The ideal horizontal facial distances are based upon the horizontal length of the eyes. As seen above, the distance from the middle eyelid confluence (medial canthus) to the lateral eyelid confluence (lateral canthus) defines the proportions of the face. In general, we expect that the horizontal axis of the nose will be equal to the horizontal axis of the eye. When the nose is larger than the eyelid distance, patients commonly present requesting a reduction of their nostrils, as an enlarged nostril diameter tends to project an angry sentiment. Next, we evaluate the vertical axis of the face. We divide the face into three equidistant parts as shown above. When the vertical nasal axis is too long or short, patients often will request either an elevation or modification of their tip location.
Once a general sense of nasal size and proportion has been taken, the nose itself is evaluated by its separate components. As a rule, I start by evaluating from the top to the bottom. Again, we divide the nose into three equidistant vaults as shown in the figure below.
The upper, bony 1/3 is evaluated for profile curvature, and for horizontal size. Here, we want to evaluate specifically how wide and how projecting the nasal bones are, and we want to define the nasofrontal angle.