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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

Excision of the depressor septi nasi muscleThe depressor septi nasi muscle between the foot plates of the medial crus and the dermocartilagenous ligament (Pitanguy's ligament) connecting the supratip area should be removed. The excised soft tissue can be rolled and inserted in front of the anterior nasal spine to eliminate the dynamic tip drooping forces and augment the acute columella-labial angle.
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Figure 6: Excision of the depressor septi nasi muscleThe depressor septi nasi muscle between the foot plates of the medial crus and the dermocartilagenous ligament (Pitanguy's ligament) connecting the supratip area should be removed. The excised soft tissue can be rolled and inserted in front of the anterior nasal spine to eliminate the dynamic tip drooping forces and augment the acute columella-labial angle.

Mentions: First, a stepladder-shaped transcolumellar incision is performed. Then, a dissection upward toward the dome, inferiorly toward the anterior nasal spine, and posteriorly toward the septal cartilage should be performed to expose the perichondrium of the medial crus. The depressor septi nasi muscle between the crura or complex tissue should be excised during the dissection, and the excised soft tissue should be rolled and inserted in front of the anterior nasal spine to augment the columella-labial angle (Fig. 6). If the columella-labial angle is too acute and the drooping tip is severe, the origin of the depressor septi nasi muscle should be dissected by using an intraoral approach, and the anterior nasal spine should be exposed to insert a V-shaped silicone implant in the dead space (Fig. 7).


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)

Excision of the depressor septi nasi muscleThe depressor septi nasi muscle between the foot plates of the medial crus and the dermocartilagenous ligament (Pitanguy's ligament) connecting the supratip area should be removed. The excised soft tissue can be rolled and inserted in front of the anterior nasal spine to eliminate the dynamic tip drooping forces and augment the acute columella-labial angle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Excision of the depressor septi nasi muscleThe depressor septi nasi muscle between the foot plates of the medial crus and the dermocartilagenous ligament (Pitanguy's ligament) connecting the supratip area should be removed. The excised soft tissue can be rolled and inserted in front of the anterior nasal spine to eliminate the dynamic tip drooping forces and augment the acute columella-labial angle.
Mentions: First, a stepladder-shaped transcolumellar incision is performed. Then, a dissection upward toward the dome, inferiorly toward the anterior nasal spine, and posteriorly toward the septal cartilage should be performed to expose the perichondrium of the medial crus. The depressor septi nasi muscle between the crura or complex tissue should be excised during the dissection, and the excised soft tissue should be rolled and inserted in front of the anterior nasal spine to augment the columella-labial angle (Fig. 6). If the columella-labial angle is too acute and the drooping tip is severe, the origin of the depressor septi nasi muscle should be dissected by using an intraoral approach, and the anterior nasal spine should be exposed to insert a V-shaped silicone implant in the dead space (Fig. 7).

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