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New technique for central lip lift with open Rhinoplasty

New technique for central lip lift with open Rhinoplasty

New technique for central lip lift with open Rhinoplasty: Why have cosmetic surgeries been so popular? Do you know that every year half a million people seek consultation for cosmetic surgeries?

The tendency towards beauty is embedded in the essence of all human beings and this beauty fascinates everybody. This fact is illustrated in this sentence: “Love of beauty is taste. The creation of beauty is art.” – Ralph Waldo Emerson. We all love landscapes, flowers, trees, animals and many natural creatures, but what usually more than any other beauty comes to our attention is the beauty of the face.

This topic is so important that many people all around the world are enthusiastic about cosmetic surgeries. Nowadays by progressing sciences, it is not impossible to achieve an appealing and ideal face. Cosmetic plastic surgeries respond very well to this desire of humans.

Rhinoplasty or nasal plastic surgery is one the most popular plastic surgeries in all over the world. According to the latest survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS) on Rhinoplasty statics, nose surgery is one of the most popular and common plastic surgeries among both men and women. For example, Iran and the USA leap into world’s top ten countries performing nasal plastic surgery.

Fortunately, With the advancement of science it is possible to perform multiple surgeries at the same time. Nowadays, combining rhinoplasty with lip lift is very popular.(New technique for central lip lift with open Rhinoplasty)

 

New-technique-for-central-lip-lift-with-open-Rhinoplasty

 

As you know, you lip and your nose and proportion between them have a great impact on your facial beauty. It is worth noting the length of the upper lip is too effective on the appearance of aesthetic aspect of the nasal structure, and even the least malformation can disturb the proportionality. So, combination of an open nasal plastic operation with a lip-lift should therefore be considered.

In this article, I am going to discuss the methods and techniques that I apply to perform a successful rhinoplasty combining lip lift. First, let’s take a look at the definition of lip lift surgery, central lip lift surgery, nasal surgery and relationship between lip and nose as the introduction.

Required Definitions for New technique for central lip lift with open Rhinoplasty

Nose surgery is technically called rhinoplasty, is commonly known as the nose job, and refers to a nasal plastic procedure that reconstructs, reshapes, and enhances the shape of the nose. This operation regards both functional and aesthetic aspects, but cosmetic nasal surgery has many fans so that it is one of the most performed plastic surgical operations in the United States in the 2000s.(New technique for central lip lift with open Rhinoplasty)

A lip lift generally known as upper lip lift refers to as upper lip shortening, subnasal lip lift, subnasal upper lip lift and a bullhorn upper lift. It is a surgical method that reshape and elevates the place of the upper lip in order to construct more youthful and graceful smile.

This cosmetic procedure is targeted to Patients whom are unsatisfied with the length of their upper lips zone. The upper lip known as area between the columella base and the red-pink of the lip. Although this length can be vary regarding the individual’s facial characteristics, the ideal measure of this area is 12-15 millimeters literally. An upper lip length beyond this gauge usually appears unnatural long, therefore, this abnormality considers for a lip lift surgery.(New technique for central lip lift with open Rhinoplasty)

In addition, there is one another type of lip lift which is called central lip lift. Like lip lift, this technique is facial aesthetic and physiognomic cosmetic plastic surgery. After this operation, the vertical disproportion of the lower is improved, so, it can have a very affirmative effect on lower facial profile.

if you own elegant nose or beautiful lip, but there is no balance and symmetry between them, your facial aesthetic features will be affected certainly. When we are considering appropriateness between lip and nose, nasolabial angle comes in.

Nasolabial angle or NLA the angle between labial surface of the upper lip (labrale superiorius) at the midline and the inferior border of the nose(subnasal). It is an aesthetic scale and criterion for nasal assessment and reconstruction. Consensus among rhinoplasty surgeons for this angle is an arbitrary range of 90 to 120 degree, but as you can see in picture below the ideal angle for men is between 90 to 95 degree and for women this range can varies from 95 to 105. Of course, regarding the anatomy of each person’s face and personal taste, this angle can be changed.(New technique for central lip lift with open Rhinoplasty)

nasolabial angle

 

You know your nose is located in the center of your face and it is prominently visible from the front and side, so the appearance of the nose can play a vital role in your facial features. A beautiful lip which is in a flawless harmony with a pleasant nose makes your overall facial appearance more appealing, increases self-confidence and certainly our thirst of interest in having a beautiful face will be quenched.

