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Smile Analysis in Rhinoplasty: A Randomized Study for Comparing Resection and Transposition of the Depressor Septi Nasi Muscle

Kalantar-Hormozi, Abdoljalil M.D.; Beiraghi-Toosi, Arash M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000436850.86785.24
Cosmetic: Original Articles
Discussion
Abstract

Background: The depressor septi nasi muscle is responsible for smiling deformity. Its manipulation is beneficial in patients with muscle hypertrophy. In addition, it enhances the smile and tip-lip relationship. In this study, depressor septi nasi muscle excision through a transfixion incision is compared with its transposition through an upper labial sulcus incision.

Methods: Two techniques of depressor septi nasi muscle treatment were performed randomly for rhinoplasty cases. Smile analysis in rhinoplasty, consisting of measurements of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and full smile, was performed on preoperative and postoperative photographs.

Results: One hundred patients were studied in two equal groups. Preoperatively, tip projection and upper lip height were decreased significantly with smiling. Generally, the effect of smiling on all five parameters was decreased significantly following rhinoplasty. The two different techniques were not significantly different in decreasing the effects of smiling on nasal length, nasal diagonal, tip projection, upper lip height, or transverse crease.

Conclusions: The two different techniques were the same in decreasing the effects of smiling. The authors recommend smile analysis in rhinoplasty, consisting of measurement of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and during smiling, before rhinoplasty for preoperative evaluation and after the operation for outcome assessment. Depressor septi nasi muscle treatment should be considered if a decrease in tip projection or upper lip height with smiling or a transverse upper labial crease during smiling is extraordinary or unsightly.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Author Information

Tehran and Mashhad, Iran

From the Department of Plastic Surgery, 15 Khordad Hospital, Shahid Beheshti Medical University; and the Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences.

Received for publication June 12, 2013; accepted July 22, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Arash Beiraghi-Toosi, M.D., Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, beiraghia@mums.ac.ir

©2014American Society of Plastic Surgeons