# Human cartilaginous tissues, for character work

The nose below the nasal bones, and the whole external ear, are cartilage. Their dimensions, sex and population splits, position and protrusion, and how they change with age. Every figure attributed.

*Reference document · 2026-10-02*

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## Summary - where the cartilage is

Cartilage is the structural material of the lower part of the nose, below the nasal bones, and of the whole external ear apart from the lobule. A nose modelled from nasal-bone geometry alone is invented below the mid-dorsum, because the lower part is cartilage. And ageing that considers only bone resorption and fat loss misses cartilage, which changes with age in its own way (section 3).

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## 1. The nasal framework

Landmarks: `n` nasion · `prn` pronasale · `sn` subnasale · `al` alare, the alar rim · `ac` alar crease

The nose is a two-tier structure: a bony vault above (nasal bones and the frontal process of the maxilla) and a cartilaginous framework below. The bony vault ends around the mid-dorsum. Everything from there to the tip and the alar wings is cartilage.

### 1.1 What the framework is made of

| Part | What it is | What it drives |
|---|---|---|
| Septal cartilage (quadrangular) | The midline plate; the keystone of the framework | dorsal height, tip projection, columellar support [9] |
| Upper lateral cartilages | Triangular sheets rolled off the septum, forming the middle vault | the mid-dorsal contour, the internal nasal valve [10] |
| Lower lateral cartilages (alar) | Horseshoe-shaped; each has medial, middle and lateral crura | tip position and form, alar sidewalls, columella, nostril shape [1] |
| Accessory and sesamoid cartilages | Small islands between the lateral crus and the piriform aperture | the lateral alar wall, the soft outer edge of the nostril |

The upper and lower lateral cartilages meet at the **scroll**, and the two domes meet at the midline tip, joined by the **interdomal ligament** (Pitanguy ligament); an interdomal fat pad of roughly **3 mm** sits between them [4]. This tip assembly is the only part of the face that is entirely cartilaginous and entirely soft. It deforms, rather than sitting on bone.

### 1.2 The septum

| Measure | Value | Note |
|---|---|---|
| Plate thickness | ≈ 2 mm | hyaline cartilage, near-uniform across the septum [9] |
| Cartilaginous dorsal length | 21 ± 5 mm (cadaver) · 26 ± 4 mm (MRI) | method-dependent spread [6][8] |
| Septal cartilage area | 692 mm² (MRI) · 817 mm² (cadaver) · 872 ± 220 mm² (CT) | decreases with age [6][7][8] |
| Cartilage share of total septum | ≈ 34% | Korean CT, all ages pooled: 0.41 in teenagers, 0.30 over 70; the rest is ethmoid, vomer and maxillary crest [7] |
| Keystone overlap with the nasal bone | 7 ± 2 mm | range 3-15 mm; shrinks with age [6] |
| Sex gap | ≈ 5 ± 4 mm shorter in females (cadaver) | not replicated by MRI, so weak [6][8] |

Who these numbers describe: the MRI series is 280 Korean patients, and the CT series 123 Korean patients aged 4 to 99 (mean 41), so the pooled CT area of 872 mm² includes children and teenagers. Within the CT series the area fell from about 1,055 mm² in teenagers to about 697 mm² over age 70, and males had significantly larger areas and a higher cartilage share.[7] The cadaver values (dorsal length, area, sex gap) come from 57 specimens[8] and were not re-checked against the full text.

### 1.3 The lower lateral cartilages

These carry the tip and the alar walls, and they are the best-measured cartilage in the face. The figures come from rhinoplasty and cadaver series: small samples, often older patients, usually a single population. They disagree about sex, and it is worth knowing which is which. Some series find the male cartilages significantly larger; others find no significant difference at all [1][5].

Korean figures are sex-specific; Indian figures are pooled across sexes (see note).

| Segment | Female | Male | Population |
|---|---|---|---|
| Lateral crus, length | 16.8 mm | 19.7 mm | Korean [2] |
| Lateral crus, width | 9.8 mm | 10.5 mm | Korean [2] |
| Lateral crus, thickness | 0.54 mm | 0.55 mm | Korean [2] |
| Medial crus, columellar segment | 8.0 mm | 10.0 mm | Korean [2] |
| Medial crus, footplate segment | 6.3 mm | 7.8 mm | Korean [2] |
| Lateral crus, length | 15.3 ± 2.2 mm | same | Indian [1] |
| Lateral crus, width | 9.8 ± 1.5 mm | same | Indian [1] |
| Lateral crus, thickness | 0.92 ± 0.25 mm | same | Indian [1] |
| Domal segment, length | 3.7 ± 0.7 mm | same | Indian [3] |
| Middle-lateral crus angle | 103 ± 8° | same | Indian [3] |

Where a series found no significant difference between the sexes, the value is pooled and shown once, marked **same**.