 

Every week, many patients come to my office because they are not comfortable with the shape of their nose.(New technique for central lip lift with open Rhinoplasty)

Here are some of the most common reason why individuals decide for a rhinoplasty:

1.The hump on the nose: many people have a bump or hump on their nose and wonder about having a cosmetic nose surgery. This type of abnormality is more obvious when viewed from the side. In this case nose surgeon remove the excess bone or cartilage only.

  1. A very big or very small nose: Too big and too small of a nose both are unappealing and unlikely. for big noses, I reduce cartilage and bone and remedy nose size. In the small noses, by grafting (grafts are taken from other parts of the body such as ear or rib cartilage) we achieve the desired nose and build up the face.
  2. Broken nose: broken nose can leave you with cosmetic and functional problems. I reposition nose bone in patients with fractured nose to boost their nose function and look better.
  3. crooked nose: crooked nose is referred to a crooked septum or septal deviation and it can cause cosmetic deformity. In this case, I use the osteotomy technique to straighten the nose bone. Most of the time, I perform rhinoplasty and septoplasty simultaneously and consequently, the appearance and function of the nose will improve.

central lip liftcentral lip lit1central lip lit2

Everybody has a specific characteristic feature, so each face demands a special rhinoplasty method. Furthermore, choosing an adept and specialist nasal surgeon has a vital impact on the final outcome of rhinoplasty.

Many patients who are not satisfied with their first nose job result come to my office and ask for a secondary surgery, or many who have had a rhinoplasty, have a long gap between lip and nose (long interspace between nose and lip is unpleasant), hence, they request a lip lift surgery.(New technique for central lip lift with open Rhinoplasty)

Most people chiefly young consumers who ask for a cosmetic nasal surgery do not like to have a long gap from lip-to-nose, therefore, I do a synchronized lip lift and rhinoplasty in a single operation.

The classic and traditional approach of lip lift despite being effective had some disadvantages and impediments. For example, visible scars remain under the columella.

I intend to describe a new version, this new approach is performed with rhinoplasty and has succeeded.

Let’s start with the consultation. In a consulting session, I hear my patient worries and desires and do a thorough examination. Then I describe whatever is necessary and advice my patient the best method which is the best for him/her.(New technique for central lip lift with open Rhinoplasty)

After analyzing rhinoplasty candidate, the person that has a long gap between nose and lip are considered for this method.

All patients are examined in my office and I individually explain and clarify my method for patients with these difficulties:

  1. Elderly patients to rectify sagging and stoop
  2. The vertical maxillary excess that means if your lip is shortened and the height of the upper jaw is much, it may eventually pull your mouth into an always open position.
  3. Tension nose which the ANS (anterior nasal spine that is crucial in the morphology of an individual’s face, consider as a support for the tip of the nose and layout of the nose and upper lip) is higher and extended lower to the front. After removing or fracturing ANS in rhinoplasty to fix the tension nose, most of the patients need another surgery to fix and shorten the gap between lip to the nose.|
  4. Many patients who may have a long space or distance between lip and base of the columellate can be suitable candidates for this method.
  5. Patients with wide lips and a long interval between lip vermillion or commissure and base of the columellate and/or position of alar are inserted to the face.
  6. I use this technique for my patients who have thick nasal skin. For these cases, imprimis I release the footplate and the medial crura, and I initially construct a short nose, then I insert a well-appointed and strong strut within medial crura, after that in order to boost the strength of the nose, I perform the base sutine stitch to enhance strength of the base of the nose. Then put on strong shield graft for constructing elegant nose tip. Almost frequently I needed to shorten this gap.
  7. Patients with different gaps on both sides (on the left and right side) of the columella will be fixed and the distance between insetala and lip vermillion will also be made up.

The technical variant of rectified bullhorn lip lift is the sub nasal lip lift. This kind of method involves either removing ellipse on either side or a cured-edge ellipse of tissue from under the nose with the removal part under the columella has a gap of 2-3mm to the base of the columella.(New technique for central lip lift with open Rhinoplasty)

Afterward, I utilize PDO04 in order to stitch the base which contains 1-2mm of tissue under the skin of the columella in the foundation of nostrils which crisscrosses the footplate cartilage and strut and back.

