There are many variables in nose surgery. So, we have put together an article to explain the nose anatomy, common nose shapes and problems, and a glossary of words that you should know. This will not only help you better explain your desires to your surgeon, but it will also help you better understand what can and cannot be done.
How your nose looks is very important when talking about aesthetics and beauty. Every nose is a different shape and many of us are not happy with how ours looks. Rhinoplasty is a surgical procedure that aims to reshape the nose to improve how it looks.
Nose jobs require a very skilled surgeon to achieve the perfect result. Your ENT or plastic surgeon needs to take a lot of factors into consideration when operating, since each nose is different, and each patient wants a different look.
Anatomy of the Nose – Surface Anatomy
First, the surface anatomy which describes the visible parts of the nose without the structures that form it on the inside. The visible anatomy of the nose includes:
- The Radix: The highest point of the nose, directly in between your eyes.
- The Dorsum: Also called the bridge. It’s the part of the nose that runs from the radix to the tip of your nose.
- The Columella: The straight column between your two nostrils
- The Alae: These are the side boundaries of the nostrils. Each side is called “Ala” and the plural is “Alae”.
Anatomy of the Nose – Below the surface
Underneath the surface anatomy (as explained above), there’s bone and cartilage. This is what gives the nose its shape. The nose can be divided vertically into 3 parts. The upper third is formed by the nasal bones. While the middle third by the upper lateral cartilages. And, the lower third from the alar cartilages:
- Nasal bones: These bones are not very hard, and are usually shaved during rhinoplasty to form the desired look. The nasal bones give the bridge of the nose its shape and projection.
- Upper lateral cartilages: Cartilage is a type of firm tissue that’s much softer than bone. It starts right below your nasal bone, in the middle third of your nose. You can try to feel it yourself (it’s the soft compressible part). These cartilages keep the nostrils widely open, and if they’re weak, your nose can have a “pinched” appearance
- Alar cartilages: These are very important as they give your nose tip its appearance and are usually manipulated during rhinoplasty. These cartilages underlie the tip of the nose, the columella, and the alae.
- Nasal septum: This is the wall that runs in the middle and separates the right and left nasal cavities from each other. You’ve probably heard of the term “deviated septum”, which refers to a problem in the nasal septum.
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Who needs a Nose Job?
Rhinoplasty can be done for a variety of cosmetic and medical reasons. Here’s a list of the possible problems that might make you consider having a nose job:
The dorsum, also known as the bridge of the nose is the region extending from the radix to the tip. The ideal dorsum should be a straight line with minimal curvature. Some common dorsum problems include:
- Large dorsal hump: This is when the dorsum projects excessively and is curved to the outside, causing a hump. It’s a common problem that is caused by enlarged nasal bones and cartilages.
- Wide nose: This can mean that the nose is wide at any part: the upper dorsum (dorsal bridge), middle dorsum (dorsal base), the tip, or the nostrils. You might feel that your nose is wide at any of these locations in a way that’s not proportional to the rest of your face.
- Under-projected dorsum: Usually associated with an under-projected nasal tip (explained below). An under-projected dorsum is one that is short and does not project enough outside the face.
- Saddle deformity: This usually happens after over-correction of a large dorsal hump, when too much tissue is shaved off. The dorsum appears like a “ski-slope”, with an inside curvature.
The tip is made of the alar cartilages. This supports the nostrils from the sides and gives the tip projection in the middle. Some nose tip problems include:
- Droopy tip: This is when the tip is pushed downward. This is commonly caused by a large nasal septum that pushes the alar cartilage down causing a droopy tip.
- Over-projecting tip: Also called “Pinocchio Nose”. Refers to when the tip projects too much outside the face, usually as a result of large alar cartilages.
- Under-projecting tip: This is when the nasal tip does not project enough away from the nose. It can be associated with an over-projecting dorsum (hump), or an under-projected dorsum.
- Bulbous tip: When the nose tip is either too large or wide.
- Boxy tip: When you look at the nose from below, it should resemble a triangle with the tip of the nose as the top corner, and the alae as the sides. If the nose appears as a rectangle, it’s said to have a boxy tip.
The alae are the sides of the nostrils. Some of the problems with the size and projection of the alae might include:
- Wide alae: This is when the alae project sideways too much, making the nostrils look wide sideways.
- Notched alae (nasal flaring): This is when the alae notch above their normal position so that the columnella appears from the sides, giving a “snarl” appearance.
- Asymmetric alae: When the right and left side of your nostrils are asymmetric.
Other nose problems
- Deviated nose: This is when the nose is deviated to one side of your face. This happens if you have a deviated septum, deviated nasal bones, deviated tip, or deviated upper lateral cartilages. Each of these problems requires a different surgical approach
- Airway obstruction: If you have trouble breathing through your nose, something might be blocking the way. This might be a deviated septum, enlarged turbinates, or another problem that can be diagnosed by a specialist surgeon.
