Rhinoplasty Glossary of Terms
Ala literally means “wing”. This term describes the outer portion of the nostril that you would pinch in, for example, if you wanted to pinch your nose. See Alar Base and Alar Base Reduction. It is principally composed of soft tissue but has a receding cartilage that runs superiorly known as the lower lateral cartilage (See Lower Lateral Cartilage). From a profile view, a normal oval shape should be created with the columella (See Columella and Alar-Columella Disparity). The ala is part of the external nasal valve (See External Nasal Valve) and may need reconstruction from over-aggressive previous rhinoplasty (See Alar Retraction) for example with an Alar-Batten Graft (See Alar-Batten Graft).
Looking at the bottom of the nose, you will see the ala (See Ala), that can be too wide in some individuals, especially in ethnic noses like African-Americans and SouthEast Asians. The base view of the nose should ideally form an isosceles triangle with the width not being too wide. (See Alar-Base Reduction.)
Alar Base Reduction
In ethnic noses (and some non-ethnic noses), the alar base (see Alar Base) may need to be reduced in width. Dr. Lam relies on two types of nasal base reductions to create a narrower base to the nose: a Sheen flap, in which the outer portion of the nose is reduced (a modification of the Weir reduction, See Weir Reduction) to decrease the flare of the nostril and a Nasal Sill Reduction (See Nasal Sill) that reduces the width of the nostril. By avoiding the classic Weir reduction, the patient is able to avert a pinched and cut-off appearance that may be seen in some celebrities like Michael and Janet Jackson. The natural alar shape should still be round after reduction.
A type of structural graft placed on the inside surface of the lower lateral cartilage (See Lower Lateral Cartilage) that makes up the ala (See Ala) in order to improve the strength and shape of the ala and thereby maintain and enhance patency of the External Nasal Valve (See External Nasal Valve). The graft functions like the flying buttresses that support a wall in Romanesque architecture.
A profile view of the nostril should show a perfect oval shape of the nostril created by the higher ala (See Ala) and the lower columella (See Columella). Alar-columellar disparity exists when a perfect oval does not exist either due to Alar Retraction (see Alar Retraction) and/or a hanging columella (a columella that is too low).
Alar retraction is a telltale sign of previous rhinoplasty that may cause Alar-Columella Disparity (See Alar-Columellar Disparity) in which the ala (See Ala) is notched upward usually due to a rim incision (See Rim Incision) being made instead of the recommended marginal incision (See Marginal Incision). Alar retraction can cause both functional breathing problems (see External Nasal Valve) and an unaesthetic appearance.
A variation of the Alar-Batten Graft (See Alar-Batten Graft) that is placed to recontour a pinched in lateral lower cartilage (see Lower Lateral cartilage) or to prevent the occurrence of a pinched tip following a dome-binding suture (See Dome-Binding Suture).
Augmentation rhinoplasty refers to creation of a larger nose, for example a higher nasal bridge and/or a larger more defined nasal tip that is usually the objective for ethnic noses as compared with the more typical objective of Reduction Rhinoplasty (See Reduction Rhinoplasty) for the Caucasian nose.
The bottom of the nose. See Alar Base.
A type of flap used to reconstruct the nasal tip when tissue has been lost through trauma or more commonly cancer-related soft-tissue loss. The principle of the bilobed flap is to recruit more elastic and mobile tissue of the bridge of the nose to the relatively inelastic nasal tip through rotating the upper bridge skin (very lax) into the middle bridge skin (moderately lax), which in turn is then rotated into the nasal tip defect (relatively inelastic). The term bilobe refers to the the two sequential lobes that are rotated successively to fill the nasal tip defect.
A knuckled appearance to the nasal tip that can appear after previous aggressive rhinoplasty, usually following a Goldman procedure (or Goldman tip) in which the dome is transected (see Dome).
A nasal tip that appears like a box, i.e., too wide and square due to overgrowth of strong Lower Lateral Cartilages. Usually, the boxiness of the cartilages is apparent due to thin overlying skin of the nasal tip.
