Soft Tissue Thickness Variations of the Nose: A Radiological Study

Abstract

Background Soft tissue thickness (STT) is a major factor affecting the outcome in rhinoplasty. However, limited information is found in the literature on the age- and gender-related variations of the nasal STT. Objectives The purpose of this study was to measure STT at various landmarks over the nasal framework and compare the age- and gender-related differences. Methods STT measurements were made at 11 landmarks in 325 patients by employing magnetic resonance imaging. Patients were divided into subgroups to compare the STT differences between female and male and between the age groups as young, middle age, and elderly. Results Soft tissue was thickest at the nasion and thinnest at the rhinion. The soft tissue coverage was significantly thicker in the male population at the supratip, tip, nasal bones, upper lateral cartilages, and alar lobules, whereas it is thicker in females at the rhinion. Average thickness of the soft tissues over the entire nasal framework increases with age except the rhinion. Conclusions The STT is variable over different parts of the osteocartilaginous framework. Gender and age influence the STT. The soft tissue is thicker at the distal half of the nose in male patients, and these areas become gradually thicker with age, whereas the soft tissue over the midvault becomes thinner. Increasing age presents a particular challenge to achieve predictable results in rhinoplasty, and an understanding of the soft tissue envelope allows for improved aesthetic outcome. Level of Evidence 2

Dermatological assessment of thick‐skinned patients before rhinoplasty—what may surgeons ask for?

“…So far, several objective methods such as computed tomography, magnetic resonance imaging, and ultrasound have been described to assess the thickness of the nasal SSTE. However, the standard of care is that surgeons rely on the clinical exam to make this assessment 3,5,11,12 …”

“…However, the standard of care is that surgeons rely on the clinical exam to make this assessment. 3,5,11,12 Patients presenting with either very thin or very thick skin can pose a challenge for the surgeon; in thin-skinned patients, even subtle irregularities of the OCF may become visible postoperatively as the SSTE-cushion's effect lacks, while thick-skinned patients pose a challenge to achieve highlighted nasal tip defining points, defined and narrow tip complex and well-defined aesthetic dorsal lines (Figures 1 and 2). 1,3,6,9,13 A thick nasal skin seems to have less ability to contract and redrape on the OCF after a size reduction rhinoplasty, bearing a high risk to produce a smaller but amorphous nose.…”

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

“…However, the majority of surgeons will rely only on their clinical experience to determine the thickness and quality of the skin. 2,6,20,21 There have been trials to estimate the skin thickness using the confocal microscopy. The measures for epidermis thickness were found to be similar for both ultrasound and confocal microscopy.…”