ORIGINAL ARTICLE Photogrammetric Analysis of Soft Tissue Facial Profile in Turkish Rhinoplasty Population Sercan Gode ��� Fatma S. Tiris ��� Serdar Akyildiz ��� Fazil Apaydin Received: 23 January 2011 / Accepted: 25 March 2011 �� Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011 Abstract Background The aim of this study was to compare the facial photogrammetric analysis results of the Turkish population who are pleased with their facial appearance with the facial analysis data of patients who underwent rhinoplasty in order to find the most prominent objective facial measurements that lead patients to surgical correc- tion of the nose. Methods Forty rhinoplasty patients (20M, 20F) and 40 people without nasal deformity (20M, 20F) were included in this study. Rhinobase software was used for photo- grammetric facial analysis. Results The differences in the nasofrontal angle (NFA), nasolabial angle (NLA), chin projection (CP), middle facial height (MFH), and tip deviation angle (TDA) between the patient and the control groups and between the males and females were statistically significant (P \ 0.05). Conclusion The most significant differences between the control group and the patient group were crooked nose, obtuse NFA, acute NLA, chin underprojection, and increased MFH. Keywords Photogrammetric analysis Rhinoplasty Analysis of the face is the preliminary and important step in the management of the rhinoplasty patients. Although facial analysis is an important prerequisite to revealing the aesthetic condition, it is a cumbersome task to accomplish [1, 2]. The shape of the human face depends mainly on both bony and soft tissue structures. The facial structures are highly influenced by age, sex, race, and ethnicity [3���7]. It is now clear that perception of acceptable aesthetics may differ from one culture to another [8]. Measurements of facial soft tissue using photogrammetric analysis stand to be important in determining normal reference values in different popu- lations [3]. It is important to know the most common deformities that cause patients to seek rhinoplastic surgery. Two- and three-dimensional photogrammetry has been conducted for facial soft tissue analysis. The value of 2D photogrammetric facial analysis has been previously evaluated and demonstrated by several studies [9���13]. Obtaining measurements from photographs is cost-effec- tive and widely applicable, and it provides a permanent record of the face [3]. Measuring the important angles and lengths on a patient���s picture is a labor-intensive task that necessitates the use of a ruler and a protractor in the tra- ditional way, or computer software. Rhinobase is free software that has an automated photographic analysis tool which decreases the entire facial analysis to a maximum of 10���15 min [1]. The aim of this study was to compare the results of facial photogrammetric analysis of a particular Turkish population who are pleased with their facial appearance with the facial analysis data of patients who have under- gone rhinoplasty in order to find significant objective facial measurements that lead patients to surgical correction of the nose. Presented in the 31st Annual Meeting of the European Academy of Facial Plastic Surgery, Dusseldorf, Germany, September 2008. S. Gode ENT Department, Ishakoglu Cayeli State Hospital, Rize, Turkey F. S. Tiris S. Akyildiz F. Apaydin Otorhinolaryngology Department, Ege University School of Medicine, Izmir, Turkey S. Gode (&) Ege Universitesi Hastanesi Kulak Burun Bogaz Bolumu, Bornova, 35100 Izmir, Turkey e-mail: sercangode@yahoo.com 123 Aesth Plast Surg DOI 10.1007/s00266-011-9726-8

Materials and Methods The study was conducted at the Department of Otorhino- laryngology of Ege University Faculty of Medicine between January 2008 and September 2008. Informed consent for photography, including permission for publi- cation, was given by all patients and controls who were included in the study. Subjects A Turkish population of 40 rhinoplasty-negative individu- als (20M, 20F) and 40 rhinoplasty patients (20M, 20F) were included in the study as the control and patient groups. Mean age of the control and patient groups was 23.9 years (range = 19���35) and 24.2 years (range = 19���34), respec- tively. All patients and individuals included in the study were born in Turkey. The control group was questioned about if they were satisfied with their facial appearance. Individuals who were satisfied with their facial appearance and were not considering aesthetic facial surgery were included in the study as the control group. Individuals with previous nasal trauma or nasal surgery were excluded from the study. The patient group included patients who under- went rhinoplasty at the Department of Otolaryngology in Ege University between January and September 2008. Instrumentation and Procedure The photographic setup was composed of a digital SLR camera (Nikon D700, Nikon, Japan), a tripod, and flash system (Multiblitz profilux 600, Multiblitz, Germany). Frontal, lateral, three-quarter, basal, and sky views were taken by the same medical photographer. Each subject stood 2 m away from the camera and the visual axis was parallel to the floor of the room for the frontal, three- quarter, and lateral views. The camera height was adjusted according to the subject���s height so that the subject���s head was horizontal to the camera lens (Nikkor f2.8 105-mm macro lens, Nikon, Japan). Subjects were seated in a fixed position and asked to gaze directly at fixed points for dif- ferent views. Standard pictures were obtained: eyes were fully open with direct gaze and lips were closed with no smile. Additional frontal, lateral, and basal pictures were taken with a ruler on one side of the head for calibration purposes during photogrammetric analysis. Rhinobase is free software that can be used for auto- mated photogrammetric facial analysis. Three calibrated views (frontal, right lateral, and basal with a ruler) are loaded for completing the aesthetic and photogrammetric analyses. After the calibration is performed by means of the ruler in the picture, when the landmarks are marked on the pictures the program calculates the required distances and angles automatically and displays them in order. The landmarks used on frontal, right lateral, and basal pictures are listed in Table 1 and demonstrated in Fig. 1. The 13 anthropometric measures taken into consideration and their descriptions are listed in Table 2. Statistical Analysis Statistical analysis was performed using the Statistical Package for Social Sciences software v17.0 (SPSS Inc., Chicago, IL). Student���s t-test was used to compare the data between the normal and the patient groups, and between Table 1 Landmarks used on digital frontal, lateral, and basal images in Rhinobase Vertex (V) Supratip (S) Pogonion (P) Trichion (Tr) Tip (T) Lateral limbus (right) (LL) Glabella (G) Tip defining point (left) (D) Medial limbus (left) (ML) Lateral border of head (left) (LH) Tip defining point (right) (D) Medial limbus (right) (ML) Lateral border of head (right) (RH) Alar flare (left) (AL) Alar base junction (ABJ) Nasion (N) Alar flare (right) (AL) Alar crease (AC) Rhinion (R) Subnasale (Sn) Columella breakpoint (C0) Endocanthus (left) (EN) Labrale superius (LS) Cervical point (C) Endocanthus (right) (EN) Stomion (St) Labrale inferius (LI) Lateral canthus (left) (LC) Menton (Me) Tragion (TR) Lateral canthus (right) (LC) Medial brow (left) (MB) Mentolabial sulcus (SI) Widest point of dorsum (left) (WD) Lateral brow (left) (LB) Posterior point of nostril Widest point of dorsum (right) (WD) Medial brow (right) (MB) Highest point of nostril Lower bony vault (left) (X) Lateral brow (right) (LB) Lowest point of nostril Lower bony vault (light) (X) Lateral limbus (left) (LL) Anterior point of nostril Corneal plane (CP) Infraorbital rim (IR) Aesth Plast Surg 123