The nose has an important place in the face. For people who consider it as a handicap, rhinoplasty allows them to change their own ideas about their appearance, and to find that they have a natural nose and not a caricature.
Recourse to surgery is not always necessary to correct a fault in nasal shape. Medical rhinoplasty, by using hyaluronic acid injections, can, in many cases, answer patients’ needs.
Analysis of the nose in Paris
The nose in the face
-The nose should represent about 1/5 of the total width, and 1/3 of the length of the face.
– The intercanthal distance (width of the eye) should be equal to the width of the nose (distance between eyebrows), and the width of the base of the nose should also be equal to this distance.
-The distance between the ‘nasal-spine’ and the upper lip must be between 1.8 and 2.8 cm.
– The line passing through the mid-point of the nasal height and the most forward projecting point of the upper lip must be 3mm in front of the chin.
Study of the nasal profile
Donne les informations les plus importantes pour la décision du type de traitement.Les angles importants sont :
The significant angles are :
– Naso-frontal (nose to forehead) angle
This measures the slope of the forehead and nasal projection. It should be between 115°-135° for men, and 120°-125° for women.
This is the most important angle for the beauty of the nose/ aesthetics of the nose. If the angle is too open (Grecian nose), the nose seems longer, and if it is too closed, the nose seems shorter.
– Dorsal angle
Flat, thus 180°. Among men the dorsum (the length of the nose) should be convex, or even with a slight boss or ridge. In women, the dorsum should be concave.
– Naso-labial angle
This measures the incline of the columella (lower part of the nose) in relation to the upper lip. It should be between 90°-100° for men, and 95°-110° for women. The tip plunges downwards if the angle is small, and is retroussé when it’s more open.
– Naso-facial angle
This is given by the angle between the line tangential to the dorsum, and the line linking the chin and glabellum (the skin between the eyebrows). This gives the nasal projection. It should be between 30° -40°.
– Nasal-chin angle
This is given by the angle between the median line of the nose, and a line passing the chin and tip of the nose. It should be between120°-130°.
– Chin-neck angle
This is given by the angle between the horizontal line from the chin to the top of the neck, and the vertical line which passes up the facial plane. It should be between 80°-95°.
Study of the nasal base
-The base of the nasal pyramid is a triangle where the base is equal to the height (of the nose).
-The nostrils have an elongated shape, and the back part is bigger than the front of the nostrils. The axis is oblique towards the front and inside, which gives a sagittal plan angle of 15°, opening towards the back.
– The upper limit of the nostrils is at mid-distance between the nasal tip and lobulo-colummella.
Study of the nasal tip
The shape and orientation of the tip are influenced by the alar cartilage. Its movement is influenced by the depressor muscle of the nasal septum, and the lifting muscle shared between the upper lip and the nose.
– Tip projection, radix depth, length of the nose
Several rules can be used to calculate the right projection for the tip.
1) The 1 :2 :3 ratio
The tip’s projection (2 on the picture), defined by the distance between the alogenian groove and the cartilage domes, should be two-thirds of the length of the nose (3 on the picture) and should be double the distance between the nasion (the most recessed part of the dip between the nose and forehead) and the inner canthus (1 on the picture).
2) The projection is adequate when 50-60% of the tip is in front of the vertical line from the upper lip, and if it is equal to 60-65% of the nose length.
3) Crumley’s triangle rule: the ideal projection allows us to draw a right-angled triangle where the sides respect the 3: 4: 5 ratios of Crumley’s triangle.
– The rotation
Rotation is defined by the angle of the naso-labial opening which should be between 90°-100° for men, and 95°-110° for women.
For the tip’s rotation-projection, visual illusions should be taken into account: The dorsum’s convexity gives the impression of a plunging tip, even though the naso-labial angle is normal; an exaggeratedly concave dorsum will give the impression of excessive rotation.
– Definition rests on characteristics which don’t always fit well together.
1) Visualisation of the cartilaginous alar reliefs when the skin is insufficiently thick to hide them.
2) Subtle depression of the upper-tip, automatization of the tip when its projections goes slightly beyond that of the dorsum.
3) Double lobulo-columella break which makes the apical lobule a clearly distinct element of the columella.
Study of the columelle
Feminine noses ideally have a double curve to the columella. Among men the columella is straight.
Sheen curve: a harmonious concave line which goes from the curve of the brow to the homolateral dome.
Parameters: the ideal measurements are as following : Width of the dorsum (10mm), width of the bony base (20mm) and alar width (30mm).
Position of the nasion in relation to the glabella.
The nasion should be 4-6mm behind the glabella.
The width of the nose lobule: the nose lobule should be 60-70% of the width of the base of the nose.
The distance between the glabella –nostril insert is equal to the distance from the nasal insert to the chin.
The ideal length of the nose is equal to the distance from the intralabial junction (where the lips meet) to the chin.
The distance corneal plane- nostril plane is equal to 0.28 times the length of the nose, and the distance corneal plane-nasion is 9-14mm.
Products used for medical rhinoplasty
– Re-absorbable tensile threads.
– Very reticulated hyaluronic acid like Restylane Perlane or moderately reticulated like Restylane. Depending on the use, the injection will be either deep or superficial, but in the greater part of cases I inject it near the surface because less product is needed using this method. The product will stay in place for a year.
Indications of medical rhinoplasty
– Correction of a plunging nasal tip.
– Correction of anomalies to nasal angles.
– Correction of the nasal dorsum.
– Correction of post-traumatic or genetic depressions and bony or cartilage bosses.
– Improvement to symmetry.
– Nostril refinement.
– Erase ala grooves (to the ala at the side of the nose).
– Improve definition to the tip.
-Correction to age-related changes: thinning of nasal edge cutaneous tissue, closing of the naso-labial angle.
-Refinement of the nostrils using tensile threads.
-Correction of functional defaults of the nasal valve during inhalation, i.e. the collapse of triangular cartilage on the cartilaginous septum when inhaling.
Les éléments qui nous permettent de donner une classification ethnique des nez sont :
|Caucasian nose – Straight, long -(Leptorrhiniens)||Asian nose – intermediate – (Mesorrhiniens)||African nose – wide and short with open nostrils (platyrrhiniens)|
|Nasal index (relationship between width and length)||Less than 60%||Between 60 et 65%||Greater than 65%|
|Tip index (relationship between the width of nostril apex and the width of the external part of the nasal ala)||Less than 70%||Between 70-80%||Greater than 80%|
|Skin||Thin, sometimes thick (but less so than for Asians)||Thick (more so than for Caucasians with abundant fibrous and fat tissue||Thick (more than Asians) with abundant fibrous and fat tissue|
|Cartilage-bone structure||Nasal spine more marked than for other ethnicities, with as a consequence, a more open naso-labial angle. Its bones are more significant than for other groups.||Low, wide flat dorsum with short bones||Wide, flat dorsum with appropriate bones and very reduced septum|
|Top||Round, and less defined tip with little projection||Round, bulbous tip, poorly defined and insufficiently projected|
The current trend for aesthetic intervention is to Europeanise the nose
Aesthetic treatment of the nose : before and after photos
For more images go to : www.dr-romano-esthetique.com/en/medical-rhinoplasty/
This page is purely informative, in accordance with the guidelines of the Ordre of Doctors.It is not a publicity for treatments .
Applications of facial aesthetic medicine