Anatomy of the Nose – Dr. Oleh Slupchynskyj
Serving Nose Surgery Patients in Manhattan / NYC
For patients considering Rhinoplasty or any other form of corrective Nasal Surgery, a strong knowledge of the anatomy of the nose can help you understand how a nose gets its unique features, as well as how any corrective surgery can alter those features and what options are available. Patients should learn that the nose does not consist of a single component, but of multiple parts.
Embryonic Development and Growth
The fetal growth of the nose starts with the neural crest cells near the top of the head. These cells move down toward the middle of the face after the first month of gestation. The nasal cartilage starts out as a thickening of the skin on either side of the eventual nose. These regions of thickened skin, called nasal placodes, divide further as the fetus develops. The placodes become specialized areas of the nose, such as the bridge, the septum and the nostrils.
The nasal bones consist of two oblong bones that extend from between the eyes and come together to form the bridge of the nose. These bones slope down to meet the upper edges of the maxilla, which runs from the corners of the eyes all the way across the cheeks and down to the upper jaw. Since nasal bone is only about a millimeter thick, the bone breaks easily. Thousands of patients each year are treated for fractured nasal bones. These fractures occur frequently as the result of a fall, collision or sports injury.
In a typical Rhinoplasty Surgery, the nasal bones are brought closer together. This procedure narrows the nose and brings its appearance back into proportion after the removal of any bumps or irregularities along the bridge.
The main section of nasal cartilage lies between the end of the nasal bones and the start of the tip. This cartilage forms the rest of the bridge, along with the septum (the dividing wall between the nostrils). The upper lateral cartilages give shape to the sides of the nose. In some cases, the lower borders of the upper lateral cartilages curve outwards, giving the nose a wider appearance.
The lower lateral cartilages (also called the “greater alar cartilages”) form the tip of the nose. These cartilages are also frequently the sites of cosmetic procedures, as patients may want the tip reduced in size or turned upward for a more presentable appearance. In older patients, the weakened cartilage can droop past the lower edge of the septum (called the “columella”) due to gravity and loss of elasticity.
As with the subcutaneous structure of bone and cartilage, the top layer of skin of the nose can also be split into vertical thirds. The skin at the top third is somewhat dense but narrows and thins out at the middle section. The lower third shows the same thickness as the upper third, since the skin at the tip has more fat deposits than the skin at the midpoint.
The skin in the middle region is typically the thinnest of all three sections of the nose. Doctors and patients must keep the skin thickness in mind during any corrective or cosmetic procedure.
The nose muscles lie deep under the skin. These muscles belong to one of four main groups:
The elevators (also called the “levator labii superioris alaeque nasi” muscles) open the nostrils and lift the upper lip. Flexing these muscles gives the face a snarling or sneering expression.
The depressors (depressor septi) constrict the nostrils and pull the outer edges of the nose downward.
The compressor (compressor nalis) compresses the bridge of the nose, pulls down the tip and lifts the corners of the nostrils.
The dilators (dilator naris) sit near the edge of the nostrils and dilate the openings.
Surgeons classify the external structure of the nose into several subunits:
- Dorsum: forms the bridge of the nose
- Alar Crease: creases the skin just above the nostrils
- Tip: forms the end of the nose
- Soft Triangle: lies between the tip and the nostrils
- Columella: connects the tip to the upper lip
- Alae: forms the outer walls of the nostrils
The largest nerve in the human head is the trigeminal nerve. As the name implies, the trigeminal nerve has three main branches:
- Ophthalmic (eyes)
- Maxillary (upper jaw)
- Mandibular (lower jaw)
The nerves of the nose split off from the ophthalmic and maxillary nerves. The nasociliary branch of the ophthalmic nerve gives sensation to the skin of the nose, as well as the front of the nasal cavity. Various branches of the maxillary nerve carry feeling to the rest of the nasal cavity and control the sneeze reflex.
The septum is the collection of cartilage and skin that separates the nostrils. In most instances, the septum forms two equal-sized passages that lead from the outer openings of the nostrils into the nasal cavity. However, some patients experience a deviated (crooked) septum, either from birth defects, injury or accidents. A deviated septum can lead to breathing problems and sleep disorders, as well as making the nose appear crooked.
As anyone who has had a nosebleed can attest, the nose has an abundant blood supply. The blood supply in the nose comes from arteries that branch off from the carotid arteries, the main arteries on the sides of the neck that feed blood to the brain. On the surface of the nose, four major arteries supply blood to the external features:
- Dorsal nasal artery (bridge of the nose)
- Lateral nasal artery (outside the nostrils)
- Angular vessels (along the side of the nose)
- Columellar artery (between the tip of the nose and the upper lip)
The interior structure of the nose is almost as complex as the exterior surface. Not only is the nose useful for breathing, the internal structures also filter, humidify and warm up the air as it passes from the nostrils, through the nasal cavity, and into the windpipe. The nostrils contain mucous membranes, which humidify the air, and small hair-like cilia, which warm the air and filter out fine particles.
Angles and Geometry
The reconstruction of a nose is much like a three-dimensional geometry problem. The surgeon must be highly qualified and experienced with regards to the angles that make the nose presentable while maintaining its functionality. For instance, the slope of the nose in relation to the plane of the face is typically between 30 and 40 degrees.
Also, ideal angles can differ between males and females. The angle formed by the upper lip, the base of the columella and the tip of the nose ranges from 90 to 95 degrees in men, but can vary from 100 to 105 degrees in women. This steeper angle gives the feminine nose the “upturned” or “button nose” appearance.
These angles can change, as the patient ages and gravity pulls at the fatty tissue at the nasal tip. This effect can cause a “droop” in the nose, so that the tip extends past the edge of the columella. Older patients can choose to undergo a procedure that will reinforce the ligaments and remove the “drooping” effect.
Preparations for Reconstructive Nasal Surgery
Dr. Slupchynskyj does not only consider the aesthetic aspects of Rhinoplasty, Septoplasty, or any other form of nasal reconstruction. The planning that goes into any surgical procedure involves not only examining the targeted problem, but also considering any potential issues that may arise as a result.
From the standpoint of appearance, the finished product must display the symmetry, texture, and contours of the ideal nose for the patient’s face. All of the bones, cartilage and skin must all remain presentable, while the nerves, blood vessels, muscles, and mucous membranes must also continue to work effectively together.
About Dr. Oleh Sulpchynskyj
A premier Manhattan Rhinoplasty Surgery provider, Dr. Oleh Slupchynskyj is frequently consulted by Ethnic Rhinoplasty and Revision Nose Surgery New York City patients. His practice offers a range of financing options for patients to looking to cover the cost of Rhinoplasty with convenient monthly payments.