Rhinoplasty continues to be a popular facial procedure and is one operation that is almost synonymous with plastic surgery. The central position of the nose on the face makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are largely dependent upon a detailed understanding of the anatomy of the nose. Whether it is a small area of nasal change or an entire nose restructuring, Â how the anatomical framework is altered will eventually be revealed through the overlying skin.
What makes your nose look like it does? Think of the shape of your nose like a single level house. The roof covering is the overlying skin, the framework of the roof is the nasal bones and upper and lower alar cartilages, the central support beam is the septum, and the walls are the nasal lining. The look of one’s nose, like the shape of the roof on the house, is directly influenced by how the framework of the roof is shaped. A hump or bump on the nose occurs, for example, because the central beam is arched (too long), raising up a normally smooth roof line. The tip of the nose is too long, for example, because the legs of the tripod support on the roof edges is too long. Deviated noses occur because the central support beam is deviated or the tripod edge supports are longer or shorter on one side.
As an Indianapolis plastic surgeon, I think of changing the nose in terms of four areas, three outer framework and one inner framework support. The upper outer one-third is the nasal bones, the middle third (also known as the middle vault) is the upper cartilages, and the lower one-third is known as the lower cartilages or the tip of the nose. The septum is the central internal support. Â One important nose area is the thickness of the outer skin which, although we can not change, definitely influences how the changed framework will eventually be seen.
Rhinoplasty surgery is about changing the way these framework parts are joined and in how they are shaped and inter-relate. Taking down a hump on the nose, for example, is a matter of lowering the roof line by reducing the nasal bones and septum heights and usually allowing the roof sides to fall back in together once shortened. Reshaping the tip of the nose is by changing how the sides of the lower cartilages come together in the middle and changing their unified angulation to the underlying septum. Building up the nose is by adding some form of graft to the top of the roofline along its entire length.
Due to the complexity of how all of these framework structures come together, many rhinoplasties today are done through an open approach to best view how the parts come together. For minor changes, however, a closed or endonasal approach still works well and is associated with a quicker recovery time and less nasal tip swelling after.
Dr. Barry Eppley
Indianapolis, Indiana