The important thing in the rhinoplasty procedure is to determine the nose shape that will suit the person's face, look natural and suit the facial contours. By performing technical and aesthetic analyses, the appropriate nose structure and size are determined. Rhinoplasty analysis In this procedure, attention is paid to factors such as the patient's gender, age, height and skin structure.
WHAT IS RHINOPLASTY ANALYSIS?
It is extremely important to have a good understanding of technical analysis, anatomy and nasal topography. The roof of the nose is formed externally by bone and cartilage structures, has a pyramid shape and is covered with skin. The skin is thick in the nasion and supratip areas and thin in the rhinion and tip areas. The bony framework consists of the nasal process of the frontal bone, nasal bones and the ascending process of the maxilla. The cartilaginous roof consists of the upper lateral cartilages, lower lateral (alar) cartilages and the quadrangular cartilage of the nasal septum. As the external nasal muscle, there are dilator and compressor ala nasi muscles innervated by the facial nerve; These help breathing by opening the nostrils during breathing.
Technical Rhinoplasty Analysis
The lower 2/3 of the nose contains cartilage structures. Both upper lateral cartilages fuse superiorly with the nasal bones and medially with the septum inferiorly. Although the upper lateral cartilages do not fuse with the nasal bones, they are their continuation caudally. They are triangular in appearance and attached laterally to the frontal process of the maxilla and the medial surface of the nasal bones. Its lower borders fall under the cephalic parts of the lower lateral (alar) cartilages (scroll area). Ligaments in this region constitute one of the major type of support mechanisms.
The lower 1/3 of the nose is called the lobule. Lobule; It consists of supratip, tip, infratip and columella. The tip is the most projected (protruding) part of the lobule and is usually formed by the union of the lateral and medial crura of the alar cartilages. The upper part of the type is called supratip, and the lower part is called infratip. Tip and columella are formed mainly by alar cartilages. The alar cartilage has a medial segment that forms the columella and a lateral segment that gives it its lobulated shape. The maximum tip projection is created by the junction (dome) of the lateral and medial crus. It determines the shape and size of the lateral crus, supratip and lobule. The lateral crus are separated from each other in the supratip region. Between them is a small triangular area that delimits the septal angle.
In this region, the dorsum is supported mainly by septal cartilage. The columella is formed by the medial crura and is covered with soft tissue and skin. The columella is affected by the size and shape of the medial crus and caudal septum. Surgical procedures performed to change the size and shape of the columella will include these elements. Medical surgery is one of the most important steps in rhinoplasty, and type supports should be well evaluated and protected during the procedure. In this way, complications can be reduced. Type supports rhinoplasty analysis It can be divided into major and minor support mechanisms:
Major Type Supports
• Shape, thickness and structure of alar cartilages
• Ligamentous connections between the medial crural footplate of the alar cartilage and the caudal part of the septum
• Ligamentous connections between the lateral crura of the alar cartilages and the upper lateral cartilages.
Minor Type Supports
• Connections between domes of alar cartilages
• Dorsal part of the cartilaginous septum
• Connections between the alar cartilages and the skin and muscle tissue on them
• Anterior nasal spine
• Membranous septum
• Sesamoid cartilage complex that supports the lateral crura of the alar cartilages.
Aesthetic Rhinoplasty Analysis
Step 1: Aesthetics rhinoplasty analysis nose size is determined. The patient's height must be known and the surgeon must determine the overall impression of the nose, such as whether the size is too small or too large for the patient's body and face. A small nose would be appropriate for small and short patients, and a larger nose would be appropriate for tall and bulky patients.
Step 2: Profile and dorsum are evaluated. Nasofrontal angle is evaluated. The deepest point of the angle is on the line just above the iris level and makes an angle of approximately 120°. If this angle is too superficial, the surgeon should take a section from the cephalic part of the nasal bones, the frontal bone, and the soft tissue covering them. If the nasofrontal angle is deeper than desired, this depth should be closed. This can usually be done with autogenous cartilage or bone radix grafts.
Step 3: Type projection is evaluated. In general, the distance from the base of the columella to the tip is roughly equal to the distance from the nasolabial angle to the superior vermillion. The detailed evaluations mentioned above can also be made. In this way, it can be decided whether the projection of the type is normal, more or less, and what kind of type change is required for the ideal projection. After deciding on its normal projection and the nasofrontal point, the dorsal profile of the nose can be created by connecting these two points. It is then determined how much cartilage and bone to remove from the dorsum to achieve the appropriate profile.
Step 4: Type rotation is evaluated. Rotation has nothing to do with projection. These two parameters should be evaluated separately. The angle of the columella with the upper lip is 90° in men and 105-110% in women. As the nasal tip rotates upward, the tip point nasofrontal point The distance between them becomes smaller. Rotation illusions are manipulations that will give the nose the appearance of the nasal tip rotating upwards. The first of these is the projection of the ptotic type. If the projection of the tip is increased, the distance of the nose from the nasofrontal point to the tip appears to be shortened, creating the sensation of increased rotation. The second is to lower the dorsum. This makes the type more distinct and makes it appear more rotated. Additionally, a similar illusion can be achieved by changing the nasolabial angle from sharp to blunt.
Step 5: Columella is evaluated. In lateral view, 3-4 mm of the columella should be visible. If more than this is seen, there is hanging columella, and if less is seen, columella retraction is in question.
Step 6: To determine asymmetries, the nose should be viewed from the frontal perspective and it should be decided which anatomical structure causes the asymmetry. The cause may be deviation of the septum or nasal bones, or a combination of these. Nose wings normally create the appearance of a flying seagull.
Step 7: The supratip-lobule is examined. If the supratip-lobule is prominent and wide, this may be due to the lateral crus of the alar cartilages or the upper lateral cartilages. The alar width is then evaluated. Alar width is determined by lines descending perpendicularly from the medial palpebral fissures. Alar cartilages should be within these limits. If it is wider, it should be narrowed.
Step 8: The nose is examined from the base. The columella should constitute 2/3 of the base height and the lobule should constitute 1/3. If these relationships are different, the type projection needs to be increased or decreased. The columella should be in the midline. Deviation of the columella to one side caudal septum It shows that it is not in place. For correction, the caudal septum must be placed in the midline. In the base view, irregularities of the medial crus can be seen. Another important information provided by the base image is the lobule width. This view also gives an idea about the procedure to be performed on the lateral crus. If the base of the nose has a good triangular appearance and appropriate projection, there is little surgery to be done on the alar cartilages.
