Defining the infratip lobule in rhinoplasty: anatomy, pathogenesis of abnormalities, and correction using an algorithmic approach.
ABSTRACT : Excess infratip lobule projection is often the result of deformities of the middle crus and lower lateral cartilage. The causes and correction of excess projection have not been well described. The classification of the deformities causing excess infratip lobule projection is defined and a surgical algorithm for addressing the infratip lobule is presented.
: A retrospective review of primary rhinoplasties was combined with the use of a cadaver model to identify the causes of excess infratip lobule projection and develop an algorithm for its correction. Specific cases are presented to demonstrate the consistency and predictability of these techniques.
: The classification of excess infratip lobule projection is divided into intrinsic (i.e., long middle crus, wide middle crus, lower lateral malposition, and combination) and extrinsic causes (i.e., prominent septum). After correcting extrinsic causes, the algorithm progresses from medial to lateral, working from the medial crus to the lateral crus. Final refinement using transdomal sutures establishes the endpoint for infratip lobule projection and alar rim position when the cephalic and caudal edges (rotational orientation) of the lower lateral cartilage lie in the same plane.
: A simple classification and logical algorithm are established to help rhinoplasty surgeons achieve aesthetic and consistent infratip lobule projection in cosmetic rhinoplasty. Establishing appropriate infratip lobule projection is essential for an aesthetic result in the lower third of the nose. The appearance of this complex area with the tip, columella, ala, and lobule has great importance in the final outcome in rhinoplasty.
: Therapeutic, V.
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ABSTRACT: Fundamental to the evolution of rhinoplasty is greater focus on the columella and its contribution to the overall aesthetic outcome. While much has been published in regards to the columella assessed in the frontal and lateral views, a paucity of literature exists regarding the basal view of the columella. The objective of this study was to evaluate the spectrum of columella deformities and devise a working classification system based on underlying anatomy. A retrospective study was performed of 100 consecutive patients that presented for primary rhinoplasty. The preoperative basal view photographs for each patient were reviewed to determine whether they possessed ideal columellar aesthetics. Patients that had deformity of their columella were further scrutinized to determine the most likely underlying etiology of the subsequent abnormality. Deformity etiologies were characterized as (1) caudal septum or nasal spine, (2) medial crura, (3) soft tissue, or (4) combination of septum or spine, medial crura, and/or soft tissue. Patients found to have abnormal volumes of soft tissue were further determined to have excess or insufficient soft tissue. Of the 100 patient photographs assessed only 16% (16/100) were found to display ideal norms of the columella. These patients exhibited normal nostril ideals with an appropriate columellar relative width and the aforementioned contour transition. The remaining 84% (84/100) of patients had some form of aesthetic abnormality and were further classified based off of the most likely underlying etiology. Type 1 deformities (caudal septum and/or spine) comprised 18% (18/100), Type 2 (medial crura 12% (12/100), Type 3 (soft tissue) 6% (6/100), and Type 4 (combination) 48% (48/100). Successful rhinoplasty requires diagnosis and treatment of the columella base. Deformities may be classified according to the underlying etiology with combined deformity being the most common. Use of the herein discussed classification scheme will allow surgeons to approach this region in a comprehensive manner. Furthermore, use of such a system allows for a more standardized approach for surgical treatment.Plastic and reconstructive surgery 12/2013; · 2.74 Impact Factor