This term refers to the full, round nasal tip that would benefit from reduction, similar to (and at times interchangeable with) the term Boxy Tip (See Boxy Tip) but generally more specifically used to refer to a rounder configuration.
A nasal tip that exhibits Bulbosity (See Bulbosity).
The little hair-like structures inside the nose designed to clear liters of nasal mucus on a daily basis. Following septoplasty, the cilia can be dysfunctional for a few days to a week and cause some unwanted nasal discharge. These microscopic hair-like extensions should not be confused with nose hairs that you trim for cosmetic reasons known medically as vibrissae (See Vibrissae).
Closed Reduction of Nasal Fracture
Less than a week following nasal fracture, the broken bones have not been entirely set yet. Pushing the bones back into position is relatively easy using a knife handle and does not require rebreaking the bones with an osteotome (see Osteotomy and Open Reduction of Nasal Fracture).
A type of rhinoplasty in which there is no incision made across the columella (See Columella). See External Rhinoplasty as a contrast to closed rhinoplasty. Also known as an endonasal rhinoplasty.
The columella is the central portion of the nostril that is composed of soft tissue overlying the cartilage structures known as the medial crura (See Medial Crura).
See Alar-Columella Disparity
A cartilage graft typically composed of harvested septal cartilage ensconced between the medial crura (See Medial Crura) of the columella (See Columella) used to maintain nasal tip support necessary following rhinoplasty.
The cartilage shaped like a bowl, hence the term conchal bowl, of the ear that lies just adjacent to the ear canal. This cartilage is used as grafting material for the nose, especially in cases of revision rhinoplasty.
A rhinoplasty procedure intended solely for cosmetic purposes unlike a functional rhinoplasty (See Functional Rhinoplasty) which is designed to correct breathing problems.
A test using either a cotton-tipped applicator (Q-tip) to stent the internal nasal valve (See Internal Nasal Valve) or using a finger to retract outward the middle vault of the nose (See Middle Vault) to test for internal nasal valve collapse.
The dome describes the recurvature of the lower lateral cartilage (See Lower Lateral Cartilage) that also represents the junction between the medial and lateral crura (See Lateral Crura and Medial Crura). Also See Dome-Binding Suture.
A suture used to tighten and reconfigure the shape of the nasal dome (See Dome) in order to create a finer, narrower nasal tip shape used during rhinoplasty.
Along the dorsum (See Dorsum), or bridge of the nose. Dorsal also describes the relative direction of the parts of the nose as opposed to ventral (the opposite of Dorsal and describes the part of the nose that touches the face), Cephalad (toward the forehead) and Caudal (toward the upper lip).
The bridge of the nose.
See Closed Rhinoplasty. The preferred term today for closed rhinoplasty.
expanded polytetraflouroethylene, see Gore-Tex
Extended Spreader Graft
A longer spreader graft (See Spreader Graft) that extends further inferiorly in order to lower a contracted nasal tip or a naturally short nose that is over-rotated and under projected. See Rotation and Projection.
External Nasal Valve
In short, the nostril. This structure that is composed of the U-shaped lower lateral cartilage (see Lower Lateral Cartilage) is an important structure that regulates nasal airflow and can be compromised due to surgery, trauma, or congenital (birth) predisposition.
A type of rhinoplasty that Dr. Lam prefers to perform in which a small incision is created across the columella (See Columella) that helps improve direct visualization of all nasal structures during Rhinoplasty. An external rhinoplasty has also been referred to in the past as open rhinoplasty or open-structure rhinoplasty, although today the term external rhinoplasty is more in vogue. For contrast, see Closed Rhinoplasty.
See Paramedian Forehead Flap
Rhinoplasty performed for breathing problems rather than cosmetic purposes. A rhinoplasty can be both functional and cosmetic. (See Rhinoplasty, See Cosmetic Rhinoplasty.)
