Traditional Anthropometrics versus Computerized Photograph Manipulation in Rhinoplasty Planning

Rhinoplasty planning requires meticulous forethought and is a source of challenge to surgeons. Traditional anthropometric analyses aim to use measurements and ideal ratios to determine the appropriate changes in nasal measurements such as length and tip projection. More recently, computerized photograph manipulation has been adopted as a means to demonstrate to patients the planned changes in a rhinoplasty and improve communication and patient confidence. It remains undetermined if the changes recommended using traditional anthropometric rhinoplasty planning are similar to those done by an experienced rhinoplasty surgeon manipulating preoperative photographs to an aesthetic ideal.

Preoperative photographs obtained for clinical use were analyzed from 97 consecutive patients seen in clinic for rhinoplasty or septorhinoplasty by the senior author (R.H.G.). Facial and nasal anthropometric measurements were performed on the preoperative photographs. The analysis prescribed by Byrd and Hobar was used to then calculate their prescribed "ideal" nasal anthropometrics. Separately, these patients had their preoperative photographs manipulated using computer manipulation software by the senior author, with an eye toward creating an aesthetically pleasing nose. Nasal anthropometrics were measured from the manipulated photographs. The changes prescribed in traditional anthropometrics were compared to those obtained from computer manipulation using univariate analyses.

The mean patient age was 35.4 years, and the population was 68% female. Average nasal proportions from the computer manipulation were a nasal length 76.1% of the midfacial height, tip projection of 57.7% of nasal length, and radix projection of 24.3% of nasal length. Computerized manipulation minimally changed nasal length relative to Byrd's analysis which decreased nasal length on average (100.3% of the original nasal length versus 88.2%, p<0.01). It prescribed a greater decrease in tip projection than Byrd's analysis (97.7% of original projection versus 99.9% of original projection, p=0.05). Computer manipulation also prescribed a lesser increase in radix projection than Byrd's analysis (100.5% of original radix projection versus 109.3% of original radix projection, p<0.01).

Byrd's analysis remains an excellent tool for guiding the changes in nasal dimensions in rhinoplasty. However, computerized manipulation may help patients and surgeons communicate a common goal. Their desired nasal dimensions may differ from those traditionally prescribed. Specifically, some patients may seek lesser decreases in nasal length or lesser increases in radix projection than Byrd's analysis prescribes. Further research in this topic is warranted, and ultimately the surgeon's judgment and patient goals should drive surgical planning.

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