Brady Chevonne, Berwick Daniele, Uppal Rajan
Department of Plastic Surgery, Wexham Park Hospital, Frimley Healthcare Foundation Trust, Slough, United Kingdom.
Uppal Plastic Surgery, St. John's Wood, London, United Kingdom.
Plast Reconstr Surg Glob Open. 2021 Apr 15;9(4):e3462. doi: 10.1097/GOX.0000000000003462. eCollection 2021 Apr.
Aesthetic rhinoplasty is one of the most challenging procedures performed by aesthetic surgeons. Tip droop, especially on smiling, may not be noted by the surgeon postoperatively but can be concerning to patients. Our aim was to determine if the division of the depressor septi nasi or its combination with a columellar strut graft during rhinoplasty produce a measurable reduction in nasal tip droop on smiling.
A retrospective casenote and photograph review was conducted on patients who had undergone aesthetic endonasal rhinoplasty, performed by a single surgeon between 2015 and 2019. In total, 29 patients had release of the depressor septi nasi muscle, whilst 11 had release of the muscle along with a strut graft. Lateral smiling photographs were taken postoperatively. Tip droop was measured as a variation of the nasolabial angle from rest to smiling using the Frankfurt line.
Photographs were taken at a mean of 14 months postoperatively. In the group who had muscle release only, a mean increase in nasolabial angle of 3.66 degrees was seen when smiling when compared with rest. In the group who had muscle release combined with strut graft, a mean increase of 2.27 degrees was seen. When using a columellar strut along with muscle release, tip droop on smiling was reduced.
This study demonstrates that columellar strut grafting in combination with muscle release can alleviate drooping of the tip better than muscle division alone after rhinoplasty. The columellar strut graft provides tip stability and can therefore be used to enhance dynamic outcomes after rhinoplasty.
鼻整形术是美容外科医生进行的最具挑战性的手术之一。鼻尖下垂，尤其是在微笑时，术后外科医生可能未注意到，但患者可能会在意。我们的目的是确定在鼻整形术中切断降鼻中隔肌或其与鼻小柱支撑移植物联合使用是否能在微笑时使鼻尖下垂得到可测量的减轻。
对2015年至2019年间由单一外科医生进行的美容性鼻内整形术患者进行回顾性病例记录和照片审查。共有29例患者进行了降鼻中隔肌松解，11例患者进行了肌肉松解并同时植入支撑移植物。术后拍摄侧面微笑照片。使用法兰克福线将鼻尖下垂测量为从休息到微笑时鼻唇角的变化。
照片拍摄的平均时间为术后14个月。仅进行肌肉松解的组，与休息时相比，微笑时鼻唇角平均增加3.66度。进行肌肉松解并联合支撑移植物的组，平均增加2.27度。在肌肉松解的同时使用鼻小柱支撑移植物时，微笑时的鼻尖下垂减轻。
本研究表明，鼻整形术后，鼻小柱支撑移植物联合肌肉松解比单纯肌肉切断能更好地减轻鼻尖下垂。鼻小柱支撑移植物可提供鼻尖稳定性，因此可用于改善鼻整形术后的动态效果。
