Section 4 Plastic and Reconstructive Problems

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

Table 4. Repeated Measures Analysis of Variance, Nasal Tip Projection, Overall Study Population* (I) Time (J) Time Mean Difference (I − J) p † Preoperative NTP (211.2 ± 37.7), n = 100 Morphed NTP 0.790 1.000 Postoperative NTP −1.880 0.124 Morphed NTP (210.4 ± 35.7), n = 100 Preoperative NTP −0.790 1.000 Postoperative NTP −2.670‡ 0.002‡ Postoperative NTP (213.1 ± 37.4), n = 100 Preoperative NTP 1.880 0.124 Morphed NTP 2.670‡ 0.002‡ NTP, nasal tip projection. *Descriptive statistics and pairwise comparisons, based on estimated marginal means.

†Bonferroni adjustment for multiple comparisons. ‡The mean difference is significant at the 0.05 level.

was no statistically significant difference between morphed nasal tip projection and postoperative nasal tip projection (Table 5). In the planned increase in nasal tip projection cohort, the Pear- son parametric correlation coefficient between planned and actual changes in nasal tip projec- tion was 0.781, which was indicative of a strong, statistically significant correlation ( p < 0.0001). In the overall study population, both morphed Goode ratio (0.66 ± 0.039) and post- operative Goode ratio (0.67 ± 0.039) were sig- nificantly higher than preoperative Goode ratio (0.61 ± 0.048) ( p < 0.0001). Postoperative Goode ratio was also higher than morphed Goode ratio (0.67 versus 0.66) ( p < 0.0001); this difference was interpreted as a desirable shift toward the ideal nasal projection/length proportion of 2:3 (0.67) (Table 6). In the overall study population, both morphed nasolabial angle (101.5 ± 6.1) and postoperative nasolabial angle (101.5 ± 6.7) were statistically significantly higher than the preopera- tive nasolabial angle (92.4 ± 10.3) ( p < 0.0001). As seen with tip projection, there was no statistically significant difference between morphed naso- labial angle and postoperative nasolabial angle (Table 7). Three patients (3 percent) in our series had minor columellar contour irregularities (Fig. 3). None of these patients belong to the planned increase in nasal tip projection cohort. Two of

these patients underwent a columellar revision procedure that was performed under local anes- thesia. Columellar irregularities were successfully corrected by revising transcolumellar scars and by using short columellar strut grafts. Two patients in our series had revisions for reasons other than columellar deformities, including one unilateral vestibular V-Y procedure for correction of alar asymmetry and one revision of right lateral oste- otomy. The total revision rate was 4 percent, and all revisions were performed after obtaining the late postoperative photographs. Of 100 patients, 92 responded to the postop- erative survey. Patients were asked to rate their current satisfaction with the functional elastic- ity of their nose during (1) activities of personal hygiene such as cleaning and wiping, and (2) activities of social interaction such as kissing and smiling on a scale from 1 (not satisfied) to 5 (extremely satisfied). The average score of satis- faction during activities of personal hygiene was 4.5, and the average score of satisfaction during activities of social interaction was 4.8 DISCUSSION In the normal nasal anatomy, an anterior septal angle of sufficient height keeps the feet of the medial crura off the anterior nasal spine; the medial crura do not bear a significant load;

Table 5. Repeated Measures Analysis of Variance, Nasal Tip Projection, and Planned Increase in the Nasal Tip Projection Cohort* (I) Time (J) Time Mean Difference (I − J) p † Preoperative NTP (204.8 ± 45.9), n = 32 Morphed NTP −7.791‡ 0.0001‡ Postoperative NTP −9.684‡ 0.0001‡ Morphed NTP (212.6 ± 45.3), n = 32 Preoperative NTP 7.791‡ 0.0001‡ Postoperative NTP −1.894 0.074 Postoperative NTP (214.5 ± 45.8), n = 32 Preoperative NTP 9.684‡ 0.0001‡ Morphed NTP 1.894 0.074 NTP, nasal tip projection. *Descriptive statistics and pairwise comparisons, based on estimated marginal means.

†With Bonferroni adjustment for multiple comparisons. ‡The mean difference is significant at the 0.05 level.