Nasal Sculpting: Calculated and Predictable Tip Elevation With Cephalic Trim

Background: Rhinoplastytechniques to affect nasal tip rotation are well described. Cephalicalar trimis a powerful method for achieving tip elevation. Previous studies and texts provide aesthetic guidelines for nasolabial angles. Often, surgeon experience determines the degree of lower lateral cartilageresection to achieve optimal results. This study analyzes the change in tip elevation with measured resections of the lower lateral cartilages. This can aid the surgeon in accurately predicting the effect of cephalicalar trimon tip elevation. Methods: Ten fresh cadaveric dissections were performed to determine the change in nasolabial angles after cephalic trimof the lower lateral cartilage. Closed rhinoplastytechnique was performed using marginal and intercartilaginous incisions to expose the lower lateral cartilage. Calipermeasurements of the lower lateral cartilagewere recorded. Serial cephalic trimwas performed in 25% increments. True lateralphotographs were obtained before and after each serial excision. Nasolabial angle measurements were obtained using a digital goniometerfor digital photo analysis. Results: Four female and 6 male cadavers were evaluated. The mean initial nasolabial angle was 106° ± 2°. The mean lower lateral cartilagewidth was 9.45 ± 1.38 mm. Serial 25% reductions in lower lateral cartilageheight resulted in a mean total nasolabial angle change of 7.4°, 12.9°, and 19.6°, respectively. The mean incremental change in the nasolabial angle was 6.47° ± 1.25°. Conclusion: The nasolabial angle is an essential aesthetic feature. Cephalic trimis a key maneuver in affecting the nasolabial angle. A 25% lower lateral cartilage cephalic trimcorrelates with an average change in the nasolabial angle of 6.47°. Knowledge of the cephalic trimto nasolabial angle relationship aids in achieving desired tip elevation.