The interdomal fat pad of the nose: a new anatomical structure

The nose is one of the most operated organs in the body and its anatomy has been well defined by plastic and ENT surgeons. Although rhinoplasty is the most commonly performed operation in plastic surgery, some unexpected results and complications may be related to unknown or unclarified anatomical structures in the nose. We aimed to evaluate the interdomal region in four fresh cadavers and 24 patients who underwent open rhinoplasty, since the nasal tip area is the most difficult part of the rhinoplasty. Detailed cartilage and soft tissue interactions were studied in fresh cadavers. The existence of the interdomal fat pad as a separate anatomical structure was proven in necropsy specimens from cadavers using various histochemical dyes. Nasal tip ultrasonography was performed preoperatively in patients who underwent rhinoplasty. All patients had a fat pad in the interdomal space, of varying sizes, but fatty (bulbous) noses had larger fat pads. Interdomal fat pad tissue, which occupies the interdomal space, was demonstrated by ultrasonography. The size of the fat pads varied from 1.2 mm x 2.4 mm to 3.6 mm x 5.2 mm. Anatomical observation and biopsies were performed during surgery. Finally, surgical and radiological anatomy of the interdomal fat pad was demonstrated in all cadavers and patients. We speculate that the interdomal fat pad is an important anatomical structure and may contribute to unexpected postoperative results in rhinoplasty. This newly defined fat pad can be assessed by ultrasonography, a safe and inexpensive technique. The surgical approach to the interdomal fat pad is solely through open rhinoplasty technique. Thus, a consideration of the interdomal fat pad and detection of its size preoperatively may play a key role in choice of technique and success of rhinoplasty.