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1 RHINOPLASTY
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4 ORIGINAL ARTICLE
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7 Preferred Nasolabial Angle in Rhinoplasty: A Cross-Sectional Analysis
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10 Solaiman M. Alshawaf, MD; Connor McGuire, MD, MHSc; Rawan ElAbd, MD, MSc;
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11 Nabil Fakih-Gomez, MD; Jason Williams, MD, FRCSC; Sarah AlYouha, MD, PhD,
12 FRCSC; and Osama A Samargandi, MD, MHSc, FRCSC
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15 Dr Alshawaf is a resident, Division of Plastic & Reconstructive Surgery, Jaber Al Ahmad
16 Al Sabah Hospital, Kuwait. Dr McGuire is a resident, and Dr Williams is a plastic surgeon,
17 Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada.
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18 Dr ElAbd is a resident, Division of Plastic and Reconstructive Surgery, McGill University
19 Health Centre, Montreal, Canada. Dr Fakih-Gomez is a plastic surgeon, Department of
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Facial Plastic & Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, Lebanon. Dr
AlYouha is a plastic surgeon, Department of Surgery, Faculty of Medicine, Kuwait
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22 University, Kuwait. Dr Samargandi is a plastic surgeon, Division of Plastic and
23 Reconstructive Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi
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24 Arabia
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26 Corresponding author: Dr Osama A Samargandi, Division of Plastic and Reconstructive
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27 Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

E-mail: Osamargandi@dal.ca; Instagram: @osamasamargandi
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30 Disclosures: The authors declared no potential conflicts of interest with respect to the
31 research, authorship, and publication of this article.
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34 Funding: The authors received no financial support for the research, authorship, and
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35 publication of this article, including payment of the article processing charge.

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38 Level of Evidence: Therapeutic V
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© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights
reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and
distributed under the terms of the Oxford University Press, Standard Journals Publication Model
(https://academic.oup.com/pages/standard-publication-reuse-rights) 1
1 ABSTRACT
2 Background: The perception of an ideal nose is influenced by a variety of factors, with
3 demographic characteristics playing a significant role in what is considered an ideal nose.
4 The nasolabial angle (NLA) is considered one of the defining features shaping the nose.
5 Objectives: This study set out to capture the perception of the ideal nasolabial angle
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6 among Canadian, Saudi, Kuwaiti, and Lebanese populations.
7 Methods: An online questionnaire-based cross-sectional study was conducted to
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8 investigate the ideal nasolabial angle among Canadian, Saudi, Kuwaiti, and Lebanese
9 populations (N=197). Participants were patients attending outpatient clinics, plastic
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10 surgery residents and medical students. The questionnaire consisted of demographics and
11 perception of respondents on the ideal NLA for each gender: Male (85, 90, 95, 100, 110)
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12 and Females (95, 100, 110, 115).
13 Results: The majority of respondents were female (81.2%) aged between 20 and 39
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(84.3%). The mean and standard deviation of ideal NLA choices in both male and female
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15 models were 97.1 +/- 6.39 and 109.5 +/- 5.32 respectively. The ideal male NLA choices
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16 were found to correlate significantly with age (p 0.044) and work status (p 0.019). In
17 choosing the ideal female NLA, age was a significant factor (p 0.012).
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18 Conclusions: Identifying the ideal NLA is essential for establishing aesthetic goals for
19 patients and surgeons alike. It is important to understand the effects of demographics on
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20 the choice of the ideal NLA, which ultimately influences the planning and outcome of
21 rhinoplasty procedure.
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1 The aesthetic rhinoplasty is a challenging cosmetic procedure performed by plastic
2 surgeons. The challenge of rhinoplasty is due to an interplay between patient’s anatomy
3 and desires, surgeon skill, difficulty in predicting outcomes, and the sheer variety of
4 techniques. While there are several important anatomic issues to address in rhinoplasty,
5 determining and constructing the nasolabial angle (NLA) is crucial for a seamless aesthetic
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6 outcome.1 Although there are variations in the methods to measure the NLA, the consensus
7 is that it is the angle between the columella and a line tangent to the philtrum. 2 The
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8 described ideal nasolabial angle ranges from 90 to 120 degrees with variable anthropologic
9 and gender differences.1 Generally, males prefer more acute angles closer to 90 degrees
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10 while females prefer closer to 100 degrees. Previous studies have found that the most
11 aesthetic female NLA was 105 degrees and for males was 97 degrees. 3 However, NLAs
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12 vary depending on age, socioeconomic status, understanding and experience with
13 rhinoplasty, country of origin, and race.3 Furthermore, since NLA is dependent on a variety
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of demographic and anthropologic differences, it can be extrapolated that such preferences
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15 would persist among plastic surgeons.1 Several studies have investigated preferred NLA in
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16 a variety of general populations. However, comparing such preferences between the
17 general population has not been completed on the populations studied in this article. Such
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18 information would be not only beneficial to patients interested in establishing aesthetic

19 goals, but also for plastic surgeons trying to understand how demographics may influence
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20 patient choices in rhinoplasty. The aim of this study is to assess plastic surgery patients’,
21 plastic surgery residents’, and medical sttudents’ perception of the ideal nasolabial angle
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22 amongst the populations studied.

