Aesthetic Plastic Surgery

, Volume 42, Issue 4, pp 1085–1089 | Cite as

Bone and Soft Tissue Nasal Angles Discrepancies and Overlying Skin Thickness: A Computed Tomography Study

  • Sami Alharethy
  • Sama Alohali
  • Ibrahim Alquniabut
  • Yong Ju Jang
Original Article Rhinoplasty



The aim of this study was to derive the normal values for bone and soft tissue nasal angles as well as the overlying skin thickness and to attempt to determine the correlation between differences in bone and soft tissue angles and overlying skin thickness in Middle Eastern patients.

Materials and Methods

Three-dimensional cephalometric analysis was performed for 100 patients who underwent computed tomography of the paranasal sinuses. The nasofrontal angle, pyramidal angle-nasal root, pyramidal angle-tip of the nasal bone, and overlying skin thickness were measured, and the results were analyzed according to sex, age, and body mass index (BMI).


All soft tissue angles were significantly larger than the bone angles, with the mean difference being 11.62°, 30.80°, and 27.05° for the nasofrontal angle (P = 0.000), pyramidal angle-nasal root (P = 0.000), and pyramidal angle-tip of the nasal bone (P = 0.000), respectively. The mean overlying skin thickness was 3.89 ± 1.48 mm at the nasion, 1.16 ± 0.6 mm at the rhinion, and 2.93 ± .97 mm at the nasal tip. Differences in the nasofrontal angle were strongly correlated with the skin thickness at the nasion (P = 0.001).


A simple clinical exam of the soft tissue nasal angles does not reflect the underlying bone angles that will be encountered during rhinoplasty. BMI does not influence nasal shape, and rhinoplasty surgery should take into account the ethnic group, age, and sex of the patient. Surgeons should leave a minor skeletal hump at the end of the nasal bone for Middle Eastern patients.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Nasal angles Nasal skin thickness Cephalometric analysis Computed tomography Rhinoplasty 



The authors extend their appreciation to the International Scientific Partnership Program ISPP at King Saud University for funding this research work through ISPP# 007.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology – Head and Neck SurgeryCollege of Medicine, King Saud UniversityRiyadhKingdom of Saudi Arabia
  2. 2.Department of Otolaryngology – Head and Neck SurgeryQassim UniversityBuraydahKingdom of Saudi Arabia
  3. 3.Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  4. 4.Department of Otolaryngology – Head and Neck SurgeryKing Abdulaziz University HospitalRiyadhKingdom of Saudi Arabia

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