Basic Nasal Anatomy and Aesthetics in Beverly Hills

  • Primary Rhinoplasty: First (hopefully the last also) rhinoplasty performed
  • Revision or Secondary rhinoplasty: rhinoplasty performed subsequent to or repeated again after a primary rhinoplasty
    • Major, requiring cartilage grafts for collapse or major deformities from original rhinoplasty (often requires sedation or general anesthesia)
    • Minor, needing small amounts of skin, nostril, or cartilage tweaking or fine-tuning (often done with just local anesthesia)
  • Septoplasty: straightening of the septum often done by removing or straightening the most curved portion
  • Turbinoplasty: modification of the turbinates (see below) without removal
  • Turbinectomy: removal of bone and or mucosa of inferior turbinates
  • Ethnic Rhinoplasty: usually refers to rhinoplasty performed on non-Caucasian noses
    • Requires a versatile and full-spectrum skill set in all techniques of rhinoplasty to provide natural results while also creating clear changes
  • Cartilage Graft: a piece of cartilage removed from one location and relocated to another.
    • Grafts are often placed in the bridge to support the bones and help breathing, in the tip to shape the tip, in the alar area to support the nostrils, and/or on top of the bridge to augment the bridge
  • Dorsum: Bridge of the nose
    • Can be “rasped” or shaved down and reduced or augmented with select cartilage grafts (i.e., diced cartilage fascia grafts or straight rib grafts) or silicone implants
  • Radix: Deepest part of nose (at its root, where it meets the forehead)
    • Can be reduced to enhance the eyes more or augmented when too deep
  • Nasal Tip: The bottom of the nose; formed by the tip cartilages
    • Often requires refinement, and its projection can be reduced or increased
    • Also can be elevated or rotated upward and even lengthened in the case of an overly shortened nose
  • Domes: the peak of the tip cartilages
    • Enhanced when tip is refined with suturing techniques and/or grafting
  • Columella: The skin bridge between the nostrils
    • Can be retracted or excessive (hanging columella) requiring modification
  • Alar rims: The skin bridge surrounding the nostrils; the roof of the nostrils
  • Alar base: the base of nostril and can be wide or flared, requiring reduction to narrow the nostrils (alae)
  • Alar sill: the floor of the nostril apertures (holes) or entry into the nostrils
  • Supratip: the area just above the tip
    • If full can cause a “pollybeak” tip
    • If too deep can look artificial (excessive supratip break)
  • Dorsal hump: the convexity or bump on the bridge of the nose
    • Requires reduction (“component dorsal reduction”)
  • Droopy tip or plunging tip: an excessively long tip that droops down
    • Can be exaggerated when smiling, causing a hooked appearance
    • Elevation, shortening, and often removal of the depressor muscle corrects this
  • Skin envelope: the skin of the nose
    • Thick skin that is sebaceous (oily) with large pores tends to be less elastic and may not contract to new (smaller) nasal framework after reduction
    • Thin skin envelope: can make underlying nasal changes more visible
  • Septum: cartilage and bony wall that divides the nose into right and left
    • When curved can obstruct the airway and complicate breathing
    • Can also be tilted or have perforations (holes)
  • Turbinates: the structures (3 on each side) that have bone and mucosal lining
    • Responsible for clearing pollution of the nose and humidifying the air in the nose
    • If enlarged (inferior turbinate hypertrophy) can be reduced or excised (partially)
    • Can enlarge during different time periods: moving from hot to cold environments; during menses, with allergic reactions, and with a cold or virus
    • Can be treated with nasal steroid sprays
  • Dynamic tip: nasal tip that moves excessively downward when talking or smiling
    • Can be treated with modification or removal of the muscle attachment (depressor septi nasi muscle)