Introduction:
ACR (or Ala-collumellar relationship) is a measurement used by surgeons to assess the aesthetic balance of the nose tip from a side profile. It looks at the relationship between the nostrils (ala) and the central strip of the nose (columella, or what connects the two alas). these measurements are used to determine if a patient has a columella or alar problem to determine the fitting corrective surgery for the patient.
Ideal Measurement:
On a side profile, the ideal amount of visible columella below the alar margin is 2-4 mm. You can measure this by using the nostril axis method. By drawing a horizontal line drawn through the long axis of the nostril. This should divide the nostril into equal halves. Ideally, both the alar rim (the top) and the columella (the bottom) should be 1-2 mm from this axis. Which creates a shape described as a "gull in flight" from the front. Like a bird with its wings spread. (The measurement)
(Example of a good ACR french male model and actor Richard Deiss)
Types Of Disproportion:
The Gunter classification Identifies 6 main types of ACR disproprtions:1- Hanging Columella
This occurs when the columella hangs >2mm below the nostril axis because of a too long of a septum or prominent nasal spine. It's also the most common disproption of the six
2- Retracted ala
This occurs when the nostril rim is pulled >2mm from the axis. Exposing too much of the internal nostrils.
3- Combined Type 1 and 2
A combination of a hanging columella and a retracted ala, leading to extreme columellar show.
4- Hanging Ala
This occurs when the nostril rim sits <1mm from the axis making it look hooded or heavy or just depressed 5- Retracted columella
The columella is tucked too far up which is <1mm from axis making the nose look short.
Combined type 4 and 5:
rare combination of a hidden columella and a hanging alar rim. This is quite rare so I couldn't find any pics.
END
END
