Nose Tip Elongation and Elevation: A Novel Filler Injection Technique

Background Filler injection for nose tip improvement remains a difficult subject due to efficacy and safety issues. Objectives To better the techniques and safety for nose tip improvement with a filler. Methods Patients seeking nose tip improvement were recruited regardless of their pre-treatment conditions. A hyaluronic acid filler is injected through the skin behind the nose tip into the potential septal space. To achieve tip elevation, the filler is retro injected from the anterior nasal spine, stopping at the mid-level of medial crura. To elongate the nose, the filler is deposited just in front of the caudal septal cartilage. The tip extends in the sagittal plane, causing the nose tip to move either caudally (tip elongation) or anteriorly (tip elevation), or both, as directed by the surgeon. Results Depending on the patients, the nose could be elongated by 2 to 6mm, and the tip could be elevated by 2 to 8 mm. Additionally, stronger columellar support, finer tip structures, and improved nasolabial angle are observed. Interestingly, the upper lip appears shorter. The nostril shapes and the alar widths are also improved. A total of 1288 cases are reported. Only two patients expressed dissatisfaction. Conclusions This technique is easy and safe to perform and, the results are natural and comparable to those from rhinoplasty surgeries. Further, this report of filler nose lengthening may be the first large series in the world. Finally, this technique works well in all populations.

Evaluation of Lip Morphology and Nasolabial Angle in Non-Syndromic Cleft Lip and/Palate and Non-Cleft Individuals

Objective: To investigate the variation between the non-syndromic cleft lip and/or palate (NSCLP) and non-cleft (NC) subjects in relation to the lip morphology (LM) and nasolabial angle (NLA). Materials and Methods: Lateral cephalogram (Late. Ceph.) of 123 individuals (92 NSCLP [29 = bilateral cleft lip and palate (BCLP), 41 = unilateral cleft lip and palate (UCLP), 9 = unilateral cleft lip and alveolus (UCLA), 13 = unilateral cleft lip (UCL)], and 31 NC) who did not undergo any orthodontic treatment were investigated. By WebCeph, an artificial intelligence- (A.I.) driven software, 2 (two) parameters of LM, namely upper lip to E line (LM-1) and lower lip to E line (LM-2), and NLA analysis was carried out for each individual. Multiple tests were carried out for statistical analysis. Results: The mean ± SD observed for LM-1, LM-2, and NLA for NC individuals were 1.56 ± 2.98, 0.49 ± 3.51, and 97.20 ± 16.10, respectively. On the other hand, the mean ± SD of LM-1, LM-2, and NLA for NSCLP individuals were 4.55 ± 4.23, 1.68 ± 2.82, and 82.02 ± 14.66, respectively. No significant variation was observed with respect to gender and side. NSCLP (different types) and NC individuals showed significant disparities in LM-1 and NLA. Conclusion: It can be concluded that parameters of lip morphology such as LM-1, LM-2, and NLA vary among NSCLP and NC individuals.

Morphological Analysis of Nose in Patients of Tessier No. 0 Cleft With a Bifid Nose in China

Objective: Facial cleft involves complex malformations. No study assessed the facial deformity of Tessier No. 0 cleft with a bifid nose. Thus, we used anthropometric measurements to access the nose in patients.Methods: A total of 24 bifid nose deformities underwent surgery at our institution between 2010 and 2019. Standardized photographs were taken preoperatively and postoperatively. Landmarks were identified on these images; measurements for nasal analysis were performed and compared with the established Chinese norms. Surgical method differences were also analyzed.Results: The median follow-up time was 2.51 years. Postoperatively, there is a significant difference in comparison with preoperative in the nasal index, medial canthus and nose width index, nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. Furthermore, the medial canthus and nose width index, and nasal width and ala length index were significantly larger in ordinary people, while ala length and nasal bridge length index and nasal tip protrusion and nasal width index were smaller. After surgery, most angles and index were standard except the nasolabial angle in the females, and ala length and nasal bridge length index in the males. Moreover, as for the group of costal cartilage transplantation, most index and angles have improved after surgery including nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. However, only nasal tip protrusion and nasal width index, columella length and nasal tip protrusion index, and nasal width and ala length index in the silicone prosthesis group implantation has significance. Costal cartilage transplantation can also better improve ala length and nasal bridge length index than the silicone prosthesis implantation.Conclusion: Most defects can be repaired with surgery, but the outcome has a lack of evaluation. Thus, anthropometric assessment can serve as a material for nasal and reconstructive surgery.

