Nasal soft tissue envelope in Caucasian patients seeking for reduction rhinoplasty: a radiological study

The soft tissue envelope (STE) of the nose contributes, along with the osteocartilaginous framework, to the nasal shape and contour. Its manipulation may pose challenges during reduction rhinoplasty, influencing aesthetic outcomes.

A retrospective study was performed in patients who underwent nasal computer tomography (CT) in our medical institution, from 2015 to 2018. On sagittal CT scans, at midline, nose length, hump height, hump length, nasofrontal angle, STE thickness, and average thickness were measured. Patients seeking primary rhinoplasty for dorsal hump reduction were compared to a control group.

The study population included 136 Caucasian Mediterranean patients (42 males; 94 females) with a mean age at nasal CT of 32.9 years. Patients seeking rhinoplasty presented a longer nose (p < 0.001) and a wider nasofrontal angle (p < 0.001). Nose length presented a significant positive correlation with both nasal hump length (r = 0.465, p < 0.001) and height nose length (r = 0.479, p = 0.002) as well as with the average STE thickness (r = 0.25, p = 0.02). Male patients presented a higher STE average thickness (4.8 ± 0.5 mm vs 3.9 ± 0.6 mm, p < 0.001). Age did not present a statistically significant correlation with any of the STE measurements. The nasal STE was thickest at the nasofrontal suture in both groups. The thinnest point of the STE was found in the rhinion in control patients, whereas in patients seeking rhinoplasty, this corresponded to the nasal hump’s apex. STE thickness over the ethmoidal point was thinner in patients seeking rhinoplasty (p < 0.001).

Through the imagiological analysis of anatomical landmarks in patients seeking rhinoplasty, our study contributes to a more objective characterization of the nasal soft tissue envelope, whose evaluation in clinical practice is usually dependent solely on the eyes and hand of the surgeon with no clear reproducible measurements. In our study, nose length correlated with the STE thickness, and the hump apex was the thinnest point of the STE in patients seeking rhinoplasty. This statement is supported by previous studies in cadaveric specimens and backs up the surgical concept that preservation rhinoplasty should encompass the preservation of important soft tissue envelope structures and not only the osteocartilaginous vault.

Level of evidence: Level IV, Diagnostic.