Importance of the depressor septi nasi muscle in rhinoplasty: Anatomic study and clinical application

An active depressor septi muscle can accentuate a drooping nasal tip and sh orten the upper lip on animation. We have found that dissection and transpo sition of the depressor septi muscle during rhinoplasty can improve the tip -upper lip relationship in appropriately selected patients. Although the an atomy of the depressor septi muscle has been described, the anatomic variat ions of this muscle hare not been previously reported. The goals of this st udy were two-fold: (1) to define the anatomic variations of the depressor s epti muscle using 55 fresh cadaver dissections and (2) to develop a clinica lly applicable algorithm for modification of this muscle during rhinoplasty in those patients with a short upper lip and/or tip-upper lip imbalance. Fifty-five fresh cadavers were dissected, and the anatomic variations of th e depressor septi muscle were recorded. Three variations of the depressor s epti muscle were delineated: type I inserted fully into the orbicularis ori s (62 percent); type II inserted into the periosteum and incompletely into the orbicular is oris (22 percent); and type III showed no, or rudimentary, depressor septi muscle (16 percent). Sixty-two patients over a 4-year peri od (from 1995 to 1999) were identified preoperatively with a hyperactive de pressor septi diagnosed by a descending nasal tip and shortened upper lip o n animation. These patients underwent dissection and transposition (not res ection) of the paired depressor septi during rhinoplasty with improvement o r correction of the tip-upper lip imbalance in 88 percent of cases. The anatomic study, surgical indications, rationale for the operative techn ique, and clinical cases are presented. Dissection and transposition of the depressor septi is a valuable adjunct to rhinoplasty in patients with a ty pe I or II muscle variant.