23
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24 METHODS
25 Study Design and Participants

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26 An online questionnaire-based cross-sectional study was conducted in a single hospital

27 from each of Dalhousie University, Halifax infirmary, Canada, Kingdom of Saudi Arabia,
28 and Jaber AlAhmed Hospital, Kuwait between the periods of April to November 2022.
29 Participants were plastic surgery patients attending outpatient clinics, plastic surgery
30 residents, and medical students. A questionnaire was provided using survey monkey to all
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1 participants (N=197) (Appendices A, B). The respondents were informed that the purpose
2 of the survey was to examine their perception of the ideal nasolabial angle and that
3 participation is optional, anonymous and that refusal or acceptance to participate will not
4 influence the outcome of care. Ethical approval was obtained from Ministry of Health,
5 Kuwait and Dalhousie University. Incomplete responses were omitted.
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6
7 Variables
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8 The questionnaire consisted of a total of 17 questions and examined 2 domains:
9 demographics and the perception of respondent regarding the ideal nasolabial angle in
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10 males and females. Demographic information included age, gender, nationality, income
11 per year, education level, marital status, employment and work sector, as well as four
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12 questions regarding past surgical history of plastic surgery procedures and specifically
13 rhinoplasty for the respondent or any related family members, as well as their knowledge
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of rhinoplasty and any desire to undergo a rhinoplasty in the future. Perception of the ideal
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15 nasolabial angle in males and females was assessed using two questions, presented with 5
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16 images for nasolabial angles for each gender: Male (85, 90, 95, 100, 110), Females (95,
17 100, 110, 115) (Figures 1, 2).
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18 The nasolabial angles were defined using a line from the columnella intersecting
19 with a line from the subnasale to the labrale superius. The female model was also edited
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20 using rhinoceros to accentuate gender specific features for the respondents to orient
21 themselves. The models were presented in a side profile view. The nasolabial angles were
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22 modified from the base model using Rhinocerus generating 5 different images for male and
23 female models each. The angles chosen reflected the most commonly quoted angles in the
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24 literature for the respective genders4 . Other parameters, including the nasal rotation,
25 dorsum, and projection remained unaltered. The images were incorporated into the online
26 survey and the image options were displayed in a randomized order to prevent bias of
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27 presenting the images in an ascending order of angles. In addition, respondents were asked
28 Yes and No questions related to personal and family history of undergoing plastic surgery
29 procedures, as well as history of undergoing rhinoplasty specifically, their knowledge of
30 the procedure and their intention to undergo a rhinoplasty in the future. The base male and
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1 female models were obtained and edited from Renderhub (artist “Davlet”) and 3dscanstore,
2 respectively, as permitted according to the licensing and terms of use.
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4 Data Analysis
5 Statistical analysis was conducted using SPSS V.28 (IBM Corp, Armonk, NY). The data
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6 was summarized by computing frequency and percentages. The Chi-square test was used
7 wherever appropriate to study the association between NLA choices in male and female
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8 models and demographic variables, as well as the association between the personal and
9 family history of cosmetic procedures, knowledge and desire of undergoing rhinoplasty,
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10 with the demographic variables. All p-values are considered statistically significant if
11 < 0.05.
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14 RESULTS
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15 Demographic Characteristics
16 A total of 197 plastic surgery patients attending outpatient clinics, plastic surgery residents,
17 and medical students completed the online survey, with a higher percentage of female
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18 respondents (81.2%). The nationalities of respondents ranked from highest to lowest were
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19 Canada (30.5 %), Kuwait (30.5%), Kingdom of Saudi Arabia (19.8%), Bahrain (10.2%),
20 and Lebanon (2.5%), others (6.6%) included respondents from Syria, Oman, Morocco,
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21 Iraq, and Russia. The majority of respondents (73.1%) reported income less than 50,000
22 per year in USD. The number of respondents in the 20-39 age group was the highest
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23 (84.2%), and 38.1% had a College/Diploma degree. Around half of the studied population
24 were single (58.9%).
25 Demographic data of the responders are summarized in Table 1. The mean and standard
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26 deviation of ideal NLA choices in both male and female models were 97.1 +/- 6.39 and
27 109.5 +/- 5.32 respectively.
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1 History of Cosmetic Procedures, Knowledge About Rhinoplasty and Intention to
2 Undergo the Procedure
3 In our study, we have found that respondents who were female (96%), students (52%), and
4 had knowledge about rhinoplasty (74%) were significantly more likely to have a desire to
5 undergo a rhinoplasty procedure in the future (Table 2).
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6
7 Demographics and the Choice of Ideal NLA in Male and Female Models
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8 The ideal male NLA choices were found to correlate significantly with age (p 0.044) and
9 work status (p 0.019) (Table 3). In choosing the ideal female NLA, age (p 0.012) was a
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10 significant factor (Table 4). There was no association between, gender, education level,
11 history of cosmetic procedures, or knowledge about rhinoplasty in regards to influencing
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12 the choice of ideal NLA in either male or female models (p > 0.05).
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14 Nationality and Gender Influence on Ideal NLA N
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15 We found no significant difference between the choices of ideal NLA in males and females
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16 between different nationalities (Table 5) or gender.
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19 DISCUSSION
20 The history of rhinoplasty dates back to the age of ancient Egyptians, and since the advent
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21 of modern medicine and introduction of cosmetic surgery, the attainment of an aesthetic

22 nose shape has been a long sought after goal. 5 The shape of the nose is defined by several
parameters including facial landmarks, linear, and angular measurements. 6 In that regard,
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24 the nasolabial angle is one of the defining features shaping the nose. The topic of measuring
25 the NLA is controversial, as the lines corresponding to these landmarks are not always
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26 obvious.2 A number of methods have been proposed for measuring the nasolabial angle.
27 Several authors have found that the NLA is most accurately defined by the angle created
28 by the line drawn through the midpoint of the nostril aperture crossing the line
29 perpendicular to the Frankfurt horizontal intersecting the subnasale. 4 Another way of
30 measuring the NLA is by drawing a line from the columella intersecting with a line from
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1 the subnasale to the upper lip (Columella-subnasale-labiralis superius). However, no
2 general consensus has been established. Despite the availability of various methods, the
3 plastic surgeon should consider employing a standardized approach in order to minimize
4 variability in angle measurements, as slight variations have shown to yield large
5 discrepancies.2 One meta analysis summarized the various methods involved in analyzing
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6 the nasal profile and evaluated their influences over nasal parameters and the facial
7 aesthetic. Our study has mainly focused on the NLA, however, it is important to also note
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8 the various factors that influencing NLA, such as the position of the upper and lower lips
9 as well as the inclination of the incisors. 7,8 In addition, the NLA is only one of many other
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10 facial features that can influence what is considered an “attractive nose”. It is important to
11 evaluate the nose in a holistic approach that is not limited to the nose itself, but rather
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12 within the broader perception of the face. 9 This has been traditionally implemented through
13 dividing the face to horizontal and vertical fifths, allowing for correlation of the nose with
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other facial structures such as the forehead, brows, eyes, cheeks, midface, lips, and chin. 10
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15 Various studies investigated the ideal nasolabial angle, and ranges from 90° to 120°
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16 were often cited,4 with slightly more acute angles in males (90 to 95) compared to females
17 (95 to 105) advocated as ideal.11 One study objectively measured the ideal NLA found that
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18 it is 97 in males and 105 in females. 3 Our results showed findings within the range of
19 previous studies, with respondents favoring more acute angles in males (Mean 97.1, SD
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20 6.39) compared to females (Mean 109.5, SD 5.32).

