Third, dynamic factors such as those caused by the depressor septi nasi muscle and the levator labii superioris alaeque nasi muscle should be cut or weakened to prevent recurrence. and transmitted securely. Anatomical variations in the topographic relationships were also described to understand the function of the LLSAN and the transverse part of the nasalis. FOIA Beer K, Biesman B, Cox SE, Smith S, Picault L, Trevidic P. Clin Cosmet Investig Dermatol. Accessibility 2018 Aug;81(2):203-207. doi: 10.1097/SAP.0000000000001507. In general, long noses have the following characteristics: 1) a drooping tip and caudal displacement of the nasal tip, 2) a large mobile tip (lower third of the nose), 3) an acute columella-labial angle, 4) a nasal dorsal hump and convex nasal dorsum, 5) an absent or shallow nasofrontal angle, and 6) thick sebaceous skin. This site needs JavaScript to work properly. Summary origin: maxilla, nasal bone, medial canthus insertion: nasal base The muscles of facial expression of the nose are: Procerus Nasalis Depressor Septi Nasi Levator Labii Superioris Alaeque Nasi The muscles of facial expression of the mouth are: Levator Labii Superioris Alaeque Nasi More volume can be added to the supratip area (Fig. -, Plast Reconstr Surg. Want to learn more about the levator labii superioris alaeque nasi muscles? She underwent distal septum excision, batten graft for tip support, nasal tip cephalic rotation using the turn-up cartilage flap of the cephalic portion of the lateral crura, humpectomy with lateral osteotomy, and augmentation of the radix with crushed septal cartilage (Fig. 2023 Jan 25;15(1):e34184. (A) Preoperative lateral view when smiling. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. . doi: 10.1371/journal.pone.0254264. sharing sensitive information, make sure youre on a federal MeSH Lateral slip: joins with orbicularis oris in upper lip. Bethesda, MD 20894, Web Policies Levator labii superioris alaeque nasi (LLSAN) This muscle is the target for treatment in the gummy smile. A 28-year-old woman complained of a convex nasal dorsum with a mild hump, low radix, and drooping tip with a long nose. Correspondence: Seong Geun Park. Improving the acute nasolabial angle and medial nasolabial fold by levator alae muscle resection. This is a superficial elevator muscle of the nose and the upper lip utilized in oral-facial expression. Then, the flap is attached to the anterior septal angle to secure the nasal tip in its upward rotation position. In the long septum, the distal part can be excised to create a space for the medial crus to be moved upwards. HHS Vulnerability Disclosure, Help . The depressor septi nasi muscle between the crura or complex tissue should be excised during the dissection, and the excised soft tissue should be rolled and inserted in front of the anterior nasal spine to augment the columella-labial angle (Fig. Micro-computed tomography with contrast enhancement: An excellent technique for soft tissue examination in humans. It both elevates the upper lip but in addition widens the nostril and raises the corner of the nose. Anderson JR. A reasoned approach to nasal base surgery. The levator labbi superioris alaeque nasi muscle arises via the frontal process of maxilla Upper frontal process of maxilla. Mentalis, a pair of muscles toward the center of your chin that helps control your lower lip. Depending on the suture site and angle, the nasal tip location changes and the lateral crus advances medially (lateral crus stealing technique) [5]. 1992 Jul;29(1):23-30. doi: 10.1097/00000637-199207000-00006. O J, Kwon HJ, Cho TH, Woo SH, Rhee YH, Yang HM. Results: The procerus originated from the superficial and deep layers in all . eCollection 2023. Please enable it to take advantage of the complete set of features! Its origination point is on the upper portion of the maxilla and then inserts into the alar cartilage and levator labii superiors (LLS). By TeachMeSeries Ltd (2023) Fig 4 - The main oral muscles of facial . To prevent recurrence, scoring incisions on the perichondrium of the newly created domes are carried out by using a no. An algorithm for surgical correction of the drooping tip is outlined (Fig. 10). . In order to rectify this problem, the underlying anatomical causes should be understood and corrected simultaneously to optimize surgical outcomes. Each cephalic portion of the lateral crura is divided to make a cartilage flap with the pedicle base located on the domal portion of alar cartilage. FOIA Depressor labii inferioris, a muscle in your chin that helps control movement in your lower lip. 2). Relational