The nasolabial angle comprises two lines, which are apparent when viewing the facial profile. The first line extends from the nasal tip to the area above the upper lip while the second line runs from the upper lip to the bottom of the nose where the nostrils divide.
The nasolabial angle depends on the nose projection and rotation of the nasal tip. In most cases, the nose surgeon will try to develop a 90- to 95-degree nasolabial angle in males and a 100- to 105-degree angle in females. To refine this angle, the surgeon will adjust the projection and rotation of the nose.
Plastic surgeon Dr. Paul McCluskey provides nose reshaping surgery to patients in Atlanta, Buckhead, Georgia, and surrounding locations.
Adjusting the CLA
It is important to assess the columella-labial angle (CLA) in rhinoplasty patients to accomplish aesthetically appealing outcomes.
An increase in this angle could cause an upward tilt of the nasal base in addition to a related reduction in the nose length. This aspect is frequently overlooked due to the differences in nasal anatomies, and doing so can result in undesirable surgical results.
The columella and upper lip share a complex relationship. It is a difficult task to maintain a particular angle in rhinoplasty patients. To accomplish this, an experienced surgeon uses various approaches such as nasal cartilage adjustments, suturing techniques, and cartilage grafts.
The caudal septum, nasal spine, and medial crura of the lower lateral cartilage are vital in shaping the columella. For this reason, these factors contribute to CLA determination.
The most aesthetically appealing columella-labial angle is 95 to 100 degrees in men and 10o to 110 degrees in women on profile view. The normal columellar display falls between 2 mm and 4 mm. A large hanging columella can significantly affect the aesthetic appearance of the nose.
Tent Pole Grafting
The ‘tent pole graft’ refers to an innovative technique which is used to set and preserve the CLA. The function of this graft is similar to the septo-columellar interpositional grafts.
But there is no need to dissect or delineate the upper lateral cartilages from the septum to insert the graft. The tent pole graft is used in difficult revision rhinoplasty cases as well as in procedures where the tip projection undergoes a major increase.
In this technique, the surgeon fixes a cartilage piece to the columellar strut in the desired position. Subsequently, they determine the optimal angle by fixing the posterior end of the graft temporarily with a needle to the supratip cartilaginous dorsum.
After determining the angle, the surgeon will suture the graft to the dorsum. This type of graft allows the extensive columellar strut to remain stable and prevents the tip from falling back. Apart from maintaining the nasal tip, the tent pole graft allows the development of the desired CLA.
A surgeon may use this technique in cases where the tip needs support, such as revision rhinoplasty procedures and cases where the nasal tip or columella is lengthened.
It is also beneficial in cases where the surgeon needs to preserve the nasal length in patients with short noses. They can maneuver this graft to manipulate the nasolabial or CLA easily.
This grafting technique is particularly helpful for patients who are not decent candidates for the septal extension graft or in cases where it is difficult to fix such a graft. For example, it can help patients with mild to moderately short noses.
Cosmetic surgeon Dr. Paul McCluskey receives patients from Atlanta, Buckhead, Georgia, and nearby areas for rhinoplasty.
Serving patients in and around Atlanta, Buckhead, Roswell, Marietta, Georgia and surrounding areas.