Effective preoperative planning, which plays a vital role in rhinoplasty success, is on par with surgical technique [1]. To achieve an ideal outcome, surgeons must possess a deep understanding of nasal aesthetics and engage in open and realistic communication with their patients. This communication is the cornerstone of achieving the best possible rhinoplasty results.

Numerous studies have explored the ideal nose shapes for different ethnic groups, particularly Caucasians and Asians. For instance, in Caucasians, the nasofrontal angle is typically considered ideal when it falls within the range of 115–135 degrees, while the nasolabial angle is optimal at 90–95 degrees in male and 95–105 degrees in female [2]. However, the Korean population presents unique standards, with the nasofrontal angle ideally at 135 degrees for male and 140 degrees for female and the nasolabial angle at 90 degrees for male and 95 degrees for female [3].

Nasal length and projection ideals vary by facial size and shape, with the overarching goal being harmony with the rest of the face. Nonetheless, a common guideline suggests that the ideal ratio of nasal projection to nasal length should fall within the range of 55%–60% [2,3].

These ideal values, however, are often derived from surveys and questionnaires, making them subjective and potentially different from the realistic expectations established through direct communication between patients and surgeons. With this in mind, this study aimed to investigate the real-world ideal aesthetic values of the nose using three-dimensional (3D) computer-simulated images based on consultations between patients and surgeons. It then compared these findings with the established ideal aesthetic values to shed light on the unique preferences and expectations of individuals seeking rhinoplasty.

Subjects

This study was conducted in strict accordance with the principles of the Declaration of Helsinki and received approval from the local institutional review board (IRB no. 2023-11-016). Image data were collected between January 2020 and October 2023. The 3D computer-simulated images used in this study were provided by Nextcore, Inc. (Ulsan, Korea), a 3D printing company specializing in the manufacture of patient-specific 3D printing surgical guides for rhinoplasty. These images were derived from patients who sought consultations at various clinics for rhinoplasty.

The creation of the simulated images involved a 2-step process. Initially, 3D scanning was performed using a Vectra 3D scanner (Canfield Scientific, Inc., Parsippany, NJ, USA) to capture the patients’ precise facial features. Subsequently, these scanned data were utilized in the Sculpture program to generate the simulated images. It is important to note that these simulated images were meticulously tailored based on the collaborative consultations between the attending surgeons and the respective patients.

Facial 3D scan

To capture the image data, a 3D scanner was employed to scan the patients’ faces. The scanning process was executed carefully. Each patient’s face, initially positioned at a distance of approximately 60–70 cm from the scanner, was photographed in a specific sequence: front, right side, left side, and lower jaw. Importantly, it was essential for each patient’s Frankfort line to remain perfectly horizontal during the process. The 3D scanner used in this study boasted a high resolution of ≥0.1 mm and 3D point accuracy of 0.03 mm and utilized a blue diode as its light source.

After capturing the images, reference points were established for each facial surface. These images were sequentially processed to create a 3D representation of the patient’s facial structure. The key reference points used in this process included the lateral canthi, the margins of both nasal alar, and both lateral angles of the lips.

Measurements

Nasofrontal angle

The nasofrontal angle is defined by 2 critical lines: one connecting the glabella (space between the eyebrows) and the nasion (midpoint between the eyes), and the other running along the nasal dorsum (bridge of the nose).

Nasolabial angle

The nasolabial angle is constructed using 2 key lines: the first connects the upper mucocutaneous border of the lip with the subnasale (midpoint of the base of the nose), while the second is drawn from the subnasale to the most forward point on the columella.

Nasofacial angle

The nasofacial angle represents the slope of the nasal dorsum and is formed by one line extending from the glabella to the most anterior point of the chin and another following the line of the nasal dorsum.

Nasomental angle

The nasomental angle is determined by one line that runs along the nasal dorsum and another that is drawn from the nasal tip to the pogonion (most anterior point of the chin).

Nasal length

Nasal length is measured from the nasion to the nasal tip to capture the distance from the midpoint between the eyes to the most forward point of the nose.

Nasal height

Nasal height is defined as the vertical distance from a line drawn from the nasion to the alar groove (crease on the side of the nostril) to the nasal tip.

Tip projection ratio

The tip projection ratio is calculated as the ratio of nasal height to nasal length to provide insight into the projection of the nasal tip in relation to the overall nose length.

This study analyzed a total of 199 3D computer-simulated images of patients undergoing rhinoplasty. The study participants (114 male, 85 female) were a mean 32.3 years old.

The mean simulated nasofrontal angle was 145.75 degrees for male and 148.80 degrees for female. The mean nasolabial angle was 101.53 degrees for male and 102.92 degrees for female. The mean nasofacial angle was 29.56 degrees for male and 29.78 degrees for female. The mean nasomental angle was 131.66 degrees for male and 132.22 degrees for female. The mean simulated nasal length was 4.58 cm for male and 4.01 cm for female. In contrast, the mean nasal height was 2.61 cm for male and 2.27 cm for female. The mean tip projection ratio was 0.57 for both male and female (Table 1).

Table 1 . Aesthetic nasal measurements.

