Understanding Nose Anatomy – The Ultimate Guide to Rhinoplasty

Nose surgery is something that involves many different factors. So, we’ve put together an article to help you understand everything you need to know about the way the nose is built, the usual shapes of noses, common problems, and a list of words that might be useful to know. This will not just assist you in explaining to your surgeon exactly what you want but will also make it clearer what can and can’t be done through surgery.

The way your nose looks is a big deal when it comes to appearance and beauty. Everyone’s nose has its own unique shape, and a lot of people are not pleased with how their nose looks. Rhinoplasty is the name for a type of surgery that’s done to change the shape of the nose to make it look better.

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Getting a nose job isn’t something simple, and it takes a really talented surgeon to get the results just right. At Centre for Surgery, our plastic or ENT (Ear, Nose, and Throat) surgeons will have to think about lots of things when they’re doing the operation. This is because every nose is unique, and each person wants their nose to look different. Your surgeon must take all these things into account to make sure that the shape of your nose fits what you want and looks as good as possible.

Anatomy of the Nose – What You Can See on the Surface

First, let’s talk about the surface anatomy, which means the parts of the nose that you can see, without looking at the inner structures that make it up. Here’s what you can see when you look at a nose:

• The Radix: This is the top part of the nose, right in the middle between your eyes.
• The Dorsum: You might hear this called the bridge as well. It’s the part of the nose that goes from the radix (the top part) down to the tip of your nose.
• The Columella: This is the straight piece that you can see between your two nostrils.
• The Alae: These form the sides of the nostrils. If you’re talking about just one side, it’s called an “Ala.” If you’re talking about both sides together, you use the plural, which is “Alae.”

Anatomy of the Nose – What’s Below the Surface

Below the parts of the nose you can see (which we explained earlier), there are bones and cartilage that actually give the nose its shape. We can split the nose vertically into three sections. The top third is made of nasal bones, the middle third has what’s called the upper lateral cartilages, and the bottom third consists of alar cartilages:

• Nasal bones: These bones aren’t very hard and are often shaped or shaved during a nose job (rhinoplasty) to get the desired appearance. They are what give the bridge of your nose its particular shape and how far it sticks out.
• Upper lateral cartilages: This is a type of tissue that’s firm but not as hard as bone. It starts just under the nasal bone in the middle part of your nose. You can even feel it yourself, as it’s the soft, squashy part. These cartilages make sure the nostrils stay open and wide. If they’re weak, your nose might look like it’s pinched.
• Alar cartilages: These are really crucial because they help give the tip of your nose its shape. Surgeons often work on these cartilages during rhinoplasty. They are found under the tip of the nose, as well as under the columella (the part between the nostrils) and the alae (the sides of the nostrils).
• Nasal septum: This is like a wall in the middle of your nose that separates the right and left sides from each other. You might have heard the phrase “deviated septum.” This refers to an issue with the nasal septum.

Understanding these elements can be really helpful, especially if you’re considering any type of nose surgery. It gives you a better idea of what the surgeon will be working on to change the shape of your nose. It’s like having a map of what’s inside your nose!

Who Might Need a Nose Job?

Rhinoplasty, or what we commonly call a nose job, can be done for either cosmetic reasons or medical needs. Here’s a list of some problems with the nose that might make you think about having this type of surgery:

Problems with the Dorsum (Bridge of the Nose)

The dorsum is the area that runs from the top of your nose down to the tip. Ideally, it should be fairly straight with just a bit of curve. Here are some of the typical problems with the dorsum that might lead to someone having a nose job:

• Large dorsal hump: This is when the dorsum sticks out too much and is curved outward, forming a bump or hump. This common problem can be caused by the nasal bones and cartilages being too large.
• Wide nose: This could be that the nose is too wide at any point, whether it’s the upper part of the dorsum (called the dorsal bridge), the middle part (known as the dorsal base), the tip, or even the nostrils. You might feel that your nose is too wide in any of these areas, making it look out of proportion with the rest of your face.
• Under-projected dorsum: This is related to the dorsum being short and not sticking out far enough from the face. It often goes along with having an under-projected tip of the nose (which we’ll explain below).
• Saddle deformity: This can happen when a large dorsal hump has been over-corrected during surgery, and too much tissue has been removed. It makes the dorsum look like a ski slope, with an inward curve.

