The Lower Nasal Base: An Anatomical Study

Abstract

Currently, most rhinoplasty surgeons focus their analysis and operative techniques on the upper nasal base, with its alar cartilages. They tend to minimize the lower nasal base, composed of the columellar base, nostril sills, and alar lobules. The requisite operative techniques are often considered ancillary techniques. In this article, the authors describe anatomical composition of the columellar base, nostril sill, and alar lobule; discuss the presence of a distinct lower nasal base; and reevaluate the nasal musculature and the nasal superficial muscular aponeurotic system in an anatomical cadaver model. They also discuss the results of both a detailed literature review (for articles related to the levator labii superioris alaeque nasalis, orbicularis oris, depressor septi nasalis, myrtiformis, and dilator naris) and the results of their own dissection of 45 fresh cadavers.

Effect of the Depressor Septi Nasi Muscle Modification on Nasal Tip Rotation and Projection

“…Many of the facial muscles affect the nose and specifically the lower nasal base [23]. Although we did not evaluate the smile in this study, many surgeons consider the depressor septi nasi as the main contributor to a plunging nasal tip.…”

Easy Recognition of Caudal Lower Cartilage Rim Localization for Marginal Incision in Tumescent Rhinoplasty

“…Kamburoğlu et al [4] set the marginal incision 3-4mm from the skin rim regardless the cartilage can be some millimeters ahead. A cadaveric study sets the variable distancies that can be observed among patients [5]. Direct palpation is technically a challenge because of the expertise the surgeon needs to have.…”

“…Marginal incisions are described by many manners: while some authors use metrical distances [3,4], others use anatomical landmarks [5], or direct palpation [6,7], which is difficult in thick skin patients. In this paper, we describe a new anatomical landmark that appears after tumescence rhinoplasty technique and how this fold affects to the surgery in terms of reducing operative time.…”

The Plunging Tip

“…8 In addition, many of these muscles affect the nose and specifically the lower nasal base. 9 It is implausible that this perceived plunge could be attributed to a single muscle. Specifically, the actions of the depressor septi nasi (DSN) and, less commonly, the levator labii superioris alaeque nasi (LLSAN) have been attributed to the tip that "plunges" on smiling.…”

“…11 The LLSAN has a labial and alar portion the insertion of which is into the upper lip as well as the nasal alae and accessory cartilages at the level of the pyriform aperture, respectively. 9 It is an obvious target when trying to correct the smiling deformity.…”