**The number that matters.** Thickness is **0.54-0.55 mm** in the Korean series [2] and **0.90-0.95 mm** in the Indian one [1]: the alar cartilage is a sliver of tissue under a millimetre thick, not a chunky form. Length and width differ noticeably between those two populations and, where a series splits them, between the sexes (compare the rows above). Neither of those is what changes how a nose reads. The two dimensions that do are the **crus angle** and the crus's **distance from the alar rim**, below.

### 1.4 Where the lateral crus sits

How far the lateral crus sits back from the alar rim is the measurement with the loudest visual consequence, and it is invisible if the nose is treated as bone plus skin. The cartilage is the same size in both populations below; only its position changes.

| Population | Medial | Middle | Lateral |
|---|---|---|---|
| Indian [1] | 2.8 ± 0.8 mm | 4.6 ± 1.0 mm | 7.0 ± 1.4 mm |
| Korean [1] | 5.7 mm | 7.4 mm | 12.3 mm |

Seated lower (the Indian pattern), the same cartilage gives a fuller, fleshier alar wall. Seated higher (the Korean pattern), it gives a thinner, more defined rim. This is the dial that separates a fleshy nostril from a crisp one.

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## 2. The external ear

Landmarks: `sa` superaurale, the top · `sba` subaurale, the lobe base · `helix` outer rim · `antihelix` inner fold

The auricle is **elastic cartilage** covered in skin, attached to the skull by skin and a fascial band (Loré's ligament). The **lobule is the exception**: skin and fat, no cartilage. The ear is therefore a cartilage form with a fat foot, which is exactly why the lobe changes across life while the cartilage above it ages on its own terms.

### 2.1 Dimensions

| Measure | Female | Male | Note |
|---|---|---|---|
| Ideal ear length (Farkas) | 59.0 mm | 63.5 mm | the beauty-standard set [13] |
| Ideal ear width | 32.5 mm | 35.3 mm | width ≈ 55% of length [13] |
| Korean adults, length | 64.5 mm | 67.1 mm | 631 adults aged 20-92, so older ears pull the means up; both gaps significant [14] |
| Korean adults, width | 27.3 mm | 29.2 mm | narrower than the idealised set [14] |
| Common adult cluster | 55-65 mm long | - | width 50-60% of length, i.e. 30-40 mm [11][12] |
| "Long ear" threshold (2 SD) | above ≈ 69 mm | above ≈ 71 mm | age- and sex-specific nomograms needed [11] |

The auricle is about **85% of adult size by age 3** and **90-95% by age 5-6**, so children's ears are proportionally enormous and adult ears look small against a much larger head [13].

### 2.2 Position and protrusion

These are the rules that make an ear read as placed rather than stuck on.

- **Long axis** inclines posteriorly by no more than about **20°** from the vertical plane of the skull. [11][12]
- **Root of the helix** sits roughly **one ear length (≈ 65 mm) behind the lateral orbital rim**, between two horizontal planes: the eyebrow above and the columella below. [12]
- **Auriculocephalic (auriculo-mastoid) angle** is normally **15-30°**, and some sources accept up to 35°. Beyond **35-45°** the ear is clinically protruding. [11][12]
- **Helix stand-off from the scalp** increases as the ear descends: **1.0-1.2 cm** at the superior third of the rim, **1.6-1.8 cm** at the helix midpoint, **2.0-2.2 cm** at the lobule. [11] The ear is not a flat plate resting on the head.
- **Scapha-conchal angle** ideally stays below **90°**. A wider one tips the scapha and fossa triangularis forward and reads as a cupped ear. [12]
- **The helix projects 2-5 mm more laterally than the antihelix**, which is the most useful single fact for a front view. [11]

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## 3. Cartilage over the lifespan

Bone resorbs and fat deflates. Cartilage does neither: its elastin and glycosaminoglycan content falls while its collagen holds, and the shape appears to drift (the nose tip rotates down, the ear lengthens) without anything coming off. How much of that drift is the cartilage itself, and how much is gravity and the soft tissue around it, is not settled. It is why some of the most recognisable age cues in the head sit in the nose and the ears.

### 3.1 Ears

| Finding | Rate | Study and sample |
|---|---|---|
| Ear length vs age | +0.22 mm/yr | Heathcote, 206 patients aged 30-93 [15] |
| Ear circumference vs age | +0.51 mm/yr | 100 young against older [16] |
| Auricle length | +0.178 mm/yr (M) · +0.162 mm/yr (F) | n=1,353 [17] |
| Earlobe length | +0.115 mm/yr (M) · +0.100 mm/yr (F) | same study [17] |
| Auricle width | +0.073 mm/yr | same study [17] |

These rates come from different samples and methods, so they are not additive. The structural point is that the lobule holds no cartilage: its change across life is fat redistribution and gravity, while the cartilage above it ages on its own clock.