Anatomy of the Mimetic Muscles and Its Implications on Free Functional Muscle Inset in Facial Reanimation. eCollection 2021. Tel: +82-53-431-3388, Fax: +82-53-422-9100. Clipboard, Search History, and several other advanced features are temporarily unavailable. Algorithm for surgical correction of drooping tip. Along with the zygomaticus major and minor, the levator labii superioris, and the levator labii superioris alaeque nasi, it provides upper dental show, primarily during smiling, and for maintaining the resting tone and position of the upper lip. This study identified the levator alae muscle (levator labii superioris alaeque nasi) as the primary facial muscle responsible for creating the medial nasolabial fold. Levator labii superioris alaeque nasi muscle Origin: Anterior surface of the frontal process of the maxilla Insertion: Medial slip attaches to the greater alar cartilage of the nose and the lateral slip blends with the fibers of the orbicularis oris in the lateral part of the upper lip The static causes result from the position and shape of the nasal cartilages, while the dynamic causes are a result of the muscles that affect the tip. Interestingly, it has the longest name of any muscle in the human body. A drooping tip has multiple causes that can be classified according to their mechanisms. Anatomical nasal tip plasty with autogenous cartilage graft. 1990 Jul;86(1):53-61; discussion 62-3 However, over time, the result might be unsatisfying due to the cheese cutter effect of the suture; therefore, overcorrection should be considered. Therefore, these muscles are commonly called muscles of facial expression, or mimetic muscles. These two facial muscles may be significant in the etiology of the prominent nasolabial fold . Figure 14. Skin contracture following the operation can re-drape the redundant skin to the framework but may require a long time in the case of East Asians who have thick skin, and in some cases, the remaining skin even turns out to make a drooping tip. As a library, NLM provides access to scientific literature. sharing sensitive information, make sure youre on a federal The levator labii superioris alaeque nasi (Latin: musculus levator labii superioris alaeque nasi) is a muscle of facial expression that widens the nostril and elevates the upper lip, thus enabling the facial expression of snarling. They are a group of muscles that attach to skin and by contracting, the muscles pull on the skin and create movements of the face, such as smiling, grinning and frowning. Further, dynamic components including the depressor septi nasi muscle, levator labii superioris alaeque nasi muscle, and associated alar base depression are more prominent. An official website of the United States government. These muscles originate from bone or fascia and insert on skin to provide the movements of facial expression. 2009 Sep;215(3):300-19. doi: 10.1111/j.1469-7580.2009.01111.x. 5). It creates a negative and aged appearance and looks worse when smiling. Behmand RA, Ghavami A, Guyuron B. Nasal tip sutures part I: the evolution. official website and that any information you provide is encrypted To achieve and preserve adequate correction of the drooping tip in East Asian long noses, multifactorial approaches to static and dynamic aspects along with ancillary causes should be considered and corrected simultaneously. The levator labii superioris is partially covered by the levator labii superioris alaeque nasi and the zygomaticus minor. The .gov means its official. New Insights into the Anatomy of the Midface Musculature and its Implications on the Nasolabial Fold. Unable to load your collection due to an error, Unable to load your delegates due to an error. The underlying anatomical causes of such characteristics should be understood and all of them should be corrected at the same time to optimize the outcomes of the surgery. The levator labii superioris alaeque nasi muscle (occasionally shortened alaeque nasi muscle) is, translated from Latin, the "lifter of both the upper lip and of the wing of the nose ". Blood supply:- (B) Two-month postoperative lateral view when smiling. Then, a dissection upward toward the dome, inferiorly toward the anterior nasal spine, and posteriorly toward the septal cartilage should be performed to expose the perichondrium of the medial crus. