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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.

Rhinoplasty tutorial >> The nasal bones >> page 3
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I have now added the skin to our diagram.  The blue line represents the skin of the nose.  The red line is the septum, and the black line is the framework of the nose -- the nose's side walls.  That framework, as we know, is bone in the upper half of the nose and cartilage in the lower half.  The skin is elastic, and it hugs the bony and cartilaginous framework underneath, giving the nose its size and shape.

The surgery is performed by using the incisions to sneak under the skin so we can see the bone and cartilage.  Then we alter the size and shape and position of the bones and cartilages, leaving the skin untouched.  After surgery, the skin will re-drape over the framework of the nose, "shrink-wrapping" to the new size and shape of the framework, giving us our results.


Click on any image in this tutorial to see a greatly-enlarged version
Above left we see the situation after removing the hump.  The skin was not disturbed.  The bone and cartilage comprising the hump were taken off.

But see what happens if we were just to quit there: the skin, when it conforms to the new shape of the nose, will show an unattractive flat spot along the dorsum.  The nose now looks too wide, and all we did was to take off the hump.

The mathematicians would say that a cross section of the nose has the approximate shape of a triangle, and by taking off the hump we have truncated that triangle, leaving ourselves with only the wide base.  We now need to narrow that wide base so the nose doesn't look too wide when we are done with surgery.


We narrow the nose by taking the side walls and moving them closer to each other, sliding them closer to the midline of the nose.  In the diagram above right, the black side walls of the nose have been moved closer to the septum in the middle.  Now when the skin conforms to the new nose, the hump is gone, but the remaining nose still has that pleasing gentle triangular cross section, without the flat spot that would appear if we didn't narrow the side walls.

In the diagrams above, it looks as though the skin (in blue) has a loooong way to go in order to shrink-wrap to the new bony framework of this hypothetical nose.  Of course, the diagrams exaggerate the actual situation, and there are a few surgical tricks, not diagrammed here, that help the skin conform.  The nasal skin only very rarely has a problem shrink-wrapping to the nose's new contours.



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All surgery depicted in this essay, except where noted, was performed by Dr. Denenberg