of photographic angles, with no patient reported outcomes.

Why this paper matters

The nose and upper lip are judged together in profile, and a change to one alters the other. This study quantifies that link for one of the most used tip techniques. Whether patients notice or object to the lip change was not assessed.

Terms

Tongue in groove: sliding the tip cartilages onto the front edge of the septum to set tip position.
Septal extension graft: cartilage attached to the septum to set tip position and projection.
Membranous septum: the soft tissue partition between the front of the septum and the columella.
Depressor septi nasi: a small muscle that pulls the nasal tip downward.
Nasolabial angle: the angle between the base of the nose and the upper lip.
Subnasal point: the point where the base of the nose meets the upper lip.

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

Abstract

Background: Several surgical techniques used for rhinoplasty can change the upper lip form over the long term. By eliminating the membranous septum and causing dysfunction of the depressor septi nasi muscle and performing other maneuvers, the tongue-in-groove (TIG) technique can exaggerate changes in the upper lip shape, length, and slope.

Methods: This study was conducted to compare the effects of the TIG technique with and without a septal extension graft (SEG) on lip slope and aesthetic angles on the profile view. A retrospective review was performed on 367 patients who underwent primary rhinoplasty using the TIG technique from 2016 to 2020. The upper lip angle (ULA), the nasolabial angle (NLA), and the columellar facial angle (CFA) were measured for comparison pre-and post-operatively.

Results: Of 367 patients, 209 underwent TIG, while the rest underwent TIG over SEG (TIG+SEG). Comparison of pre-and post-operative ULAs showed significant changes in both groups. Although mean ULAs increased in both groups, some of the patients in each group experienced a decrease in ULA. The percentage of the patients with increased post-operative ULA significantly grow with increase in the pre-operative NLA (p < 0.05). However, no significant correlation was found between pre-operative CFA and post-operative ULA.

Conclusion: The present study suggests that TIG with and without SEG can change the lip slope on the profile view, possibly due to the shift of the subnasal point superiorly and posteriorly.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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