Anatomy of a rhinoplasty: emphasis on the middle third of the nose

The nose is an organ that serves many functions. These functions are intimately involved in an organ that occupies a very aesthetically prominent position on the face. A thorough knowledge of the anatomy is of the utmost importance for surgeons attempting to preserve or improve the functional capability and the aesthetic appearance of the nose. Nasal anatomy is extremely complex with a myriad of different three-dimensional variances. The middle third of the nose has largely been overlooked in its importance. The components of this portions of the nose consist of the paired upper lateral cartilages, the dorsal aspect of the septum, and the scroll of the upper lateral cartilages upon the lower lateral cartilages. This area is of key importance to the nasal valve area and can have a major impact on the functional capabilities of the nose. A description of the confluence of the flare of the septum to the upper lateral cartilages is necessary for an understanding of changes that may occur during rhinoplastic operations. A knowledge of the anatomy of the middle third of the nose may prevent nasal valve collapse, a pinched appearance of this portion of the nose, or an aesthetically unappealing appearance.