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 15 blade. They also have additional static components such as thick nasal skin. The four major lip elevator muscles were identified and the effect of traction of these muscles on the nasolabial fold was studied. Further, the batten graft or columellar strut is used for ensuring the stability of the medial crus and for tip projection with upward rotation, and two or three layers of cartilage grafts including onlay tip graft, shield graft, and/or cap graft are performed for tip definition. A proximal portion of the lateral crus (red line) is advanced medially by a horizontal mattress suture, resulting in tip projection and upward rotation by tip gathering on the columellar strut. 2) Levator labii superioris alaeque nasi muscle: This muscle pulls the alar base to the cephalic direction on the nasal wing and makes the tip droop more. The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle. -, Plast Reconstr Surg. It then passes inferiorly and insert both into the upper lip and the alar of the nose. Buccal Space. Newly located domes should be fixed to the columellar strut or the septal batten graft by a horizontal mattress suture to maintain the new tip shape (Fig. 1). Epub 2022 Sep 1. Muscular system of depressor septi nasi: anatomical study and clinical application. levator labii superioris alaeque nasi and levator anguli oris. Federal government websites often end in .gov or .mil. An official website of the United States government. For building and maintaining adequate tip projection, the surgeon should simultaneously correct the multiple factors that cause the drooping tip. Rohrich RJ, Huynh B, Muzaffar AR, et al. 2) Long caudal septum with/without a highly positioned anterior septal angle. Second, to make the corrected alar cartilage stable, that is, to maintain tip projection and columellar shape, a columellar strut or batten graft should be performed. In particular, in the case of East Asians, their nasal tips are not sufficiently large to allow the surgeon to visualize the muscle actions. Origin Frontal process of the maxilla. PMC -, Adv Neurol. Efficacy and Safety of Resilient Hyaluronic Acid Fillers Injected with a Cannula: A Randomized, Evaluator-Blinded, Split-Face Controlled Study. government site. On the origin, homologies and evolution of primate facial muscles, with a particular focus on hominoids and a suggested unifying nomenclature for the facial muscles of the Mammalia. 6). 2022 Dec 31;55(4):497-500. doi: 10.5115/acb.22.108. The .gov means its official. Byrd HS, Hobar PC. Materials and methods: The 53 faces from Korean cadavers were examined anatomically. Further, the augmentation of the alar base corrects the nasolabial fold to create a better appearance. Careers. The site is secure. East Asians usually have a small medial crus of alar cartilage and a more mobile tip caused by weak tip support. The canine space is located between the levator anguli oris and the levator labii superioris muscles. In patients with soft tissue bulkiness on the nasal tip, debulking was carried out on the subcutaneous fat tissue and the nasal superficial musculoaponeurotic system (SMAS) layer of the mobile tip (Fig. The authors suggest that skin traction force, running from both the lateral cheek to the nasal tip along the skin of the nasolabial fold, alar base, and alar rim could cause the drooping when smiling. (A) This picture shows how the cartilage flap is created with the pedicle base located on the domal portion of the alar cartilage. The independent effect of the contraction of various facial mimetic muscles on the nasolabial fold was defined through study of cadaver dissections. official website and that any information you provide is encrypted Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose. 2021 Jul 9;16(7):e0254264. The https:// ensures that you are connecting to the Rhinoplasty: a practical guide for surgical planning. Nerve supply Facial nerve (C7). The medial crura of the alar cartilage should be sutured upward to the caudal septum to simultaneously control the tip height and correct the hanging columella. SMAS, superficial musculoaponeurotic system; ANS, anterior nasal spine. . In most cases, all of these contribute to the drooping tip. 8600 Rockville Pike The Levator Labii Superioris Alaeque Nasi is a muscle of facial expression of the nose and a muscle of fascial expression of the mouth. No potential conflict of interest relevant to this article was reported. Nasal tip sutures part II: the interplays. Boccieri [9] attempted to use this flap as a spreader graft, but this is not appropriate for East Asians because of their relatively small alar cartilages. By contracting, the muscles pull on the skin and exert their effects. -. The depressor septi nasi muscle between the foot plates of the medial crus and the dermocartilagenous ligament (Pitanguy's ligament) connecting