The SMAS and Fat Compartments of the Nose: An Anatomical Study
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ORIGINAL ARTICLE
AESTHETIC
The SMAS and Fat Compartments of the Nose: An Anatomical Study Cemile Nurdan Ozturk • Jeffrey D. Larson Can Ozturk • James E. Zins
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Received: 31 May 2012 / Accepted: 16 October 2012 / Published online: 8 January 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013
Abstract Background The soft tissue envelope of the nose consists of skin, the superficial musculoaponeurotic system (SMAS), and multiple layers of fat. Similar layers have been well described in the neck and face regions but there are few reports of its detailed anatomy in the nose. Methods Nine fresh Caucasian cadaver noses were dissected in the subcutaneous, sub-SMAS, and submuscular layers. Specimens were examined to determine the extent and continuity of the nasal SMAS into the face. Fat distribution in different layers was also analyzed. Results A distinct layer of SMAS in continuation with the facial SMAS was identified in all cadavers. The subcutaneous fat was found to be concentrated in the glabella, lateral wall of the nose, tip and supratip areas. Distribution of sub-SMAS fat was similar to that of superficial fat. An additional layer of fat underneath the transverse nasalis muscle was identified. The presence of an interdomal fat pad was confirmed. In the upper lateral wall of the nose, an area of deficient muscle, where the SMAS and a small amount of fat were the only soft tissue coverage, was observed. Conclusions We have confirmed the existence of the SMAS in the nose as a unique layer. We have also provided a detailed description of fat distribution. The knowledge of soft tissue coverage and fat distribution in the nose allows for various surgical modifications and provides an essential basis for procedures. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full C. N. Ozturk J. D. Larson C. Ozturk J. E. Zins (&) Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk A60, Cleveland, OH 44195, USA e-mail: [email protected]
description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Nose SMAS Superficial musculoaponeurotic system Fat Nasal SMAS Fat compartments Anatomy Cadaver
The superficial musculoaponeurotic system (SMAS) is a well-described entity in the neck and face region [1–4]. Manipulation of the SMAS by either plication or release and repositioning has become a keystone in face-lift surgery. Less well detailed is the extension of the SMAS in the nasal region. There are few reports of its detailed anatomy and applications in clinical practice [5–8]. This study describes the SMAS and fat compartments of the nose.
Materials and Methods Macroscopic evaluation was carried out on nine fresh Caucasian cadavers. Mean cadaver age was 72.5 years and included three males and six females. The surgical exposure was performed via elevation of the nasal skin through a
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