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An Anatomic and Histologic Analysis of the Alar-Facial Crease and the Lateral Crus

Patel, Jagruti C. MD; Fletcher, James W. MD; Singer, David MD; Sullivan, Patrick MD; Weinzweig, Jeffrey MD

doi: 10.1097/01.sap.0000099711.40020.1c
Original Article
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The key to achieving an excellent result following rhinoplasty lies in a strong fundamental knowledge of nasal anatomy. The purpose of this study was to analyze the anatomic and histologic relationship of the nose to the alar-facial crease. Fifteen cadaver noses were dissected and a total of thirty lower lateral cartilages were measured. Two fresh cadaver noses were fixed in neutral buffer formalin and embedded in paraffin. They were then sectioned into 6-μ coronal and sagittal sections and stained with hematoxylin and eosin, Eosin von Geison, and safranin to evaluate for collagen, elastin and muscle, respectively. Measurements of the lower lateral cartilages showed the average lateral crural height was 23.5 mm (± 2.5 mm), lateral crus width was 11.7 mm (± 1.5 mm), lateral domal width was 5.7 mm (± 0.9 mm), and intercrural distance was 20.2 mm (± 3.2 mm). No statistical differences were noted between male and female cadaver measurements. Histologic sections showed the area of the alar-facial crease to have a greater quantity of elastin fibers compared with muscle, collagen, or cartilage. These elastin fibers were predominantly orientated vertically (anterior-posterior) rather than horizontally (cephalo-caudad). This study demonstrates a higher ratio of elastin to collagen fibers in the region of the alar-facial crease.

A fixed cadaver study demonstrated no statistical differences in lower lateral cartilage dimensions between women and men. Histologically the alar-facial crease demonstrated a high predominance of elastin fibers.

From The Wound Healing & Tissue Engineering Laboratory, Department of Plastic Surgery, Brown University School of Medicine, Rhode Island Hospital, Hasboro Children's Hospital, Providence, RI.

Received December 19, 2002 and accepted for publication, after revision, August 28, 2003.

Presented in part at the 70th Annual Meeting of the American Society of Plastic Surgeons, Orlando, FL, 2002, and the New England Society of Plastic and Reconstructive Surgeons Annual Meeting, Mystic, CT, 2002.

Reprints: Jeffrey Weinzweig, MD, The Wound Healing & Tissue, Engineering Laboratory, Department of Plastic Surgery, Brown University School of Medicine, Rhode Island Hospital, Hasboro Children's Hospital, 2 Dudley Street, Suite 380, Providence, RI 02905. E-mail: scalpels@aol.com

© 2004 Lippincott Williams & Wilkins, Inc.