The Anatomy of a Rhinoplasty

The Anatomy of a Rhinoplasty
Rhinoplasty (nose surgery) is one of the top requested
cosmetic procedures for both men and women in plastic
surgery. The prominence of the nose and its significance to
the appearance of the face makes the need for any
rhinoplasty surgery to be very precise. Good results in
rhinoplasty are dependent upon an understanding of the
complex framework of bone and cartilage that make up the
nose. Rhinoplasty surgery changes the shape of this
framework which is revealed through the overlying skin.

Think of your nose as a house. The shingles are the
overlying skin, the framework and timbers are the cartilage
and bone, and the drywall the nasal lining. The support
that lies underneath the highest roof angle is the septum.
(cartilage) What makes anyone's nose look the way it does,
like a house, is a reflection of how the framework is
structured and the roof (skin) that drapes over this
framework. As plastic surgeons we think of the nose as 4
areas, the upper 1/3 which is bone, the middle 1/3 known as
the middle vault which is all cartilage which is straight,
and the lower 1/3 or the tip of the nose which is a
combination of scroll-shaped cartilages that come together
over the septum and is what gives everyone their unique tip
shape. (which is the most different between any two people)
The fourth area is the skin, which dependent upon its
thickness, can show the underlying framework well if it is
thin but can hide much of it if it is thick.

When we alter the nose we are changing the way the
framework (bone and cartilage) is joined together and is
shaped. This could be taking down the height of the roof in
one area (that bump on your upper nose), reshaping the tip
of the nose (by changing the shape of the scrolled
cartilages, breaking the bone along the bridge to narrow
the nose (collapsing the walls), or in some cases adding to
the roof line with implants or cartilage to raise the
height of the roof line.

Due to the complexity of how all of these framework
structures come together, most rhinoplasties today are done
'open'. While this used to be a controversial area (what
was known as the most contested 6 millimeters of skin on
the body), it is now accepted to produce the best results
in most nose surgeries. All that this means is the skin is
lifted off of the tip of the nose so all the framework
structures can be seen. To no surprise, you can shape
better what you can see better. This only leaves a nearly
imperceptible scar at the middle of the skin between your
nostrils. (known as the columella) This is a very small
price to pay for a better rhinoplasty result!

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Dr Barry Eppley is a board-certified plastic surgeon in
private practice at Clarian Health in Indianapolis,
Indiana. He writes a daily blog on trends in plastic
surgery at http://www.exploreplasticsurgery.com