Aim: The classical dissection plane in rhinoplasty is in the sub-SMAS plane with traumatic dissection
of tissues and as a result significant and prolonged postoperative edema, especially in the external approach.
A complete subperichondrial/periosteal route has been recently described. It seems to allow for simpler
postoperative follow-up than external or closed approach performed in the sub-SMAS plane. However, little
is known about the exact histological planes that are really dissected during surgery.
Material and methods: Histological examinations of 10 cadavers noses dissected in the so-called
subperichondrial/subperiosteal plane were performed.
Results: The subperichondrial plane is truly subperichondrial and consists in a dissection under the
chondrogenic layer of the perichondrium. Subperichondrial dissection necessitates sharp scrapping to separate
the cartilage from the chondrogenic layer. The perichondrium is naturally thicker on the dorsum, which
explains why it is easier to begin the dorsal dissection at the W point. Scroll cartilages are consistent and show
between 9 and 13 isolated cartilages, most of the time, 1 major and several minors cartilages. Optimal strategy
to ease the dissection is discussed
Conclusions: The subperichondrial/subperiosteal route, although necessitating significant dissection
of the teguments of the nasal pyramid, is respectful of the anatomy of the nasal pyramid. It allows minimal
traumatic maneuvers than in the sub-SMAS route, despite of the large dissection performed
