Download PDF
Facial Plast Surg
DOI: 10.1055/a-2624-8475
Original Research

The Footplates Reposition Technique for Improving Tip Stability, Balancing Columellar–Labial Junction, and Upper Lip Lifting

Helena Hotz Arroyo Ramos
1   Otolaryngology, Private Practice, Vitoria, Brazil
,
Fernando Nakamura
2   PerFace Institute, Private Practice, Brasilia, Brazil
,
Rebeca Silva Chiabai Loureiro
3   Otolaryngology, Private Practice, Sâo Paulo, Brazil
,
Julia Kozelinski
1   Otolaryngology, Private Practice, Vitoria, Brazil
,
Leila Freire
3   Otolaryngology, Private Practice, Sâo Paulo, Brazil
,
Dean M. Toriumi
4   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction

The footplates of the medial crura are relevant structures that play an important role in the columella and nostril sill design. They also work as a connection between the nasal and oral muscles, as the insertion of the superficial orbicularis oris nasalis (SOON) is placed into the footplates and the continuation of the superficial muscular aponeurotic system (SMAS) is situated within the membranous septum. Moreover, the SOON is a powerful depressor of the nasal tip.

Objectives & Hypothesis

Many techniques attempt to reconstruct the tip support with grafts, but footplates and their connections can play an important role.

Study Design

We describe a surgical technique that involves footplate release and repositioning for better sill design, improvement of tip support and stability, better balance of the columellar–labial junction (CLJ), upper lip lifting, and eversion of the vermilion.

Methods

This retrospective study reviewed the medical records of 64 patients who underwent all steps described in the paper.

Results

The patients were followed up for 12 months and decreases in philtrum length were accompanied by an enhanced vermilion showing creating a more favorable balance.

Conclusion

The footplate release and repositioning technique can be incorporated as an adjunct in rhinoplasty to provide additional tip support, facilitate nasolabial angle adjustment, and assist in upper lip repositioning.

Keywords

rhinoplasty - upper lip - vermilion - labial philtrum - nasolabial angle


Publication History

Article published online:
17 June 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Daniel RK, Glasz T, Molnar G, Palhazi P, Saban Y, Journel B. The lower nasal base: an anatomical study. Aesthet Surg J 2013; 33 (02) 222-232
    CrossrefPubMedSearch in Google Scholar
  • 2 Lee MR, Tabbal G, Kurkjian TJ, Roostaeian J, Rohrich RJ. Classifying deformities of the columella base in rhinoplasty. Plast Reconstr Surg 2014; 133 (04) 464e-470e
    PubMedSearch in Google Scholar
  • 3 Han SK, Ko HW, Kim WK. Advantages of adding a footplate incision in Asian rhinoplasty. Ann Plast Surg 2004; 53 (01) 65-69
    PubMedSearch in Google Scholar
  • 4 Hur MS, Lee S, Jung HS, Schneider RA. Crossing fibers may underlie the dynamic pulling forces of muscles that attach to cartilage at the tip of the nose. Sci Rep 2023; 13 (01) 18948
    PubMedSearch in Google Scholar
  • 5 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
    CrossrefPubMedSearch in Google Scholar
  • 6 Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol 1984; 110 (06) 349-358
    PubMedSearch in Google Scholar
  • 7 Janeke JB, Wright WK. Studies on the support of the nasal tip. Arch Otolaryngol 1971; 93 (05) 458-464
    PubMedSearch in Google Scholar
  • 8 Westreich RW, Courtland HW, Nasser P, Jepsen K, Lawson W. Defining nasal cartilage elasticity: biomechanical testing of the tripod theory based on a cantilevered model. Arch Facial Plast Surg 2007; 9 (04) 264-270
    CrossrefPubMedSearch in Google Scholar
  • 9 Westreich RW, Lawson W. The tripod theory of nasal tip support revisited: the cantilevered spring model. Arch Facial Plast Surg 2008; 10 (03) 170-179
    CrossrefPubMedSearch in Google Scholar
  • 10 Davis RE, Ostby ET. How to create ideal alar form and function. Facial Plast Surg 2020; 36 (01) 34-45
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Xia TY, Punjabi A, Oh JH, Wee C, Guyuron B. Updated dynamics of rhinoplasty: a review of the literature and comprehensive list of the findings. Aesthetic Plast Surg 2020; 44 (03) 904-909
    CrossrefPubMedSearch in Google Scholar
  • 12 Rohrich RJ, Huynh B, Muzaffar AR, Adams Jr WP, Robinson Jr JB. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 2000; 105 (01) 376-383 , discussion 384–388
    CrossrefPubMedSearch in Google Scholar
  • 13 Oh SH, Choi S, Kim DW, Jeong JY. Intranasal approach for manipulating the depressor septi nasi. J Craniofac Surg 2012; 23 (02) 367-369
    CrossrefPubMedSearch in Google Scholar
  • 14 Benlier E, Top H, Aygit AC. A new approach to smiling deformity: cutting of the superior part of the orbicularis oris. Aesthetic Plast Surg 2005; 29 (05) 373-377 , discussion 378
    CrossrefPubMedSearch in Google Scholar
  • 15 Cardim VLN. et al. Lifting nasolabial com realce do vermelhão. Rev Bras Cir Plást 2011; 26: 466-471
    CrossrefPubMedSearch in Google Scholar
  • 16 Baldini N, Alomani M, Fonseca E, Saban Y. A nasal columellar base stabilizing suture technique. Plast Reconstr Surg 2024; 153 (02) 331e-333e
    PubMedSearch in Google Scholar
  • 17 Raphael P, Harris R, Harris SW. The endonasal lip lift: personal technique. Aesthet Surg J 2014; 34 (03) 457-468
    CrossrefPubMedSearch in Google Scholar