Symmetrization in primary tip rhinoplasty after resection of the cephalic portion of the lower-lateral cartilage

Roberto Valeriani; Edoardo Bruno; Diego Ribuffo; Maurizio Valeriani

doi:10.1016/j.jpra.2023.12.008

Symmetrization in primary tip rhinoplasty after resection of the cephalic portion of the lower-lateral cartilage

JPRAS Open. 2023 Dec 12:39:181-190. doi: 10.1016/j.jpra.2023.12.008. eCollection 2024 Mar.

Authors

Roberto Valeriani¹, Edoardo Bruno², Diego Ribuffo², Maurizio Valeriani³

Affiliations

¹ School of Applied Medical Surgical Sciences, University of Rome Tor Vergata, Via Montpiller 1, 00133, Rome, Italy.
² Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Via Giovanni Maria Lancisi 2, 00161, Rome, Italy.
³ Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.

Abstract

Background: The cephalic trim allows the remodeling of the alar cartilages by removing the cranial portion of the lower-lateral cartilages; this resection determines raising the tip of the nose through its rotation. The objective of this study is to demonstrate how a greater symmetry of the lower-lateral cartilages after resection of the cephalic portion is obtainable by introducing a specific additional surgical time into the procedure.

Methods: Between June 2016 and December 2021, forty-six patients underwent primary rhinoplasty with the cephalic portion of the alar cartilage resection. After the cephalic trim symmetry of the nose tip was then assessed through a specific additional surgical maneuver in 23 patients (Group A), whereas in 23 patients, the evaluation of symmetry was performed according only to the surgeon's personal judgment (Group B). Preoperative and postoperative pictures were evaluated in the symmetry of the two sides of the faces considering anthropometric measurements and the judgment by ten plastic surgeons uninvolved in this study.

Results: None of the patients had completely symmetric values. Objectively, the degree of asymmetry in Frankfurt's plane, considering RMLLA (midline-lateral alar margin ratio), was significantly decreased in Group A. Subjectively, more patients in Group A who were judged with asymmetrical face before rhinoplasty were evaluated with a symmetrical face after rhinoplasty than those in Group B.

Conclusions: We believe that in closed rhinoplasty, the symmetry of the postoperative sides of the face is increased by performing an easily replicable intraoperative maneuver as described.

Keywords: Cephalic trim; Face symmetry in Frankfurt's plane; Lower-lateral cartilages.