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Ilusions in Rhinoplasty

Daniel G. Becker MD FACS

PENN Medicine - BeckerENT

Clinical Professor, Facial Plastic & Reconstructive Surgery

Department of Otolaryngology-Head & Neck Surgery

University of Pennsylvania

Surgical Anatomy – A Prerequisite

Facial and Nasal Analysis – The Basics

www.therhinoplastycenter.com

www.RhinoplastyArchive.com

www.RhinoplastyArchive.com

The Nose: Inside and Out

The Nose: Inside and Out

Illusions in Rhinoplasty: An Advanced

Discussion of Nasal Analysis

Lecture Goals: Understand Illusions in

Rhinoplasty and How They Affect Surgical

Decision Making

Illusions in Appearance

• Illusions are aspects of the nose that make

the nose appear different than actual – longer

or shorter, more or less projected, etc…

• These illusions can contribute to a favorable

or desired appearance… or detract from it.

• A solid foundation in nasal anatomy and nasal

analysis is a prerequisite to a discussion of

rhinoplasty illusions.

Illusions in Rhinoplasty

Tardy ME Jr, Becker DG, et al.

1995 Jul;11(3):117-137

Nasal projection: Anterior

protrusion of nasal tip from face

Goode's method:

A line drawn through the alar crease,

perpendicular to the Frankfurt plane. The

length of a horizontal line drawn from

the nasal tip to the alar line divided by

the length of the nasion-to—nasal tip

line. Normal, 0.55 to 0.60

Crumley's method: The nose with normal

projection forms a 3-4-5 triangle (i.e., alar point-to-nasal tip line (3), alar point-to-nasion line (4), nasion-to-nasal tip line (5). With this method, the nasofacial angle is 36 degrees

Byrd's method: Tip projection is two-thirds

(0.67) the planned postoperative (or the ideal) nasal length. Ideal nasal length in this approach is two-thirds (0.67) the midfacial height (5)

Illusions of tip projection

• Dorsal hump creates illusion of relative

underprojection

• Dorsal concavity creates illusion of relative

overprojection.

• That is to say, changing the relationship

between dorsum and tip can alter the

appearance of projection.

Illustrative Patient Photos

Redacted for syllabus

Illustrative Patient Photos

Redacted for syllabus

An Overprojected Tip Gives the

Appearance of a Weaker Dorsum

• So, deprojecting the tip should give an

illusion of a stronger dorsum

Illustrative Patient Photos

Redacted for syllabus

Illusions of the Dorsum

• A dorsal convexity (aka “hump”) gives the

appearance of narrowness on frontal view

• This appearance can be addressed with

hump reduction

Illustrative Patient Photos

Redacted for syllabus

Illusions of the Dorsum

• A low dorsum gives the appearance of

increased nasal width due to less shadowing

along the lateral nasal wall.

• This appearance can be significantly

changed with augmentation.

Illustrative Patient Photos

Redacted for syllabus

Definition of length

• The nose has “3 lengths”

– Nasion to Tip is “Central Length”

– Nasion to Alar Margin are “Lateral Lengths”

• A short or long lateral length may reflect a

retracted or hooded ala

• A short or long central length may reflect an

acute or obtuse nasolabial angle

• Also, a deep nasofrontal angle creates an

illusion of shorter length, and vice versa.

Nasofrontal angle

• A deep nasofrontal angle lends the appearance of a

short nose, as does an obtuse nasolabial angle or

accentuated double break

Illustrative Patient Photos

Redacted for syllabus

Nasal length - tip

• An acute nasolabial angle lends the

appearance of length

• An obtuse nasolabial angle lends an

appearance of a shorter nose.

Illustrative Patient Photos

Redacted for syllabus

Nasal length and

ala-columellar

relationship

• 9 possible

combinations

• Differing effects on the

appearance of length

Illustrative Patient Photos

Redacted for syllabus