Surface aesthetics of an attractive nose result from certain lines, shadows, and highlights with specific proportions and breakpoints. Analysis emphasizes geometric polygons as aesthetic subunits. Evaluation of the complete nasal surface aesthetics is achieved using geometric polygons to define the existing deformity and aesthetic goals. The relationship between the dome triangles, interdomal triangle, facet polygons, and infralobular polygon are integrated to form the “diamond shape” light reflection on the nasal tip. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, define an operative plan to achieve specific goals, and select the appropriate operative technique.
Key points
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Surface aesthetics of an attractive nose are the result of certain lines, shadows, and highlights with specific proportions and breakpoints.
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Evaluation of the complete nasal surface aesthetics is achieved using the concept of geometric polygons to define the existing deformity and the aesthetic goals.
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The concept of a lateral crus resting angle in the ideal nose is defined.
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The relationship between dome triangles, interdomal triangle, facet polygons, and infralobular polygon is integrated to form the “diamond shape” light reflection on the nasal tip.
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The principles of geometric polygons allow the surgeon to analyze deformities, define an operative plan to achieve specific goals, and select the appropriate operative technique.
The primary objective of rhinoplasty surgery is to create an attractive functional nose without any surgical stigmata. However, this goal can only be achieved if the surgeon understands the direct linkage between surface aesthetics, underlying anatomic structures, and functional factors. The appearance of an attractive nose is created by certain lines, shadows, and highlights covering the nasal dorsum, tip, and base. During rhinoplasty surgery, these surface aesthetics with their proportions and breakpoints must be maintained, emphasized, and created. Analysis of the nasal anatomy through the surface aesthetic concepts enables proper identification of the underlying anatomic structures contributing to the shape and hence proper planning of surgery ( Fig. 1 ). The following aesthetic concepts enable the rhinoplasty surgeon to analyze the underlying nasal anatomy and the reflections on the surface, and to plan and perform the rhinoplasty procedure with respect to the surface aesthetics of the nose.
Nasal analysis: learn to sketch the nose
You cannot perform a good surgery unless you can draw the organ precisely. Design increases awareness. You cannot solve a problem that you cannot see. Design allows you to analyze a good nose and imitate it well. Draw the nose contours; create the shades. Draw the edges of the cartilages.
Sketch from the Front
The nose tip is composed of 3 circles. The middle circle includes more cartilage than the circles on the sides. There is a 3:2 ratio for these circles. Investigate the boundaries where the nose touches the face. Also draw the lateral aesthetic lines. Investigate the relation between lateral aesthetic lines and dorsum aesthetic lines, the beginning and ending points. Look at your friend’s nose during the drawing. You will start to see details that you never recognized before. This will increase your awareness. Draw the “nostril sill” and understand its anatomy well. See the close relation between the nostril sill and the footplate. Investigate the endpoint of the nostril sill. If the scar of the alar surgery conforms to the nostril sill anatomy, then the human eye cannot recognize the scar. Investigate the fusiform structure constituted by the nasal dorsum. You can understand the dorsal aesthetic lines better. Shadowing is a further step. Investigate the relation between dorsal aesthetic lines and shadows. Adding some light to the dorsal aesthetic lines will make your drawing more realistic ( Fig. 2 ).
Sketch from the Side
Determine the length and height of the nose. Determine the nasolabial angle. We will use the same circles again. The 3:2 ratio is the same as from the front. The line that passes tangent to the bottom edge of the circles gives us the nasolabial angle. The lateral view of the nostrils is also very important. Examine the nostril peak point and the C point relation. Examine the columellar and lobule ratio. You can copy from beautiful noses in these drawings. It is easier to make drawings from beautiful nose photos ( Fig. 3 ).
Sketch from Above and Below
It is also important to draw the nose from top and bottom. If you make drawings from all angles by using the same cubic forms, your brain will take the photo of the cartilages and make a 3-dimensional model of it ( Fig. 4 ).
Nasal analysis: learn to sketch the nose
You cannot perform a good surgery unless you can draw the organ precisely. Design increases awareness. You cannot solve a problem that you cannot see. Design allows you to analyze a good nose and imitate it well. Draw the nose contours; create the shades. Draw the edges of the cartilages.
Sketch from the Front
The nose tip is composed of 3 circles. The middle circle includes more cartilage than the circles on the sides. There is a 3:2 ratio for these circles. Investigate the boundaries where the nose touches the face. Also draw the lateral aesthetic lines. Investigate the relation between lateral aesthetic lines and dorsum aesthetic lines, the beginning and ending points. Look at your friend’s nose during the drawing. You will start to see details that you never recognized before. This will increase your awareness. Draw the “nostril sill” and understand its anatomy well. See the close relation between the nostril sill and the footplate. Investigate the endpoint of the nostril sill. If the scar of the alar surgery conforms to the nostril sill anatomy, then the human eye cannot recognize the scar. Investigate the fusiform structure constituted by the nasal dorsum. You can understand the dorsal aesthetic lines better. Shadowing is a further step. Investigate the relation between dorsal aesthetic lines and shadows. Adding some light to the dorsal aesthetic lines will make your drawing more realistic ( Fig. 2 ).
Sketch from the Side
Determine the length and height of the nose. Determine the nasolabial angle. We will use the same circles again. The 3:2 ratio is the same as from the front. The line that passes tangent to the bottom edge of the circles gives us the nasolabial angle. The lateral view of the nostrils is also very important. Examine the nostril peak point and the C point relation. Examine the columellar and lobule ratio. You can copy from beautiful noses in these drawings. It is easier to make drawings from beautiful nose photos ( Fig. 3 ).
Sketch from Above and Below
It is also important to draw the nose from top and bottom. If you make drawings from all angles by using the same cubic forms, your brain will take the photo of the cartilages and make a 3-dimensional model of it ( Fig. 4 ).
Aesthetic nasal polygons
The nose can be analyzed as aesthetic units using the concept of geometric polygons. A polygon is defined as a plane figure with at least 3 straight sides and angles. Evaluation of the nasal surface using polygons allows identification of shadows and highlights that are linked to the underlying anatomic structures that can be modified surgically. Thus, the goal of surgery is to modify, rearrange, and/or reconstruct the nasal infrastructure, thereby creating nasal surface polygons that are symmetric and aesthetically pleasing.
From the glabella downward, we can define the glabella polygon, dorsal bone polygon, dorsal cartilage triangle, lateral bone polygons, upper lateral polygons, dome triangles, lateral crus polygons, interdomal triangle, facet polygons, infralobular polygon, columellar polygon, and footplate polygons ( Fig. 5 ). The intersection and juxtaposition of the polygons define the “lines” and “points” that rhinoplasty surgeons use to analyze the nose. Although somewhat tedious to define, these polygons are easily sketched on standard nasal photographs and quickly mastered for operative planning.
Dorsal cartilage polygon
The dorsal cartilage polygon is the area from the tip until the keystone region. It can be seen clearly as a section looking anterior in thin-skinned patients (see Fig. 5 ; Fig. 6 ). In the cartilage anatomy, there is a groove from the center of the cartilage top point until the keystone. This groove is 1 to 2 mm deep and filled by the dorsal perichondrium. The Pitanguy ligament is on top of this perichondrium. The Pitanguy ligament was initially named the “dermocartilaginous ligament.” Pitanguy stated that this ligament begins from the supratip dermis, passes through the area between the dome and the septal angle, and is finally attached to the medial crura. In terms of surgical importance, he has stated: “cut this ligament for nose rotation, if the ligament is too much then resect.”