21 The wide range and variation in what is considered an ideal NLA has been
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22 attributed to various factors: gender, age, ethnicity, and education level, all of which play
23 significantly into the patient and general public’s perception of an ideal nose, in addition
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24 to surgeon preference and method of nasolabial angle measurement. 4 It is interesting to

25 note Naraghi et al12 findings in that patients opting for rhinoplasty had similar aesthetic
26 nasal proportions to matched controls from the general population, implying that opting
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27 for rhinoplasty is highly influenced by psychological reasons that could be very

28 challenging to satisfy. This further complicates the surgeons decision-making with the
29 patient population. Thus, the operating surgeon should always strive to recognize the
30 consortium of factors that play into performing a satisfying rhinoplasty in the eyes of his
31 patients. Our study demonstrated that respondents who were aged 20-39 (87.5%), which
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1 were the highest proportion of respondents, favored a male NLA of 90 to 95 (p 0.044). In
2 addition, work status played a significant role in the choice, with those who are students
3 choosing a 100-degree angle as ideal (59.7%), whereas employees were more likely to
4 prefer a 95-degree angle (45.8%) (p 0.049). In choosing the ideal female NLA, age (p
5 0.012) was a significant factor, with 87% preferring an angle of 110. Other demographic
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6 data as well as history of cosmetic surgery or knowledge of rhinoplasty, and intention to
7 undergo rhinoplasty, were not significant in the choice of ideal male or female NLA.
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8 However, we found that in terms of intention to undergo rhinoplasty in the future,
9 respondents who were female (96%), students (52%), with knowledge about rhinoplasty
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10 procedure (74%) were significantly found to have a desire to undergo a rhinoplasty
11 procedure.
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12 In terms of nationality, we found no difference between respondents from Canada
13 compared to those from Middle Eastern countries. One previous study done in Saudi
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Arabia that compared the ideal NLA in male and female models with similar angles to our
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15 study found that more acute angles were preferred, with male raters preferring angles of
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16 89.5 ± 3.5 (mean ± SD) for males and 90.8 ± 5.6 for females, while female raters preferred
17 angles of 89.3 ± 3.8 for males and 90.5 ± 4.8 for females.13 Our study found a more acute
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18 preference of NLA in both males and females, NLA choices in both male and female
19 models were 97.1 +/- 6.39 and 109.5 +/- 5.32 respectively, with no significant difference
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20 between genders or nationalities in terms of North American versus Middle Eastern origins.
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22 Aesthetic rhinoplasty remains to be a unique plastic surgery procedure, and the

23 ‘perfect’ outcome remains to be a subjective decision. The findings of this study can be
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24 used to guide the discussion plastic surgeons have with patients opting to undergo
25 rhinoplasty as well as guide surgeons in surgical planning and performing this procedure
26 on patients with specific demographic factors. We believe our findings reinforce ideal NLA
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27 findings previously cited in the literature. The images we created can be shown to the
28 patients to enhance the discussion and reinforce patient perception on different nasolabial
29 angles.
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1 Limitations
2 The multinational aspect of this study brings forth participants with diverse geographical
3 and ethnic backgrounds. This has the potential for creating bias in the choice of the ideal
4 NLA based on the respondents’ own ethnic or cultural standards of what is considered as
5 attractive. Furthermore, the 3D models used in the study, which have Caucasian features,
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6 could also play a role in influencing the choice of the NLA. This was an inevitable
7 consequence of using preset 3D models. Perhaps this is something that can be accounted
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8 for in future studies by either presenting a number of 3D models from each ethnic group
9 or by possibly creating mathematically averaged renderings of the studied populations.
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11 CONCLUSIONS
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12 Identifying the ideal NLA is essential for establishing aesthetic goals for patients and
13 surgeons alike. It is important to understand the effects of demographics on the choice of
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the ideal NLA, which ultimately influence the planning and outcome of rhinoplasty
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15 procedures performed on the intended population. We found the mean and standard
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16 deviation of ideal NLA choices in both male and female models were 97.1 +/- 6.39 and
17 109.5 +/- 5.32 respectively, which falls in line with previously reported preferred NLA in
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18 the literature.
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21 Supplemental Material
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22 This article contains supplemental material located online at

23 www.aestheticsurgeryjournal.com.
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24
25 REFERENCES
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26 1. Brown M, Guyuron B. Redefining the Ideal Nasolabial Angle: Part 2. Expert Analysis.
27 Plastic and Reconstructive Surgery. 2013;132(2):221e-225e.
28 doi:10.1097/PRS.0b013e3182958b40
29 2. Harris R, Nagarkar P, Amirlak B. Varied Definitions of Nasolabial Angle: Searching

