Pigott R W
Department of Plastic Surgery, Frenchay Hospital, Bristol.
Br J Plast Surg. 1988 Nov;41(6):593-607. doi: 10.1016/0007-1226(88)90167-1.
A study of the changing configuration of the nose tip with age shows that the columella naturally takes a greater share of nose tip projection with increasing age. In the infant and small child, when most repairs are done, nose tip projection is due more to the alar dome component than to the columella. Over-lengthening the columella at the expense of alar dome projection results in an unaesthetic nose at maturity. The nasal correction should be towards a normal proportion for age and attention must be paid to alar dome configuration. Where the inferior view shows a "tent tip" skyline, lateral crus advancement is required and can be achieved in asynchronous repairs by Pigott alar leapfrog at primary repair or by Potter V-Y advancement at the time of forked flap columella lengthening. The profile view of the nose and lip shows that the lip "drops" from a point about two-thirds of the way from nostril apex to alar base. A key stitch advancing the alar bases at the time of columella lengthening allows the philtral area to bow forwards as a prow so that it comes to lie in a normal relationship with the columella in the profile view.
一项关于鼻尖形态随年龄变化的研究表明，随着年龄的增长，鼻中隔在鼻尖突出度中所占的比例自然会增大。在婴儿和小孩阶段，即大多数修复手术进行的时期，鼻尖突出度更多地归因于鼻翼穹窿部分，而非鼻中隔。以牺牲鼻翼穹窿突出度为代价过度延长鼻中隔，会导致成年后鼻子外观不佳。鼻部矫正应朝着符合年龄的正常比例进行，并且必须关注鼻翼穹窿的形态。当从下方观察呈现“帐篷尖”轮廓时，需要进行外侧脚推进，这可以在初次修复时通过皮戈特鼻翼跨越式修复或在分叉皮瓣鼻中隔延长时通过波特V-Y推进来实现。鼻唇的侧面观显示，唇部从鼻孔顶端到鼻翼基部约三分之二处的一点向下倾斜。在鼻中隔延长时，通过关键缝线推进鼻翼基部，可使鼻小柱区域向前弯曲成船头状，从而在侧面观中与鼻中隔保持正常关系。
