JAMA FPS JAMA Facial Plastic Surgery · 2019

Assessing Nasal Soft-Tissue Envelope Thickness for Rhinoplasty: Normative Data and a Predictive Algorithm

Dey JK, Recker CA, Olson MD, Bowen AJ, Panda A, Kostandy PM, Lane JI, Hamilton GS 3rd.

PubMed 31486840 Publisher (DOI)Free full text (PMC)

What this paper says

Measuring CT scans of 190 patients, nasal skin thickness ranged from 6.7 mm at the root to 2.1 mm at the mid-bridge, and expert surgeons predicted it accurately by eye, most reliably at the tip.

Overview

How thick the skin over the nose is determines how much of the underlying framework shows, and no validated tool existed for assessing it before surgery. This study measured thickness at defined points on high-resolution CT scans and tested whether experienced clinicians could predict those values from photographs.

Sections of note

Retrospective review plus prospective assessment by 4 expert raters at an academic tertiary referral center; 190 adult patients; data analyzed March 2019.
Patients had high-resolution maxillofacial CT scans and standardized photographs, and no history of nasal fracture, septal perforation, rhinoplasty or other conditions altering nasal form.
78 of the 190 were women; mean age 45 years, SD 17.
Mean thickness: sellion 6.7 mm SD 1.7, rhinion 2.1 mm SD 0.7, supratip 4.8 mm SD 1.0, tip 3.1 mm SD 0.6, columella 2.6 mm SD 0.4.
Thickness followed a nearly normal distribution at each site, with most patients in a medium range.
Experts predicted thickness accurately, with highest accuracy at the tip, r 0.73, prediction accuracy 91 percent.
Agreement between the expert raters was strong, r 0.83 to 0.89.

What it means for a patient

Skin thickness varies more than fourfold across the nose, thickest at the root and thinnest partway down the bridge.
Experienced surgeons can judge it by looking, most reliably at the tip, so a scan is not required.
The thin skin at the mid-bridge is why irregularities there show most readily.
Limits: 190 patients at one center, and the CT scans were obtained for other reasons, so the population may not represent rhinoplasty candidates.

Why this paper matters

Skin thickness is repeatedly named as the variable that limits how much definition surgery can produce, yet it has been assessed impressionistically. This supplies normal values and validates the visual assessment surgeons already use. Whether acting on that assessment improves outcomes is not tested here.

Terms

Soft-tissue envelope: The skin, fat and muscle covering the nasal framework.
Sellion: The deepest point of the bridge between the eyes.
Rhinion: The point where the nasal bone meets the cartilage on the bridge.
Supratip: The area just above the nasal tip.
Normative data: Reference values describing what is typical in a population.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools.

Objective: To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose.

Design, Setting, And Participants: This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019.

Main Outcomes And Measures: Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest).

Results: Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip (r, 0.73; prediction accuracy, 91%). A strong positive correlation was noted among the experts' STE estimates (r, 0.83-0.89), suggesting a high level of agreement between individual raters.

Conclusions And Relevance: There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.

Level Of Evidence: NA.

Abstract as indexed by PubMed; the article is open access (PubMed Central).