Provenance and mechanism. The 0.22 mm/yr finding is Heathcote's 1995 BMJ study, cited here through a 2023 paper [15] whose title proposes that facial adiposity stretches the auricle, which would make the lengthening a soft-tissue effect and not a change in the cartilage. Tan et al. attribute their ear-circumference growth to "ageing changes of collagen", yet the cadaver study in §3.3 found no significant change in collagen content. These explanations conflict, so treat the rates as descriptive, not as evidence of mechanism. The +0.51 mm/yr regression has the form ear circumference = 88.1 + 0.51 × age, from 100 young people compared with older ones.[16]

### 3.2 The nose

Paired 3D-CT of the same 48 Korean adults (33 women, 15 men) over an average of 12 years (women 12.4 ± 1.1, men 11.8 ± 1.3) [20]. With only 15 men, "not significant" for the male glabella and pyriform angles (p = 0.086 and 0.072) may reflect sample size and not an absence of change.

| Change | Female | Male |
|---|---|---|
| Profile nasal length | +1.4 ± 1.9 mm | +1.7 ± 1.7 mm |
| Nasal bridge height | +1.3 ± 1.6 mm | +1.2 ± 1.6 mm |
| Nasofrontal angle | +2.5 ± 5.2° | +3.2 ± 5.4° |
| Nasofacial angle | -2.0 ± 2.1° | -2.3 ± 2.9° |
| Glabella angle | -9.1 ± 9.8° | not significant |
| Pyriform angle | -8.5 ± 10.1° | not significant |

The aged nose is **longer, with the tip angulating downward**. That is tip ptosis: as the support loosens, the tip rotates down and the nasolabial angle closes.

### 3.3 Why

Cartilage tissue change per year of age: percentage change in the share of tissue stained, 33 cadavers aged 55-93 (cross-sectional) [19]:

| Tissue | Change per year |
|---|---|
| Auricular cartilage, glycosaminoglycans | -0.97% |
| Auricular cartilage, elastin | -0.98% |
| Septal cartilage, glycosaminoglycans | -2.4% |
| Auricular and septal, cell density and size | decline significantly |
| Collagen content | no significant change |

**The mental model.** Cartilage loses its *resilience* (elastin and GAG down) while keeping its *bulk* (collagen flat), and gravity does the rest. Model that as a slow rotation and droop on the nose tip and a slow elongation on the ear and lobe, on sliders separate from the bone-resorption and fat-deflation dials, because the three move in different directions on different clocks.

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## 4. Not covered here

This document covers the nasal framework, the external ear and cartilage ageing. It does not cover:

- **Facial soft-tissue thickness.** Per-landmark thickness tables would turn bony landmarks into surface points.
- **Mimetic musculature.** The expression muscles that produce the nasolabial fold and other creases.
- **Teeth and lips.** Both are strongly age-linked.

