Introduction
In the vibrant city of New York City, plastic surgery for nasal dorsum line optimization has become a popular option for those looking to enhance their facial aesthetics. The nose, being the most central and defining feature on the face, plays a crucial role in overall facial harmony. Whether it's to correct a crooked nose, smooth out bumps on the nasal bridge, or achieve a more balanced facial profile, many individuals are turning to the expertise of plastic surgeons in New York City. This guide will delve into various aspects of nasal dorsum line optimization, including nasal analysis, different types of rhinoplasty procedures, and the use of advanced technologies such as 3D printed surgical guides.
Nasal Analysis in Rhinoplasty
Overview of Nasal Analysis
Nasal analysis in rhinoplasty is a comprehensive process used by plastic surgeons to evaluate the proportions and contours of an individual's nose in comparison to the aesthetic standard considered “ideal.” As a facial plastic surgeon, Dr. Cangello emphasizes that while these aesthetic standards are helpful, beauty is subjective, especially when dealing with ethnically diverse patient groups. Nasal analysis serves as a guidepost rather than a strict rule, with the ultimate goal being to achieve the results requested by the individual patient.
Assessing Ideal Nasal Proportions
Dr. Cangello begins the nasal analysis by assessing the overall face and naso - facial proportions. This involves analyzing both facial height and width:
Facial Height
The face is divided into three equal horizontal thirds. The top third extends from the hairline to just between the eyebrows, the middle third from just below the glabella to the subnasale (where the bottom of the nose meets the upper lip), and the lower third from the subnasale to the menton (the lowermost projection of the chin). Ideally, the nose should encompass almost the entire middle horizontal third of the total facial height. If the horizontal thirds are unbalanced, adjustments can be made during nasal surgery to improve the overall facial appearance.
Facial Width
The face is sectioned into equal vertical fifths. The outermost fifths on either side of the face extend from the farthest edge of each ear to the outside corner of each eye, the next two fifths span the outer and inner corners of each eye, and the innermost fifth in the center of the face extends between the inner corners of each eye. The central fifth is used to determine the ideal width of the nose, and the nostrils’ outer perimeter should not extend beyond this region. In some cases, a wide nasal base may adhere to ethnic beauty standards, but nasal base reduction is often performed during ethnic rhinoplasty.
Other Considerations in Nasal Assessment
In addition to facial proportions, Dr. Cangello reviews the surface landmarks of the nose and their relationships to each other and other facial features. Some of these important landmarks include:
- Radix: The centermost point of the depression between the glabella, known as the root of the nose, located at the top of the nasal anatomy.
- Dorsum: Also called the bridge of the nose, it connects the nose to the rest of the face and consists of an upper segment of bone and a lower segment of cartilage.
- Upper Vault: Composed of a pair of nasal bones attached to the frontal and maxillary bones, it can affect the width of the nose.
- Middle Vault: The middle third of the nasal bridge, composed of the dorsal part of the nasal septum and two upper lateral cartilages, which is crucial for both appearance and function.
- Nasal Tip: Located in the lower third of the nose, it should ideally be the most forward - projecting portion above the midline of the nostrils and is essential for the overall shape and appearance of the nose.
- Alar Rim: Also known as the nostril rim, it is a convex arc that extends above each nostril from the nasal tip to the face and ends at the top of the nasolabial fold, affecting the appearance of the nasal tip and nostrils.
- Columella: A bridge of soft tissue located under the nasal tip and between the nostrils, attaching the nose to the upper lip.
- Alar Base: Where the base of the nose attaches to the face, along with the columella and the upper lip.
- Nostril Sill: The area of skin at the base of the nostril when viewed from below, located between the alar base and columella.
Naso - Facial Relationships
Several angles and lines are also considered in nasal analysis to ensure proper nasal and facial harmony:
Brow Tip Aesthetic Line
Also referred to as the dorsal aesthetic line, it curves out from the bottom of the inner eyebrow towards the nose, runs along the nasal bridge, and curves back away from the bridge towards the nasal tip. During nasal analysis, Dr. Cangello assesses this line from the front view and takes steps during rhinoplasty to ensure symmetry and an elongated hourglass shape.
Nasofrontal Angle
The angle created by the intersection of the glabella and the dorsum. Ideally, the radix below this angle should measure 115 - 125 degrees in women and 120 - 130 degrees in men. The vertex of the nasofrontal angle should fall within 1 - 2 millimeters of the upper eyelid crease. Deviations from this range can result in a nose that appears either excessively short or long.
