Reply: Nostrilplasty by Manipulating the Dilator Naris Muscles: A Pilot Study.

Abstract

Sir: We appreciate Drs. Goffinet, Barbier, Lascombes, and Goga for their interest and insight into our article entitled “Nostrilplasty by Manipulating the Dilator Naris Muscles: A Pilot Study.”1 We also respect their informative and outstanding cadaver study that included three elderly Caucasians. In fact, lower nasal area muscles are small, vague, and difficult to identify exactly. In addition, the muscle volume is significantly different between races. Furthermore, because of differences in terminology, any discussion of nasal musculature is fraught with confusion and conflict. Previous studies have elucidated the anatomy of the nasal muscles and their functions using dissection, magnetic resonance imaging, and electromyography. Anatomists have always identified a “dilator naris.” However, the described morphology and relationships between nasal musculatures have differed among authors. A consensus of the denomination of muscles is still lacking.2–4 One group defined it as the nasalis portion of the transverse nasalis5; another group described it as the deep layer of the levator labii superioris6; and others considered it a separate muscle.7 Bruintjes et al. have mentioned that “dilatator naris” is of muscle origin from lateral crus inserted to the alar skin and that “pars alaris” is the perpendicular muscle.8 After reviewing previous studies conducted by numerous groups, we selected the term “dilator naris,” because dilator naris is the name most frequently used by rhinoplasty surgeons.4,7,9–12 We also conducted a series of anatomical studies using fresh cadavers. Our series of anatomical and histologic studies of Asian noses have indicated that anterior and posterior components of the dilator naris muscles can directly affect the alar lobule and nostril shape by enlarging the nostrils and maintaining the laterally extruding ala.13–15 The dilator naris anterior and posterior muscles are well developed in a nose with horizontal or round nostril compared to those in a nose with a vertical nostril shape. Moreover, there are some differences in muscle insertion area between the two nostril shapes. We hypothesized that resecting well-developed dilator naris muscles could change nostril shape. Our study was designed to confirm this hypothesis, and the term dilator naris was used in the article to coincide with the term used in our previous studies. In conclusion, we agree that a consensus for the denomination of muscles is needed among rhinoplasty surgeons. Further study is needed to determine the difference between races. We are glad that our idea can lead to more discussion about rhinoplasty, especially in nostrilplasty. It will certainly create a more aesthetically acceptable nostril shape and projected tip. We thank these authors again for their interest in our article. It provided a platform for discussion. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Jae-A Jung, M.D., Ph.D.Eun-Sang Dhong, M.D., Ph.D.Seung-Kyu Han, M.D., Ph.D.Department of Plastic SurgeryKorea University College of MedicineSeoul, Republic of Korea