Rhinoplasty anatomy
Rhinoplasty is by far the most anatomically complex procedure in facial plastic surgery. To understand rhinoplasty better, it helps to isolate the different structural parts that make up a nose. Understanding the anatomy of the nose will be very helpful in your ability to communicate with your surgeon and to visualize the anatomy responsible for the unique features of your nose.
The structural framework of the nose is made up of cartilage and bone, similar to a wooden frame of a house. The skin and soft tissue of the nose cover this structural framework, producing the final shape. The upper one third of the nose (between the eyes) is the bony part, while the middle and lower thirds of the nose are made of cartilages. The septum is a midline partition that divides the nose into two haves.
UPPER THIRD
The bony portion of the nose is attached to the facial bones on each side and to the bone of the forehead above. Below, it attaches to and overlaps the upper lateral cartilages.
Anatomy of the nasal bones
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MIDDLE THIRD
The middle third of the nose is made up of two relatively flat pieces of cartilage called the upper lateral cartilages. These are overlapped above by the nasal bones and below by the lower lateral cartilages. In the midline, the upper lateral cartilages fuse to the cartilage of the septum.
Anatomy of the upper lateral cartilages
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LOWER THIRD
The lower third of the nose is made up of the paired lower lateral cartilages. These are also called the alar cartilages (meaning wing-like), since they are shaped like the wings of a bird in flight. These cartilages can vary quite a bit in size, shape, angulation, and orientation and are responsible for the wide range of nasal tip shapes.
Anatomy of the lower lateral cartilages
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Anatomy of the lower lateral cartilages, base view
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SEPTUM
The septum divides the nasal passages into two halves, beginning at the nostril opening and extending all the way to the back of the throat. The septum is made up of cartilage in the front and of bone further back. The septum joins the two upper lateral cartilages in the front of the nose. The septum acts as a pedestal upon which the rest of the nose sits. If the septum is crooked, too long, or too short, it can make the entire nose to appear the same way. Deviation or twisting of the septum can also obstruct the nasal passages. Septal deviation can be present since birth or it can develop over time during facial growth. Injury to the nose can also create a deviated septum.
SKIN
Your skin plays an equally important role as the bone and cartilage in determining the final shape of your nose. Ideally, the skin and soft tissue should be thin enough to re-drape over the nasal framework, but not too thin so that all details of the bone and cartilage can show through. Thick skin can be a problem in rhinoplasty since it obscures the details of the cartilage and bone underneath and can limit the amount of improvement possible with rhinoplasty. Thin skin is a less of a problem but in extremes it can be a problem since it exaggerates any subtle asymmetries or irregularities of the underlying cartilage and bone.
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