When viewing the facial profile, it is apparent that the nasolabial angle comprises two lines. The first line runs from the tip of the nose to the area above the upper lip, and the second line goes from the upper lip to the bottom of the nose where the nostrils bifurcate.
The nose projection and rotation of its tip impacts the degree of the nasolabial angle. For most patients, the surgeon will try to create a 90- to 95-degree nasolabial angle in men and a 100- to 105-degree angle in women. An adjustment in the projection and rotation of the nose can refine this angle.
Focused double board certified plastic surgeon Dr. Geoffrey R. Keyes provides rhinoplasty to patients in Beverly Hills, Los Angeles, Bakersfield, California, and surrounding communities.
Adjusting the CLA
The columella-labial angle (CLA) is a vital parameter to be assessed in rhinoplasty patients to achieve aesthetically desirable outcomes. If there is an increase in this angle, it causes an upward tilt of the nasal base along with a concomitant reduction in the nose length. Due to the differences in the anatomies of the noses, this aspect is often overlooked resulting in sub-optimal surgical outcomes.
There exists a complex relationship between the columella and upper lip. It is challenging to maintain a specific angle in rhinoplasty patients, and this involves the use of various methods such as suturing techniques, nasal cartilage adjustments, and cartilage grafts.
The nasal spine, caudal septum, and medial crura of the lower lateral cartilage are instrumental in shaping the columella. Therefore, these aspects are contributory factors in determining the CLA.
The most cosmetically appealing columella-labial angle is 95° to 100° in males and 100° to 110° in females on profile view. The normal columellar display ranges from 2 mm to 4mm. An extensive of hanging columella can majorly disrupt the cosmetic appearance of the nose.
Tent Pole Grafting
The ‘tent pole graft’ is an advanced technique used to set and preserve the columellar lip angle. This graft works in a way similar to the septo-columellar interpositional grafts.
However, there is no requirement to dissect or delineate the upper lateral cartilages from the septum to place the grafts. This type of graft is used in challenging secondary nose surgeries as well as cases where the tip projection undergoes a significant increase.
This technique involves fixing a cartilage fragment to the columellar strut in the desired position. After that, the optimal angle is determined by fixing the posterior end of graft temporarily with a needle to supratip cartilaginous dorsum.
Upon determining the angle, the surgeon sutures the graft to the dorsum. The tent pole grafts enable the extensive columellar strut to be stable and does not allow the tip to fall back. In addition to the advantages in the maintenance of the nose tip, it also allows the creation of the desired CLA.
A surgeon may employ this technique when the tip requires support in secondary rhinoplasty procedures and cases where tip or columella lengthening is performed as well as to preserve the nasal length in patients who have short noses. This graft can be maneuvered to adjust the nasolabial or columella-labial angle conveniently.
The tent pole graft technique is especially useful in cases where the septal extension graft is not possible or very challenging to fix. (For instance, it can help patients who have a mild to moderate short nose.)
Caring double board certified plastic surgeon Dr. Geoffrey R. Keyes receives patients from Beverly Hills, Los Angeles, Bakersfield, California, and other towns and communities in this part of California for rhinoplasty.
For more information on the surgical and non-surgical procedures and treatments by Double Board Certified Cosmetic Plastic Surgeon, Dr. Geoffrey R. Keyes, please contact us at (800) 859-7509. Offices in Los Angeles and Bakersfield, CA.
Serving Greater Los Angeles, Beverly Hills, Orange County and surrounding areas of California.