Nasolabial Angle & Tip Rotation
The nasolabial angle is formed at the intersection of the columella and the upper lip. Nasal tip rotation refers to the nasal tip’s position in relation to an arc on the face when viewed in profile. The ideal nasolabial angle is 100 - 105 degrees in women and 90 - 95 degrees in men. Deviations can lead to an under - rotated or over - rotated nasal tip, affecting the overall naso - facial balance.
Frankfort Plane
This is the most accurate way to determine nasal tip rotation. It uses a line extending from the lowermost point of the eye socket towards the ear canal, and a second line bisecting it parallel to the columella. The ideal angle for nasal tip rotation is 15 - 30 degrees in women and 0 - 15 degrees in men.
Nasal Tip Projection
Dr. Cangello determines how far the nasal tip protrudes from the face using the Goode method. By measuring the ratio between two distances related to the alar line and the nasal tip, he can assess if the nasal tip projection is within the ideal range of 0.55 - 0.60. An over - or under - projected nose can be addressed during rhinoplasty.
Columellar Show
It refers to the amount of columellar sidewall or inner nostril lining visible when viewing the nose from the profile. The ideal amount is 2 - 4 millimeters. Excess or insufficient columellar show can affect the appearance of the nostrils and overall nasal aesthetics.
Nasal Tip & Nasal Base
When assessing the nasal tip from the frontal view, there is no one ideal shape. Dr. Cangello looks for a shape that is in balance with the overall naso - facial features. The ideal nasal tip should transition symmetrically towards the alar rim, smoothly into the dorsum and supratip, and downward to blend with the columella. The nostrils should be slightly visible from the front. The nasal base, when viewed proximally, should generally have a soft triangular shape. Excessively wide nasal bases may require nasal base reduction surgery.
Types of Rhinoplasty Procedures for Nasal Dorsum Line Optimization
Traditional Rhinoplasty
Traditional rhinoplasty is a well - known procedure that involves directly removing the cartilage and bone components of the bump on the nose. The goal is to reduce the size of the nose by shaving down the bump. However, this method can sometimes leave an “open roof deformity,” similar to taking the roof off a house. When this occurs, the surgeon may need to use techniques like cartilage grafting to address the issue.
Preservation Rhinoplasty
How it Differs from Traditional Rhinoplasty
Preservation rhinoplasty is a relatively new trend in cosmetic nose surgery. Instead of directly removing the bump, the surgeon alters the height of the nasal bridge beneath the overlying bone and cartilage. By making tissue resections underneath the bump and allowing it to stretch out and fall backward, a straight line is created while maintaining the natural components of the nasal dorsum. This technique offers an alternative to traditional structural rhinoplasty and can produce a more natural result without the need for extensive reconstruction.
What it Can Fix
In the hands of an experienced surgeon, preservation rhinoplasty can straighten a crooked nose, correct breathing issues, deproject a disproportionately large nose, smooth bumps on the nasal bridge, and reshape the nasal bridge.
Benefits
Preservation rhinoplasty has several advantages, including improving facial harmony and balance while maintaining the patient's unique look, ensuring a long - term positive outcome, maintaining or improving breathing function, providing an alternative for addressing a dorsal hump, and creating a very natural result without the need for reconstructing the bridge of the nose.
Ideal Candidates
Ideal candidates for preservation rhinoplasty are those who desire to shorten the projection or remove bumps from the nose and have not had previous nose surgeries. However, men or women with thick skin and soft cartilage or tissue may not be the best candidates.
Open and Closed Rhinoplasty Techniques
At Mount Sinai, expert facial plastic surgeons offer both open (external) and closed (endonasal) rhinoplasty procedures. The choice between the two depends on the patient's unique anatomy and functional and aesthetic goals.
Closed (Endonasal) Rhinoplasty
During this procedure, all incisions are made inside the nose. The advantage is the lack of an external scar and a relatively shorter duration of the operation.
Open (External) Rhinoplasty
In this approach, a small incision is added at the base of the nose to increase the surgical field of vision. This allows for better visualization of the nasal anatomy and more complex alterations and grafting to be performed.
