The Incidence of Nasal Tip and Upper Lip Malposition in Primary Rhinoplasty

For an optimal aesthetic plan for correction of nasal tip disharmony, it is crucial to note lip and tip disproportions.

In this study we sought to investigate the incidence of preoperative upper lip malposition in primary rhinoplasty patients.

In total, 150 consecutive primary rhinoplasty patients were included. The position of the upper lip was measured during smiling relative to the incisors and gum line, and categorized as ideal, inadequate incisor show, or excessive gum show. Nasal length was categorized based on soft tissue cephalometic analysis of life-size photographs as long, ideal, or short. Tip projection was categorized as overprojected, ideal, or underprojected. The columella was categorized as hanging, ideal, or retracted.

Standardized photographs of 139 primary rhinoplasty patients met inclusion criteria. Forty-seven (34%) patients had an ideal upper lip position, 83 (61%) inadequate incisor show, and 7 (5%) excessive gum show. Sixteen (12%) had a short nose, 45 (33%) ideal length, and 76 (55%) a long nose. Fourteen (10%) had an underprojected tip, 38 (28%) had an ideal tip projection and 85 (62%) an overprojected tip. None of the nasal parameters were predictive of upper lip position. Tip overprojection (odds ratio [OR] 3.03, P = .02) and hanging columella (OR 2.97, P = .001) were predictive of a long nose. Tip underprojection was predictive of short length (OR 35, P < .0001).

There is a high incidence of upper lip malposition in patients undergoing primary rhinoplasty. It is vital for the rhinoplasty surgeon to identify it preoperatively and plan the surgical maneuvers accordingly to prevent exacerbating an insufficient incisor show or excessive gum show.