Interdomal Fat Pad: An Important Anatomical Structure in Rhinoplasty

Objective  To describe the interdomal fat pad, an important anatomical structure that, to our knowledge, has not been reported in the rhinoplasty literature. Design  Anatomical observations were made during a consecutive series of external rhinoplasties, and the existence of the interdomal fat pad was documented in patients with noses of varying nasal skin thicknesses. Setting  Private facial plastic surgery practice. Patients  One hundred consecutive white patients undergoing external rhinoplasty were analyzed. Thirty-seven patients were undergoing secondary rhinoplasty and were excluded. Sixty-three patients undergoing primary rhinoplasty were enrolled into the study. Intervention  None. Main Outcome Measures  The nasal skin type of each patient was subjectively determined preoperatively to be thin, average, or thick. The presence or absence of a distinct fat pad between the domes of the lower lateral cartilages was observed and recorded in each group of patients. Results  Among the 63 patients studied, 22 had thick skin; 31, average skin; and 10, thin skin. Well-defined interdomal fat pads were noted in 12 patients with thick skin, 13 patients with average skin, and 2 patients with thin skin. Conclusions  There is a distinct anatomical structure that we refer to as the interdomal fat pad that exists in noses of all skin types. The awareness of this structure should encourage a careful and direct examination of the undersurface of nasal tip skin. An unrecognized, extensive fat pad may interfere with tip narrowing and refinement. It may be the cause of persistent postrhinoplasty supratip fullness and excessive tip width.