What are the different types of rhinoplasty?
There’s the open rhinoplasty and there’s the closed rhinoplasty. These are two different techniques that surgeons can utilise when performing a nose job. Our surgeons have experience using both these techniques to deliver excellent aesthetic results, and they might combine the two to achieve the look you desire. Each technique has its uses in specific situations and can provide certain advantages over the other technique.
The open technique is mainly chosen when the problem is in either the tip or alae. A small incision is made in the skin of the columella (between your nostrils) and the excess tissue is taken away. The remaining tissue is then redesigned to achieve the desired shape. After which, the skin is closed, and usually, no visible scarring is left after healing.
The closed technique is chosen when the problem is mainly in the dorsum (bridge) of the nose. A small incision is made inside the nose to perform the surgery, and the skin is left untouched.
What can I expect after a nose job?
Our surgeons Dr Stephen Kleid, MB BS FRACS Ear, Nose and Throat Surgeon and Dr Richard Sackelariou FRACS (Plas) are some of the top plastic and ENT surgeons in Australia who offer rhinoplasty with excellent results.
They will discuss your concerns with you and try to learn what it is that you don’t like about your nose. Then they will explain how they can help make your nose more aesthetically pleasing and more proportional to the rest of your face.
After surgery, you can expect some discomfort, swelling, pain, congestion, and bleeding for the first week. However, this will get better as the days pass, and should not last more than a week or two. You should know that full recovery might take a long time, and your nose will not settle into its final shape until at least a few months have passed.
It’s important that you have realistic expectations about what the surgery can achieve as well as the shape of your new nose. Hopefully, your surgeon will do his/her best to give you the beautiful nose you’ve always wanted and you’ll be very happy with the overall improvement in your facial aesthetics.
Before and After Photos of Nose Surgery
Below are a few before and after photos of real patients with real results. If you would like to see more before and after photos you can visit – 90 real patient nose job Before and After Photos – Rhinoplasty and Septoplasty. Our surgeons are highly experienced and the results on our website speak for themselves.
Glossary – Some important rhinoplasty and nose surgery words
Bony vault: The bony part of your nose, also includes the nasal bones and bony septum).
Bulbous tip: A nose tip that’s too large and too round.
Cartilage: A type of tissue that is softer than bone and is responsible for maintaining the nose structure.
Cartilage graft: Cartilage tissue that is taken from another part of your body, for example, your ear, which is then grafted into the nose to treat certain conditions.
Columella: The narrow strip of tissue that separates the nostrils, also called the columella.
Columellar Show: The height of the columella showing from the sides.
Caudal Excess Deformity: A cosmetic deformity of the nose where the septum is too long and the upper lip is too short.
Closed rhinoplasty: A type of surgical incision in which no external skin incision is done.
Cocaine Nose: A deformity that’s often seen in cocaine abusers, where the nasal dorsum collapses and the septum is perforated.
Deviated septum: The cartilage that separates the nostrils is misaligned which can cause partial nasal airway obstruction.
Dorsum: The nasal bridge.
Edema: Tissue swelling.
General anaesthesia: Either injectable drugs or gases given to ensure you are asleep during surgery and feel no pain.
Hanging Columella: An above-average columellar show, where the columella is over-protruding downward and a big part of it is showing from the sides
Hematoma: Blood collection beneath the wound.
Intravenous sedation: Sedatives administered by injection into a vein to help you relax, however, you won’t be completely asleep.
Local anaesthesia: A drug injected directly to the site of surgery to numb it so that you won’t feel any pain.
Mucosal lining: The thin layer of tissue that covers the surface of the septum as well as the inside of the nose.
Nasolabial angle: The angle between your columella and your upper lip.
Nasofrontal angle: The angle between your radix and your forehead.
Necrosis: Tissue death.
Nasal septum: A wall of bone and cartilage located in the middle of your nose to separate the two nasal cavities.
Osteotomy: Removal of part of the nasal bone.
Open rhinoplasty: A surgical technique where a skin incision needs to be done.
Open Roof Deformity: Formation of a gap between the nasal bones due to overcorrection of a large dorsal hump.
Projection: How much your nose protrudes in front of your face.
Radix: The highest part of your nose, almost directly between your eyes.
Rhinoplasty: Surgery to reshape the nose.
Septoplasty: Surgery to correct and straighten the septum.
Seroma: Fluid collection beneath the wound.
Turbinates: Large bony bumps in your nasal cavity coated by a mucosal lining that serve different physiological functions. Turbinate overgrowth can also lead to breathing difficulty.
If you would like to learn more about Nose Anatomy or Rhinoplasty you can read more by clicking any of the links below;
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