Is it possible to define the ideal lips?

SUMMARY: The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.

Use of intranasal corticosteroids in adenotonsillar hypertrophy.

OBJECTIVES: This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy. METHOD: The related literature was searched using PubMed and Proquest Central databases. RESULTS: Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system. CONCLUSION: Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

Open rhinoplasty: effectiveness of different tripplasty techniques to increase nasal tip projection.

PURPOSE: To study the effectiveness of 3 different tipplasty techniques to increase nasal tip projection (NTP). MATERIALS AND METHODS: NTP of 61 patients who underwent open rhinoplasty were retrospectively studied in 3 different tipplasty techniques used to increase NTP. Using a standard measurement technique, the preoperative and postoperative NTP ratio was measured for every patient preoperatively and at least 1 year after surgery. The study population of 61 patients was divided into 3 groups. Group 1 (n-32) underwent the author's routine nasal tip procedure (columellar strut, conservative cephalic trim of the lateral crura, and transdomal mattress sutures). Group 2 (n = 10) underwent the routine procedure and, in addition, has further medical recruitment of the lateral crura. Group 3 (n = 19) underwent the routine procedure and, in addition, has a tip cartilage graft. RESULTS AND CONCLUSION: The mean gain NTP postoperatively was highest in group 3 and lowest in group 1, and this was statistically significant. Causes of these differences in the NTP gain are discussed.

Simultaneous open rhinoplasty and alar base excision: is there a problem with the blood supply of the nasal tip and columellar skin?

In a prospective study, 15 consecutive patients who underwent simultaneous open rhinoplasty and alar base excision were included to investigate whether there is a problem with the blood supply of the nasal tip and columellar skin. During the surgical procedure in these patients, there was transection of the columellar arteries and external nasal arteries, and frequently of the alar branches of the angular artery. Yet, none of the patients had any evidence of ischemia of the nasal tip or columellar skin, and there was primary wound healing with a thin-line transcolumellar scar in all patients. Techniques to avoid injury to the lateral nasal artery and nasal tip plexus are discussed. It was concluded that simultaneous open rhinoplasty and alar base excision is safe as long as certain surgical principles are applied.

Open rhinoplasty: columellar scar analysis in an Arabian population.

This prospective study included 50 consecutive Saudi Arabian patients who underwent open rhinoplasty. All patients had a minimum follow-up of 1 year after surgery. The columellar scar was assessed objectively and subjectively at the final follow-up. An unsatisfactory scar was considered present if anything other than a barely visible, level, and thin-line scar without notching was evident. Objectively, 39 patients (78 percent) were considered to have a satisfactory columellar scar. The percentage of unsatisfactory scars (22 percent) was higher than expected prior to performing the study, and one patient was actually conscious about the deformity. Causes and prevention of unsatisfactory columellar scars were discussed.

Alterations in nasal sensibility following open rhinoplasty.

Alterations of nasal sensibility following open rhinoplasty were studied both subjectively and objectively. In a prospective study, 25 patients were included. All patients underwent open rhinoplasty using a middle columellar incision. Subjective questioning and objective testing of nasal sensibility using the Semmes-Weinstein monofilaments were obtained preoperatively and both 3 weeks and 1 year after surgery. The match-paired Student's t-test was used for statistical analysis. At 3 weeks after surgery, there was subjective and significant objective alteration of sensibility in the area of skin supplied by the external nasal nerve (nasal tip and adjacent upper columella). This altered sensibility, however, recovered by 1 year after surgery. The recovery was thought to be due either to recovery of the external nasal nerve itself, or to collateral sprouting from the nerves supplying the adjacent areas of nasal skin.