3D Printed Surgical Guides in Rhinoplasty
Introduction to 3D Printed Surgical Guides
As computer simulation for rhinoplasty continues to rise, 3D printed surgical guides have emerged as a valuable tool. These guides are based on 3D images and can assist surgeons in aligning with their original surgical plan. A study evaluated the utility of 3D printed surgical guides as an intraoperative tool to help establish dorsal height and tip position.
How They Work
Patients undergoing rhinoplasty first have preoperative virtual 3D surgical simulations. These simulations are used to create a 3D printed nasal kit, which includes ceramic models of the preoperative and simulated nose, a sagittal contour guide, and a customized postoperative nasal splint. The nasal guides are sterilized and used for continual intraoperative assessment of the profile contour, specifically dorsal height and tip position.
Results
The study found that with the use of 3D printed surgical guides, the final tip position was on average of 0.8 ± 0.7 mm from simulated projection and 0.3 ± 0.2 mm from simulated rotation. Similarly, projection for the cartilaginous and bony dorsum was within 1.0 ± 0.8 and 0.8 ± 0.7 mm of the simulation, respectively. This shows that 3D printed surgical guides can improve adherence to desired aesthetic goals during rhinoplasty.
Nasal Implants for Nasal Dorsum Line Optimization
Overview of Nasal Implants
When the nose needs cosmetic enhancement or functional improvement, nasal implants can be an option. Implants are derived from synthetic material or donated and banked biological material, as opposed to grafts, which come from natural cartilage, skin, mucous membrane, or muscle.
Types of Nasal Implants
Synthetic Implants
Materials such as silicone and Gore - Tex® are commonly used in synthetic implants. They are inert and are usually ignored by the body. Some synthetic implants, like Medpor, integrate with the body, similar to artificial joints.
Biologically Sourced Implants
Examples include rib cartilage and Alloderm, which is harvested from cadaver skin with the cells stripped out to allow the patient's own cells and blood vessels to grow into it. Biologically sourced implants are available in unlimited amounts, unlike using one's own natural cartilage.
Risks and Benefits
While synthetic implants have a long - track record of safety, there are still risks such as infection and the possibility of the implant shifting. Biologically sourced implants may also have risks. However, implants can provide cosmetic enhancement and structural support. During a consultation, a facial plastic surgeon like Dr. Yagoda in New York City will discuss all the options, risks, benefits, and alternatives with the patient.
The Procedure and Recovery
Rhinoplasty with implants can be performed in an office - based surgical facility or a NYC hospital under local anesthetic with IV sedation or general anesthesia. The procedure takes between 45 minutes and two hours, and most incisions are made internally, leaving no visible scars. After the surgery, patients can return to work in about a week, start using a stationary bike or treadmill by the second week, and return to full activities by the third week. The nose's shape and profile will continue to refine over the next 12 to 18 months.
Choosing a Hospital and Surgeon in New York City
Credentials and Experience
When considering a hospital and surgeon for nasal dorsum line optimization, it is crucial to look at the surgeon's credentials. Surgeons who are double - board certified in facial plastic and reconstructive surgery and otolaryngology (ear, nose, and throat) have extensive expertise in nasal function, as well as nasal and facial aesthetics. For example, the facial plastic surgeons at Mount Sinai have this double - board certification, ensuring that patients receive high - quality care.
Multidisciplinary Approach
Hospitals like Mount Sinai offer a multidisciplinary approach. They have a wide range of specialists and subspecialists available to address any specific concerns related to nasal breathing, nasal allergies, sinus disease, or deformity after cancer treatments. This allows for combined surgeries when appropriate, providing comprehensive care for patients.
Patient Reviews and Testimonials
Reading patient reviews and testimonials can give you an idea of the experiences of previous patients. Positive reviews can indicate a surgeon's skill and the quality of care provided by the hospital. You can also ask for before - and - after photos to see the results achieved by the surgeon.
Conclusion
In New York City in 2025, there are numerous options available for nasal dorsum line optimization. From comprehensive nasal analysis to various types of rhinoplasty procedures, including preservation rhinoplasty, and the use of advanced technologies like 3D printed surgical guides and nasal implants, patients have the opportunity to achieve their desired nasal aesthetics. However, it is essential to choose a qualified surgeon and a reputable hospital to ensure a safe and successful procedure. Whether you are looking to correct a specific nasal issue or simply enhance your facial appearance, take the time to research your options and consult with a professional. If you are considering nasal dorsum line optimization, we encourage you to reach out to a trusted plastic surgeon in New York City to discuss your goals and learn more about the available treatments.
