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Published on: May 20, 2016
The Golden Triangle Method: A Novel Simulation Framework for Rhinoplasty Design
Yusuf Erbayat1, Ahmet Kirazoglu2, Kemalettin Yıldız3
1Department of Plastic, Reconstructive and Aesthetic Surgery, Recep Tayyip Erdogan University Teaching and Research Hospital, İslampasa Mh. Sehitler Cd. No:74 Merkez, Rize, Turkey. erbayaty@gmail.com.
Background:
Current rhinoplasty simulation relies on subjective landmark planning and compartmentalized parameter analysis, resulting in inconsistent designs. This study introduces a unified geometric framework to assist in the design of harmonious noses.
Objectives:
To develop and provide proof-of-concept validation for a geometric framework that systematically determines optimal nasal landmark positions based on facial proportions, and to evaluate its aesthetic acceptability.
Methods:
This prospective study included 30 young Turkish women (aged 18-30 years) seeking primary rhinoplasty, evaluated by 20 board-certified plastic surgeons (17 included in Visual Analog Scales analysis after outlier exclusion) and the patients themselves. The Golden Triangle method employs a 36°-apex isosceles triangle to determine key nasal landmarks within a cohesive geometric framework. Simulations were created using GeoGebra (which also calculated nasal ratios and angles) and Adobe Photoshop. Evaluators rated pre- and post-simulation images using Visual Analog Scales (0-100). Technical parameters were evaluated on 5-point Likert scale by surgeons.
Results:
Patient VAS scores increased from 41.3 ± 10.1 to 81.9 ± 3.3 (p < .001; Cohen's d = 5.41), and surgeon ratings improved from 34.7 ± 6.3 to 72.6 ± 4.4 (p < .001; Cohen's d = 7.02). The coefficient of variation decreased by 66.2% for patients' and 53.7% for surgeons' ratings, indicating improved interrater agreement on simulation images. Technical parameters reached "ideal" consensus in 93-97% of cases. Nasal ratios and angles converged toward population-specific reference values with reduced variability.
Conclusions:
The Golden Triangle method provides a systematic approach to rhinoplasty simulation, significantly improving aesthetic ratings and interrater agreement using affordable software.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