30 for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the
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1 Ideal Method. Plastic and Reconstructive Surgery - Global Open. 2016;4(6):e752.
2 doi:10.1097/GOX.0000000000000729
3 3. Sinno HH, Markarian MK, Ibrahim AMS, Lin SJ. The Ideal Nasolabial Angle in
4 Rhinoplasty: A Preference Analysis of the General Population. Plastic and
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5 Reconstructive Surgery. 2014;134(2):201-210. doi:10.1097/PRS.0000000000000385

6 4. Armijo BS, Brown M, Guyuron B. Defining the Ideal Nasolabial Angle: Plastic and
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7 Reconstructive Surgery. 2012;129(3):759-764. doi:10.1097/PRS.0b013e3182402e12
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8 5. Eisenberg I. A history of rhinoplasty. S Afr Med J. 1982;62(9):286-292.
9 6. Piombino P, Zace P, Grassia MG, et al. Anthropometric Parameters for Nose
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10 Evaluation and Nasal Surgery Planning. Journal of Craniofacial Surgery.
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2020;31(6):1620-1624. doi:10.1097/SCS.0000000000006543
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12 7. Kaur J, Garg H, Kaldhari K, Rukshana R, Khundrakpam D, Saini V. Relationship of
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13 Nasolabial Angle with Maxillary Incisor Proclination and Upper Lip Thickness in
14 North Indian Population. International Journal of Clinical Pediatric Dentistry.
15 2023;15(5):489-492. doi:10.5005/jp-journals-10005-2432
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16 8. Jankowska A, Janiszewska-Olszowska J, Jedliński M, Grocholewicz K. Methods of

17 Analysis of the Nasal Profile: A Systematic Review with Meta-analysis. Grippaudo
18 C, ed. BioMed Research International. 2021;2021:1-18. doi:10.1155/2021/6680175
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19 9. Özkan MÇ, Bayramiçli M. Perception of Nasal Aesthetics: Nose or Face? Aesth Plast
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20 Surg. 2022;46(6):2931-2937. doi:10.1007/s00266-022-02943-2
21 10. Bueller H. Ideal Facial Relationships and Goals. Facial plast Surg. 2018;34(05):458-
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22 465. doi:10.1055/s-0038-1669401
23 11. Kim DW, Egan KK. Metrics of Nasal Tip Rotation: A Comparative Analysis: The
24 Laryngoscope. 2006:872-877. doi:10.1097/01.mlg.0000216796.63683.d3
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1 12. Naraghi M, Atari M, Asadollahi H. When Aesthetics, Surgery, and Psychology Meet:
2 Aesthetic Nasal Proportions in Patients Having Rhinoplasty and Normal Adults. Surg
3 J. 2016;02(1):e44-e48. doi:10.1055/s-0036-1579658
4 13. Alharethy S. Preferred nasolabial angle in Middle Eastern population. Eur Arch
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5 Otorhinolaryngol. 2017;274(5):2339-2341. doi:10.1007/s00405-017-4507-x

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7 Figure Legends
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9 Figure 1. Male nasolabial angles.
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11 Figure 2. Female nasolabial angles.

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146x49 mm ( x DPI)
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Figure 1
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2
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4
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146x49 mm ( x DPI)
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Figure 2
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1 Table 1: Demographics
Demographics Overall (N=197)

Gender
Male 37 (18.8%)
Female 160 (81.2%)
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Nationality
Canada 60 (30.5%)
Kuwait 60 (30.5%)
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Kingdom of Saudi Arabia 39 (19.8%)
Bahrain 20 (10.2%)
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Lebanon 5 (2.5%)
Others 13 (6.6%)
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Income
<49,999 144 (73.1%)
50,000-99,999
100,000-149,999
N 36 (18.3%)
9 (4.6%)
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>= 150,000 8 (4.1%)
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Education
High School 17 (8.6%)
College/Diploma 75 (38.1%)
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Bachelor 72 (36.5%)
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Master 22 (11.2%)
PhD 11 (5.6%)
Marital Status
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Single 116 (58.9%)

Married 69 (35.0%)
Common law 6 (3.0%)
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Divorced 6 (3.0%)
Work
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Student 98 (49.7%)
Employee 67 (34.0%)
Un-employed 18 (9.1%)
Retired 11 (5.6%)
Others 3 (1.5%)
Age
20 - 39 166 (84.3%)
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Overall (N=197)
20 (10.2%)
11 (5.6%)
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N
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Demographics
40 - 59
>= 60
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1 Table 2: Association Between Demographics and Intention to Undergo Rhinoplasty
Association between demographics and Yes Total

No (n=147) p value
intention to undergo rhinoplasty (n=50) (n=197)
Gender 0.0021
35.0
Male 2.0 (4.0%) 37.0 (18.8%)
(23.8%)
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48.0 112.0 160.0
Female
(96.0%) (76.2%) (81.2%)
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<
Nationality
0.0011
12.0 48.0
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Canada 60.0 (30.5%)
(24.0%) (32.7%)
56.0
Kuwait 4.0 (8.0%) 60.0 (30.5%)
(38.1%)
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12.0 27.0
Kingdom of Saudi Arabia 39.0 (19.8%)
(24.0%) (18.4%)
Bahrain
N
13.0
7.0 (4.8%) 20.0 (10.2%)
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(26.0%)
Lebanon 3.0 (6.0%) 2.0 (1.4%) 5.0 (2.5%)
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6.0
Others 7.0 (4.8%) 13.0 (6.6%)
(12.0%)
Income 0.9191
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37.0 107.0 144.0

<49,999
(74.0%) (72.8%) (73.1%)
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8.0 28.0
50,000-99,999 36.0 (18.3%)
(16.0%) (19.0%)
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100,000-149,999 3.0 (6.0%) 6.0 (4.1%) 9.0 (4.6%)