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## Sources

01. Kasliwal & Belaldavar (2018). *Anthropometric Overview of Lower Alar Cartilage: An Indian Perspective.* Indian J Otolaryngol Head Neck Surg. - https://pmc.ncbi.nlm.nih.gov/articles/PMC6224830/
02. Anthropometric Study of Alar Cartilage in Asians (52 alar cartilages in 26 Koreans; sex-split length, width, thickness). - https://exa.ai/library/publication/x51t6f7cyly
03. Real-time per-operative assessment of the lower lateral nasal cartilage morphology (crus dimensions; middle-lateral crus angle). - https://journals.lww.com/cmre/fulltext/2025/01000/real_time_per_operative_assessment_of_the_lower.2.aspx
04. Research on Macroanatomic and Histologic Characteristics of the Lower Lateral Nasal Cartilages in Vietnamese (thickness, interdomal ligament, interdomal fat pad). - https://oamjms.eu/index.php/mjms/article/view/oamjms.2019.365
05. Anthropometric measurements of alar cartilage in the Turkish population sample. - https://www.springermedizin.de/anthropometric-measurements-of-alar-cartilage-in-the-turkish-pop/52067874
06. Analysis of the Development of the Nasal Septum according to Age and Gender Using MRI (cartilaginous dorsal length; keystone overlap; septal areas). - https://pmc.ncbi.nlm.nih.gov/articles/PMC2671753
07. Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage Using 3D Facial Bone CT (septal cartilage area and its share of the septum). - https://pmc.ncbi.nlm.nih.gov/articles/PMC3961615
08. Miles et al. (2007). *Anatomical variation of the nasal septum: analysis of 57 cadaver specimens.* Otolaryngol Head Neck Surg. - https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/pdf/10.1016/j.otohns.2006.11.047
09. Nasal septum - structure, division into osseous and cartilaginous parts, ≈2 mm thickness. - https://en.wikipedia.org/wiki/Nasal_septum
10. Lateral process of the nasal septal cartilage / upper lateral cartilage dimensions. IMAIOS e-Anatomy. - https://www.imaios.com/en/e-anatomy/anatomical-structures/lateral-process-of-nasal-septal-cartilage-1536897660
11. Aesthetic Otoplasty: Principles, Techniques and an Integrated Approach to Patient-Centric Outcomes (normal auricle dimensions, position and protrusion). - https://doi.org/10.1007/s00266-019-01441-2
12. Surgery of the auricle (ear length and width; auriculocephalic and scapha-conchal angles). - https://pubmed.ncbi.nlm.nih.gov/12739182
13. Pediatric otoplasty - auricle growth (85% of adult size by age 3, 90-95% by 5-6 yr) and the Farkas "idealised" auricle dimensions. - http://drwise.com/assets/img/img-export/1709653114-research-otoplasty.pdf
14. Anthropometry of the External Ear in Korean Adults: A Multicenter Study. - https://pmc.ncbi.nlm.nih.gov/articles/PMC12148551
15. Why do human ears get longer with age? Auricular stretching by facial adiposity (Heathcote's 0.22 mm/yr ear-length finding). - https://www.sciencedirect.com/science/article/abs/pii/S0306987723000737
16. Ear size as a predictor of chronological age (ear circumference +0.51 mm/yr). - https://pubmed.ncbi.nlm.nih.gov/18653105/
17. Cross-sectional anthropometric study of the external ear (per-dimension age regression coefficients, n=1,353). - https://exa.ai/library/publication/h7g25nt8vdw
18. Ito et al. (2001). *A Morphological Study of Age Changes in Adult Human Auricular Cartilage With Special Emphasis on Elastic Fibers.* The Laryngoscope. - https://onlinelibrary.wiley.com/doi/10.1097/00005537-200105000-00023
19. Age-related histologic and biochemical changes in auricular and septal cartilage (elastin and glycosaminoglycan loss rates). - https://pubmed.ncbi.nlm.nih.gov/28846132/
20. Differences in Nasal Shapes and the Degree of Changes Over a Decade or More: A Paired Analysis (sex-split ageing of the nose over ~12 years). - https://ncbi.nlm.nih.gov/pmc/articles/PMC10933809

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## Revision notes

- **Created 2026-10-02.**
- **Sources are a first pass.** Nasal cartilage dimensions come from rhinoplasty and cadaver series: small n, often older subjects, usually one population each. Treat them as shape guidance, not population norms.
- **One conflict flagged.** Claims in circulation that the upper lateral cartilage underlaps the nasal bone by a large margin sit against much smaller values in the surgical literature, and imaging puts the keystone overlap at 7 ± 2 mm (§1.2). Both extremes are treated as suspect here.
- **Ear length varies by population and method.** The Korean multicentre figures run several millimetres above the Farkas idealised set for the same sex.
- **Fact-check pass (2026-10-02).** Re-checked against the papers: the nose-ageing CT study (all twelve values), the tissue-loss rates, the Korean ear dimensions (n=631), the Indian crus data and the Korean comparison distances, the CT septum area and share, and the ear-circumference regression. Fixed: a "medial crus, width 3-4 mm" row was removed because its cited paper reports no medial crus data; the septum tables are no longer headed "adults" (the CT series spans ages 4-99, Korean patients); the nose-ageing sample is now named (48 Korean adults, 33 women and 15 men); the ear-ageing mechanism is flagged as disputed, and the 0.22 mm/yr finding is attributed to Heathcote 1995 rather than the 2023 paper it was cited through; the lifespan intro no longer states the cartilage mechanism as settled. Not re-checked: the cadaver septum values and the MRI dorsal length and area (abstracts only), the Farkas ideal ear dimensions, the otoplasty angles and stand-offs, and the Korean alar series. Several sources remain secondary or indirect (Wikipedia, IMAIOS, exa.ai listings, a clinic PDF) and have not been replaced.
- **Uncited figures removed.** A figure now appears only with a citation next to it, and this page no longer refers to any other page in the set. Removed: the "lower two-thirds" of the nose, the "0.5-0.95 mm across every study" thickness range and the "about 30%" and "about 17%" variation figures (replaced by the cited Korean and Indian thicknesses), the "roughly 9 mm over 50 years" extrapolation (arithmetic on a rate, not a finding), and the "~15 mm" and "1-2 mm" overlap figures in the conflict note above.
- **Growth rates are mostly cross-sectional regressions**, so they mix ageing with cohort effects. The paired-CT nose study is the strongest design in the set, because it follows the same people.