Profileplasty: Comprehensive Facial Profile Management Algorithm Based on 426 Patients.

Objective: Profileplasty traditionally involves improving a nasal hump or an underprojected chin. However, this procedure can correct other facial defects like saddle nose or prognathism. To establish the best overall profile, the nose, the midface, and the chin should be considered altogether. This study aimed to describe typical facial profiles and propose an algorithm for targeted correction.

Methods: Patients who underwent rhinoplasty, with or without other facial procedures performed by the senior author were reviewed. Patients with pre and postoperative photographs and clinical follow-up were included. Images were analyzed using Goode and Steiner analyses and E and S lines to assess and categorize nasal and facial profiles. A treatment algorithm for each sub-group was proposed based on expert opinion. Adherence to the algorithm was validated by reviewing patients' charts.

Results: A total of 426 rhinoplasty patients were included, with 72 also undergoing orthognathic surgery, including genioplasty. There were 2 general groups of patients: (1) poor nasal profile with a balanced facial profile and (2) poor nasal profile with an unbalanced facial profile. Group 1 included (1a) prominent (n = 298) or (1b) flat (n = 56) nasal dorsum. Group 2 included (2a) convex profile (n = 38), (2b) concave profile (n = 32), and (2c) "pseudo-dorsum" (n = 2). Proposed treatments for group 1 involved balancing the nasal dorsum and nasofrontal angle, whereas group 2 involved modifying the nasal dorsum and repositioning the maxilla/mandible. Of patients, 98.6% followed the proposed treatment algorithm.

Conclusion: This study describes common profile patterns and highlights a profileplasty algorithm that offers systematic treatment planning for most patients.