The Tent Pole of the Nose Revisited in Rhinoplasty

I think it is worth exploring a concept that allows me to discuss with prospective rhinoplasty patients exactly how I approach noses and what the specific limitations are for a particular individual based on the unique characteristics of one’s anatomy.  The tent pole analogy is my favorite go-to metaphor to help explain how I evaluate a nose based on the nature of the skin and underlying cartilage.  The tent fabric that covers a tent represents the skin of the nose; the tent pole underneath represents the nasal cartilage.  In traditional rhinoplasty, especially for white noses, the procedure involves reshaping the underlying cartilages and bones and allowing the skin to redrape over the new framework.  For someone with moderately strong cartilages and relatively thinner skin, this technique works well.  However, when the tent poles are weak (the cartilages) and the tent fabric is thick (the skin) then no matter what one does to the tent poles, the thick tent fabric will prevent one from seeing the results.  Further, if the tent poles are flimsy and they are reduced further, the tent itself can collapse further downward or in the language of a rhinoplasty can lose some projection or degree of how far the nose projects forward.  Further, scar tissue can then fill the void between the unsettling tent fabric and the over reduced framework which can lead to the opposite of what is desired, i.e., a more bulbous-looking nose.  This condition exists much more commonly in ethnic noses like in Asian, Hispanic, and African patients.  In this case, structural grafting of additional cartilage may be a preferred method.  To use the tent analogy, making thicker tent poles to push through the thick fabric maybe the preferred method for creating more visible definition to the nasal tip without risking too much show of the tent poles as when one sees the cartilage of the nose start to be seen in a too defined way in thin skinned white noses that have been previously overdone.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8188. To Learn more about Dr Lams’ rhinoplasty procedures or to ask Dr Lam a question please visit his rhinoplasty forum.