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Multifactorial approaches for correction of the drooping tip of a long nose in East asians.

Park SG, Jeong H, Ye CH - Arch Plast Surg (2014)

Bottom Line: Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between.The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle.The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards.

View Article: PubMed Central - PubMed

Affiliation: Joseph's Plastic Surgery Center, Daegu, Korea.

ABSTRACT
A long nose with a drooping tip is a major aesthetic problem. It creates a negative and aged appearance and looks worse when smiling. In order to rectify this problem, the underlying anatomical causes should be understood and corrected simultaneously to optimize surgical outcomes. The causes of a drooping tip of a long nose are generally classified into two mechanisms. Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between. The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle. The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards. Many surgical methods have been introduced, but partial approaches to correct such deformities generally do not satisfy East Asians, making the problem more challenging to surgeons. Typically, East Asians have thick nasal tip soft tissue and skin, and a depressed columella and alar bases. The authors suggest that multifactorial approaches to static and dynamic factors along with ancillary causes should be considered for correcting the drooping tip of the long noses of East Asians.

No MeSH data available.


Related in: MedlinePlus

Lateral crus stealing techniqueA proximal portion of the lateral crus (red line) is advanced medially by a horizontal mattress suture, resulting in tip projection and upward rotation by tip gathering on the columellar strut.
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Figure 3: Lateral crus stealing techniqueA proximal portion of the lateral crus (red line) is advanced medially by a horizontal mattress suture, resulting in tip projection and upward rotation by tip gathering on the columellar strut.

Mentions: In cases with a long longitudinal axis of the lateral crus, and with short, underdeveloped medial crus, a horizontal mattress suture should be performed in the proximal portion of the lateral crus to simultaneously correct the drooping tip and the hanging columella. Depending on the suture site and angle, the nasal tip location changes and the lateral crus advances medially (lateral crus stealing technique) [5]. Narrowing the angle between the medial and the lateral crus of the alar cartilage rotates the tip up and pulls up the hanging columella [6,7]. To prevent recurrence, scoring incisions on the perichondrium of the newly created domes are carried out by using a no. 15 blade. Newly located domes should be fixed to the columellar strut or the septal batten graft by a horizontal mattress suture to maintain the new tip shape (Fig. 3).


Multifactorial approaches for correction of the drooping tip of a long nose in East asians.

Park SG, Jeong H, Ye CH - Arch Plast Surg (2014)

Lateral crus stealing techniqueA proximal portion of the lateral crus (red line) is advanced medially by a horizontal mattress suture, resulting in tip projection and upward rotation by tip gathering on the columellar strut.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228203&req=5

Figure 3: Lateral crus stealing techniqueA proximal portion of the lateral crus (red line) is advanced medially by a horizontal mattress suture, resulting in tip projection and upward rotation by tip gathering on the columellar strut.
Mentions: In cases with a long longitudinal axis of the lateral crus, and with short, underdeveloped medial crus, a horizontal mattress suture should be performed in the proximal portion of the lateral crus to simultaneously correct the drooping tip and the hanging columella. Depending on the suture site and angle, the nasal tip location changes and the lateral crus advances medially (lateral crus stealing technique) [5]. Narrowing the angle between the medial and the lateral crus of the alar cartilage rotates the tip up and pulls up the hanging columella [6,7]. To prevent recurrence, scoring incisions on the perichondrium of the newly created domes are carried out by using a no. 15 blade. Newly located domes should be fixed to the columellar strut or the septal batten graft by a horizontal mattress suture to maintain the new tip shape (Fig. 3).

Bottom Line: Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between.The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle.The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards.

View Article: PubMed Central - PubMed

Affiliation: Joseph's Plastic Surgery Center, Daegu, Korea.

ABSTRACT
A long nose with a drooping tip is a major aesthetic problem. It creates a negative and aged appearance and looks worse when smiling. In order to rectify this problem, the underlying anatomical causes should be understood and corrected simultaneously to optimize surgical outcomes. The causes of a drooping tip of a long nose are generally classified into two mechanisms. Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between. The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle. The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards. Many surgical methods have been introduced, but partial approaches to correct such deformities generally do not satisfy East Asians, making the problem more challenging to surgeons. Typically, East Asians have thick nasal tip soft tissue and skin, and a depressed columella and alar bases. The authors suggest that multifactorial approaches to static and dynamic factors along with ancillary causes should be considered for correcting the drooping tip of the long noses of East Asians.

No MeSH data available.


Related in: MedlinePlus