The Soft Triangle: An Often Neglected Area in Rhinoplasty

Overview

The soft triangle is the small area of the nostril rim just below the tip, where skin meets skin with no cartilage between. It is easily damaged during rhinoplasty and rarely discussed. The authors identified patients with a problem in that area before and during surgery, grouped them by anatomy, and compared photographs to see how grafts affected nostril length and shape.

Sections of note

• 127 of 841 patients (15 percent) were assessed as having an anatomical issue at the soft triangle and were included.
• Patients were divided into three groups by features identified during surgery.
• Before and after photographs were compared for effects on nostril length and nostril to lobule harmony.
• Average follow-up was 27 months, range 6 to 60 months.
• Postoperative notching of varying degree occurred in six of 127 patients.
• Notching by group: one of 31 in the first group, two of 24 in the second, three of 72 in the third. Level of evidence 5.

What it means for a patient

• About one rhinoplasty patient in seven has an anatomical weakness at the nostril rim that needs specific attention during surgery.
• Notching of the rim is a visible deformity that is difficult to correct afterwards, so identifying the risk beforehand matters.
• Notching still occurred in about five percent of the treated group, so grafting reduced but did not remove the risk.
• Single-centre series, no untreated comparison group, and outcomes judged from photographs rather than by patients. The abstract does not say what defined each of the three groups.

Why this paper matters

Rhinoplasty complications are usually discussed in terms of the bridge and the tip, and the nostril rim receives less attention despite being immediately visible. Quantifying how often the anatomy is at risk gives a reason to plan incisions around it. What defines the three anatomical groups and how grafts differ between them is not resolved in the abstract.

Terms

• Soft triangle: the small soft area of the nostril rim just below the tip, containing no cartilage.
• Notching: a visible dent or step in the nostril rim after surgery.
• Lobule: the rounded lower part of the nose containing the tip and nostrils.
• Graft: a piece of tissue, usually cartilage, added to support or reshape an area.
• Intraoperative: occurring or observed during the operation.