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Applying the Tent Concept to Understanding the External Structure of the Nose

External Structure of the Nose

Applying the Tent Concept to Understanding the External Structure of the Nose

Every year half a million people seek consultation to enhance the appearance of their nose. Some are unhappy with the nose they were born with or the way it has aged. Others have suffered a traumatic injury which causes disfigurement or an inability to breathe appropriately. Before considering nose surgery, it is important to understand the anatomy and function of the nose. Dr. Barrera will evaluate your nasal function and address your cosmetic concerns. A proper facial analysis balancing medical expertise and your specific concerns will be performed.

The appearance of the nose is the result of a complex relationship between a soft tissue envelope and a bony and cartilaginous skeleton. Nasal airway support is largely affected by the bone and cartilage framework underneath the skin.

The soft tissue envelope is like a tent. The shape and contour result from the interaction between the soft tissue envelope and the underlying scaffold. If we remove the external fabric of the tent, we will see the scaffold underneath.

Tent

 The soft tissue envelope is thicker superiorly and inferiorly, and thinnest over the midportion of the nose.

This is an important consideration in any manipulation of the nasal profile.

 

 

 

Nose

Variations in the soft tissue envelope can affect rhinoplasty outcomes. The skin thickness, skin texture and elasticity, and skin type can all affect rhinoplasty results. Dr. Barrera will make note of this during your examination and counsel patients to the limitations it may present.

 

 

 

 

 

Let’s review the tent fabric or soft tissue envelope. The layers of the envelope are:

Epidermis and dermis of the skin

Subcutaneous tissue

Nasal SMAS

Areolar tissue (which is the dissection plane for rhinoplasty)

Perichondrium and periosteum

 

The nasal bones are paired structures that extend from the frontal bone above to the upper lateral cartilages below and maxilla laterally.

Another often overlooked component of the soft tissues of the nose are the fibrofatty tissue complexes in each ala.

These are very important in alar support, and require cartilage support during recontruction, even if the alar cartilage itself is not resected. If the lower lateral carilages are either vertically oriented or over resected from previous rhinoplasty, patients will have difficulty breathing and may require functional rhinoplasty to repair the nasal valve of the nose.

nose2