Rhinoplasties (nose jobs) are the most commonly performed facial cosmetic surgical procedure. In 2011, approximately 244,000 rhinoplasties were performed in the United States. In addition to being the most popular facial procedure, it is also one of the most complicated. The nose is the most prominent part of the face, and even a small nasal abnormality can throw off the aesthetic appearance of the entire face.
In order to determine the best possible nasal features that can be achieved with rhinoplasty, cosmetic surgeons must do a pre-surgery facial analysis, paying specific attention to the nose. This facial analysis allows the cosmetic surgeon to determine the best size and shape of nose for the face, given the size and shape of the existing nose, as well as the rest of the facial features. The overall goal is to find a pleasing, balanced aesthetic between all of the facial features.
Dividing the Face into Sections
Facial analysis begins with photographs of the front and side views of the patient’s face. A grid is then laid over the frontal image, where the face is horizontally divided into thirds and vertically into fifths. The entire nose, including the nostrils should occupy the middle square, both horizontally and vertically.
Facial width is determined from the five vertical lines in the grid. Ideally, the distance between each of the five vertical lines will be equal. The two outermost fifths of the face should be the distance from the ear to the inner corner of the eye.
The area where the nose joins the upper lip should form the top line of the bottom third of the face. The lower space between the eyebrows, or glabella, will be the dividing line between the top and middle thirds of the face. Ideally, the distance between the three horizontal lines on the face will be equal.
The nose itself is also divided into horizontal thirds, where the nasal bones and bridge form the upper third, the upper cartilage dorsal area forms the middle third, and the bottom third is the nasal tip. Again, the ideal nose will be equidistant between the top, middle, and lower third of the actual nose itself.
There are other points, or landmarks, on the nose that must be considered. For example, on a profile view of the face, the angle from the glabella to the nasal tip should be 120 to 130 degrees for males, and 115 to 125 degrees for women. Looking at the lower nose, the angle from the top of the upper lip to the base of the columella (the soft cartilage that divides the nostrils) should be 90 to 95 degrees for men and 100 to 105 degrees for women.
The concept of nasal analysis may seem very complicated. In fact, it is an exacting, mathematical means to ensure that the cosmetic surgeon provides the patient with the proper height and width of nose to fit the rest of the facial features.
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