Ilusions in Rhinoplasty

Transcription

1 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

2 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.

3 Surgical Anatomy A Prerequisite (see

4

5 and also

6 Illusions in Rhinoplasty Tardy ME Jr, Becker DG, et al Jul;11(3):

7 Illusions in Rhinoplasty: An Advanced Discussion of Nasal Analysis Lecture Goals: Understand Illusions in Rhinoplasty and How They Affect Surgical Decision Making

8 Nasal projection (objective definition): Anterior protrusion of nasal tip from face Goode's method: (an objective measure) 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

9 Crumley's method: (another objective measure) The nose with normal projection forms a triangle (i.e., alar point-tonasal tip line (3), alar pointto-nasion line (4), nasion-tonasal tip line (5). With this method, the nasofacial angle is 36 degrees Byrd's method: (see above) 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)

10 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.

11

12

13

14 Computer Simulation

15 Computer Simulation

16

17

18

19

20 Applying this Knowledge: An Overprojected Tip Gives the Appearance of a Weaker Dorsum So, deprojecting the tip should give an illusion of a stronger dorsum

21

22

23

24

25

26

27 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

28

29

30

31

32 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.

33

34

35

36

37

38

39

40 Definition of length (complicated) The nose has (you see) 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.

41 Nasofrontal angle A deep nasofrontal angle lends the appearance of a short nose, as does an obtuse nasolabial angle or accentuated double break

42

43 Computer simulation

44

45 Nasal length - tip An acute nasolabial angle lends the appearance of length An obtuse nasolabial angle lends an appearance of a shorter nose.

46

47

48

49

50

51

52 Nasal length and ala-columellar relationship 9 possible combinations Differing effects on the appearance of length

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68