A 20-patient retrospective study in JAMA Facial Plastic Surgery showed an increase in upper lip projection when the nasal tip projection was increased by either a columellar strut or tongue-in-groove maneuver.
This relationship between upper lip and nasal tip projection was first discovered about a year ago by the study’s second author Steven Dayan, M.D., Chicago Center for Facial Plastic Surgery, who was reviewing some of his post-surgical patients' photographs.
“As an innovator in the field, Dr. Dayan is always evaluating facial relationships to better understand the aging process and how to achieve a more harmonious facial rejuvenation,” first author Eric Cerrati, M.D., a facial plastic surgery fellow at the University of Illinois at Chicago, tells Cosmetic Surgery Times. “Once we noticed the relationship and we realized its potential applications, we decided to test the hypothesis by conducting a retrospective study.”
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The causal relationship was uncovered unintentionally, “but we were not surprised by it,” Dr. Cerrati says. “There have been numerous published studies evaluating the relationship between the nose and the upper lip; however, ours is the first to demonstrate that a rhinoplasty maneuver can project the upper lip.”
Dr. Cerrati says that most prior studies have placed emphasis on how dynamic upper lip movement is affected by rhinoplasty, such as the amount of teeth and gum that show when a patient smiles.
The current study found that the Z angle demonstrated a statistically significant decrease of 2.7°.
And while the vermilion height did not change significantly, there was a trend toward an increase in mean height of 0.051.
The discovery of this new relationship “can and should be used while counseling pre-surgical rhinoplasty patients,” Dr. Cerrati says. “Rather than addressing each concern independently, understanding how one maneuver affects nearby structures allows surgeons to effectively and efficiently address patients' concerns to create a natural appearance.”
The two authors believe the most meaningful application of their revelation is in facial rejuvenation. “This relationship highlights the importance of the facial bone structure, which we know changes over time,” Dr. Cerrati says.
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Dr. Cerrati says most rejuvenation procedures are aimed at repositioning the soft tissue, but do not address the underlying bony resorption.
“One area of resorption is the premaxilla, which we believe is an integral part in aging changes of the nose and upper lip,” Dr. Cerrati says. “Currently, we are investigating a new approach to perioral rejuvenation.”
