Journal of Clinical and Aesthetic Dermatology

APR 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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37 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 R E V I E W that have three components: a medial branch, a middle branch, and a lateral branch. The piriform, interalar ligaments, and the elastic fibers connect the cartilages to each other. 4 The blood supply of the nose originates from both the internal and external carotid arteries. A branch of the internal carotid, the supratrochlear, and a branch of the external carotid, the facial artery, give rise to the branches that cross the midline to form the vascular network that crosses the dorsum. Its irrigation consists of branches of the ophthalmic and facial arteries. The supratrochlear artery, a branch of the ophthalmic artery, gives rise to the angular, lateral, and external nasal arteries. The facial artery has a superior path toward the angular artery, and following along its path below the nose, it gives origin to the upper labial artery. The upper labial artery branches into filter branches, columellar branches, and nasal arches (Figures 1 and 2). The muscular part consists of the nasal transverse, nasal wing lifter, lip and nose lifter, and procerus and orbicularis oculi muscles. The external nasal sensitivity is mediated by the ophthalmic and maxillary branches, which are branches of the trigeminal nerve. The sensitivity of the cephalic part, radix, nasion, and the lateral faces of the nose are innervated by the branches of the supratrochlear nerve and infratroclear, which are branches of the ophthalmic nerve. The external nasal branch of the ethmoidal nerve emerges between the nasal bone and the superior lateral cartilage, innervating the part of the nasal tip to the columella. Several components and external reference points should be noted by the clinician when considering nasal characteristics and alterations. From the top to the bottom, the nose is divided into the glabella, the radix (deepest part of the back), the rhinion (cartilaginous bone union), the supratip (the lowest point of the back, immediately above the nasal tip), and the nasal tip. The nasal tip is the most prominent part of the nose. The nasal pyramid comprises the nostrils, the columella, and the nasal wings (which form the sides of the nasal tip and attach the lobe of the tip to the skin of the face), while in the lower part of the columella, there is the subnasal region. MATERIALS AND METHODS Subjects. We analyzed the clinical data of 44 patients who underwent nasal filling with hyaluronic acid between December 2016 and July 2017. All patients signed a consent form and were informed about the procedure. Photoconsent was provided by individuals whose photos appear in this article. Symmetry measurements. After obtaining patient medical history, we analyzed their noses in relation to their faces and then individually. 5 During the procedure, it is first necessary to exclude intraoral deformities, retrognathisms or prognathisms, and asymmetries. The anthropometric measurements of the nose are the most important part of the nonsurgical rhinoplasty planning, including the patient indication and the technique used, all tailored to the patient's desired results. The evaluation starts by analyzing the position of the nose in relation to each third of the face. When dividing the face into thirds latitudinally, the ideal nose should be localized in the middle third of the face and extend from the glabella to the subnasal region (Figure 3). When dividing the face into fifths longitudinally, ideally, the nose should be present in the central fifth and extend into the medial intercantal areas. This extension is the same width of the nasal base in an ideal nose (Figure 4). However, facial differences often produce nasal wings that are wider or narrower. The central fifth should be divided in half to analyze any deviated nasal septum.Viewing the patient from the front, the physician should measure the nasal length, going from the radix to the tip. This distance must be the same from the center point between the lips to the chin in an ideal nose (Figure 5). To calculate and draw the ideal nasal length (RTi), we use two different methods: RTi=0.67 x length of the middle third of the face, or RTi=SM. Next, the profile analysis must be done. An ideal nose is characterized by a high and projected tip, taking into account ethnic and racial characteristics. 1 The patient's profile should be analyzed for length, height, contour, tip projection, radix depth, and nasolabial angle. It is key to remember that these parameters should be evaluated in both static and dynamic form. 4 The real radix projection is calculated by the distance from the corneal plane to the radix plane. The ideal radix projection derives from the ideal nasal length: radix projection=RT1 x 0.28. The average is 9mm to 14mm. The ideal measure of nasal tip projection corresponds to a line drawn from the subnasal area to the tip. This value should ideally correspond to the nasal length value multiplied by 0.67. The nasal length is obtained through a transit line from the radix to the nasal tip, as cited above (Figure 6). While referring to the anatomical reference points, the physician begins to measure the angles and calculate the projections. The physician begins with the nasofrontal angle (aNF), which is defined when two lines are drawn from the radix, one parallel to the back and another parallel to the glabella. The angle of the cross between these two lines should measure 115 to 130 degrees. The larger this angle, then the longer the nose and the lower the tip (Figure 6). Next, the physician measures the columella labial angle (aCL). This is a tangent line of the columella crossing a line from the subnasal area toward the labial limb. The measurement of the columella labial angle in women is usually 95 to 125 degrees and, in men, 90 to 100 degrees. FIGURE 1. Facial arteries FIGURE 2. Facial arteries

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