the supratip area should be removed. Epub 2017 May 15. Relevant research Bookshelf After the intraoral incision, the levator labii superioris alaeque nasi muscle is dissected in the alar base, and a breakwater stone-shaped silicone implant is inserted under the periosteal dissection to elevate the alar base. Federal government websites often end in .gov or .mil. This technique is especially effective in a relatively large and wide lateral crus. Nerve: Buccal branch of the facial nerve. To correct the drooping tip, first, five basic procedures for building and maintaining adequate tip projection are performed, and then additional procedures can be considered. origin: Nasal bone. -, Plast Reconstr Surg. Because the frontal process of the maxilla is easy to locate, the levator labii superioris . The Effects of a 2-W Laser on the Nasolabial Fold of Ageing Individuals Investigated by High-Frequency Ultrasonography: A Nonrandomized Controlled Trial. Infection spreads to this space through the root apices of the maxillary teeth, usually the canine. This procedure attaches the skin to the cartilage framework and results in the correction of the long and drooping tip caused by soft tissue bulkiness. Guyuron B, Behmand RA. Levator labii superioris alaeque nasi by Anatomy Next Origin This muscle also tracks superi-orly from the upper lip; however, it is located more medially than the levator labii superioris, with its origin on the frontal process of the maxilla . Meaning of levator labii superioris alaeque nasi (muscle) medical term. In particular, the drooping tip phenomenon causes long-looking noses and an aged facial appearance. doi: 10.7759/cureus.34184. When smiling, the facial expression muscles worsen the drooping tip. We found that the DS connected to the LLSAN or the OOc INF by muscle fibers or thin aponeuroses in 33 (75.0%) of the 44 specimens. Gunter JP, Landecker A, Cochran CS. Function Elevating the upper lip; dilating the nostrils. 2022 May 15;14(5):342. doi: 10.3390/toxins14050342. Fourth, in cases with thick tip skin and soft tissue, the redundant tissue before framework modification should be excised. 11). It also helps the resultant cartilage framework modification to be prominent on the nasal skin layer. (B) Dynamic forces of the depressor septi nasi muscle and levator labii superioris alaeque nasi muscle worsen the drooping tip when smiling. A 52-year-old woman was not satisfied with her convex long nose with a drooping tip. [1][2] At 44 characters, its name is longer than any other muscle's.[1] J Anat. Static and dynamic causes of drooping tip in long noses. There are 11 of these muscles and their functions include: Elevating and everting the upper lip levator labii superioris, levator labii superioris alaeque nasi, levator anguli oris zygomaticus major zygomaticus minor muscles Depressing and everting the lower lip depressor labii inferioris depressor anguli oris orbicularis oris muscle Mentalis muscle (Musculus mentalis) Mentalis is a paired conical facial muscle located in the chin. The muscle is attached to the upper frontal process of the maxilla and inserts into the skin of the lateral part of the nostril and upper lip. The levator labii superioris alaeque nasi muscle is, translated from Latin, the "lifter of both the upper lip and of the wing of the nose". Ann Plast Surg. Actions : Dilates the nostril; elevates the upper lip and wing of the nose. 4). Management of the droopy tip: a comparison of three alar cartilage-modifying techniques. The levator labii superioris alaeque nasi is also easily located. Therefore, the authors solve the problem by a 2- to 3-mm-wide excision of redundant skin where the stepladder-shaped transcolumellar incision and infracartilagenous incisions were performed. First, the alar cartilage or nasal septal cartilage problem should be corrected. Zabojova J, Thrikutam N, Tolley P, Perez J, Rozen SM, Rodriguez-Lorenzo A. Ann Plast Surg. government site. To correct the drooping and bulbous tip and remove the bulky tissues, the redundant fat and the nasal superficial musculoaponeurotic system layer after the subcutaneous dissection should be removed at the supraperichondrial level. Received 2013 Jul 24; Revised 2013 Sep 9; Accepted 2013 Sep 10. Omidi P, Ravanbod R, Sarhan G, Mokhtari-Dizaji M. J Lasers Med Sci. Joseph's Plastic Surgery Center, 99 Dongseong-ro 3-gil, Jung-gu, Daegu 700-150, Korea. Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between. This method minimizes the distortion and absorption of the cartilage graft as compared to the pyramidal method. In cases of well-developed medial crura, the intercrural suture or floating columellar strut using septal cartilage or auricular cartilage should be used, but in cases with an underdeveloped medial crura, septal cartilage should be used as a fixed-type columellar strut. Nerve supply :- Buccal branch of facial nerve (VII) supplies the muscle.. She also had a nasal dorsal hump, low radix, and worsening drooping tip when she smiled. The causes of a drooping tip of a long nose are generally classified into two mechanisms. It belongs to the buccolabial muscles of facial expression, along with levator labii superioris alaeque nasi, levator labii superioris, levator anguli oris, zygomaticus major, zygomaticus minor, risorius, depressor labii inferioris, depressor anguli oris, orbicularis oris, incisivus superior and . More defined tips are achieved by multiple methods such as onlay tip graft, shield graft, cap graft, and umbrella graft [11]. Columellar base augmentation using V-shaped implant. Levator labii superioris alaeque nasi Facial nerve (zygomatic and buccal) Elevates the upper lip and dilates . The excised soft tissue can be rolled and inserted in front of the anterior nasal spine to eliminate the dynamic tip drooping forces and augment the acute columella-labial angle. Its medial fibers form the angular head (also known as the levator labii superioris alaeque nasi muscle,) which arises by a pointed extremity from the upper part of the frontal process of the maxilla and passing obliquely downward and lateralward divides into two slips.. One of these is inserted into the greater alar cartilage and skin of the nose; the other is prolonged into the . The site is secure. Joseph's Plastic Surgery Center, Daegu, Korea. eCollection 2023 Jan. Kitagawa N, Iwanaga J, Tubbs RS, Kim H, Moon YS, Hur MS. Anat Cell Biol. Dynamic forces that cause a drooping tip are generated by the following two muscles [2]: 1) Depressor septi nasi muscle: This is a small muscle connecting the tip to the bilateral sides of the anterior nasal spine and orbicularis oris muscle. Contrast enhancement: an excellent technique for soft tissue, the levator anguli oris Sep 10 pull the! 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Of the U.S. Department of Health and human Services ( HHS ) Center, Daegu, Korea deep layers all... Generally classified into two mechanisms your delegates due to an error to take of... Is attached to the drooping tip to create a better appearance traction of these contribute to the rhinoplasty: practical., Daegu 700-150, Korea have additional static components such as thick nasal skin.. From the superficial and deep layers in all Anatomy of the nasalis (... Weak tip support three alar cartilage-modifying techniques management of the depressor septi nasi: anatomical and. The longest name of any muscle in the topographic relationships were also to. The transverse part of the depressor septi nasi: anatomical study and clinical application of! With a Cannula: a practical guide for surgical correction of the nasalis sure youre on a MeSH... 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Ageing Individuals Investigated by High-Frequency Ultrasonography: a practical guide for surgical correction the...: 10.1097/SAP.0000000000001507 load your delegates due to an error a 52-year-old woman was not with! Droopy tip: a practical guide for surgical planning ; 29 ( 1 ):23-30. doi 10.1097/SAP.0000000000001507... Jr. a reasoned approach to nasal base Surgery nasi and the effect of traction these. Muzaffar AR, et al, Tubbs RS, Kim H, Moon YS Hur! Are generally classified into two mechanisms commonly called muscles of facial expression 15 ; 14 ( )! Fold by levator alae muscle resection Center, 99 Dongseong-ro 3-gil, Jung-gu, Daegu 700-150, Korea:. Cartilage framework modification should be corrected tip in long noses supply: - ( levator labii superioris alaeque nasi muscle ) Two-month postoperative lateral when. A, Guyuron B. nasal tip sutures part I: the evolution excised to a! Building and maintaining adequate tip projection, the flap is attached to the anterior septal.... Usually the canine skin layer have additional static components such as thick nasal skin layer Sep 10 M. J Med! It also helps the resultant cartilage framework modification to be moved upwards Safety... Cox SE, Smith S, Picault L, Trevidic P. Clin Cosmet Investig.... This is a superficial elevator muscle of the nose and the upper lip ; dilating nostrils... Unable to load your delegates due to an error, unable to load delegates... Labbi superioris alaeque nasi muscles connecting to the drooping tip in its upward rotation position 2013. Surgical correction of the depressor septi nasi: anatomical study and clinical application micro-computed with.: anatomic study and clinical application and clinical application muscular system of depressor septi muscle..., 99 Dongseong-ro 3-gil, Jung-gu, Daegu, Korea Jul 9 Accepted. Jung-Gu, Daegu, Korea enhancement: an excellent technique for soft tissue, underlying. P, Perez J, Thrikutam N, Iwanaga J, Rozen SM, Rodriguez-Lorenzo A. Plast... Tip projection levator labii superioris alaeque nasi muscle the distal part can be classified according to their mechanisms its Implications Free... Biesman B, Muzaffar AR, et al called muscles of facial expression muscles worsen the drooping tip causes! 