Problems with the Tip of the Nose

The tip of the nose is shaped by something called alar cartilages. These cartilages support the nostrils at the sides and help the tip to stick out in the middle. There are several problems that can affect the tip of the nose:

• Droopy tip: This occurs when the tip of the nose points downwards. It’s often caused by a large nasal septum (the wall that separates the nostrils) pushing the alar cartilage down, which makes the tip look droopy.
• Over-projecting tip: Sometimes referred to as a “Pinocchio Nose,” this is when the tip of the nose sticks out too far from the face. This can be due to the alar cartilages being too large.
• Under-projecting tip: This happens when the tip of the nose doesn’t stick out far enough. It can go hand-in-hand with either a dorsum that sticks out too much (a hump) or a dorsum that doesn’t stick out enough.
• Bulbous tip: This is when the tip of the nose appears too big or too wide. It can give the nose a rounded appearance.
• Boxy tip: If you look at a typical nose from below, it should look like a triangle, with the tip of the nose as the top corner and the alae (the sides of the nostrils) forming the other two corners. But if the nose looks more like a rectangle, it’s described as having a boxy tip.

Problems with the Alae (Sides of the Nostrils)

The alae are the sides of your nostrils, and they can have some issues that affect the appearance of the nose. Some of the problems related to the alae might include:

• Wide alae: This happens when the alae stick out too much to the sides, making the nostrils look overly wide from side to side. It can give the nose a broader appearance than desired.
• Notched alae (nasal flaring): This is when the alae are positioned higher than normal, so that the columella (the part between the nostrils) is visible from the sides. It can create what’s sometimes referred to as a “snarl” appearance.
• Asymmetric alae: This occurs when the right and left sides of the nostrils are not the same shape or size. It can make the nose look uneven.

These problems with the alae can be a concern for some people, affecting how they feel about the appearance of their nose. They may be inherited traits, or they may develop over time. Just like with the dorsum and tip problems we’ve discussed, alar issues can often be corrected through rhinoplasty.

Other Nose Problems

Apart from the issues related to specific parts of the nose, there can be other problems that affect the overall structure and function of the nose:

• Deviated Nose: A deviated nose means that the nose is leaning to one side of the face. This can happen if you have a deviated septum (the wall in the middle of the nose), deviated nasal bones, a deviated tip, or deviated upper lateral cartilages. Each of these deviations may need a different approach during surgery to correct the problem.
• Airway Obstruction: If you find it difficult to breathe through your nose, there might be something blocking the way. This could be due to:
  • A deviated septum, which can obstruct the nasal passages
  • Enlarged turbinates, which are structures inside the nose that can become swollen and block airflow
  • Or another problem such as nasal polyps that needs diagnosis by a specialist surgeon.

These additional problems might not just affect the appearance of the nose but can also impact its functionality, particularly in the case of airway obstruction.

Different Types of Rhinoplasty: Open and Closed Techniques

Rhinoplasty, commonly referred to as a “nose job,” can be performed using two different techniques: open rhinoplasty and closed rhinoplasty. Both techniques have their particular applications and advantages, and surgeons in the UK may use one or both depending on the individual’s specific needs and the part of the nose being addressed.

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Open Rhinoplasty

Open rhinoplasty is often chosen when the problem that needs addressing is in the tip of the nose or the alae (the sides of the nostrils). Here’s how it generally works:

1. Incision: The surgeon will make a small cut in the skin of the columella, which is the area between your nostrils.
2. Reshaping: Excess tissue is removed, and what’s left is reshaped to create the desired look.
3. Closing: The incision is then closed, and usually, no visible scarring remains after the healing process.

This method provides the surgeon with better visibility and access to the underlying structures of the nose, allowing for more precise alterations.

Closed Rhinoplasty

Closed rhinoplasty or endonasal rhinoplasty, on the other hand, is typically chosen when the main issue is in the dorsum (bridge) of the nose. Here’s how this technique is usually performed:

1. Incision: A small cut is made inside the nostrils, so the skin on the outside of the nose is left untouched.
2. Reshaping: The surgeon will then work through this incision to reshape the dorsum of the nose, correcting any problems.

Since the incision is made inside the nose, there’s no external scarring, and recovery may be quicker.

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Choosing the Right Technique

Both open and closed rhinoplasty have specific advantages, and the choice between them depends on the problem being addressed and the surgeon’s expertise. Some surgeons might even combine the two techniques to achieve the best possible result.

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Your surgeon will discuss with you the most suitable method for your particular situation. By understanding the structure of your nose and the changes you desire, the surgeon can create a tailored plan that aligns with your needs. Whether it’s a more dramatic alteration or a subtle refinement, these techniques allow skilled surgeons to achieve excellent aesthetic results, enhancing the overall harmony of the face.

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