The Anatomy of the Nose
Although the nose looks like a structure with continuous, flowing lines, it is made up of many separate components that need to fit together in a very specific way to create those lines. The smooth, seamless continuity that nature can create needs to be replicated by the rhinoplasty surgeon.
The nose is a hollow organ with an outer skeleton containing empty space. In addition, form and function are very closely related. Specifically, the breathing function of the nose is intimately linked to its shape. Therefore, it is very important that the nose’s function be considered during rhinoplasty surgery. Esthetic modification needs to avoid disrupting the delicate balance that allows the nose to function properly as a breathing organ. Furthermore, if a patient undergoing a rhinoplasty also has breathing difficulties, this needs to be addressed simultaneously. Therefore, the surgeon needs to have expertise and experience in both esthetic and functional nasal surgery.
Components of the Nose
The nose is composed of a skeleton covered by “the skin-soft tissue envelope”. The skeleton is composed of several bones and cartilages of different shape connected together. Another very important component of the skeleton, which is inside the nose, is the nasal septum. The septum is a vertical wall separating the two nostrils into right and left. It is similar to a pole holding up a tent. The tent, in this case, is the remaining skeleton of cartilage and bones of the nose, as well as the skin and soft tissue envelope covering them. The skin-soft tissue envelope is composed of layers of soft tissue, muscle, and skin.
The Skeleton of the Nose
The top third of the nasal skeleton, near the eyes, is composed of the nasal bones. The lower two thirds is composed of cartilage. The septum also forms an integral part of the nasal skeleton. It is a vertical wall that separates the two sides of the nose. Many people have a certain degree of deviation of this septum rendering the space in the two sides of the nose asymmetrical. This does not usually pose a problem. However, a small number of people have a deviation severe enough to cause a significant narrowing of the breathing passage on one or both sides of the nose. This causes nasal obstruction that is only correctable surgically.
The Skin-Soft Tissue Envelope
This is a very important component of nasal anatomy that is frequently overlooked by inexperienced surgeons. Skin types vary a great deal among different ethnic groups and a significant variability also exists within members of the same ethnic group. People with fair skin and/or freckles, frequently have thin skin and soft tissues. People with darker skin or people of southern European, Mediterranean or Middle-Eastern descent generally have thicker, oilier skin. In addition, certain groups of people have nasal anatomy that requires specific needs, for example Asians and people of African descent.
Rhinoplasty targets mainly the cartilages and bones of the nose. When skin is very thick, particularly at the tip of the nose, it camouflages the tip cartilages and, in the same way, blunts any refinements made to those cartilages. This poses a limitation on the degree of refinement or reshaping that can be accomplished with rhinoplasty. Very thin skin and soft tissues pose a different challenge. The bone and cartilage are clearly visible under this kind of skin. As a result, even minor imperfections in the underlying structures will be evident.
People with very thick or very thin skin can still be good candidates for surgery. Excellent results can be achieved with rhinoplasty, particularly if the surgeon takes into careful consideration the patient’s particular skin type.
A deviated septum should be repaired surgically when it causes either a nasal obstruction or, in certain particular instances, a cosmetic deformity. To obtain the best results, the deviated septum should be surgically repaired during the rhinoplasty. This repair can include removal or reshaping of certain deviated portions of cartilage or bone that form the septum. Therefore, rhinoplasty surgeons should have experience not only in improving the outer esthetics of the nose, but also in repairing its functional aspects.
The cartilage has a “memory”
Cartilage and bone differ a great deal in their composition, and therefore the techniques used to modify them are different.To alter the shape of a bone, the surgeon can simply break it, reposition it, and let it heal in the desired position. Cartilage is quite different, however. If one looks at the ear, which is composed entirely of cartilage, it has a very characteristic shape with a variety of curvatures and folds. If one bends the ear and then releases it, it immediately returns to its original shape. This elasticity is what is sometimes referred to as the “memory” of the cartilage. This makes cartilage more challenging for the surgeon to work with. He needs to employ various maneuvers to overcome this memory and ensure that the modifications will be permanent.
Dr. Samaha uses his expertise and extensive experience in both esthetic and functional nasal surgery for the benefit of his patients. This allows him to achieve an optimal esthetic result while maintaining the key functional components of the nose. His patients appreciate their pleasing, natural esthetic result in a nose that breathes well.