Surgical treatment of the nasolabial angle in balanced rhinoplasty

Nasal analysis and surgical planning are crucial for a successful, aesthetically pleasing rhinoplasty. One of the key parameters for evaluation is the nasolabial angle. The nasal spine, caudal septum, and medial crura of the lower lateral cartilages provide the framework for this area. Alteration of these structures, as well as nasal tip rotation and projection, may affect the resultant nasolabial angle, length of the upper lip, and overall harmony of the nose. Fullness at the nasolabial junction caused by a pushing philtrum may also result in an unbalanced appearance. The literature is replete with methods for categorizing the nasal tip and with recommendations for surgical treatment. Treatment of the caudal septum and nasal spine is often an afterthought that is left up to the aesthetic judgment of the surgeon. To make this a more systematic decision, in 1990 we devised a classification for analysis and treatment of this area. This study included the length of the nose, the nasolabial angle, and the presence of a pushing philtrum, with suggested treatment to allow proper tip placement and to provide aesthetic balance to the nose. The only modification was in the order of presentation of nasal types. Since that publication, the senior author has consistently followed these guidelines and has found them to be a reliable tool in creating a harmonious result in rhinoplasty.