>= 150,000 2.0 (4.0%) 6.0 (4.1%) 8.0 (4.1%)
Education 0.6371
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6.0
High School 11.0 (7.5%) 17.0 (8.6%)
(12.0%)
19.0 56.0
College/Diploma 75.0 (38.1%)
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(38.0%) (38.1%)
19.0 53.0
Bachelor 72.0 (36.5%)
(38.0%) (36.1%)
5.0 17.0
Master 22.0 (11.2%)
(10.0%) (11.6%)
PhD 1.0 (2.0%) 10.0 (6.8%) 11.0 (5.6%)
Marital Status 0.0911
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No (n=147) p value
34.0 82.0 116.0
Single
(68.0%) (55.8%) (58.9%)
13.0 56.0
Married 69.0 (35.0%)
(26.0%) (38.1%)
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Common law 0.0 (0.0%) 6.0 (4.1%) 6.0 (3.0%)
Divorced 3.0 (6.0%) 3.0 (2.0%) 6.0 (3.0%)
Work 0.0301
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26.0 72.0
Student 98.0 (49.7%)
(52.0%) (49.0%)
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14.0 53.0
Employee 67.0 (34.0%)
(28.0%) (36.1%)
8.0
Un-employed 10.0 (6.8%) 18.0 (9.1%)
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(16.0%)
Retired 0.0 (0.0%) 11.0 (7.5%) 11.0 (5.6%)
Others N
2.0 (4.0%) 1.0 (0.7%) 3.0 (1.5%)
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Personal history of plastic surgery 0.4011
6.0 25.0
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Yes 31.0 (15.7%)
(12.0%) (17.0%)
44.0 122.0 166.0
No
(88.0%) (83.0%) (84.3%)
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Family history of plastic surgery 0.1931

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9.0 40.0
Yes 49.0 (24.9%)
(18.0%) (27.2%)
41.0 107.0 148.0
No
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(82.0%) (72.8%) (75.1%)

Personal history of rhinoplasty 0.3891
Yes 4.0 (8.0%) 7.0 (4.8%) 11.0 (5.6%)
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46.0 140.0 186.0

No
(92.0%) (95.2%) (94.4%)
<
Knowledge about rhinoplasty procedure
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0.0011
37.0 68.0 105.0
Yes
(74.0%) (46.3%) (53.3%)
13.0 79.0
No 92.0 (46.7%)
(26.0%) (53.7%)
Age 0.1351
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No (n=147) p value
45.0 121.0 166.0
20 - 39
(90.0%) (82.3%) (84.3%)
5.0 15.0
40 - 59 20.0 (10.2%)
(10.0%) (10.2%)
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>= 60 0.0 (0.0%) 11.0 (7.5%) 11.0(5.6%)
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2 1. Pearson's Chi-squared test
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4
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N
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TE
EP
CC
A
18
1 Table 3: Association Between Demographics and Male Nasolabial Angle (NLA)
Association between
demographics and male 85 90 95 100 110 Total p
NLA (N=10) (N=40) (N=48) (N=77) (N=22) (N=197) value
Gender 0.7231
PT
1.0 10.0 8.0 13.0 5.0 37.0
Male
(10.0%) (25.0%) (16.7%) (16.9%) (22.7%) (18.8%)
9.0 30.0 40.0 64.0 17.0 160.0
RI
Female
(90.0%) (75.0%) (83.3%) (83.1%) (77.3%) (81.2%)
Nationality 0.8921
SC
2.0 7.0 15.0 28.0 8.0 60.0
Canada
(20.0%) (17.5%) (31.2%) (36.4%) (36.4%) (30.5%)
4.0 15.0 15.0 21.0 5.0 60.0
Kuwait
U
(40.0%) (37.5%) (31.2%) (27.3%) (22.7%) (30.5%)
Kingdom of Saudi 3.0 8.0 9.0 14.0 5.0 39.0
Arabia
7.0
N
(30.0%) (20.0%) (18.8%) (18.2%) (22.7%) (19.8%)
1.0 4.0 6.0 2.0 20.0
A
Bahrain
(10.0%) (17.5%) (8.3%) (7.8%) (9.1%) (10.2%)
M
0.0 0.0 2.0 3.0 0.0 5.0
Lebanon
(0.0%) (0.0%) (4.2%) (3.9%) (0.0%) (2.5%)
0.0 3.0 3.0 5.0 2.0 13.0
Others
D
(0.0%) (7.5%) (6.2%) (6.5%) (9.1%) (6.6%)

Income 0.8221
TE
8.0 29.0 32.0 57.0 18.0 144.0

<49,999
(80.0%) (72.5%) (66.7%) (74.0%) (81.8%) (73.1%)
2.0 9.0 11.0 12.0 2.0 36.0
EP
50,000-99,999
(20.0%) (22.5%) (22.9%) (15.6%) (9.1%) (18.3%)
0.0 1.0 4.0 3.0 1.0 9.0
100,000-149,999
(0.0%) (2.5%) (8.3%) (3.9%) (4.5%) (4.6%)
CC
0.0 1.0 1.0 5.0 1.0 8.0

>= 150,000
(0.0%) (2.5%) (2.1%) (6.5%) (4.5%) (4.1%)
Education 0.7611
A
2.0 2.0 4.0 5.0 4.0 17.0

High School
(20.0%) (5.0%) (8.3%) (6.5%) (18.2%) (8.6%)
4.0 15.0 14.0 35.0 7.0 75.0
College/Diploma
(40.0%) (37.5%) (29.2%) (45.5%) (31.8%) (38.1%)
4.0 17.0 20.0 23.0 8.0 72.0
Bachelor
(40.0%) (42.5%) (41.7%) (29.9%) (36.4%) (36.5%)
19
Association between
NLA (N=10) (N=40) (N=48) (N=77) (N=22) (N=197) value
0.0 4.0 6.0 10.0 2.0 22.0