The momentous point is the way of using the needle. It must first enter from the side that means to be moved up and the backside(dorsum) must be stretched further toward inside and lower.

Thereupon if we look at the columella from the lateral view, we will be able to see excess skin at the base of columella among the sides of the open incision and caudal and mucosal of the septocolumellar site. So, I remove and eliminate extra skin while I retain and keep the tissue connection under the skin and pick up the base of columella skin in order to suture and stitch the columella skin and caudal mucosal of the septocolumellar site.

After that, the distance between both sides of insert alar place and vermillion need to be gauged in a vertical line to make sure that the gaps on both sides of the columella are equal and identical, and the horizontal gap between insert alar and columella must be the same on both sides. In the other words, the distance between the cuboid line of the lip and columella base must be equitable on both sides.

Then, when we look at the nasolabial, the relation we can maintain is keeping the equal distance between nose project and the distance between the lip to columella or nose projection may be a little further.

 

In the end, it is noteworthy this technique helps us to reduce distance between lip and nose in rhinoplasty, but this may have some disadvantages. First, this method reduces columella show in nasolabial angle. I put plumping graft in this situation to solve this issue. Another difficulty associated with this technique is reducing rotation of nose after applying this technique, so we must have more rotation rather than normal. Eventually this kind of surgery may cause necrosis in columella when connection under skin is unsaved or in patient who have had many nasal surgeries.

Despite these obstacles, the patient’s request will be made and the final result depends on the patient’s decision.

We all know all types of surgeries have some disadvantages, but our tendency toward beauty and elegance can fade out them. In addition, choosing an adept surgeon can minimize these problems. An expert and skillful surgeon helps you to make the best decision.(New technique for central lip lift with open Rhinoplasty)

Author : Dr. Farshid Mahboubirad (Otorhinolaryngologist)

please click bellow to watch video ” New technique for central lip lift with open Rhinoplast”

New technique for central lip lift with open Rhinoplast video
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References:

  1. Rhinoplasty Articles and papers retrieved from http://drrohrich.com/articles/rhinoplasty
  2. JAMA Network Articles of the Year retrieved from http://jamanetwork.com/journals/jama/fullarticle/2656812
  3. New Technologies in Rhinoplasty Make Nasal Surgery Easier retrieved from http://www.rhinochicago.com/new-technologies-in-rhinoplasty-make-nasal-surgery-easier/
  4. Combining Rhinoplasty With Upper Lip–Lift Using a Single Incision Line retrieved from http://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2656186?redirect=true
  5. Medical Reasons for a Rhinoplasty Procedure retrieved from http://www.mdface.com/blog/medical-reasons-for-a-rhinoplasty-procedure/
  6. UPPER LIP LIFT retrieved from http://www.drhilinski.com/procedures/upper-lip-lift/
  7. 4 Reasons Why A Rhinoplasty Might Be Right for You retrieved from http://www.drspiegel.com/2013/01/4-reasons-why-a-rhinoplasty-might-be-right-for-you/
  8. Rhinoplasty retrieved from http://www.healthline.com/health/rhinoplasty
  9. Lip lift Retrieved from http://en.wikipedia.org/wiki/Lip_lift
  10. Medical Definition of Rhinoplasty retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=5363
  11. Defining the ideal nasolabial angle retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22090249
  12. Varied Definitions of Nasolabial Angle retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956864/
  13. NASOLABIAL ANGLE retrieved from http://www.shahfacialplastics.com/articles/plasticpedia/nasolabial-angle
  14. UPPER LIP LIFT retrieved from http://www.drhilinski.com/procedures/upper-lip-lift/
  15. UPPER LIP LIFT retrieved from http://www.beverlyhillscenter.com/lips/
  16. https://www.ncbi.nlm.nih.gov/pubmed/26038373 retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26038373

About the Author

doctormahboubirad
About Dr. mahboubirad Farshid mahboubi rad specialist in ear, nose and throat Dr. Who allocated most of his activities in the field of rhinoplasty and face, spent his general Medical courses at the Shahid Beheshti University Graduated in13 81 and since 85 to 89 has spent expertise times in the field of ear, nose and throat in Amir Alam hospital and Imam Khomeini Hospita | nose surgery

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