The new anatomical viewpoint of the nose: the interdomal fat pad

To the plastic surgeon, the nose is one of the most interesting and challenging facial structures and its anatomy is well defined. From the point of view of aesthetic surgery, the nasal tip area is an especially important structural unit, and the most difficult to address in rhinoplasty. The objective of this study was to demonstrate the existence of the nasal interdomal fat pad as a distinct anatomical structure that occupies the interdomal space and is apart from subcutaneous fat. In our study we proved the existence of the interdomal fat pad by histochemical studies and anatomical observations in 88 patients who underwent primary external rhinoplasty and three fresh cadavers. All specimens were examined by hemotoxylen-eosin, Sudan black, and oil red staining, as well as S100 protein immunoreactivity staining. The mass of the interdomal fat pad was greater in patients with bulbous noses and/or divergent alar cartilage than in patients with thin skin. We speculated that the interdomal fat pad may be the major anatomic structure contributing to unexpected results in difficult cases, such as those involving bulbous noses. According to our study, the existence of the interdomal fat pad should be kept in mind during the preoperative planning of rhinoplasty.