Question: Why is the anatomy important?
Answer: The anatomy is the underlying reason that your nose looks however it does. Accurate assessment of the patient's anatomy, whether for a first-time rhinoplasty or for a revision rhinoplasty, allows the surgeon to develop a rational and realistic surgical plan. Furthermore, recognizing variations in the anatomy is critical to preventing complications.

If you need a revision rhinoplasty, your surgeon will attempt to determine what your anatomy used to look like, and what it looks like now. This will allow him or her to develop the optimal surgical plan. This kind of analytic ability is an acquired skill based upon experience in rhinoplasty.

Question: Teach me some basic nasal anatomy and anatomic terms so I will be able to understand your answers better later on in this website.
Answer: A simplified diagrammatic overview of nasal anatomy is presented here. The diagrams shown here review the surface anatomy and the structural (i.e., beneath the surface) anatomy of the nose. They are reprinted with permission from Rhinoplasty Dissection Manual, a textbook by Dr. Dean Toriumi and Dr. Daniel Becker.

Surface Anatomy of the Nose

You may want to print out the diagrams, so that you can refer to them if necessary later in the website.

Figures 1-4 show the nose from 4 viewpoints. Important surface landmarks are labelled.

Figure 1: Frontal 1 - glabella 2 - nasion 3 - tip-defining points 4 - alar-sidewall 5 - supra-alar crease 6 - philtrum
Figure 2: Base 1 – infratip lobule 2 - columella 3 – alar sidewall 4 – facet, or soft-tissue triangle 5 - nostril sill 6 - columella-labial angle or junction 7 - alar-facial groove or junction 8 - tip defining points
Figure 3: Lateral 1 - glabella 2 - nasion, nasofrontal angle 3 – rhinion (osseocartilaginous junction) 4 - supratip 5 - tip-defining points 6 - infratip lobule 7 - columella 8 - columella-labial angle or junction 9 - alar-facial groove or junction
Figure 4: Oblique 1 - glabella 2 - nasion, nasofrontal angle 3 - rhinion 4 - alar sidewall 5 - alar-facial groove or junction 6 - supratip 7 - tip-defining point 8 – philtrum
Figures 5-7 show the internal anatomy, beneath the skin.
Figure 5: Oblique 1 - nasal bone 2 - nasion (nasofrontal suture line) 3 - internasal suture line 4 - nasomaxillary suture line 5 - ascending process of maxilla 6 - rhinion (osseocartilaginous junction) 7 - upper lateral cartilage 8 - caudal edge of upper lateral cartilage 9 - anterior septal angle 10 - lower lateral cartilage - lateral crus 11 - medial crural footplate 12 - intermediate crus 13 - sesamoid cartilage 14 - pyriform aperture
Figure 6: Lateral 1 - nasal bone 2 - nasion (nasofrontal      suture line) 3 - internasal suture line 4 - nasomaxillary suture      line 5 - ascending process of      maxilla 6 - rhinion      (osseocartilaginous      junction) 7 - upper lateral cartilage 8 - caudal edge of upper      lateral cartilage 9 - anterior septal angle 10 - lower lateral cartilage        lateral crus 11 - medial crural footplate 12 - intermediate crus 13 - sesamoid cartilage 14 - pyriform aperture
Figure 7: Base 1 - tip-defining point 2 - intermediate crus 3 - medial crus 4 - medial crural footplate 5 - caudal septum 6 - lateral crus 7 - naris 8 - nostril floor 9 - nostril sill 10 - alar lobule 11 - alar-facial groove or        junction 12 - nasal spine
The septum is the midline structure inside your nose that divides your nose into left and right. The septum is an important structure in septorhinoplasty. Its anatomy is shown here.
Figure 8: Septum 1 – quadrangular caratilage 2 – nasal spine 3 – posterior septal angle 4 – middle septal angle 5 – anterior septal angle 6 – vomer 7 – perpendicular plate of      ethmoid bone 8 – maxillary crest,      maxillary component 9 – maxillary crest –      palatine component
Figures 9-10 are not as important for the web viewer, but they highlight the important fact that the skin over the nose has muscles and blood vessels. This may seem obvious, but it is important because if the surgeon does not fully recognize the importance of this fact, they may operate in the incorrect tissue planes, which can result in violation of the muscle and blood vessels and subsequent abnormal scarring.
Figure 9: Musculature A: Elevator muscles -     1. Procerus     2. Levator labii alaequae         nasi     3. Anomalous nasi B: Depressor muscles -     4. Alar nasalis     5. Depressor septi nasi C: Compressor muscles -     6. Transverse nasalis     7. Compressor narium         minor D: Minor dilator muscles -     8. Dilator naris anterior E: Other -     9. Orbicularis oris    10. Corrugator
Figure 10: Vasculature 1 – dorsal nasal artery 2 – lateral nasal artery 3 - angular vessels 4 - columellar artery

 
Ask Dr. Becker a question about corrective nose surgery or arrange an appointment for a nose surgery consultation, by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.