New Study Shows Rhinoplasty Can Also Change Another Important Facial Feature

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Increasing the tip projection of the nose is a common objective for many people who elect to undergo a rhinoplasty. A new report published in JAMA Facial Plastic Surgery, however, shows that some of the techniques used by plastic surgeons to achieve this result may be increasing the projection of another feature as well—the upper lip.

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A study conducted by Chicago plastic surgeon Steven Dayan, MD, evaluated 20 patients who underwent primary rhinoplasty between October 2014 and September 2015. Pre- and postoperative photos were evaluated for changes in nose tip projection, upper lip projection and lip vermilion height. Out of the 20 patients evaluated, 18 showed that when their nose tip projection was increased using two types of conventional rhinoplasty methods (columellar strut and tongue-in-groove maneuver), there was also a measurable increase in the projection of their upper lip.

Westborough, MA, facial plastic surgeon Min Ahn, MD, breaks down what these terms mean: “A columellar strut is a piece of cartilage, usually taken from the septum, that is inserted between the two disc-like parts of the tip cartilage that are between the nostrils, to serve as strut, for support and projection. It’s somewhat like an umbrella pole except the tip of the pole does not touch the skin. The tongue-in-groove maneuver is attaching the two disc-like parts of the tip cartilage that are in between the nostrils to a higher point on the septum so that the tip sticks out further. The septum is the ‘tongue’ and the ‘groove’ is the space between the two parts of the tip cartilage. To mimic this, put your fingers slightly in your nostrils, pinch and push your nose away from your face.”

“The results of this study should help surgeons counsel their patients as to the possibility of increased lip projection with increased tip projection,” continues Dr. Ahn. “However, not all patients who have their tip projected further from the face during rhinoplasty experience more projection in their lip. If the patient is adamantly opposed to increased lip projection, the surgeon and patient should discuss alternative ways to increased projection or a compromise of less tip projection. A compromise might be a smaller columellar strut or a nonsurgical injection of filler to the tip.” 

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