The structure of the nose has direct implication for nasal breathing - the main function of the nose. Although the mouth can function as an alternate route of breathing, mouth breathing is inferior to the nose in quality and comfort. The reason for this is multifold but mainly related to air quality and quantity delivered to the lungs.
Skin of the Nose
The nose is covered by skin. Interestingly, the skin quality changes dramatically from one part of the nose to the next which directly influences nasal appearance. The nature of the nasal skin envelope impacts also significantly certain changes that can be achieved through rhinoplasty.
In general, from top to bottom the nasal skin starts out thick, gets thinner and thick again. In the upper portion, the skin between the eyebrows and just below is relatively thick. When you pinch the skin in this region between index finger and thumb, you can get an appreciation for the skin thickness. Underneath the skin is a relatively strong facial muscle called the procerus. The procerus muscle is responsible for the horizontal crease that is present in some people and usually deepens when we frown. Sometimes, this muscle is weakened surgically or with Botox.
The skin overlying the mid-portion of the nose is thin. This is the reason why the bones of a nasal bump sometimes show a defined edge. Important for removal of a bump during rhinoplasty, this region has to be just perfectly smooth. If total evenness is not achieved, sharp unnatural edges may show through the thin skin envelope.
The lower tip segment of the nose again has thicker skin. The reason for this lies in the abundance of sebaceous glands. The skin is draped tightly over the underlying tip cartilages, therefore pinching of the skin in the tip region is impossible without pinching the structural cartilages. The skin quality in this region is of utmost importance for nasal tip definition before and after rhinoplasty. Many patients with thick skin are bothered by a poorly defined nasal tip. Because of the limitations available in thinning thin skin in this region, a defined tip is not always achievable.
Underneath the skin of the nose is a thin sheath of muscle and connective tissue. We mentioned already the procerus muscle which runs vertically from the upper nasal bridge to the forehead. The procerus muscle is the largest muscle associated with the nose. Other muscles of truly functional significance center on the lower nose. The nostrils will widen with breathing in, an action made possible through the nasal dilator muscles. When we breathe more forcefully, this muscles action will be more apparent. The last nasal muscle of significance to rhinoplasty is called the depressor septi muscle. Its action can be observed in some people who develop a droopy nose with smiling. This undesirable consequence of smiling on the nasal appearance can be so pronounced that patients may avoid smiling altogether – obviously a poor compromise. The action of this nose muscle can be weakened by improving nasal tip support or by even transecting the muscle during cosmetic rhinoplasty.
Nasal Skeleton – Bones & Cartilages of the Nose
For ease of better understanding, we can divide the nose into three parts: the upper third of the nose skeleton is made of bone; the middle and lower thirds are made up of cartilage.
The nasal bones are paired – one on each side. Eye glasses rest with their little clear plastic nasal pads on skin that overlies these nasal bones left and right. These nasal bones connect to the forehead bone on top, the tear bones towards the eyes on each side, and the upper jaw bone towards the cheeks. In the center, the nasal bones attach to the bony nasal septum. The nasal septum continues internally towards the tip as a cartilaginous sheath. The septum is important for both breathing and nasal support alike. The nasal interior is quite complex in its anatomy and functional aspects. It contains outlets of the multiple nasal sinuses and contains additional bones called turbinates which may play a role in sinusitis, nasal breathing and air humidification.
The mid-portion of the nose is made up by the two trapezoid-shaped cartilages as side walls called “upper lateral cartilages”. Towards the top, these cartilages are relatively firmly connected with the nasal bones and therefore follow changes of bone configurations. It is only rarely necessary, that these upper lateral cartilages require separate attention during the rhinoplasty. If these cartilages become dislodged from the nasal bones or if partial removal is performed without care, nasal obstruction may occur – commonly referred to as internal nasal valve collapse. In the midline, these upper lateral cartilages fuse densely with the nasal septum.
Beneath and loosely attached to the cartilages of the nasal mid-portion are the two lower lateral cartilages – important structures that determine the shape of the lower third of the nose. These paired cartilages have a complex form and vary in their shape just enough from person to person to create the diversity of nasal tip contours. The cartilaginous nasal septum contributes to the nasal tip configuration by providing various amounts of support and height.
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