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Original Investigation |

Population-Based Assessment of Currently Proposed Ideals of Nasal Tip Projection and Rotation in Young Women

Omar Ahmed, MD1; Amrita Dhinsa2; Natalie Popenko, BS2; Kathryn Osann, PhD, MPH3; Roger L. Crumley, MD, MBA4; Brian J. Wong, MD, PhD4
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, New York University, New York, New York
2student, University of California, Irvine, Irvine
3School of Medicine, University of California, Irvine, Irvine
4Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange
JAMA Facial Plast Surg. 2014;16(5):310-318. doi:10.1001/jamafacial.2014.228.
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Published online

Importance  There is no universally accepted quantitative metric that defines the ideal nasal tip rotation and projection.

Objective  To identify the ideal nasal tip projection (NTP) and rotation by using 3 classic NTP methods (Crumley 1, Crumley 2, and Goode).

Design, Setting, and Participants  Lateral facial portraits of normal-appearing white women aged 18 to 25 years were selected from a previously validated and attractiveness-scored database of images. Each image was digitally modified to fit the NTP ideals outlined by the Crumley 1, Crumley 2, and Goode methods with columellar facial angles (rotation metric) of 96°, 101°, 106°, 111°, and 116° (15 modified images per portrait). These variants were incorporated into electronic surveys that were distributed to traditional focus-group and online social-network participants. Analysis was performed using paired comparison analysis, a consumer preference research analytic. The traditional focus-group participants were undergraduate students at the University of California, Irvine, whose online social-network contacts were also used.

Main Outcomes and Measures  Mean ranks.

Results  There were no significant differences in preference between the traditional focus-group (n = 106) and online participants (n = 3872) (P > .05). The most preferred rotation variant for all 3 NTP methods was 106° (Crumley 1: mean rank, 2.11 [95% CI, 2.07-2.16]; Crumley 2: mean rank, 2.07 [95% CI, 2.02-2.12]; and Goode: mean rank, 2.05 [95% CI, 1.99-2.11]; P < .001). Crumley 1 was considered to be the most attractive NTP method (mean rank, 1.84 [95% CI, 1.82-1.85]; P < .001) overall and was the most preferred NTP method for faces of above-average attractiveness (mean rank, 1.78 [95% CI, 1.76-1.80]; P < .001). No significantly preferred NTP method was found for faces of average attractiveness (P > .05). The most aesthetic combination of tip rotation and projection was a columellar facial angle of 106° with the Crumley 1 tip projection.

Conclusions and Relevance  To our knowledge, this is the first population-based study to attempt to simultaneously determine the ideal NTP and rotation. Each classic NTP method uses measurements dependent on both projection and rotation; thus, ideal rotation for each NTP method must be determined before comparison of the ideals. A rotation of 106° (columellar facial angle) was found to be the most aesthetic. The Crumley 1 method was determined to be the most attractive nasal tip variant overall.

Level of Evidence  NA.

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Figure 1.
Paired Comparison Analysis and Survey Presentation Format

A, Paired comparison analysis schematic using Crumley 1 rotation variants of 1 of 6 faces. The series of the 5 portraits depicts a synthetic face altered to fit the Crumley 1 ideal across 5 rotation variants using the columellar facial angle (CFA) metric. The table demonstrates that 5 rotation variants allow for 10 unique side-by-side comparisons to be made per nasal tip projection method per face. B, Survey presentation format of side-by-side comparisons as seen by the participants. This presentation was used for all surveys.

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Figure 2.
Phase 1 Subsurvey and Phase 2 Survey Schematic

A, Phase 1 subsurvey versions. Each nasal tip projection method (Crumley 1, Crumley 2, or Goode) represents a series of 10 unique side-by-side comparisons made by the participant (5 rotation variants allows for 10 unique comparisons). Each line segment represents a subsurvey version with 20 side-by-side comparisons. The boxes in the columns for faces 5 and 6 represent subsurvey versions with 30 side-by-side comparisons. The total number of subsurvey versions is 14. Each subsurvey was randomly distributed to participants. B, Phase 2 survey schematic for one face. The columellar facial angle (CFA) 106 variant for Crumley 1, Crumley 2, and Goode was identified to be the most aesthetic in phase 1. The schematic demonstrates that 3 rotation-optimized nasal tip projection variants allow for 3 unique side-by-side comparisons to be made for each face.

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Figure 3.
Nasal Tip Projection Ratios as Described by Crumley 1, Crumley 2, and Goode

A, For the Crumley 1 method, the ratio of the length of a line drawn from the nasion to the vermillion-cutaneous border of the upper lip (AB) should be 3.53 to the length of a line drawn perpendicular through the nasal tip (CD). B, For the Crumley 2 method, the ratio of the length of a line drawn from the nasion running tangent to the alar crease and terminating at the edge of the mandibular profile (AB) should be 4.23 to the length of a line drawn perpendicular through the nasal tip (CD). C, For the Goode method, the ratio of the length of a line from the alar crease to the nasal tip that is perpendicular to a line tangent to the alar crease (AB) should be 0.55 to 0.60 of the length of a line from the nasal tip to the nasion (BC).

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