External Nasal Deformities: Classification, Aetiology, Anatomy and Treatment

Alterations in the shape of the external nose may be associated with a congenital or acquired defect of the external nose. These changes may cause aesthetic dissatisfaction or even impair an individual’s breathing function.

The condition typically affects the cartilaginous and/or bony parts of the pyramid.

Etiology

Changes in nose shape may be caused by various factors:

• Injury. It is the most common cause. It includes sports, car, birth, domestic injuries and falls.
• Diseases. Deformity may be caused by:
  • skin diseases (e.g., rosacea);
  • general (systemic) diseases (syphilis, Wegener’s granulomatosis, leprosy);
  • nasal infections (e.g., septal abscess).
• Congenital factors. A disproportionate nasal shape may have genetic or ethnic origins.

Anatomy

Leonardo da Vinci is thought to have devised the theory of ideal facial symmetry, also known as the golden ratio, which is now used to determine nasal irregularities. According to his theory, the left and right halves of the face should mirror each other.

Da Vinci also introduced the golden ratio (1 : 1.618) concept, which helps identify the right facial proportions. The intervals between facial features (eyes, nose, mouth) should correspond to this ratio.

To analyze the facial profile, modern plastic surgery utilises geometric lines and points, such as the nasion, rhinion, pronasale, and subnasale, and determines the nasofrontal and nasolabial angles. When the proportions are distorted, the external nose shape is considered to be altered.

Note that this article does not deal with the aesthetic analysis of the face. Below, you can find the most common types of nasal deformities.

Classification of external nasal deformities

Currently, there is no established classification system for external nasal deformities. Our goal is to describe the most common types.

When the cartilaginous part of the nose fails to develop properly, the columella, apex, and alae of the nose change their shape, position and orientation. Nasal cartilages are also responsible for the stiffness of the distal third of the nasal dorsum. The bony part of the nose is responsible for the shape of the bridge of the nose, the profile of the nose, and the presence of a hump or saddle-shaped deformity.

Abnormalities in the development of the bone or cartilage of the nose

• Rhinokyphosis (eagle nose) is a nasal deviation in which the middle third of the dorsum becomes thicker, and a hump develops. Upon visual examination, the nose resembles a beak.
• Rhinolordosis (saddle deformity) manifests when the bony or cartilaginous part in the area of the nasal septum becomes destabilised. This causes the dorsum to sink down and widen.
• Platyrynia (flat nose) is a deformity characterised by a broad, flattened external nose with a rounded tip.
• Brachyrhinia (wide short nose) is a nasal deformity characterised by a short and thick nose with a possibly upturned apex.
• Leptorhinia (narrow nose) is a deformity characterised by a narrow, long nose with typical weakness of the alar cartilages.
• Rhinoscoliosis (lateral deviation) is a deformity with a typical deviation of the midline of the nose, in which the bridge of the nose is curved in an arc shape.

Caused by skin diseases

• Rhinophyma is a chronic skin inflammation induced by rosacea. The condition also involves significant thickening of the nasal skin, resulting in an external nasal deformity.

Clinical Manifestations

These conditions affect the appearance of the nose and may impair its functions, such as breathing or smelling.

Diagnosis

A healthcare professional should perform a visual examination to evaluate the external nose shape and ask the patient about complaints.

Treatment

The external nose shape may be corrected using minimally invasive techniques. These include fillers injected into specific areas of the nose. However, this method is not suitable for more severe defects and the result is temporary.

Surgical therapy aims to correct the external and/or internal nose, its appearance, and breathing function. Depending on the deformity type, rhinoplasty may be either closed or open.

Course and treatment of rhinophyma

Aetiology of rhinophyma

Rhinophyma results from persistent chronic inflammation of the skin secondary to rosacea. It is very common among middle-aged and senior males and is rarely seen in females. Genetic predisposition is also one of the key factors. Prolonged UV exposure and unhealthy lifestyles (smoking, alcohol abuse, excessive consumption of spices) tend to exacerbate the condition. Hormonal disorders may also promote and aggravate rhinophyma.

Rhinophyma anatomy

Connective tissue, blood vessels, and sebaceous glands start to proliferate secondary to chronic skin inflammation. Gradually, the nasal skin develops dense red nodules covered with superficial vessels. Then the nodules transform into cyanopurpuric tuberous build-ups, and telangiectasia may develop. Sebaceous glands become significantly enlarged and produce excessive amounts of discharge.

Clinical presentation of rhinophyma

Patients are primarily concerned about their disfigured appearance. Their nose becomes cyanotic, tuberous, and significantly enlarged. The pores are also bigger, and the skin is oily and shiny. In extreme cases, the condition may cause pain and discomfort. Symptoms tend to worsen over time.

Diagnosis of rhinophyma

Diagnosis is based on medical history and a physical examination. Dermatologist/cosmetologist advice is generally recommended.

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Treatment of rhinophyma

Medical treatment may halt the disease.

Patients are advised to break their bad habits and limit exposure to high temperatures and UV.

Antibacterial ointments, azelaic acid, and retinoids have proven to be effective.

Laser treatment of pathologically altered tissues may be an option. This method targets hypertrophied vessels and reduces inflammation.

Significant overgrowth of the external nasal tissues typically necessitates surgery. In this case, specialised tools and electric impulses are used to excise excessive tissues.