Quantitative Measurements of the Bulbous Tip in Ethnic Rhinoplasty

Background: Refinement of the bulbous nasal tip continues to be one of the more challenging aspects of ethnic rhinoplasty. Better objective measures are necessary to quantitatively assess changes in surgery of the bulbous tip. We propose the use of a new nasal anatomic landmark in the subnasal vertex view, designated c(1), in conjunction with previously described landmarks to offer an improved means of characterizing the bulbous tip. Together, these landmarks form a pentagon, allowing for measurement of its angles and distances to quantitatively evaluate the nasal tip in the subnasal vertex view. We hypothesize that this method will provide a means of demonstrating a decrease in tip bulbosity postoperatively. Methods: An institutional review board-approved retrospective analysis of 44 nonwhite patients undergoing ethnic rhinoplasty was undertaken and preoperative and postoperative photographs in the subnasal vertex view were subjected to the proposed analysis. All patients underwent an open approach rhinoplasty with a combination of tip defatting and cartilage graft placement. Using the polygonal construct, several angles, distances, and areal indices were measured from the preoperative and postoperative photographs and comparison was made for statistical significance. Results: All but 1 of the 8 parameters examined demonstrated statistical significance comparing preoperative and postoperative values. These measures, thus, allow the surgeon to objectively assess and ascertain a reduction in tip bulbosity of postoperative ethnic rhinoplasty patients. Conclusions: This article presents a new anatomic landmark c1 seen from a subnasal view of the tip. This landmark can be combined with previously established landmarks to create a polygon that allows for a simple yet objective method for measuring the reduction and contouring of the ethnic bulbous tip.