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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