title: Effects of the Rhinoplasty Maneuvers on Upper Lip Position and Incisor Show.
abstract: BACKGROUND
  Smiling involves dynamic movements that include nasal tip descent and upper lip ascent. The effect of rhinoplasty on upper lip position is poorly described.
  
  
  METHODS
  One hundred charts were reviewed in reverse chronologic order. Inclusion criteria were receiving one of the rhinoplasty maneuvers of interest, at least 6 months of follow-up, and pre- and postoperative photographs by a professional medical photographer with matching maximum smile extent and size. Maxillary incisor show was measured as the vertical distance between the caudal border of the upper lip and the caudal-most aspect of maxillary central incisors. Pre- and postoperative maxillary incisor show was compared by open versus closed approach and rhinoplasty maneuver with and without controlling for depressor septi nasi (DSN) release.
  
  
  RESULTS
  Sixty-one females and fifteen males with a mean age of 39 years and mean follow-up of 16 months were included. No significant differences were seen between open versus closed approaches (p > 0.05). A decrease in postoperative maxillary incisor show was observed following columella strut, extended spreader graft, and DSN release (p < 0.05). No significant change in maxillary incisor show was seen after nasal spine graft, maxillary augmentation, tip rotation suture, shield graft, columella retraction, or tip suspension suture (p > 0.05). Patients undergoing footplate approximation and alar base resection had a significant decrease in maxillary incisor show (p < 0.05), but this significance was lost upon controlling for DSN release (p > 0.05).
  
  
  CONCLUSIONS
  Certain caudal rhinoplasty maneuvers may result in decreased maxillary incisor show, particularly when the DSN muscles are involved. Examination of upper lip position and patient discussion is important for maximizing outcome.
  
  
  METHODS
  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 .
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Hongyang
authors.initials: H
authors.lastname: Pi
authors.affiliation: Department of Plastic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kurlander
authors.affiliation: Case Western Reserve School of Medicine, 29017 Cedar Road, Cleveland, Lyndhurst, OH, 44125, USA. bahman.guyuron@gmail.com.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005152:Facial Muscles / Q000502:physiology; D005260:Female; D006801:Humans; D007180:Incisor / Q000503:physiopathology / Q000601:surgery*; D008046:Lip / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods*; D012904:Smiling
keywords: Depressor septi nasi; Rhinoplasty; Smile