Profileplasty: Comprehensive Facial Profile Management Algorithm Based on 425 Patients
Alvaro Reategui1, Navid Pourtaheri1, Connor Peck1, Maria Laura Reategui2, Joaquin Reategui3, Sarah Phillips1, Joseph Lopez1, Derek Steinbacher1
1Yale New Haven Hospital, New Haven, CT, 2Geisel School of Medicine at Dartmouth, Hanover, NH, 3Larner College of Medicine at the University of Vermont
Background: The nasal profile is treated in the context of the overall facial profile. An algorithm for facial profile management, including the chin and facial support, is typically underemphasized in patients undergoing rhinoplasty. This study aims to describe common facial profiles and to propose an algorithm for targeted correction.
Methods: All patients from 2010-2019 who underwent rhinoplasty performed by the senior surgeon were reviewed. If patients also previously underwent orthognathic surgery or genioplasty, only those who underwent these procedures performed by the senior author with 12-months follow-up were included. The nasal profile and overall facial profile were determined. Lastly, specific treatments were enumerated for each patient.
Results: A total of 425 rhinoplasty cases were analyzed. There were two general categories of patients needing rhinoplasty: Group 1) poor nasal profile with balanced facial profile and 2) poor nasal profile with an unbalanced facial profile. Analysis of Group 1 patients resulted in two subtypes: 1a) prominent or 1b) flat nasal dorsum. Treatment for Group 1 focused on balancing the nasal dorsum and nasofrontal angle. Analysis of Group 2 patients resulted in three subtypes: 2a) convex facial profile; 2b) concave facial profile; and 2c) “pseudo-dorsum” secondary to retroposition of the lower third of the nose. Treatment for Group 2 centered around modifying the nasal dorsum and repositioning the maxilla and/or mandible.
Conclusions: This study describes a series of common facial and nasal profile patterns and highlights a profileplasty algorithm that allows for systematic treatment planning, applicable to 98.6% of our included patients.
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