Facial Analysis of the Rhinoplasty Patient March 2012

TITLE: Facial Analysis of the <= span class=3DSpellE>Rhinoplasty Patient
SOURCE: Grand Rounds Presentation, Department of Otolaryngology
The University of Texas Medical Branch (utmb Health)
DATE: March 29, 2012
RESIDENT PHYSICIAN: Regina Rodman, MD
FACULTY PHYSICIAN: Tamara Watts, MD
SERIES EDITOR: Francis B. Quinn, Jr., MD
ARCHIVIST: Melinda Stoner Quinn, MSICS

"This material was prepared by resident physicians in partial fulfillment of educational requirements established f= or the Postgraduate Training Program of the UTMB Department of Otolaryngology/= Head and Neck Surgery and was not intended for clinical use in its present form.= It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to= its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and sho= uld not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion."

INTRODUCTION

Although beauty is easily recognizable within a given culture, it is often difficult to define objectively. Understanding what combination of symmetry, proportions, angles and relationships is considered the standard for the attractive face gives the surgeon an understanding for what is askew. Correction of these asymmetries de= termines the surgical plan.

Quality of photos

· Frontal -Frankfort plane, centered and symmetric, equal distance

· Lateral- Frankfort plane

· Oblique- nasal tip with malar eminence (dist= al medial canthus aligned distal oral commisure)

· Base- nasal tip infrabr= ow line

Facial Analysis

· Horizontal 1/3s

· Vertical 1/5 (intracant= hal distance)

· Straight line from glabella to menton (see deviation)

· Curved sweeping line from medial brow to nas= al tip

· Alar base=3D intercanth= al distance

· Bony sidewall 75% of nasal base

Tip

· Front

· Tip defining points- two gentle domes

· Angle of divergence 50-60 degrees
(distance middle crus from each other; bulbous-box&= ;ball vs narrow)

· Columella from f= ront appears gentle curve, gull in flight

· Lateral

· Nasofrontal angl= e- glabellaà nasionàtip 115-130 better to note projection of glabella
Projection- Goode: nasionàtip: tip à alar crease should be 1.0:0.6
&= nbsp; -Crumley 3,4,5 3=3Dalar crease to tip,= 4=3Dalar crease to nasion, 5=3Dnasi= on to tip

· Dorsum- slightly posterior to line from nasion to tip

· Nasofacial Angle= - 36 degrees (30-40), tipànasion line from glabellaàpogonion

· Nasolabial Angle= - Men 90-95, 95-110, line across no= stril, vertical line (perpendicular to Frankfort) through upper lip

· Alar-Columella- = 2-4 mm show

· Base View

· Lobule 1/3, columella 2/3

· Nostrils pear shaped and symmetric

Chin

· Men- vertical line through lower lip vermill= ion, chin should touch

· Women- diagonal line through both vermillion should be within 2-3 mm chin

Forehead

· Note orientation relative to Frankfort plane, sloping, flat, protruding

SOURCES

Castellano, Dominic. Castellano&HowardSpecialtyCenter Tampa,Fl , Osler Review Course

Lam Sam. Pictoral Documentation: Traditional Photography and D= igital Imaging. Head and Neck Surgery-Otolaryngology, Lippincott Williams and Wilkins 2206

Orten, Steven and Hilger, Peter. = Facial Analysis of the Rhinoplasty Patient. Papel<= i>: Facial and Plastic ReconstructiveSurgery, 2= 002.

Zimbler, Marc Ham, Jongwook. Aesthetic Facial Analysis, Cummings: Otolaryngology: Head and Neck Surgery, 4^th ed