Alar Rim Deformities in Korean Primary Rhinoplasty Patients

Background and Objectives: The alar-columellar relationship plays an important role in the esthetic balance of the nose. We analyzed alar rim deformities and aesthetic concerns and expectations among patients by deformity type in Korean primary rhinoplasty patients.Materials and Methods: Retrospective photographic analysis was done on 336 patients planning to undergo primary rhinoplasty at Kyung Hee University Hospital at Gangdong. We categorized their alar rim deformities as normal, hanging columella, retracted columella, hanging ala, retracted ala, convex ala, concave ala, thick ala, and a combination of the above. Patients’ aesthetic concerns and expectations about their nose were analyzed by preoperative questionnaire.Results: Of the enrolled patients, 38 (11.3%) had no alar rim deformities, and the other 298 patients (88.7%) had one or more deformities. The most prevalent alar rim deformity was hanging ala (59.2%), followed by convex ala (53.3%) and thick ala (32.1%). Male patients were more likely to have convex ala and retracted columella than female patients. More than one-half of the patients (64.1%) had two or more deformities and tended to be young (p=0.028). Patients with thick ala had several reasons for being dissatisfied with their nose and various demands for correction.Conclusion: Distinctive characteristics of alar rim deformities should be considered in surgical planning in order to obtain satisfactory results in Korean primary rhinoplasty patients.

Restoring Balance and Symmetry to the Aging Nose

Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose—typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner. There is also weakening of the external nasal valve thus causing functional impairment too. As a result, rhinoplasty techniques used in younger patients may not be suitable in the aging nose. In this article, the authors describe their experience and outline the evidence on the management of the aging patient with facial and nasal asymmetry.

Considerations in Feminization Rhinoplasty

Rhinoplasty can be a key part of facial feminization for transgender women. Commonly, the required results necessitate significant deprojection of the nose in addition to the reduction of contour irregularities and shaping of the nostrils to a more round appearance. Pitfalls can include disproportion of the tip anatomic subunits, inadvertent creation of epicanthal folds, soft tissue pollybeak creation, and hanging columella among others.

Clinical and Molecular Spectrum of Four Patients Diagnosed with Mowat-Wilson Syndrome

Mowat-Wilson syndrome (MWS) is a rare autosomal dominant syndrome characterized by distinctive facial features, congenital heart defects, Hirschsprung disease, genitourinary anomalies, various structural brain anomalies, and intellectual disability. Pathogenic mutations that result in haploinsufficiency in the <i>ZEB2</i> gene cause MWS. In this study, we aimed to evaluate the clinical features and molecular analysis results of 4 MWS patients. All patients were examined by an expert clinical geneticist. Dysmorphological abnormalities were recorded. Data including demographic, clinical, and laboratory findings were obtained from hospital records. <i>ZEB2</i> gene analysis was performed using a Sanger sequencing method. All patients had typical facial features of MWS such as widely spaced eyes, broad eyebrows with a medial flare, low-hanging columella, prominent or pointed chin, open-mouth expression, and uplifted earlobes. Four different heterozygous mutations were identified; 2 mutations were frameshift (c.246_247delGGinsC, c.980_980delG), 1 was nonsense (c.2083C&#x3e;T), and 1 was splice site (c.808–2A&#x3e;G). Two of them (c.246_247delGGinsC, c.980_980delG) have not been previously reported in the literature. By defining 2 novel mutations, this study contributes to the molecular spectrum of MWS, while also providing a further insight for genetic counseling. It also demonstrates the importance of dysmorphological examination in clinical diagnosis.