Anatomy

  • Glabella – point where the forehead meets the nose, in between the eyebrows.
  • Nasion – bony point where the nose begins.
  • Radix – “root” of the nose.
  • Rhinion – point of transition between the nasal bones and the nasal cartilage on the bridge.
  • Upper lateral cartilage – paired cartilages that connect the nasal bones to the nasal tip cartilages.
  • Lower lateral cartilage – tip cartilages.
  • Ala – “wing” of the nose.
  • Alar-facial groove – border of the nose and the cheek.
  • Columella – soft tissue between the nostrils.
  • Nasal valve – internal and external portions of the nose corresponding to areas of high airflow resistance.
  • Nasal vestibule – entrance to the nose, in the nostrils.
  • Nostril sill – soft tissue at the floor of the entrance to the nostril.
  • Septum – cartilaginous and bony structure that supports the nose and separates the nasal passage into left and right sides.
  • Maxilla – upper jaw bone.
  • Turbinate – bony outcroppings in the nose, covered with mucosa; assist in directing airflow and providing humidification.
  • Nasolabial angle – the angle that the nose makes with the upper lip in profile.
  • Nasofrontal angle – the angle that the nose makes with the forehead in profile.
  • Soft triangle – also known as the facet; the skin at the top of the nostril where it meets the tip.
  • Tip-defining points – the highest points, bilaterally, in the nasal tip.

Techniques

  • Dorsal hump (bump) removal – reduction of the bone and cartilage convexity along the bridge of the nose.
  • Rasp – use of a sharp file to reduce the height and smooth the surface of the nasal bones.
  • Osteotomy – surgical cut in a bone; used to move the nasal bones during rhinoplasty.
  • Cephalic trim – removal of a portion of the superior and medial aspects of the lateral crus of the lower lateral cartilage; a way to reduce overall tip volume.
  • Dome division – a technique that divides the nasal tip cartilage at the dome in order to shorten and/or reshape the tip.
  • Lateral crural overlay – a technique involving division, overlap, and repair of the lateral crus of the lower lateral cartilage; allows for narrowing of the tip without significantly weakening its structure.
  • Lateral crural strut grafts – cartilage placed underneath the lateral crura to flatten and strengthen the sides of the tip.
  • Alar rim grafts – cartilage placed along the rim of the nostril to support the soft tissue and reduce the risk of alar retraction.
  • Spreader grafts – cartilage placed along the dorsal septum to widen the internal nasal valve region and support the sidewalls of the nose.
  • Batten grafts – cartilage placed along the nasal sidewalls to prevent collapse; commonly used in closed (endonasal) rhinoplasty.
  • Flaring suture – mattress suture placed in the upper lateral cartilages, cantilevered on the dorsal septum, to reduce sidewall collapse with inspiration.
  • Septoplasty – alternation of the shape or structure of the nasal septum.
    Inferior turbinate reduction – reduction of the volume of the inferior turbinates; performed to open the airway.
  • Rotation – increase in the nasolabial angle.
  • Alar base modification – changes in the shape and/or width of the base of the nose.

Problems

  • Alar retraction – elevation of the alar rim, frequently from scar tissue and healing forces.
  • Bulbous tip – wide or full tip region.
  • Columella show – visibility of the inside of the nose on the profile view.
  • Deviated septum – deviation of the septal bone and cartilage from the midline, frequently causing nasal obstruction.
  • Droopy (ptotic) tip – tip position that is under-rotated or downward in orientation.
  • Inverted “V” deformity – visibility of the nasal bone edges due to poorly supported upper lateral cartilages.
  • Nasal valve collapse (external) – collapse of the nostrils and alar tissues with inspiration.
  • Nasal valve stenosis (internal) – tightness of the area inside the nose bounded by the septum, inferior turbinate, and upper lateral cartilage; narrowest part of the nasal airway.
  • Polly beak deformity – fullness in the area above the tip, causing the appearance of convexity.
  • Saddle nose deformity – collapse of the bridge of the nose due to failure of the internal support.
  • Turbinate hypertrophy – enlargement of the turbinate tissues, most commonly the inferior turbinates.
Double Board Certified Plastic Surgeon at Evan Ransom MD

Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.