New insights into tip supporting structures. Consequences for nasal surgery

Background: Knowledge of tip supporting structures is crucial for successful rhinoplastic surgery. The aim of this study was to provide detailed anatomical and histological descriptions of the tip supporting structures. Methods: Serial coronal sections of the entire external noses from seven cadavers were studied after staining by Mallory-Cason and Verhoeff-Van Gieson procedures. Results and conclusions: We found no histological evidence of ligaments between the cartilaginous- and bony parts of the nasal skeleton, and between the skin and the nasal skeleton. Instead, we found a perichondrial-periosteal lining within the soft tissue envelope. The main tip supporting and shaping structures are: Septal and lobular cartilages, premaxillae, and the soft tissue envelope including the periosteal-perichondrial envelope/membrane. These findings may have clinical relevance in functional and aesthetic rhinoplasties.