Lower Lateral Cartilage Repositioning Objective Analysis Using 3-Dimensional Imaging. Anthony Bared, MD; Ali Rashan, MD; Benjamin P. Caughlin, MD; Dean M. Toriumi, MD.
Article: Lower Lateral Cartilage Repositioning Objective Analysis Using 3-Dimensional Imaging
Authors: Anthony Bared, MD; Ali Rashan, MD; Benjamin P. Caughlin, MD; Dean M. Toriumi, MD.
Source: JAMA Facial Plastic Surgery. 2014;16(4):261-267.
Date: July 2014
Importance. In recent years, with the advent of 3-dimensional (3D) imaging techniques, it has become possible to objectively measure rhinoplasty results. However, few studies have used 3D imaging software to assess postoperative rhinoplasty results of the nasal tip.
Objective. To analyze nasal tip volumes of patients with bulbous tips and measure postoperative nasal tip volume changes in patients who have undergone lower lateral cartilage (LLC) repositioning.
Design, Setting, and Participants. A prospective study of patients with a preoperative diagnosis of bulbous nasal tip and cephalically oriented LLC as measured intraoperatively (with angles less than 30 degrees from the midline) who underwent rhinoplasty by a single surgeon and preoperative and postoperative 3dMD imaging at a university hospital.
Interventions. Rhinoplasty with LLC repositioning and preoperative and postoperative 3dMD system imaging. We also used 3dMDvultus software for the analysis of nasal tip volume changes.
Main Outcomes and Measures. Changes in nasal tip volume and LLC angle.
Results. Thirty-one patients met the inclusion criteria (25 women and 6 men; mean age, 33 years). Among these, there were 16 primary and 15 revision cases with a follow-up range of 1 to 19 months. Statistical tests included a paired t test on volume and angle changes as well as correlative and exploratory analyses to gain further insight into the analysis population over time. The change in the LLC angle after repositioning was found to be statistically significant. The mean decrease in volume on the right was 0.0254 mL, and the mean decrease on the left was 0.0249 mL. The mean total volume change was a decrease of 0.0503 mL. An exploratory analysis suggested that subjects with longer follow-up displayed a greater reduction in volume. Using 5 months as a cutoff, we found that the subgroup with longer follow-up displayed a mean total bilateral volume change of −0.07 mL compared with −0.03 mL in the subgroup with shorter follow-up.
Conclusions and Relevance. We found that LLC repositioning when used to address bulbous nasal tips and cephalically oriented LLCs leads to significant increase (preoperative to postoperative) in the angle of the LLC (to a more caudal orientation). We also found an overall trend of decreasing nasal tip volume throughout follow-up. Although not statistically significant, the overall decrease in volume is clinically meaningful when paired with favorable positioning of the LLC. Exploratory analyses suggest that treatment effect is consistent across sexes and that greater decrease in total volume might be found with longer follow-up.