Section 4 Plastic and Reconstructive Problems

Plastic and Reconstructive Surgery s !PRIL

Table 6. Repeated Measures Analysis of Variance, Goode Ratio, and Overall Study Population* (I) Time (J) Time Mean Difference (I − J)

p †

Preoperative GR (0.61 ± 0.048), n = 100

GR morphed

−0.053‡ −0.060‡ 0.053‡ −0.007‡ 0.060‡ 0.007‡

0.0001‡ 0.0001‡ 0.0001‡ 0.0001‡ 0.0001‡ 0.0001‡

GR postoperatively GR preoperatively GR postoperatively GR preoperatively

Morphed GR (0.66 ± 0.039), n = 100

Postoperative GR (0.67 ± 0.039), n = 100

GR morphed

GR, Goode ratio. *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.

Table 7. Repeated Measures Analysis of Variance, Nasolabial Angle, Overall Study Population* (I) Time (J) Time Mean Difference (I − J)

p †

Preoperative NLA (92.4 ± 10.3), n = 100

NLA morphed NLA postoperatively NLA preoperatively NLA postoperatively NLA preoperatively NLA morphed

−9.020‡ −8.980‡ 9.020‡ 0.040 8.980‡ −0.040

0.0001‡ 0.0001 0.0001‡

Morphed NLA (101.5 ± 6.1), n = 100

1.000

Postoperative NLA (101.5 ± 6.7), n = 100

0.0001‡

1.000

NLA, nasolabial angle. *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.

and the columella is soft, mobile, and flexible. Although relying on medial crural strength for nasal tip support/projection can be a surgically successful strategy in selected rhinoplasty cases, it is also associated with clinically significant but infrequently discussed sequelae such as nasal tip rigidity and loss of columellar flexibility. 10,12 Rohrich et al. have classified columellar strut grafts and proposed a clinical algorithm for their application. 12 They recommended using either

type 3 (long and floating) or type 4 (long and fixed) columellar strut grafts for increasing nasal tip projection. Although nasal tip projection can be stabilized or increased with the use of a long columellar strut, this occurs at the expense of a rigid and fixed columella. In our experience, patients who undergo reconstruction with a long, fixed columellar strut may complain of difficulty wiping their nose, or the nose may be felt like a stick on the cheek when kissing.

Fig. 3. Examples of postoperative columellar contour irregularities in the absence of columellar strut grafts. Unwanted bowing of intrin- sically weak medial crura ( left ) and columellar notching beneath the transcolumellar incision ( right ).