Importance of the nasal-to-cervical relationship to the profile in rhinoplasty surgery

There is general agreement that when discussing surgery with the prospectiv e rhinoplasty patient, one may also include discussion of the chin because of the important interrelationship between these two regions. It is apparen t that on the profile-lateral view, the four prominences-the forehead, nose , chin, and neck-balance and complement one another. The cervical region, t he fourth dimension, was examined to estimate the aesthetic significance of the nasal-to-cervical relationship and to determine the implications to rh inoplasty surgery. Part I of the study was a survey to test the hypothesis that the cervical r egion affects the perceived impression of the nose. Four standard facial-pr ofile black-and-white photographs were chosen to represent varying degrees of nasal dorsum hump and cervical ptosis problems. Using computer-altering software, only the cervical regions were altered to create a pair of photog raphs for each of the four profiles: one with a youthful-looking non-ptotic cervical region, the other with a ptotic aged-looking cervical region. Rat ers were asked to give their first-impression opinions of which nose subjec tively appeared "better." Raters consistently (84 percent of the time) chos e the nose on the faces with he less ptotic neck as being better. Therefore , a less ptotic neck improved the perceived appearance of the nose. Part II was a retrospective chart review of the rhinoplasty patients of a s ingle surgeon by independent raters. To estimate the aesthetic significance of the nasal-to-cervical relationship, the proportion of patients undergoi ng rhinoplasty surgery who could have potentially benefited from a Youth-re storing neck procedure was determined. Criteria originally described by Ell enbogen and Karlin for judging the results of youth-restoring neck procedur es were used as relative indications for neck surgery. An average of 27.2 p ercent of the patients did not have visible criteria and therefore by defin ition had relative indications for neck-rejuvenating procedures when underg oing rhinoplasty surgery. As demonstrated in part I of the study, improving the neck could improve the perceived results of the rhinoplasty. Part III of the study validated the Ellenbogen and Karlin criteria. The pre sent authors found that the original criteria were probably based on female patients, that male and older patients had more indications for surgery, a nd that there was significant interrater agreement with the youthful criter ia. In summary, the authors established that a strong nasal-to-cervical relatio nship exists whereby the perceived appearance of the nose is affected by th e neck. The significance of this relationship to rhinoplasty surgery was de termined, and it was found that more than 27 percent of rhinoplasty patient s could obtain better perceived nasal results with a concomitant neck-rejuv enating procedure. Consequently, discussing neck-rejuvenating procedures wi th the rhinoplasty patient is valuable.