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Anatomy and Surgical Treatment of the Depressor Septi Nasi Muscle: A Systematic Review

Sinno, Sammy M.D.; Chang, Jessica B. B.S.; Saadeh, Pierre B. M.D.; Lee, Michael R. M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 838e–848e
doi: 10.1097/PRS.0000000000001169
Cosmetic: Original Articles

Background: Although the majority of nasal alterations in rhinoplasty result from either augmentation or reduction of bone and cartilaginous substructure, modifications of influential soft-tissue provide significant contribution to the final result. The depressor septi nasi muscle is a soft-tissue structure well known to influence the final result in rhinoplasty. The objective of this study was to perform a standardized, comprehensive review of relevant data published with regard to the depressor septi nasi muscle.

Methods: A comprehensive search of the terms “depressor septi muscle” and “depressor septi nasi muscle” was performed using the PubMed, MEDLINE, and Cochrane databases. Articles were reviewed for relevancy and included if criteria were met. A secondary review was performed of all articles cited, to maximize diligence.

Results: Forty-three articles were identified in the initial search. Thirteen of the 43 were found to meet inclusion criteria. Secondary search revealed additional studies meeting inclusion criteria. Altogether, there were 175 cadaver specimens and 821 surgically treated patients for which data were available. Anatomical reports and nomenclature were found to vary. Surgical approach and muscle treatment diverged, with objective data showing no superior method.

Conclusions: Although variation exists in anatomical reports regarding the depressor septi nasi muscle, the prevailing thought is that it originates from the maxilla and/or orbicularis oris muscle. More importantly, the muscle inserts on the medial crura and adjacent soft tissue. Disruption of this relationship provides the basis for surgical treatment of tip descent on animation.

New York, N.Y.; and Shreveport, La.

From the Department of Plastic Surgery, New York University; and The Wall Center for Plastic Surgery.

Received for publication July 27, 2014; accepted September 16, 2014.

Disclosure: The authors have no financial interests to disclose.

Michael R. Lee, M.D., The Wall Center for Plastic Surgery, 8600 Fern Avenue, Shreveport, La. 71105,

©2015American Society of Plastic Surgeons