Upon viewing the facial profile, it becomes obvious that the nasolabial angle consists of two lines. The first line extends from the nose tip to the region above the upper lip while the second line runs from the upper lip to the bottom of the nose where the nostrils divide.
The nose projection and the rotation of the nasal tip impact the degree of the nasolabial angle. The surgeon will try to develop a 90- to 95-degree nasolabial angle in males and a 100- to 105-degree angle in females for most patients. Adjustments in the projection and rotation of the nose can refine this angle.
Board certified plastic surgeons at the Aesthetic Center for Plastic Surgery (ACPS) provide rhinoplasty to patients in Houston, Texas, TX, and surrounding locations.
Adjusting the CLA
The columella-labial angle (CLA) is an important metric to be evaluated in nose reshaping surgery patients to attain aesthetically appealing results.
An increase in this angle can lead to an upward tilt of the nose base along with an associated reduction in the nose length. This aspect is frequently overlooked due to the difference in nasal anatomies, which results in sub-optimal surgical results.
The columella and upper lip share a complex relationship. It is difficult to maintain a particular angle in rhinoplasty patients. Doing so involves the use of various methods such as nasal cartilage adjustments, cartilage grafts, and suturing techniques.
In shaping the columella, the nasal spine, caudal septum, and medial crura of the lower lateral cartilage play an important part. These aspects contribute towards determining the CLA.
The most aesthetically appealing CLA is 95 to 100 degrees in men and 100 to 110 degrees in women on profile view. The normal columellar display lies between two to four mm. A substantial or hanging columella can significantly disrupt the aesthetic appearance of the nose.
Tent Pole Grafting
The ‘tent pole graft’ refers to a cutting-edge technique used to set and maintain the CLA. This graft functions in a manner similar to the septo-columellar interpositional grafts.
But there is no need to delineate or dissect the upper lateral cartilages from the septum for graft placement. This graft type is used in challenging revision rhinoplasty procedures and cases where the tip projection needs to be increased significantly.
In this procedure, the surgeon fixes a piece of cartilage to the columellar strut in the desired position. Afterwards, they establish the optimal angle by fixing the posterior end of graft temporarily with a needle to supratip cartilaginous dorsum.
When this optimal angle is determined, the graft is sutured to the dorsum. The tent pole grafts allow the extensive columellar strut to be stable and prevents the tip from falling backwards. Along with the benefits of maintaining the nose tip, this also enables the development of the desired CLA.
A surgeon may use this technique when the tip needs support in revision rhinoplasty procedures and in cases where the columella or tip lengthening is undertaken. It also helps preserve the nasal length in patients with short noses. The graft can be manipulated to adjust the CLA easily.
The tent pole graft technique is particularly useful in instances where the septal extension graft is very difficult to fix or not possible at all. For example, it can help patients with a mild to moderate short nose.
Cosmetic surgeons at the ACPS receive patients from Houston, Texas, TX, and nearby areas for nose reshaping surgery.
For more information about The Aesthetic Center for Plastic Surgery (ACPS) physicians and the cosmetic surgery treatments and procedures they perform please click here or call us at 713.799.9999. We have offices in and around Houston, Texas.
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