Master
(0.0%) (10.0%) (12.5%) (13.0%) (9.1%) (11.2%)
PT
0.0 2.0 4.0 4.0 1.0 11.0

PhD
(0.0%) (5.0%) (8.3%) (5.2%) (4.5%) (5.6%)
Marital status 0.0991
RI
3.0 22.0 26.0 50.0 15.0 116.0
Single
(30.0%) (55.0%) (54.2%) (64.9%) (68.2%) (58.9%)
7.0 16.0 15.0 25.0 6.0 69.0
SC
Married
(70.0%) (40.0%) (31.2%) (32.5%) (27.3%) (35.0%)
0.0 0.0 4.0 2.0 0.0 6.0
Common law
(0.0%) (0.0%) (8.3%) (2.6%) (0.0%) (3.0%)
U
0.0 2.0 3.0 0.0 1.0 6.0
Divorced
(0.0%) (5.0%) (6.2%) (0.0%) (4.5%) (3.0%)
Work N 0.0191
A
2.0 16.0 22.0 46.0 12.0 98.0
Student
(20.0%) (40.0%) (45.8%) (59.7%) (54.5%) (49.7%)
M
4.0 16.0 22.0 20.0 5.0 67.0

Employee
(40.0%) (40.0%) (45.8%) (26.0%) (22.7%) (34.0%)
1.0 6.0 2.0 6.0 3.0 18.0
D
Un-employed
(10.0%) (15.0%) (4.2%) (7.8%) (13.6%) (9.1%)
TE
3.0 2.0 2.0 2.0 2.0 11.0

Retired
(30.0%) (5.0%) (4.2%) (2.6%) (9.1%) (5.6%)
0.0 0.0 0.0 3.0 0.0 3.0
Others
(0.0%) (0.0%) (0.0%) (3.9%) (0.0%) (1.5%)
EP
Personal history of
0.7111
plastic surgery
CC
1.0 7.0 10.0 11.0 2.0 31.0

Yes
(10.0%) (17.5%) (20.8%) (14.3%) (9.1%) (15.7%)
9.0 33.0 38.0 66.0 20.0 166.0
No
(90.0%) (82.5%) (79.2%) (85.7%) (90.9%) (84.3%)
A
Family history of plastic

0.7171
surgery
3.0 13.0 11.0 18.0 4.0 49.0
Yes
(30.0%) (32.5%) (22.9%) (23.4%) (18.2%) (24.9%)
7.0 27.0 37.0 59.0 18.0 148.0
No
(70.0%) (67.5%) (77.1%) (76.6%) (81.8%) (75.1%)
20
Association between
NLA (N=10) (N=40) (N=48) (N=77) (N=22) (N=197) value
Personal history of
0.4881
rhinoplasty
PT
0.0 4.0 3.0 4.0 0.0 11.0

Yes
(0.0%) (10.0%) (6.2%) (5.2%) (0.0%) (5.6%)
10.0 36.0 45.0 73.0 22.0 186.0
No
RI
(100.0%) (90.0%) (93.8%) (94.8%) (100.0%) (94.4%)
Knowledge about
0.6041
rhinoplasty procedure
SC
3.0 23.0 27.0 41.0 11.0 105.0
Yes
(30.0%) (57.5%) (56.2%) (53.2%) (50.0%) (53.3%)
7.0 17.0 21.0 36.0 11.0 92.0
U
No
(70.0%) (42.5%) (43.8%) (46.8%) (50.0%) (46.7%)
Intention to undergo a
rhinoplasty N 0.8371
A
1.0 10.0 12.0 21.0 6.0 50.0
Yes
(10.0%) (25.0%) (25.0%) (27.3%) (27.3%) (25.4%)
M
9.0 30.0 36.0 56.0 16.0 147.0

No
(90.0%) (75.0%) (75.0%) (72.7%) (72.7%) (74.6%)
Age 0.0441
D
5.0 35.0 42.0 67.0 17.0 166.0

20 - 39
(50.0%) (87.5%) (87.5%) (87.0%) (77.3%) (84.3%)
TE
2.0 3.0 5.0 7.0 3.0 20.0

40 - 59
(20.0%) (7.5%) (10.4%) (9.1%) (13.6%) (10.2%)
3.0 2.0 1.0 3.0 2.0 11.0
EP
>= 60
(30.0%) (5.0%) (2.1%) (3.9%) (9.1%) (5.6%)
1
CC

3
A
21
1 Table 4: Association Between Demographics and Female Nasolabial Angle (NLA)
Association between
100 105 110 115 Total p
demographics and 95 (N=6)
(N=16) (N=38) (N=69) (N=68) (N=197) value
female NLA
Gender 0.2451
3.0 4.0 6.0 10.0 14.0 37.0
PT
Male
(50.0%) (25.0%) (15.8%) (14.5%) (20.6%) (18.8%)
3.0 12.0 32.0 59.0 54.0 160.0
Female
(50.0%) (75.0%) (84.2%) (85.5%) (79.4%) (81.2%)
RI
Nationality 0.9741
2.0 3.0 10.0 22.0 23.0 60.0
SC
Canada
(33.3%) (18.8%) (26.3%) (31.9%) (33.8%) (30.5%)
2.0 7.0 13.0 16.0 22.0 60.0
Kuwait
(33.3%) (43.8%) (34.2%) (23.2%) (32.4%) (30.5%)
U
Kingdom of Saudi 1.0 3.0 9.0 18.0 8.0 39.0
Arabia (16.7%) (18.8%) (23.7%) (26.1%) (11.8%) (19.8%)
Bahrain
1.0 2.0 N3.0 6.0 8.0 20.0
A
(16.7%) (12.5%) (7.9%) (8.7%) (11.8%) (10.2%)
0.0 0.0 1.0 2.0 2.0 5.0
Lebanon
M
(0.0%) (0.0%) (2.6%) (2.9%) (2.9%) (2.5%)
0.0 1.0 2.0 5.0 5.0 13.0
Others
(0.0%) (6.2%) (5.3%) (7.2%) (7.4%) (6.6%)
D
Income 0.3791
4.0 13.0 27.0 53.0 47.0 144.0
TE
<49,999
(66.7%) (81.2%) (71.1%) (76.8%) (69.1%) (73.1%)
2.0 2.0 7.0 13.0 12.0 36.0
50,000-99,999
(33.3%) (12.5%) (18.4%) (18.8%) (17.6%) (18.3%)
EP
0.0 0.0 4.0 2.0 3.0 9.0

