AUGMENTATION OF THE COLUMELLA-LABIAL ANGLE TO PREVENT THE SMILING DEFORMITY IN RHINOPLASTY

Aesthetic diagnosis of the smiling deformity, which is functional rath er than anatomical, is essential to provide the best treatment in rhin oplasty. The nasal tip tends to rotate inferiorly during smiling, and the central upper lip moves superiorly. A posteriorly sloping upper li p with a retrodisplaced columella-labial junction gives an unaesthetic appearance. Downward movement of the tip and a sharper nasolabial ang le are usually aesthetically unpleasant. In 28 nasal surgeries, augmen tation of the columella-labial angle with cartilage strip grafts has b een performed. The augmentation of the angle and additionally cutting of the depressor septi muscle created a wider nasolabial complex, and this angle looks full and more pleasant. This procedure has mainly bee n used as an additional procedure to standard reduction rhinoplasty in order to improve smiling deformity. Strip cartilage grafts were inser ted subcutaneously into the upper lip extending half way to the colume lla and secured with a transcutaneous suture under the columella labia l angle to prevent misslocation. Augmentation by the cartilage graft t ogether with cutting the depressor septi muscle prevented elevation an d shortening of the upper lip, and also drooping of the nasal tip. Thi s procedure provided an aesthetically pleasant appearance both at rest and during smiling.