Commentary on: The Lower Nasal Base: An Anatomical Study

Abstract

In “The Lower Nasal Base: An Anatomical Study,” Dr Daniel and his coauthors undertook the dissection of 45 cadaver noses to fully appreciate the anatomy of the lower nasal base. This is an often neglected and not fully understood anatomical region1,2 consisting of the columellar base, nostril sills, and alar lobules. Their dissections are simply some of the best that our readers will ever see. The authors begin by clearing up some common misconceptions: (a) there is, in fact, a distinct lower nasal base consisting of the columellar base, nostril sills, and alar lobules; (b) the medial border of the levator labii superioris alaeque nasalis (LLSAN) becomes the defining muscle of the alar crease; (c) more than 1 muscle depresses the nasal tip (eg, the LLSAN), although the depressor septi nasalis (DSN) is usually attributed to be the only muscle responsible for that; (d) the transverse line or fold that occurs on forceful smiling represents the junction between 2 components of the orbicularis; and (e) the entire alar lobule is actually devoid of cartilage. The authors also clarify some debatable issues, including the idea that the DSN is a paired muscle that originates from the maxilla just above the medial incisor and the concept that Pitanguy's ligament is not a true dermocartilaginous ligament because if it were, it would contradict the 5-layer laminate concept of the nasal soft tissue envelope.3 Their video gives a nice demonstration of the distinct tether that allows the tip to be pulled down by muscular contracture, an action that involves …