Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review

Abstract

In this systematic review we aim to (1) describe the anatomy and function of the soft tissue triangle, (2) identify the existing rhinoplasty literature that discusses the role of the soft tissue triangle, (3) provide a summary of the outcome measures for soft tissue triangle techniques in rhinoplasty, and (4) demonstrate the need for further research reviewing soft tissue triangle techniques in rhinoplasty. A systematic literature review was conducted from 2002 to 2019 utilizing MEDLINE/PubMed, Embase, Ovid, and Cochrane databases with the keywords, “rhinoplasty” and “soft tissue triangle” or “facet” to identify articles that describe the anatomical significance, clinical applicability, and rhinoplasty outcomes involving the soft tissue triangle. A total of 26 studies were identified as appropriate for inclusion. The vast majority describe the relationship of structure and function of the soft tissue triangle with particular focus on notching and retraction. The soft tissue triangle is an important area of the nose often neglected in rhinoplasty. This area is a common source of patient dissatisfaction and the need for revision rhinoplasty. Due to this fact, a formal evaluation of the role of the soft tissue triangle in nasal airway patency is needed. Specific validated outcome measures such as the NOSE (Nasal Obstruction and Septoplasty Effectiveness) score or the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) should be employed in the evaluation of surgical intervention to the soft tissue triangle.

Keywords

soft tissue triangle - soft facet - rhinoplasty - infratip lobule

• References

• 1 Ali-Salaam P, Kashgarian M, Persing J. The soft triangle revisited. Plast Reconstr Surg 2002; 110 (01) 14-16
• 2 Dayan SH. Evolving techniques in rhinoplasty. Facial Plast Surg 2007; 23 (01) 62-69 , discussion 70–79
• 3 Nguyen DQ, Motley R, Cooper MA. Repair of nasal soft triangle notching. J Plast Reconstr Aesthet Surg 2008; 61 (08) 966-968
• 4 Rowe-Jones J. Refining the nasal tip-an anatomical approach. Facial Plast Surg 2014; 30 (02) 113-122
• 5 Foda HM. Nasal soft-tissue triangle deformities. Facial Plast Surg 2016; 32 (04) 339-344
• 6 Campbell CF, Pezeshk RA, Basci DS, Scheuer JF, Sieber DA, Rohrich RJ. Preventing soft-tissue triangle collapse in modern rhinoplasty. Plast Reconstr Surg 2017; 140 (01) 33e-42e
• 7 Koppe T, Giotakis EI, Heppt W. Functional anatomy of the nose. Facial Plast Surg 2011; 27 (02) 135-145
• 8 Lam SM, Williams III EF. Anatomic considerations in aesthetic rhinoplasty. Facial Plast Surg 2002; 18 (04) 209-214
• 9 Funk E, Chauhan N, Adamson PA. Refining vertical lobule division in open septorhinoplasty. Arch Facial Plast Surg 2009; 11 (02) 120-125
• 10 Rohrich RJ, Liu JH. Defining the infratip lobule in rhinoplasty: anatomy, pathogenesis of abnormalities, and correction using an algorithmic approach. Plast Reconstr Surg 2012; 130 (05) 1148-1158
• 11 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
• 12 Jung DH, Kwak ES, Kim HS. Correction of severe alar retraction with use of a cutaneous alar rotation flap. Plast Reconstr Surg 2009; 123 (03) 1088-1095
• 13 Kayabasoglu G, Nacar A. The soft triangle: an often neglected area in rhinoplasty. Aesthetic Plast Surg 2015; 39 (05) 659-666
• 14 Çakır B, Küçüker İ, Aksakal İA, Sağır HÖ. Auto-rim flap technique for lateral crura caudal excess treatment. Aesthet Surg J 2017; 37 (01) 24-32
• 15 Goodrich JL, Wong BJ. Optimizing the soft tissue triangle, alar margin furrow, and alar ridge aesthetics: analysis and use of the articulate alar rim graft. Facial Plast Surg 2016; 32 (06) 646-655
• 16 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
• 17 Bayram AA, Kilavuz AE, Serin GM. The importance of soft triangle in rhinoplasty. J Craniofac Surg 2016; 27 (06) e536-e537
• 18 Rohrich RJ, Afrooz PN. The infratip lobule butterfly graft: balancing the transition from the tip lobule to the alar lobule. Plast Reconstr Surg 2018; 141 (03) 651-654
• 19 Sawhney R, Sokoya M, Ducic Y. Prophylactic measures to prevent soft tissue abnormalities after trauma. Facial Plast Surg 2017; 33 (06) 639-642
• 20 Daniel RK. Rhinoplasty: septal saddle nose deformity and composite reconstruction. Plast Reconstr Surg 2007; 119 (03) 1029-1043
• 21 Ansari K, Asaria J, Hilger P, Adamson P. Grafts and implants in rhinoplasty—techniques and long-term results. Oper Tech Otolaryngol—Head Neck Surg 2008; 19 (01) 42-58
• 22 Foulad A, Volgger V, Wong B. Lateral crural tensioning for refinement of the nasal tip and increasing alar stability: a case series. Facial Plast Surg 2017; 33 (03) 316-323
• 23 Lee M, Zwiebel S, Guyuron B. Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg 2013; 132 (04) 769-776
• 24 Guyuron B, Ghavami A, Wishnek SM. Components of the short nostril. Plast Reconstr Surg 2005; 116 (05) 1517-1524
• 25 Higuera S, Hatef DA, Stal S. Rhinoplasty in the Hispanic patient. Semin Plast Surg 2009; 23 (03) 207-214
• 26 Choi JY, Kang IG, Javidnia H, Sykes JM. Complications of septal extension grafts in Asian patients. JAMA Facial Plast Surg 2014; 16 (03) 169-175
• 27 Casanueva F, Gerecci D. Objective comparison of nasal tip contours in the basal view between dome binding and hemitransdomal tip suture techniques in rhinoplasty. JAMA Facial Plast Surg 2016; 18 (06) 481-487
• 28 Stewart MG, Smith TL, Weaver EM. , et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004; 130 (03) 283-290
• 29 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42