Anthropometric Study of Facial Morphology in Northern Thai Population Aged 1 to 18 Years Old to Inform the Timing of Craniofacial Reconstruction

Objective: To determine normal range of craniofacial structures, compare between male and female and establish growth curves in subjects aged 4 to 18 years old. Moreover, to determine normal range of craniofacial structures in subpopulation aged 1 to 3 years old. Materials and Methods: The present study was a cross-sectional study including 388 healthy subjects consisted of 363 subjects aged 4 to 18 years old and 25 subjects aged 1 to 3 years old. Both groups were Northern Thai. All subjects were measured to record the craniofacial anthropometry and established the growth curves in 6 regions including head, face, orbit, nose, labio-oral and ears. Results: In the population aged 4 to 18 years old, upper vermillion height of males was 9.03±2.92 mm. while in females was 8.45±2.38 mm (p=0.039). Left auricular length of males was 57.22±5.33 mm, while in females was 55.89±4.59 mm (p=0.011). Right auricular length of males was 57.40±5.35 mm, while in females was 55.91±4.75 mm (p=0.006). In the population aged 1 to 3 years old, left palpebral fissure of male was 10.42±2.45 mm, while in females was 8.27±1.43 mm (p=0.041). The trend in morphological face height was stable after 13 years old. The trend in physiognomical face height, binocular width, mouth width, and auricular height was stable after 16 years old. The trend in forehead height, mandible width, and nasolabial angle was stable after 18 years old. Conclusion: Each of the parameters showed a tendency to be stable at a specific cut-off age. Therefore, craniofacial reconstruction should be carried out after the specific cut-off ages identified in the results. Keywords: Facial anthropometry; Anthropometrics; Craniofacial; Northern Thai

Correlation between objective evaluation and subjective evaluation of facial profile in skeletal Type II females

Objectives: The objective of this study was to find the cephalometric measurements that correlate with the visual perception. Materials and Methods: A total of 250 lateral cephalograms of patients from the year 2016 to 2018 were hand traced and analyzed. Thirty-six hard- and soft-tissue measurements were obtained from the lateral cephalometric analysis. Silhouettes obtained from cephalometric films were rated by 10 orthodontists based on their level of convexity. For each sample, the rating of visual perception was correlated with all the cephalometric (hard and soft) measurements. Results: ANB, AF-BF, L1-NB (mm), overjet, anterior maxillary alveolar height, posterior maxillary alveolar height, lower lip to E plane, and H angle were positively correlated with the visual perception. On the contrary, Pg. to N perpendicular and Pg. to NB (mm) were negatively correlated with the visual perception. However, the measurements in the vertical dimensions did not have any significant correlations with visual perception. H angle showed a higher correlation with visual perception than the nasolabial angle, facial contour angle, and lower lip to E plane. Conclusion: The agreement between objective cephalometric measurements and subjective visual perception was less than expected. In general, only 27% of the cephalometric measurements had a significant correlation with visual perception. Therefore, orthodontic treatment planning based solely on cephalometric analysis can result in unsatisfactory treatment outcomes. An inclusion of subjective measures such as visual perception in orthodontic diagnosis and treatment planning is necessary.

Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement. Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student’s t-test and multivariate analysis. Differences were considered significant for P-values ≤.05. Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004). Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.

