title: Nasal Sculpting: Calculated and Predictable Tip Elevation With Cephalic Trim.
abstract: BACKGROUND
  Rhinoplasty techniques to affect nasal tip rotation are well described. Cephalic alar trim is a powerful method for achieving tip elevation. Previous studies and texts provide aesthetic guidelines for nasolabial angles. Often, surgeon experience determines the degree of lower lateral cartilage resection to achieve optimal results. This study analyzes the change in tip elevation with measured resections of the lower lateral cartilages. This can aid the surgeon in accurately predicting the effect of cephalic alar trim on tip elevation.
  
  
  METHODS
  Ten fresh cadaveric dissections were performed to determine the change in nasolabial angles after cephalic trim of the lower lateral cartilage. Closed rhinoplasty technique was performed using marginal and intercartilaginous incisions to expose the lower lateral cartilage. Caliper measurements of the lower lateral cartilage were recorded. Serial cephalic trim was performed in 25% increments. True lateral photographs were obtained before and after each serial excision. Nasolabial angle measurements were obtained using a digital goniometer for digital photo analysis.
  
  
  RESULTS
  Four female and 6 male cadavers were evaluated. The mean initial nasolabial angle was 106° ± 2°. The mean lower lateral cartilage width was 9.45 ± 1.38 mm. Serial 25% reductions in lower lateral cartilage height resulted in a mean total nasolabial angle change of 7.4°, 12.9°, and 19.6°, respectively. The mean incremental change in the nasolabial angle was 6.47° ± 1.25°.
  
  
  CONCLUSIONS
  The nasolabial angle is an essential aesthetic feature. Cephalic trim is a key maneuver in affecting the nasolabial angle. A 25% lower lateral cartilage cephalic trim correlates with an average change in the nasolabial angle of 6.47°. Knowledge of the cephalic trim to nasolabial angle relationship aids in achieving desired tip elevation.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Redstone
authors.affiliation: Department of Surgery, University of Illinois at Mt Sinai, Chicago.
authors.forename: Saeed
authors.initials: S
authors.lastname: Chowdhry
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Durham Alan
authors.initials: DA
authors.lastname: North
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Ron
authors.initials: R
authors.lastname: Hazani
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Brad
authors.initials: B
authors.lastname: Drury
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoder
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Cooperman
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Virginia
authors.initials: V
authors.lastname: Yoder
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Jarrod A
authors.initials: JA
authors.lastname: Little
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Florman
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Ky.
authors.forename: Bradon J
authors.initials: BJ
authors.lastname: Wilhelmi
keywords: cephalic alar trim; lower lateral cartilage; nasal sculpting rhinoplasty; nasal tip elevation; nasolabial angles