A SIMPLE WAY TO THINK OF THE NOSE
A simple way to understand the nose is to think of it as a tent. This tent is divided into three parts. The upper third, the middle third and the lower third. It is pitched and given structural support by bone in the upper third, bone and cartilage in the middle third and cartilage only in the lower third.
The lining of the nose is modified hair bearing skin at the nostrils and transitions to mucosa superior early. The purpose of this part of the mucosa is to humidify the air destined for the lungs. The lung alveoli need humidified warm air before they can extract oxygen. The increased surface area afforded by the protrusions into the nose increases the nose’s ability to humidify this air. At the root of the nose where inside only a thin plate of bone separates the brain from the outside world projections from the olfactory nerve into the nose gives specialised mucosa which confers our sense of smell. This is vital for our sense of taste and of course can be affected by any surgery to the septum of the nose or trauma to the face.
The lower third of the nose and tip are supported by the cartilaginous septum and are shaped by their lower lateral cartilages. Simply spoken this part of the nose gives the tip of the nose its definition and shape. The middle third is defined by the cartilaginous septum which often gives the shape of the dorsal hump and the upper lateral cartilages which define part of the width of the nose in this section. The upper third is defined by the nasal bones. These are some of the thinnest bones in the body. As such are easily prone to fracture by trauma or controlled force. Their problems can define the width of the nose, the angle of the nose and its roots with the upper face and of course nasal prominence in this region.
Any rhinoplasty surgery or nose job involves appropriate manipulation, resection, reshaping and re-draping of these structures. The overlying skin has unique characteristics in different patient population. In general, the upper third is the thinnest skin the middle third is of medium thickness and oiliness and the lower third some of the thickest and oilier skin in the body. This has impact on the final result of surgery. In people with very thin skin any console irregularity is likely to be seen and felt. Equally, those with thicker skin, any manipulation or resection is more likely to be camouflaged by the overlying draped thick skin.
