Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length

Abstract

depressor septi in rhinoplasty has been used to correct the smiling deformity. Studying the effects of this maneuver on the upper lip length is important for operative planning, as well as for patient counseling.OBJECTIVE To define an approach to the resection of the depressor septi muscle during functional and aesthetic rhinoplasty and to determine whether performing this maneuver causes any measureable change in the length of the upper lip in the repose position. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical record review and photographic analysis were performed on 36 patients who had undergone rhinoplasty involving resection of the depressor septi by either of 2 of the investigators at a tertiary care academic center and a private practice between 2010 and 2013. All maneuvers performed during the procedure were recorded. Preoperative photographs were compared with postoperative photographs using Adobe Photoshop, and percent change in upper lip length was calculated.INTERVENTION Rhinoplasty involving resection of the depressor septi. MAIN OUTCOME AND MEASUREPercent change in upper lip length, calculated by measuring the ratio between upper lip length and intercanthal distance and comparing the preoperative and postoperative ratios.RESULTS Thirty-six patients were evaluated, including 22 men and 14 women. Postoperative photographs were taken a mean (range) of 7.06 months (7 days to 2 years) after surgery. The mean change was a 1.74% decrease in upper lip length; 24 patients (67%) had a decrease (mean [maximum], 5.89% [21.22%]), and 12 patients (33%), an increase (mean [maximum], 6.55% [12.68%]) in upper lip length. Compared with the preoperative lip length, the mean (95% CI) postoperative lip length was 100.09% (97.35%-102.83%) in women vs 95.37% (90.86%-99.88%) in men (P = .07). No predictable factors determined whether a patient would develop a postoperative increase or decrease in upper lip length.CONCLUSIONS AND RELEVANCE Resection of the depressor septi muscle during rhinoplasty is a well-documented maneuver often used in the treatment of the ptotic tip and smile deformity. This descriptive study showed that resection of the depressor septi muscle has an unpredictable but small effect on upper lip length in the repose position.LEVEL OF EVIDENCE 3.

Effects of open rhinoplasty on upper lip position in profile and frontal views

“…A study executed by Ho et al (2014) revealed that DSN muscle transection is not predictable but has little effect on high lip length. 13 In another study, Kalantar Hormozi et al (2014) concluded that there was no statistically significant difference between DSN muscle transection or displacement at high lip length changes. 14 As mentioned earlier, DSN modification increases the upper lip length.…”

Impact of Tongue-in-Groove Technique on Smile and Lip Position: A Comparative Analysis with and without Septal Extension Graft

“…They used TIG and columellar strut in their surgeries [6]. Techniques focusing on the nasal tip, such as transfixion and mid-columellar incisions, dissection between the medial crura and around the nasal base, and excision of the dermo-cartilaginous ligament and the depressor septi muscle, can alter the shape, length, and position of the upper lip after surgery [7]. Additionally, NLA, CI, smNLA, and smCI showed significant improvements after surgery in both groups (p<0.001).…”

Ethnically Sensitive Rhinoplasty

“…14,39 The author prefers treatment of the smile deformity by extending the full transfixion incision inferiorly to the nasal spine, identifying the muscle at its attachment and excising bilaterally (Figures 15 and 16). 35…”

“…Treatment of the smile deformity can be accomplished in a variety of ways. [35][36][37][38] All interventions focus on alteration of the depressor septi nasi muscle. The depressor septi is a paired muscle contained within the columella, which originates on the medial crura footplates and caudal septum and has variable insertion patterns in the region of the orbicularis oris and nasal spine.…”