Section 4 Plastic and Reconstructive Problems

6OLUME .UMBER s #OLUMELLAR 3TRUT 'RAFT IN 2HINOPLASTY

Fig. 1. Illustration of our surgical routine for maintaining nasal tip support in primary open approach rhinoplasty. Paramedian and median supporting ligament reconstruction ( red ellipses ) along with a proper anterior septal angle position is performed in every case.

profile photographs from the alar midpoint to the nasal tip by using methods described pre- viously by Byrd and Hobar. 9 Preoperative right profile and morphed right profile images were identical, which enabled a direct, linear, pixel- based measurement of nasal tip projection. Preoperative and postoperative right profile pic- tures, however, had subtle differences in fram- ing, distance, and resolution. To minimize the effects of these differences, measured postop- erative nasal tip projection was adjusted by using a correction coefficient that was calculated by dividing a fixed distance (superior margin of the tragus to the lateral canthus) on the preop- erative photograph by the same fixed distance on the postoperative photographs as described previously in the literature. 10,11 The measured postoperative nasal tip projection multiplied by the correction coefficient gave the adjusted postoperative nasal tip projection that was used in statistical analysis. Percentage differences between preoperative nasal tip projection and morphed nasal tip pro- jection values were calculated for each patient to better describe and analyze planned changes in nasal tip projection. Percentage differences between preoperative nasal tip projection and adjusted postoperative nasal tip projection values were calculated for each patient to better describe and analyze actual changes in nasal tip projection (Fig. 2). If the planned change in nasal tip projec- tion was an increase greater than 1 percent, those patients were also included in a separate “planned increase in nasal tip projection” cohort.

Analysis of Nasal Tip Rotation and Nasal Profile Proportions Nasal tip rotation was analyzed by using the nasolabial angle, which was measured at the inter- cept of the columellar break point to the subnasale line with the superior labial point to the subnasale line. Nasal profile proportions were analyzed by using the Goode ratio. The Goode ratio was calcu- lated by dividing the distance from the alar point to the nasal tip by the distance from the nasion to the nasal tip (Fig. 2). All measurements were performed by the same surgeon (H.U.) to ensure consistency. Statistical Analysis Statistical analysis of the data was performed by using SPSS Version 17 (SPSS, Inc., Chicago, Ill.). Nasal tip projections, nasolabial angles, and Goode ratios were compared between preopera- tive, morphed, and postoperative groups by using the repeated measures analysis of variance test with a Greenhouse-Geisser correction. Post hoc tests using the Bonferroni correction were used to make pairwise comparisons. The linear correla- tion between planned and actual changes in nasal tip projection was also assessed by calculating the Pearson parametric correlation moment coeffi- cient. The chi-square test was used to examine the differences in distribution tables. RESULTS Of the 100 patients in our series, 86 were female and were 14 male. The average patient age was 27.6 years (range, 17 to 55 years), and the