A type of synthetic material that Dr. Lam uses to build a depressed nasal bridge used during Augmentation Rhinoplasty (See Augmentation Rhinoplasty). In Dr. Lam’s opinion, it is not ideal for nasal tip augmentation (although some surgeons use it for this purpose). Dr. Lam prefers Gore-Tex over silicone due to its relative opacity, thinness, lack of encapsulation, lightness, and improved tissue fixation (but still ease of removal if need be). Gore-Tex is a brand name trademarked by W.L. Gore & Associates from Flagstaff, Arizona. As of November 2006, W.L. Gore has stopped the manufacture of Gore-Tex for the cosmetic market. However, most surgeons still refer to expanded polytetraflouroethylene (ePTFE) as Gore-Tex. Currently, a “Gore-Tex” equivalent that is comprised of the same expanded polytetraflouroethylene (ePTFE) is made by Surgiform for the cosmetic market. EPTFE comes in SAM (Subcutaneous Augmentation Material) sheets and solid blocks: Dr. Lam prefers the softness of the former for nasal augmentation.
A graft is a material used to build the structure or shape of the nose and can either be autogenous (from own’s own body like nose/ear cartilage and rib) or alloplastic (synthetic materials like Gore-Tex, See Gore-Tex).
An incision carried out inside the nose between the upper and lower lateral cartilages that can provide access to the nasal bridge for modification during closed rhinoplasty (See Closed Rhinoplasty).
Internal Nasal Valve
The internal nasal valve is considered the main regulator of nasal airflow in the Caucasian nose and is comprised of the anterior septum, the anterior head of the inferior turbinate (See Turbinate), and the angle that the anterior septum forms with the upper lateral cartilage (See Upper Lateral Cartilage). The angle between the septum and the upper lateral cartilage should be a minimum of 10 to 15 degrees to ensure patency. A Cottle Test can be used to distract the upper lateral cartilage to determine the compromise of the internal nasal valve. A spreader graft (See Spreader Graft) can be used to stent open this angle to help improve breathing. Internal nasal valve collapse can occur from overzealous hump reduction of the bridge, deviated septum, an oversized inferior turbinate, etc.
Inverted V Deformity
A visible inverted V that can be seen through the skin following rhinoplasty in an individual with short nasal bones who had a hump reduction and/or osteotomies (see Osteotomy).
John Orlando Roe
The “Father of Rhinoplasty”, a facial plastic surgeon, performed the first endonasal rhinoplasty (See Closed Rhinoplasty) in 1887.
The smooth flow of air in a non-turbulent fashion through the nasal passage. The inferior turbinate can help guide the flow of air and, in Dr. Lam’s opinion, should not be removed but only reduced by fracturing the turbinate bone (See Turbinate). A deviated septum can also obstruct laminar flow and create the sensation of obstruction.
Singular form for Lateral Crura. See Lateral Crura.
Plural form of Lateral Crus. The cartilages that extend across the ala (See Ala) and is joined with the medial crura that rests under the columella – both together comprise the lower lateral cartilage (See Lower Lateral Cartilage).
Lower Lateral Cartilage
The U-shaped cartilage structure that defines the tip and base of the nose and can be modified during rhinoplasty to create an improved appearance to the nasal tip. It is comprised of the medial and lateral crura (See Medial Crura and Lateral Crura). Also, it is the most flexible part of the nose as compared with the relatively immobile Upper Lateral Cartilage (See Upper Lateral Cartilage) in the central third of the nose and the fixed, immobile nasal bones of the upper third of the nose (See Nasal Bone).
The incision performed along the caudal (bottom) border of the lateral crura (See Lateral Crura) for access to the nasal tip used during both External and Closed Rhinoplasty (See External Rhinoplasty and Closed Rhinoplasty.) The outdated Rim Incision (See Rim Incision) can instead cause unfavorable Alar Notching/Retraction (See Alar Retraction) following Rhinoplasty.
Plural form of Medial Crus.
Singular form for Medial Crura. See Medial Crura. The medial crura describe the cartilages that compose the columella (See Columella).
See Upper Lateral Cartilage. The central third of the nose composed of the Upper Lateral Cartilage.
The pink lining of the inside of the nose lined by cilia (See Cilia).
The nasal bone forms the upper third of the nose and can be fractured during a severe blow to the nose.
