Dr. Kridel in Vogue Magazine, where he was
the only facial plastic surgeon noted for Texas.
Dr. Kridel voted top doc for women by H Texas Magazine.
Dr. Kridel named as a Super Doctor in Texas Monthly Magazine.
NASAL TIP PROJECTION HAS been defined as the distance along a perpendicular
line from the vertical
facial plane to the
most anterior projecting point of the nasal
tip. When the nose is overprojected,
it draws undue attention and the normal
nasofacial harmony is disturbed. This overprojection
can vary from a subtlety noticed
only on close analysis to a grossly
overprojected “Pinocchio” nose.
Numerous reports have not only defined
the proportions and angles that constitute
the aesthetic deal but also developed
formulas to determine how closely an
individual patient matches these aesthetic
ideals. The thoughtful analysis by Crumley
and Lanser1 is perhaps the most accepted
and quoted (Figure 1).
Figure 1. Computer-generated image depicts ideal nasal projection as derived by analysis by Crumley and Lanser.1 Their results defined an ideal ratio equal to 0.2833 using the length from nasion to upper vermilion–cutaneous junction of the upper lip (AE) compared with the length of a perpendicular from this line to the tip-defining point (BD).
However,
the variables suggested by Crumley and
Lanser1 and many of those who have followed
do not take into consideration that
projection of the nasal tip cannot be viewed
in isolation and that the height of the nasal
radix must be factored into the equation
lest a nose be judged as overprojected
when the only problem is a low radix.1-3 In
addition, few reports outline a systematic
approach on the choice of techniques to accomplish
the deprojection once this analysis
has been completed.
It has been our experience that true nasal
tip overprojection is uncommon. More
often, it is relative and multifactorial. In the
past, attention in the literature has largely
been directed toward achieving and maintaining
increased projection. As such, the
overprojected nasal tip, as the focus of far
less attention, continues to represent a challenging task for even the most experienced facial plastic
surgeon.
To help implify the surgical approach to the overprojected
nasal tip, we ompleted a retrospective analysis
of the patients who underwent deprojection procedures
in the private practice of the senior author (R.W.H.K.).
We used this review to refine our algorithm of preferred
methods in achieving deprojection and introduce our experience
with medial crural overlay (MCO).