Nasolabial Angle in Profiles Perceived as Attractive: A Scoping Review

Context: The nose and lips area play an important role in facial appearance and nasolabial angle (NLA) can be considered as a determinant factor for attractiveness. The perception of beauty and attractiveness is vastly influenced by media and thus, can change with trends over time. The aim of this study was to conduct a systematic review of literature on NLA in faces perceived as attractive over time and in different ethnic groups. Evidence Acquisition: This study was performed following preferred reporting items for systematic reviews and meta-analyses extension for Scoping Reviews (PRISMA-ScR) guideline. We conducted an electronic search using PubMed, Scopus, and Embase databases with the employment of MeSH and free text terms "beauty"[MeSH], "esthetics"[MeSH], "soft tissue", "nasolabial angle", "attractive" and "cephalometric analysis". The inclusion criteria were studies that indicated facial attractiveness by a panel of at least 10 judges, evaluated the soft tissue profile characteristics, and reported the preferred NLA. Results: The search results revealed 271 related articles, of which 21 studies investigated NLA as a conducive factor in profile attractiveness and were included in the review. The range of preferred NLA was 86° to 107° for men and 84° to 123.12° for women. Conclusions: The most pleasing lip position and subsequently NLA is influenced by variables including the observer and subject’s gender, and their ethnic background as well as time. Over all, NLA in faces perceived as attractive is more obtuse in women than men. Compared to white norms, NLA is more acute among Chinese and African-Americans, while amongst Iranian women, it is not distinctly far from North American Caucasians. Over the course of time, preferred NLA has significantly changed in women but has been unwavering in men.

Association of Upper Lip Morphology Characteristics with Sagittal and Vertical Skeletal Patterns: A Cross Sectional Study

Background: Upper lip morphology is essential in diagnosis and treatment of orthodontics and orthognathic surgery. This study is aimed to evaluate the association between upper lip characteristics (ULCs) and skeletal patterns (SPs). Methods: 2079 patients were involved and grouped by sagittal and vertical. Class I, II, and III were identified by ANB angle, while normodivergent, hyperdivergent, and hypodivergent were identified by Facial Height Index and Sum of Angles. ULCs were evaluated by superior sulcus depth, nasolabial angle, upper lip length, basic upper lip thickness, and upper lip thickness. Confounders including demography, malocclusion, upper incisors, and upper lips were adjusted by multivariate linear regression to identify the association between ULCs and SPs. Group differences were evaluated with analysis of variance and Chi-square test. Results: The mean value of ULCs and prevalence of SPs were explored in the Western China population. ULCs were significantly different in various sagittal, vertical, and combined SPs. Superior sulcus depth was negatively related to Class II, and positively related to Class III and the hypodivergent pattern after adjusted by confounders. Conclusion: ULCs significantly varied among different SPs, while only superior sulcus depth was independently associated with SPs, indicating superior sulcus depth is the only ULC that might be significantly corrected by intervention of skeletal growth.

Evaluation of Different Parameters Responsible for Perception of a Pleasing Profile - A Photographic Silhouette Study from Vadodara, India

BACKGROUND Orthodontics has witnessed a paradigm shift in the perception of aesthetics. Soft tissue assessment and correction has become a greater concern when compared with dental and skeletal correction. In the current era, pleasing profile is a prime requisite. The purpose of this study is to evaluate different parameters responsible for perception of a pleasing profile. METHODS Hundred dental students with well-balanced faces were selected. Profile photographs of participants were taken by DSLR camera maintaining standardized photography protocol. The principal investigator had measured ten soft tissue parameters for each profile photograph. These profile photographs were further converted into profile silhouettes. 10 laypersons appraised each profile silhouette using visual analog scale (VAS). The obtained scores were again correlated with photographic measurements of each individual to identify role of different parameters responsible for pleasing profile. RESULTS When comparing the data statistically, significant differences were found amongst the parameters between less attractive and more attractive profile; parameters include facial convexity angle, naso-labial angle, protrusion of lip relative to each other, vertical lip to chin ratio and vertical height ratio. CONCLUSIONS It was clear from this study that, amongst individuals with normal overjet, overbite and a pleasing profile, those subjects with more obtuse facial convexity angle, obtuse nasolabial angle, slightly more protruded upper lip than lower lip, equivalent vertical height ratio, and smaller lip-chin ratio vertically, were found to be more attractive, as perceived by laypersons. KEY WORDS Parameters, Photographic Soft Tissue Analysis, Silhouette Study, Pleasing Profile