The cycle in which the nose becomes more engorged on one side than the other that occurs every 4 to 12 hours accounting for why the nose may feel more obstructed on one side compared with the other during different times of the day.
See Sill, Nasal
See External Nasal Valve and Internal Nasal Valve
A colloquial term that is used for rhinoplasty. See Rhinoplasty.
The circular aperture of the nose opening. I hope I don’t need to define this term for all of you!
Nostril Sill Reduction
A type of alar-base reduction (See Alar-Base Reduction) of the nostril sill (See Sill, Nostril) to reduce the nostril size, which can be combined with a Sheen Flap (See Sheen Flap).
Open Reduction of Nasal Fracture
Greater than a week following nasal trauma, the nasal bones become fixed and must be fractured with an osteotome (See Osteotomy) like during Cosmetic Rhinoplasty to straighten the bones. Compare with Closed Reduction of Nasal Fracture.
See External Rhinoplasty.
Open Roof Deformity
After the hump on the bridge of the nose is reduced, the bridge appears to be flatter like a roof with the top, central part removed. Performing medial and lateral osteotomies (See Osteotomy) can close the open roof deformity, which is typically the last step in rhinoplasty. Note: some surgeons perform bridge modification as the first step during rhinoplasty instead.
The act of surgically fracturing the nasal bones in order to close an open roof deformity (See Open Roof Deformity) following a hump reduction of the nasal bridge or to realign broken nasal bones during an open reduction of nasal fracture (See Open Reduction of Nasal Fracture). Osteotomies are generally classified as Lateral Ostetomies and Medial Osteotomies.
Paramedian Forehead Flap
A flap from the forehead that is used to reconstruct the outer skin of the nose after traumatic or more commonly cancer-related soft-tissue loss. The flap requires at least two separate operations to perform. The first operation involves rotating the forehead flap onto the missing nasal tissue while leaving the blood supply from the forehead’s supratrochlear artery. Several weeks later, the flap’s blood supply is severed and the flap is inset. Several months later, additional refinements and trimming may be necessary to create the ideal aesthetic outcome. Surprisingly, the forehead flap provides the best color and texture match to the nose than any other tissue other than from the nose itself.
The unaesthetic appearance of a nasal tip that has been overly and unnaturally narrowed in configuration.
An anatomic term used to describe the fibrous adhesions that join the domes together.
A type of deformity that occurs when an inexperienced rhinoplasty surgeon takes down a dorsal hump by only rasping the nasal bone and thereby making the principal hump which is primarily cartilage in nature even bigger in appearance resembling a parrot’s “pollybeak.” See Upper Lateral Cartilage.
The degree to which the nose tip stands forward of the face from the profile view. A nose that appears too retruded or short (like in certain ethnic noses) is described as under projected. A nose that appears to be too far forward to the face is known as over projected. There are certain mathematical formulae to describe aesthetic nasal projection like Goode’s Rule.
The opening of the nose (i.e., the hole) seen on a skull. The lateral osteotomy (See Osteotomy) is near or on the Pyriform Aperture.
The upper recess of the nose between the eyes that is composed of thick nasal bone and which defines the nasal-frontal angle. It is also the point where the nose “begins” and is referred to as the “starting point” by some surgeons. Generally, the ideal starting point for the nose in the Caucasian patient is approximately at the crease of the eyelid. Dr. Lam prefers a more conservative nasal profile and height for the Asian patient with the starting point approximating the central portion of the nose or at the very limit the eyelashes.
A shortened term that some surgeons use to describe “rhinoplasty” or a type of animal with a large proboscis.
Commonly referred to as a “nose job”, rhinoplasty simply means to change the shape of the nose. Most commonly, rhinoplasty describes a cosmetic procedure (See Cosmetic Rhinoplasty)
The incision performed along the edge of the nostril skin to access the nose in the past that created unfavorable notching of the ala (See Alar Retraction) over time following rhinoplasty. Today, a marginal incision is preferred instead to avoid this type of complication. (See Marginal Incision.)
