Subnasal Lip Lift and Its Effect on Nasal Esthetics.

BACKGROUND: The subnasal lip lift has emerged as a standard procedure for the treatment of an elongated upper lip. Despite its popularity, limited literature has studied its effect on nasolabial esthetics. The purpose of this study is to describe the effect of the subnasal lip lift on nasal and labial esthetic parameters. METHODS: The authors conducted a retrospective case review of patients who underwent a subnasal lip lift procedure without concurrent rhinoplasty between January 1, 2008, and December 31, 2019. The outcome variables were lip length, tooth show, vermillion display, alar width, nasolabial angle, columellar-lobular angle, Crumley analysis, and Simons analysis. Preoperative and postoperative values were compared and analyzed using paired sample t-tests. RESULTS: Overall, 55 female patients with an average age of 52 years and a mean follow-up of 14 months were included in the study. Subnasal lip lift resulted in a statistically significant 21.5% reduction in lip length, 31.5% increase in the vermilion show, and a 1.52 mm increase in tooth show (P < .0001). In relationship to nasal esthetics, there was a statistically significant decrease in nasolabial angle of 4.56° (P < .0001), a 2.2% increase in alar width (P < .001), and a 26.3% increase in nasal projection per Simons analysis (P < .0001). The study did not demonstrate a significant change in columellar-lobular angle or Crumley projection analysis. CONCLUSIONS: Subnasal lip lift procedure can significantly impact lower nasal esthetics, specifically by decreasing the nasolabial angle and potentially contribute to pseudo-overprojection of the nasal tip, as shown by the results of this study.

Nonvascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is Length of Graft a Factor of Success?

PURPOSE: The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with nonvascularized bone grafts (NVBGs) is dependent on the length of the graft. MATERIALS AND METHODS: The inclusion criteria were patients who had received NVBGs, such as anterior or posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation of the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow-up, location of defect, etiology of defect, and postoperative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4 months postoperatively. Failures were considered loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting. RESULTS: We identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. The mean age of the patients at the time of grafting was 55 years (range, 17 to 81 years), with a mean follow-up length of 18 months. The length of defects ranged from 2 to 22 cm. The grafts were 6 cm or less in length in 7 defects and greater than 6 cm in length in 22 defects. All cases were grafted at a minimum of 6 months after resection, and bone morphogenetic protein was used in 25 cases (86%). Failure occurred in 1 patient in the group with grafts of 6 cm or less and 2 patients in the group with grafts greater than 6 cm, corresponding to success rates of 86% and 91%, respectively. Eight patients experienced minor complications such as wound dehiscence or infection, which resolved with local measures and antibiotics. CONCLUSIONS: The results of our study show that NVBGs are a viable, safe, and effective treatment option for segmental mandibular defects over 6 cm in length in non-irradiated patients.