The Oriental nose: an anatomical basis for surgery

Fifteen Oriental noses were examined macrosurgically and microscopically. Five soft tissue layers overlying the osseocartilaginous framework are identified: the skin, the subcutaneous areolar plane, the vascular-fibromuscular layer, the deep areolar plane and perichondrium/periosteum. Two natural planes of dissection are represented by these areolar planes which separate the nose into an overlying skin envelope, a vascular-fibromuscular layer and an underlying osseocartilaginous framework. The cartilaginous framework provides projection, support and shape to the dorsum and tip of the nose but not to the alar lobule as this is devoid of cartilage. As there is no cartilage in the Alar lobule, the term 'Alar Cartilage' is misleading and the term 'Tip Cartilage' is introduced to replace it. The skin of the nose is specialised and has the ability to retain its shape even after dissection. This is due to an arrangement of elastin fibres in the upper dermis and the subcutaneous areolar plane which confers elasticity to the skin especially in the region of the Alar lobule which is a skin and fibromuscular sandwich. The vascular fibromuscular layer is like a sheet draping the osseocartilaginous framework. The main arteries of the nose lie on this layer. Injection studies of the blood supply reveal many arterial variations but always a distinct alar artery, columellar artery and alar plexus that have not been previously named. The alar groove is a junction between the alar lobule which is soft tissue alone and the tip which is soft tissue, supported by cartilage. The alar groove lies over the lateral edge of the tip cartilage and here there is muscular attachment to the fibromuscular layer.