The opposite of Augmentation Rhinoplasty (See Augmentation Rhinoplasty) that is intended to reduce a nose that is seemingly too big like a bridge that is too high or a nasal tip that is too wide or bulbous (See Boxy Tip and Bulbous Tip.)
A rhinoplasty (see Rhinoplasty) performed to correct a previous rhinoplasty, that may have led to an unacceptable functional deficit (breathing) and/or cosmetic deformity.
A graft harvested from the cartilage portion of one’s rib or from irradiated cadaveric rib used to rebuild part of the nose when grafting materials conventionally harvested from the septum and the ear are depleted or insufficient. Rib grafts may be necessary in severe forms of trauma, cancer and/or complicated revision rhinoplasty (See Revision Rhinoplasty) procedure.
The degree to which the angle of the nose tip makes with the upper lip. The more obtuse the angle, i.e., the higher the position of the nose tip, the greater is considered the rotation. The more acute the angle (the lower the nose tip is relative to the upper lip), the lesser the extent of rotation. Therefore, a nose tip that is too upturned is considered over-rotated. And a sagging nasal tip is considered under-rotated. A male nose in general should be around 90 to 95 degrees relative to the upper lip and a female nose should be slightly more rotated at 95 to 105 degrees.
A second-time rhinoplasty, See Revision Rhinoplasty and Tertiary Rhinoplasty
Modification of the septum performed to alleviate breathing problems that arise from a deviated or crooked septum. A septoplasty can also be undertaken to harvest cartilage as grafting material (See Graft, Grafting) during rhinoplasty. Dr. Lam routinely performs a septoplasty during his rhinoplasty, which can be also called septo-rhinoplasty. Another term that surgeons use to describe a septoplasty is submucous resection or SMR. Although a small degree of distinction exists between the two terms, suffice it to say that they can be used interchangeably.
The septum describes the structure that serves as a partition between the two sides of the nose. It is composed of a central cartilage structure (quandrangular or quadralateral cartilage) anteriorly and a bony component supero-laterally (the ethmoid bone) and infero-laterally (the vomer). It is lined with mucosa (See Mucosa) and can be modified in structure via a septoplasty (See Septoplasty) for breathing purposes or for grafting material during rhinoplasty.
A Sheen Flap is a type of Alar-Base Reduction (See Alar-Base Reduction) that preserves the natural curvature of the outer nostril shape. The major objective is reduction in the flare of the nostril but not necessarily to reduce the nostril size, which is undertaken via a nostril sill reduction (See Nostril Sill Reduction).
See Tip Graft
There are two principal types of silicone, liquid and solid. In the past, Dr. Lam used solid silicone implants for augmentation rhinoplasty (See Augmentation Rhinoplasty). However, he now much prefers the use of Gore-Tex for bridge augmentation (See Gore-Tex). He still uses liquid silicone to make minor modifications to the bridge of the nose as needed.
The nasal sill is the shelf-like attachment of the nostril to the face which can be reduced during a nasal sill reduction (See Nasal Sill Reduction). It can be thought of as the posterior aspect of the nostril that rests on the face and adjoins the alar curvature (See Ala).
The soft triangle refers to the anterior most aspect of the nostril. Specifically, it refers to the soft tissue overlying the dome (See Dome) that is very sensitive to disruption, deformity, and notching if the surgeon is not careful during surgical manipulation and wound closure. It is also an area that bears special mention during cancer reconstruction of the nose.
The rigid plastic and metal device applied to the outer bridge of the nose for the first week following rhinoplasty to maintain nasal shape during healing following osteotomies. There are many brands of nasal splints, including Aquaplast, Denver, etc. Dr. Lam prefers the Denver nasal splint for rhinoplasty.
A spreader graft is a graft usually derived from a straight piece of septum wedged between the upper lateral cartilage and the septum for one of several reasons: 1) to improve a collapsed middle vault (See Middle Vault and Inverted V Deformity), 2) to correct a twisted middle vault, 3) to stent a collapsed internal nasal valve (See Internal Nasal Valve). Also, the spreader graft can be placed with an extension down to the nasal tip (lower lateral cartilage) called an extended spreader graft (See Extended Spreader Graft) to help lengthen a nasal tip that is over-rotated, short, and contracted. The spreader graft can be placed either endonasally (i.e., via a closed rhinoplasty approach, See Closed Rhinoplasty) or via an external rhinoplasty approach (See External Rhinoplasty).
