Can A Rhinoplasty Reverse The Adverse Nasal Effects From A LeFort 1 Procedure?
Q: Dr. Eppley, i had a LeFort 1 with maxilla impaction and slightly advancement. Now Im left with a potruding mouth area, a more upturned nose and a longer upper lip. My biggest concerns are the upper lip inclination(more convex and straight) and the more upturned nose. Can a rhinoplasty with tip derotation influence the inclination of the upper lip, so its more concave after? What procedure do you recommend based on the picture for a better upper lip – nose relationship?
Thank you very much and best regards.
A: The anatomic cause of some your midface concerns is that the caudal septum and anterior nasal spine is more forward than it was which can push the base of the nose forward (opening the nasolabial angle) and the tip of the nose upward. The degloving of all the soft tissue attachments to the bone, which is necessary to do the surgery, and the movement of the maxilla forward creates a long upper lip and contributes partially to the mouth protrusion.
In improving the nose-lip relationship, the anterior nasal spine and base of the pyriform aperture bone must be reduced through an intraoral approach. This will decrease the open nasolabial angle. The tip of the nose, however, will not just automatically derotate. Infralobular onlay grafts or an interpositional cartilage graft between the dome and the caudal septum are needed to push the tip of the nose back down.
Dr. Barry Eppley