100,000-149,999
(0.0%) (0.0%) (10.5%) (2.9%) (4.4%) (4.6%)
CC
0.0 1.0 0.0 1.0 6.0 8.0

>= 150,000
(0.0%) (6.2%) (0.0%) (1.4%) (8.8%) (4.1%)
Education 0.3061
1.0 1.0 2.0 8.0 5.0 17.0
A
High school
(16.7%) (6.2%) (5.3%) (11.6%) (7.4%) (8.6%)
0.0 6.0 16.0 24.0 29.0 75.0
College/diploma
(0.0%) (37.5%) (42.1%) (34.8%) (42.6%) (38.1%)
4.0 5.0 12.0 27.0 24.0 72.0
Bachelor
(66.7%) (31.2%) (31.6%) (39.1%) (35.3%) (36.5%)
1.0 3.0 2.0 8.0 8.0 22.0
Master
(16.7%) (18.8%) (5.3%) (11.6%) (11.8%) (11.2%)
22
Association between
100 105 110 115 Total p
(N=16) (N=38) (N=69) (N=68) (N=197) value
female NLA
0.0 1.0 6.0 2.0 2.0 11.0
PhD
(0.0%) (6.2%) (15.8%) (2.9%) (2.9%) (5.6%)
Marital status 0.6751
PT
3.0 8.0 25.0 37.0 43.0 116.0
Single
(50.0%) (50.0%) (65.8%) (53.6%) (63.2%) (58.9%)
3.0 8.0 12.0 24.0 22.0 69.0
RI
Married
(50.0%) (50.0%) (31.6%) (34.8%) (32.4%) (35.0%)
0.0 0.0 0.0 4.0 2.0 6.0
Common law
SC
(0.0%) (0.0%) (0.0%) (5.8%) (2.9%) (3.0%)
0.0 0.0 1.0 4.0 1.0 6.0
Divorced
(0.0%) (0.0%) (2.6%) (5.8%) (1.5%) (3.0%)
U
Work 0.1331
3.0 6.0 18.0 37.0 34.0 98.0
Student
(50.0%)
1.0 5.0
N
(37.5%) (47.4%) (53.6%) (50.0%)
16.0 19.0 26.0
(49.7%)
67.0
A
Employee
(16.7%) (31.2%) (42.1%) (27.5%) (38.2%) (34.0%)
1.0 1.0 3.0 8.0 5.0 18.0
M
Un-employed
(16.7%) (6.2%) (7.9%) (11.6%) (7.4%) (9.1%)
1.0 2.0 1.0 4.0 3.0 11.0
Retired
D
(16.7%) (12.5%) (2.6%) (5.8%) (4.4%) (5.6%)

0.0 2.0 0.0 1.0 0.0 3.0
Others
TE
(0.0%) (12.5%) (0.0%) (1.4%) (0.0%) (1.5%)

Personal history of
0.7851
plastic surgery
EP
2.0 2.0 5.0 11.0 11.0 31.0

Yes
(33.3%) (12.5%) (13.2%) (15.9%) (16.2%) (15.7%)
4.0 14.0 33.0 58.0 57.0 166.0
No
CC
(66.7%) (87.5%) (86.8%) (84.1%) (83.8%) (84.3%)

Family history of
0.1871
plastic surgery
A
1.0 0.0 10.0 19.0 19.0 49.0

Yes
(16.7%) (0.0%) (26.3%) (27.5%) (27.9%) (24.9%)
5.0 16.0 28.0 50.0 49.0 148.0
No
(83.3%) (100.0%) (73.7%) (72.5%) (72.1%) (75.1%)
Personal history of
0.9831
rhinoplasty
23
Association between
100 105 110 115 Total p
(N=16) (N=38) (N=69) (N=68) (N=197) value
female NLA
0.0 1.0 2.0 4.0 4.0 11.0
Yes
(0.0%) (6.2%) (5.3%) (5.8%) (5.9%) (5.6%)
6.0 15.0 36.0 65.0 64.0 186.0
No
PT
(100.0%) (93.8%) (94.7%) (94.2%) (94.1%) (94.4%)

Knowledge about
rhinoplasty 0.4831
RI
procedure
2.0 6.0 19.0 39.0 39.0 105.0
Yes
(33.3%) (37.5%) (50.0%) (56.5%) (57.4%) (53.3%)
SC
4.0 10.0 19.0 30.0 29.0 92.0
No
(66.7%) (62.5%) (50.0%) (43.5%) (42.6%) (46.7%)
Intention to undergo
U
0.3551
a rhinoplasty
Yes
0.0
(0.0%)
2.0
N10.0 21.0 17.0 50.0
(12.5%) (26.3%) (30.4%) (25.0%) (25.4%)
A
6.0 14.0 28.0 48.0 51.0 147.0
No
(100.0%) (87.5%) (73.7%) (69.6%) (75.0%) (74.6%)
M
Age 0.0121
4.0 10.0 33.0 60.0 59.0 166.0
20 - 39
(66.7%) (62.5%) (86.8%) (87.0%) (86.8%) (84.3%)
D
0.0 3.0 4.0 8.0 5.0 20.0

40 - 59
TE
(0.0%) (18.8%) (10.5%) (11.6%) (7.4%) (10.2%)