A third-time rhinoplasty, See Revision Rhinoplasty and Secondary Rhinoplasty.
Tip Defining Points
The two blanched highlights that are visible when the nose is viewed head on, especially visible with flash photography as two small white circles on the nasal tip. The white circles visible on flash photography or bright overhead lights correspond with the recurvature of the nasal tip cartilages known as the dome (See Dome).
A graft (See Graft, Grafting) that is used to structure the nasal tip. There are many types of nasal tip grafts. However, there are two major types: an onlay tip graft (a graft that rests on top of the nasal domes) and a graft that extends along the columella (See Columella) past the nasal tip called a Shield Graft. In general, Dr. Lam reserves these types of grafts for thick-skinned Asian patients, as he feels that over time they can become visible in thinner-skinned Caucasians and therefore are not worth the risk.
The nasal tip can refer to the entire base of the nose including both nostrils. However, Dr. Lam prefers to use the term to describe only the central 1/3 of the nose triangle viewed from the base perspective, also known as the Lobule.
A term used to describe only a selective cosmetic modification to the nasal tip and possibly the ala as well (See Nasal Tip and Ala).
The term to describe how the nasal tip is naturally supported through a system of major and minor ligamentous structures as well as those supports that must be reconstituted through grafts and sutures following rhinoplasty to maintain or enhance nasal tip position.
The concept developed by the late great Jack Anderson of how to conceive of the nasal tip as a tripod structure with the joined medial crura (See Medial Crura) being the inferior leg of the tripod and the lateral crura (See Lateral Crura) being the two remaining tripod legs. When the medial crura are lengthened, the tip achieves greater projection and rotation, and vice versa. When the lateral crura are lengthened, the tip achieves greater projection and less rotation – just like altering the legs of a tripod would.
The three paired structures that hang down in each nostril from the lateral nasal wall that serve to humidify, clean, moisten, and maintain laminar nasal flow, especially the inferior turbinate. The turbinates also protect major structures inside the nose: the inferior turbinate covers the opening for the nasolacrimal duct (tear duct), the middle turbinate has the opening for the maxillary sinus, frontal sinus, and ethmoid sinuses, and the superior turbinate has the opening to the sphenoid sinus. The anterior head of the inferior turbinate also forms part of the internal nasal valve (See Internal Nasal Valve) and can thereby obstruct airflow. Each turbinate is composed of an inner bone called a concha and surrounding mucosa. Dr. Lam believes that selective reduction of the anterior head of the inferior turbinate should be undertaken by gently fracturing the conchal bone while maintaining the surrounding mucosa so that the natural and important functions of the turbinate are maintained.
Upper Lateral Cartilage
The upper lateral cartilages are paired and compose the middle vault (See Middle Vault) of the nose. They are semi-mobile cartilages that along with the angle that they form with the nasal septum constitute the internal nasal valve (See Internal Nasal Valve), the main regulator of nasal flow in the Caucasian nose. When an individual has a prominent hump, about 80 to 90% of the hump is composed of excess cartilage in the region of the upper lateral cartilage. Most inexperienced rhinoplasty surgeons mistakenly believe that the hump is primarily a bony problem, and rasping of the nasal bone (See Nasal Bone) only worsens the size of the hump leaving a so-called Pollybeak Deformity (See Pollybeak Deformity).
See External Nasal Valve and Internal Nasal Valve
The medical term for nose hairs that serve to protect the nose from macro pollutants that may enter the nasal passage during breathing.
The older style of alar-base reduction (See Alar-Base Reduction) that can lead to an unnatural notched appearance to the ala (See Ala). Dr. Lam instead performs selective and combined Sheen flap (See Sheen Flap) and nasal sill reductions instead (See Nasal Sill Reduction).