Dynamic Rhinoplasty: Treatment of the Tip Muscles

• Published in: Seminars in plastic surgery Vol. 12; no. 1; pp. 21 - 43
• Main Authors: De Souza Pinto, Ewaldo Bolivar, Da Costa Muniz, Adriane, Erazo I., Patricia J., Abdalla, Priscila C. S. P.
• Format: Journal Article
• Language: English
• Published: 1999
• Subjects: Feature; upper lip; rhinosculpture; nasal tip; Dynamic rhinoplasty; functional rhinoplasty; nasal-lip relation; nasal muscles surgery
• ISSN: 1535-2188; 1536-0067
• DOI: 10.1055/s-2008-1080203

ABSTRACT Since the end of 1993 we have been using a new approach for the treatment of the muscles intimately related with the nasal tip and the upper lip, today known as dynamic rhinoplasty. 1–4 With the idea of improving the dorsal-tip-labial relationship, the dynamic rhinoplasty technique is based on doing an intraoral Z-plasty at the labial frenum, permitting access for the local musculature, represented by the depressor septi nasal muscle and its three fasciculi (medial, intermedial, and lateral). Following that, we do the subperiostal undermining of the medial bundles, freeing them from the lower nasal spine, followed by the treatment of the intermedial bundles (which substitute the former by the special kind of plication at the median line level, accordingly with the primary characteristics of the upper lip: short or long). Initially, we used the new method only for treatment of black nose or for cases of “exuberantly” fallen nasal tip. Now, with improvements in surgical technique, it is possible to operate on almost any kind of nose-lip combination, including mouth breather patients and even cases with long upper lip and upright nose tip. In this way the authors have established a semiologic classification, discussing both surgical indication and technique, and also showing the importance of combining the several surgical stages (septoplasty, dynamic rhinoplasty, rhinosculpture, and turbinectomy) involved in each group.