The Anatomy of a Rhinoplasty

Rhinoplasty (nose surgery) is one of the most requested cosmetic procedures in plastic surgery. The prominence of the nose makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are dependent upon an understanding of the complex anatomy that makes up the nose. Rhinoplasty surgery changes the shape of the support framework which is then 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 septum supports the highest roof angle of the nose. (cartilage) Everyone's nose is different due to variations in the framework structure and the thickness of the skin that overlies it. 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. The skin is the fourth and final component which can be think or thin, masking or revealing the udnerlying framework.

When we alter the nose we are changing the way the framework (bone and cartilage) is joined together and is shaped. Many structures can be altered to effect an outer appearance change such as dropping down the roofline (getting rid of that hump), makes the upper nose less wide by moving in the lower bone walls, refining the tip by rescuplting tyhe shape of its scrolled cartilages, or even making the roofline higher by adding implants or cartilage to it.

Due to the complexity of how all of these framework structures come together, most rhinoplasties today are done 'open'. While open rhinoplasty used to be controversial, it is now the most common way rhinoplasty surgery is performed today. All that this means is the skin is lifted off of the tip of the nose so all the framework structures can be seen. You can always shape better what you see better. This results in a nearly invisible scar at the middle of the strip of skin between the nostrils. (known as the columella) This small scar is insignificant given the benefits of getting a better rhinoplasty result!