Rhinoplasty Analysis

Dr Steve Byrd , Dalllas Plastic Surgeon, reviews his published methods of rhinoplasty analysis.

It has been said that if you don't know where you are going, every road will take you there. Nothing could be more true than in rhinoplasty where I believe it is absolutely essential to have a detailed preoperative plan that describes the ideal nasal dimensions based on facial proportions as well as the identification of all problematic anatomy.

I begin by determining the ideal nasal length for the face(RTi). Ideal nasal length is equal to two thirds of the mid facial height (MFH), measured from the glabella to the alar bases, and is exactly equal to the stomion to menton (SM) distance. RTi not only serves as a reference for whether the nose needs to be shortened or lengthened, but also serves as the key proportion for determining the ideal projection of the nose.

Ideal nasal tip projection is two thirds the ideal nasal length while radix projection is 9-12 mm in front of the cornea. The ideal dorsum (bridge) extends between these two points.

Ideal chin projection is determined by a line drawn from a point on the nasal dorsum at 1/2 RTi and passing across the upper lip. The ideal chin in the female will project 3mm back of this line while in the male it will touch the line.

At this point we have a basis for knowing which dimensional changes will produce the best looking nose by creating both intrinsic and extrinsic nasal proportion. An important point to remember, however, is that while nasal proportion is based on chin vertical, a small or underdeveloped chin gives the illusion of a too large nose. Care must be taken not to over-operate the nose and to consider enlarging the chin in these situations(see chin augmentation).