2.0 3.0 1.0 1.0 4.0 11.0
>= 60
(33.3%) (18.8%) (2.6%) (1.4%) (5.9%) (5.6%)
EP

2
3
CC
A
24
1 Table 5: Ideal Male and Female NLA Compared to Nationality
Gender Kingdom
Canada Kuwait of Saudi Bahrain Lebanon Others Total p
NLA
(N=60) (N=60) Arabia (N=20) (N=5) (N=13) (N=197) value
(N=39)
Male 2.0 4.0 3.0 1.0 0.0 0.0 10.0
PT
85

(3.3%) (6.7%) (7.7%) (5.0%) (0.0%) (0.0%) (5.1%)
7.0 15.0 8.0 7.0 0.0 3.0 40.0
90
(11.7%) (25.0%) (20.5%) (35.0%) (0.0%) (23.1%) (20.3%)
RI
15.0 15.0 9.0 4.0 2.0 3.0 48.0
95 0.8921
(25.0%) (25.0%) (23.1%) (20.0%) (40.0%) (23.1%) (24.4%)
SC
28.0 21.0 14.0 6.0 3.0 5.0 77.0
100
(46.7%) (35.0%) (35.9%) (30.0%) (60.0%) (38.5%) (39.1%)
8.0 5.0 5.0 2.0 0.0 2.0 22.0
110
U
(13.3%) (8.3%) (12.8%) (10.0%) (0.0%) (15.4%) (11.2%)
Female 2.0 2.0 1.0 1.0 0.0 0.0 6.0
0.9741
95
(3.3%)
3.0
(3.3%)
7.0
(2.6%)
3.0
N(5.0%)
2.0
(0.0%)
0.0
(0.0%)
1.0
(3.0%)
16.0
A
100
(5.0%) (11.7%) (7.7%) (10.0%) (0.0%) (7.7%) (8.1%)
M
10.0 13.0 9.0 3.0 1.0 2.0 38.0
105
(16.7%) (21.7%) (23.1%) (15.0%) (20.0%) (15.4%) (19.3%)
22.0 16.0 18.0 6.0 2.0 5.0 69.0
110
D
(36.7%) (26.7%) (46.2%) (30.0%) (40.0%) (38.5%) (35.0%)

23.0 22.0 8.0 8.0 2.0 5.0 68.0
115
TE
(38.3%) (36.7%) (20.5%) (40.0%) (40.0%) (38.5%) (34.5%)
2 1.Pearson's Chi-squared test. NLA, nasolabial angle.

EP
3
4
CC
A
25

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1 RHINOPLASTY

27 Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

35 publication of this article, including payment of the article processing charge.

18 information would be not only beneficial to patients interested in establishing aesthetic

22 amongst the populations studied.

25 Study Design and Participants

26 An online questionnaire-based cross-sectional study was conducted in a single hospital

21 of modern medicine and introduction of cosmetic surgery, the attainment of an aesthetic

20 6.39) compared to females (Mean 109.5, SD 5.32).

24 to surgeon preference and method of nasolabial angle measurement. 4 It is interesting to

27 for rhinoplasty is highly influenced by psychological reasons that could be very

22 Aesthetic rhinoplasty remains to be a unique plastic surgery procedure, and the

22 This article contains supplemental material located online at

29 2. Harris R, Nagarkar P, Amirlak B. Varied Definitions of Nasolabial Angle: Searching

Downloaded from https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjad309/7279052 by guest on 11 October 2023

9 6. Piombino P, Zace P, Grassia MG, et al. Anthropometric Parameters for Nose

16 8. Jankowska A, Janiszewska-Olszowska J, Jedliński M, Grocholewicz K. Methods of

20 Surg. 2022;46(6):2931-2937. doi:10.1007/s00266-022-02943-2

Downloaded from https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjad309/7279052 by guest on 11 October 2023

9 Figure 1. Male nasolabial angles.

11 Figure 2. Female nasolabial angles.

Demographics Overall (N=197)

Single 116 (58.9%)

Association between demographics and Yes Total

37.0 107.0 144.0

100,000-149,999 3.0 (6.0%) 6.0 (4.1%) 9.0 (4.6%)

Family history of plastic surgery 0.1931

(82.0%) (72.8%) (75.1%)

46.0 140.0 186.0

(0.0%) (7.5%) (6.2%) (6.5%) (9.1%) (6.6%)

8.0 29.0 32.0 57.0 18.0 144.0

0.0 1.0 1.0 5.0 1.0 8.0

2.0 2.0 4.0 5.0 4.0 17.0

0.0 4.0 6.0 10.0 2.0 22.0

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4.0 16.0 22.0 20.0 5.0 67.0

3.0 2.0 2.0 2.0 2.0 11.0

1.0 7.0 10.0 11.0 2.0 31.0

Family history of plastic

Downloaded from https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjad309/7279052 by guest on 11 October 2023

9.0 30.0 36.0 56.0 16.0 147.0

5.0 35.0 42.0 67.0 17.0 166.0

2.0 3.0 5.0 7.0 3.0 20.0

2 1. Pearson's Chi-squared test

0.0 0.0 4.0 2.0 3.0 9.0

0.0 1.0 0.0 1.0 6.0 8.0

(16.7%) (12.5%) (2.6%) (5.8%) (4.4%) (5.6%)

(0.0%) (12.5%) (0.0%) (1.4%) (0.0%) (1.5%)

2.0 2.0 5.0 11.0 11.0 31.0

(66.7%) (87.5%) (86.8%) (84.1%) (83.8%) (84.3%)

1.0 0.0 10.0 19.0 19.0 49.0

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0.0 3.0 4.0 8.0 5.0 20.0

(0.0%) (18.8%) (10.5%) (11.6%) (7.4%) (10.2%)

1 1. Pearson's Chi-squared test

Downloaded from https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjad309/7279052 by guest on 11 October 2023

(36.7%) (26.7%) (46.2%) (30.0%) (40.0%) (38.5%) (35.0%)

(38.3%) (36.7%) (20.5%) (40.0%) (40.0%) (38.5%) (34.5%)

2 1.Pearson's Chi-squared test. NLA, nasolabial angle.

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