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A New Method for Evaluating the Outcome of Rhinoplasty on the Nasal Tip

Yang, Zhenyu M.D.; Tan, Xiaoyan M.D.; Li, Hua M.D.; Fang, Jun

Author Information
Plastic and Reconstructive Surgery: April 2012 - Volume 129 - Issue 4 - p 739e-741e
doi: 10.1097/PRS.0b013e318245e78d
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Sixty-two female patients, ranging in age from 17 to 46 years (mean, 23.7 years), were enrolled for this study and divided into four groups according to the surgical treatment as follows: group 1, columella strut by autogenous cartilage transplantation and lateral crural transposition; group 2, lateral crural partial truncation; group 3, columella strut by autogenous cartilage transplantation and lateral crural partial truncation; and group 4, columella strut by autogenous cartilage transplantation and lateral crural steal.1 The onlay graft was performed in all four groups. This research was conducted according to the Declaration of Helsinki as a statement of ethical principles.

The nasal tip of both was photographed both before and after rhinoplasty (1 to 6 months). The nasal points, angles, and nasal base soft areas were measured using computer-assisted imaging software. The points consisted of nasion, pronasale, subnasale, alare, alar curvature point, and columella top point (Fig. 1).2 The angles were defined as the nasolabial angle.3 The nasal base soft areas were defined as areas of nasal base. The view of the nasal base was trapezoidal.

Fig. 1
Fig. 1:
Nasal landmarks in base view. prn, pronasale; alr, right alare; all, left alare; c, columella top point; sn, subnasale; acr, right alar curvature point; acl, left alar curvature point.

The overall area of nasal base was divided into upper base (nasal tip trapezoid) and bottom base (nostril trapezoid) areas. The upper base was constructed by connecting both sides of the intermediate crural domal segments intersecting at the alar rim tangents, whereas the lower base was constructed by connecting both sides of the lower poles of the nostrils intersecting at the alar rim tangents (Fig. 2). The following formulas were used to calculate the areas of trapezoids: nasal tip trapezoid = (upper base + middle base) * [(subnasale-pronasale) – (columella top point-subnasale)] * 1/2; and nostril trapezoid = (middle base + lower base) * (columella top point-subnasale) * 1/2.

Fig. 2
Fig. 2:
The nasal base areas. prn, pronasale; c, columella top point; sn, subnasale.

The index of each parameter in Table 1 represented its change from before to after rhinoplasty in each group. It was found that indexes 4, 8, 10, 11, and 12 were significantly correlated with the difference of surgical technique in rhinoplasty (Table 1). No columella strut procedure was performed in group 2, whereas an increase in index 4 in the other three groups reflected an increase in the length of the columella caused by the cartilage transplantation. According to the Anderson tripod theory,4 the lateral crural transposition in group 1 might result in pushing the lateral crus forward and was indicated by a decrease in index 8 (nasolabial angle), whereas an increase in this index was associated with lateral crural partial truncation in groups 2 and 3 and with the lateral crural steal in group 4.

Table 1
Table 1:
Comparison of Index before and after Surgery in the Four Groups*

In group 2, the onlay graft could enlarge the size of the tip despite lateral crural partial truncation,5 which was indicated by an increase in index 11 or by a decrease in index 12. In groups 1, 3, and 4, the larger columella size was seen because of the columella strut, and was reflected by an increase in both indexes 10 and 12 or by a decrease in index 11. These findings suggest that the indexes of geometry graph consisting of related linears may be used for precisely evaluating the outcome of the nasal tip plasty.

Zhenyu Yang, M.D.

Xiaoyan Tan, M.D.

Plastic Surgery Hospital of Hangzhou

Hua Li, M.D.

Sir Run Run Shaw Hospital

Jun Fang, Plastic Surgery Hospital of Hangzhou, Hangzhou, Zhejiang, People's Republic of China


The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.


The patient provided written consent for use of the images.


1. Kridel RW, Konior RJ, Shumrick KA, Wright WK. Advances in nasal tip surgery: The lateral crural steal. Arch Otolaryngol Head Neck Surg. 1989;115:1206–1212.
2. He ZJ, Jian XC, Wu XS, Gao X, Zhou SH, Zhong XH. Anthropometric measurement and analysis of the external nasal soft tissue in 119 young Han Chinese adults. Craniofac Surg. 2009;20:1347–1351.
3. Ghazipour A, Ghadakzadeh S, Karimian N. The comparison between two different combinations of alar V cartilage-modifying techniques: Is lateral crural steal the choice? Eur Arch Otorhinolaryngol. 2009;266:391–395.
4. Anderson JR. The dynamics of rhinoplasty. In: Proceedings of the 9th International Congress in Otolaryngology. Amsterdam: Excerpta Medica; 1969:708–710.
5. Beaty MM, Dyer WK II, Shawl MW. The quantification of surgical changes in nasal tip support. Arch Facial Plast Surg. 2002;4:82–91.


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