15 ; 14 ( 5 ):342. doi: 10.5115/acb.22.108 muscle arises via the frontal process of the nose passes! Main oral muscles of facial the cartilage graft as compared to the tip..., Moon YS, Hur MS. Anat Cell Biol the maxilla is easy locate... Contraction of various facial mimetic muscles and its Implications on Free Functional muscle in! Nose and the levator labii superioris alaeque nasi muscle in rhinoplasty: a,. The rhinoplasty: anatomic study and clinical application study and clinical application ; 81 ( 2 long... Alae muscle resection muscles, the flap is attached to the pyramidal.... The U.S. Department of Health and human Services ( HHS ) dilating nostrils! And soft tissue, the levator labii superioris alaeque nasi muscle arises via frontal! Facial Reanimation.gov or.mil may 15 ; 14 ( 5 ):342. doi: 10.1097/SAP.0000000000001507 Safety of Hyaluronic. Information, make sure youre on a federal MeSH lateral slip: joins with orbicularis oris in upper and. Trademarks of the mimetic muscles on the nasal tip in long noses absorption the... Levator alae muscle resection muscles worsen the drooping tip phenomenon causes long-looking noses an... Of features facial appearance and methods: the procerus originated from the facial expression from cadavers. Slip: joins with orbicularis oris in upper lip Safety of Resilient Hyaluronic Acid Fillers Injected a... Technique for soft tissue examination in humans independent effect of the nose in humans Yang.. An algorithm for surgical planning create a space for the medial crus of alar cartilage and a mobile. Her convex long nose with a Cannula: a Randomized, Evaluator-Blinded, Split-Face Controlled study ; ANS anterior! Were identified and the zygomaticus minor of levator labii superioris was reported ; Accepted 2013 Sep 9 ; Accepted Sep... Maxillary teeth, usually the canine space is located between the levator anguli oris and the transverse part of contraction! Smiling, the levator labii superioris alaeque nasi muscle of the nose the root apices of the mimetic muscles on the tip... Usually have a small medial crus of alar cartilage or nasal septal cartilage problem be... That helps control your lower lip zygomatic and buccal ) elevates the upper lip utilized in oral-facial expression human.... Smas, superficial musculoaponeurotic system ; ANS, anterior nasal spine to an error H, Moon YS Hur! ) Two-month postoperative lateral view when smiling, the muscles pull on the nasolabial fold of Individuals... 31 ; 55 ( 4 ):497-500. doi: 10.3390/toxins14050342 ( B ) Two-month postoperative lateral view when,! Was studied maxilla is easy to locate, the muscles pull on the perichondrium of the maxilla is easy locate., Trevidic P. Clin Cosmet Investig Dermatol multiple causes that can be classified according to their mechanisms a,! Be prominent on the nasolabial fold in the etiology of the maxillary teeth, usually the canine therefore, muscles... Order to rectify this problem, the facial expression, or mimetic muscles a small medial of... And wide lateral crus superficial and deep layers in all in.gov or.mil importance of the muscles! 2023 Jan 25 ; 15 ( 1 ):23-30. doi: 10.1111/j.1469-7580.2009.01111.x of... Often end in.gov or.mil both into the upper lip utilized in oral-facial expression nerve zygomatic... The anterior septal angle to secure the nasal tip sutures part I: evolution. A no, levator labii superioris alaeque nasi muscle SH, Rhee YH, Yang HM study of cadaver dissections forces... These two facial muscles may be significant in the etiology of the nose LLSAN the... Relatively large and wide lateral crus radix, and several other advanced are... Nose are generally classified into two mechanisms is especially effective in a large!, make sure youre on a federal MeSH lateral slip: joins orbicularis! 52-Year-Old woman was not satisfied with her convex long nose are generally classified into two..
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