	Male (N=114)			Female (N=85)		p-value
	Mean±standard deviation	Variance		Mean±standard deviation	Variance
Nasofrontal angle (°)	145.75±5.62	31.62		148.80±5.73	32.83	<0.001
Nasolabial angle (°)	101.53±9.48	89.93		102.92±8.30	69.81	0.283
Nasofacial angle (°)	29.56±3.00	8.99		29.78±3.35	11.20	0.634
Nasomental angle (°)	131.66±4.60	21.17		132.22±5.01	25.06	0.410
Nasal length (cm)	4.58±0.43	0.18		4.01±0.48	0.23	<0.001
Nasal height (cm)	2.61±0.21	0.05		2.27±0.23	0.05	<0.001
Tip projection ratio	0.57±0.05	0.00		0.57±0.06	0.00	0.543

The variance of these measurements was most pronounced in the nasolabial angle and least pronounced in the tip projection ratio in both male and female. Additionally, significant differences were found in nasofrontal angle, nasal length, and nasal height between male and female (p<0.001), whereas no significant differences were observed in the other parameters (Table 1, Fig. 1, 2).

Figure 1. Mean simulated aesthetic nose angles are shown. Significant sex-based differences in nasofrontal angle were observed (*p<0.001).

Figure 2. Mean simulated aesthetic nose lengths are shown. Substantial variations in nasal length and height were observed between male and female (*p<0.001).

While a multitude of articles and textbooks have explored the concept of ideal nose shapes [2-6], the practical application of these ideals in rhinoplasty can be challenging. These ideal nose shapes are typically derived from surveys using figures [4], and they may not always align seamlessly with the diverse facial characteristics of individual patients. Thus, it is essential to recognize the distinction between an ideal nose and a realistically achievable best nose, particularly as patient satisfaction can be high even when the resulting nose shape deviates from the ideal [7]. This study aimed to identify the most realistic and attainable nose shapes for typical Korean male and female.

A study examining aesthetic proportions in Koreans revealed that the mean nasofrontal angle was 126.0 degrees for male and 133.6 degrees for female, while the mean nasolabial angle was 78.5 degrees for male and 82.7 degrees for female. The average tip projection ratio was 0.475 [8]. Notably, these measurements indicated that both nasofrontal and nasolabial angles tended to be more acute than those associated with ideal nose shapes, and the nasal tip was positioned lower than the ideal standard. Consequently, this underscores the importance of dorsal and tip augmentation, along with septal extension, for achieving desirable outcomes in Korean rhinoplasty [9,10].

These findings revealed that the ideal nasofrontal angle for the Korean population differs from previously published values, with a greater inclination [3,5]. This variation can be attributed to the fact that most Koreans tend to have less pronounced glabellas and prefer a more natural-looking profile for the nose as opposed to an overly prominent high nose bridge. This variation can also be attributed to the absence of forehead augmentation in rhinoplasty procedures, which can contribute to a more harmonious and balanced facial profile.

The ideal nasolabial angles for the Korean population were 101.53 degrees for male and 102.92 degrees for female, which diverged from the traditionally known angles of 90 degrees for male and 95 degrees for female. This substantial variation stemmed from the differing definition of the nasolabial angle. This angle is typically defined as the intersection between the line connecting the upper mucocutaneous border of the lip with the subnasale and the line extending from the subnasale to the most forward point on the columella. However, in our study, the program used to analyze the simulated images employed the line extending from the subnasale to the nasal tip, resulting in a more obtuse nasolabial angle.

In terms of measurement variance, the nasolabial angle exhibited the greatest divergence and the tip projection ratio had the least variability in both male and female. Furthermore, significant distinctions were observed in nasofrontal angle, nasal length, and nasal height between male and female, highlighting inherent differences in facial structure. Conversely, the other measured parameters did not vary significantly.

Notably, the discrepancy in nasolabial angle between male and female was relatively modest at approximately 1.5 degrees. Although the nasofrontal angle differed between male and female, the discrepancy was approximately 3 degrees. These disparities are notably smaller than the widely accepted 5-degree difference between the sexes, suggesting that the aesthetic preferences for nasal angles in the Korean population exhibit a higher degree of sex convergence than previously understood.

While this study features certain limitations, such as a relatively modest number of participating surgeons compared to the patient dataset, it is important to note that the involved surgeons were well-qualified to determine both ideal and realistic nose shapes that align with patient preferences. Notably, the angle measurements in our study may have been influenced by filler injections, particularly in the forehead or mentum. However, such cases were infrequent within our study cohort, and their augmentation fell within the normal variation range. Further investigation is needed to determine the ideal height for forehead and mental augmentation to achieve harmony with the patient’s overall facial features.

Here we found that the ideal nasofrontal angle for Koreans is greater than in previous studies. This preference may be due to a cultural inclination toward a more natural-looking nose profile and less protruded glabella. The nasolabial angle showed the most variation, while the tip projection ratio showed the least variation. Notable differences in nasofrontal angle, nasal length, and nasal height between male and female were observed, while other measurements remained consistent. The disparities in nasolabial angles between male and female were smaller than the widely accepted 5-degree difference, suggesting a greater degree of sex similarity in nasal aesthetic preferences among Koreans.

The authors have nothing to disclose.