Nasal Analysis

The nose can be conveniently divided into several subunits: the dorsum, the sidewalls (paired), the hemilobules (paired), the soft triangles (paired), alae (paired), and the columella. Viewing the external nasal anatomy by its subunits is important because defects that span an entire subunit are usually repaired with reconstruction of that subunit. Burget suggests replacement of the entire subunit if more than 50% of the subunit is lost during resection.³ Aesthetically, the nose—from the nasion (nasofrontal junction) to the columella-labial junction—ideally occupies one third of the face in the vertical dimension. From ala to ala, it should ideally occupy one fifth of the horizontal dimension of the face.

The nasofrontal angle between the frontal bone and nasion is usually 120° and slightly more acute in males than in females. The nasofacial angle, or the slope of the nose compared with the plane of the face, is approximately 30-40°. The nasolabial angle between the columella and philtrum is about 90-95° in males and 100-105° in females.

On profile view, normal columella show, ie, the height of the nasal aperture visible, is 2-4 mm. The dorsum should be straight. From below, the alar base forms an isosceles triangle, with the apex at the infratip lobule just beneath the tip. Appropriate projection of the nasal tip, or the distance of the tip from the face, is judged by using the Goode rule. Tip projection should be 55-60% of the distance between the nasion and tip-defining point. A columellar double break may be present, marking the transition between the intermediate crus of the lower lateral cartilage and the medial crus.