One of the most sought after facial cosmetic procedures in non-Caucasians in our Caribbean plastic surgery clinic at Trinidad Intitute of Plastic Surgery is ethnic rhinoplasty (nose reshaping, nose job).
The noses of East Indians, Afro-Americans and Afro-Caribbeans, Asians and Hispanics or Arabs have features have strikingly different features than a Caucasian nose. Thus ethnic rhinoplasty is really a different ball game than Western rhinoplasty, almost a completely different discipline.
It is necessary, therefore, to approach each ethnic group’s nose individually and aim to have a better balance of the nose to the rest of the face, rather than a standard or ‘cookie-cutter-type’ nasal appearance. It is also important to appreciate that most ethnic patients do not want a Caucasian-looking nose, rather they want a nose that is consistent with their ethnicity but in better balance.
One of the challenges in ethnic rhinoplasty is the thick and oily skin that most East Indians, African-Americans, Asians, and Hispanics have. This thick skin imposes a disadvantage, a small delicate look to the nose can not be surgically created. One advantage to thick skin, however, is that any irregularities of the underlying bone and cartilage will not be easily seen.
The ethnic rhinoplasty patient almost always has broader and flatter nasal bones and nasal tips that are more wide and less defined. The most crucial point about ethnic rhinoplasty is to recognize that some things are weak or missing – structure, support, height of bridge, strength of tip cartilage (necessary to impart a less flat and broad look), projection of the tip while others are in excess – width of base, size of nostrils, downward rotation of tip, in short there is imbalance in the nose. The procedure of ethnic rhinoplasty is about restoring that balance by strengthening the weak parts, building up what is missing and reducing what is too much.
The difficulties are twofold: first, material is needed to build up the nose. We do not use any synthetic implants in the nose, only the body’s own cartilage or bone to build up the bridge and tip. Secondly, sometimes huge corrections are needed, particularly reductions of nostril size, size of the base of the nose or increase height of the bridge and projecion of the tip. However, the features of the nose move easily only by a couple of millimeters in each direction – bigger, smaller, higher, lower, upwards, downwards.
While implants to build up the nose are easier to use, since they come ‘off-the-shelf’, there is always an increased risk of implant infection, changing position after surgery causing asymmetry, and even possibly eroding through the skin. Cartilage and bone grafts require a donor site, are harder to work with, and generally do not produce as much change nor as easily as implants. However, infections with grafts from your own body are much less likely. Nearly all real catastrophes after rhinoplasty arise from the use of synthetic material in the nose.
Ethnic rhinoplasty can be very rewarding and help harmonize the facial features. The surgery must be approached, however, with a good understanding of the underlying anatomy, which is really very different than what one is used to seeing in Caucasian noses, and what the patient’s nasal goals are.
Ethnic rhinoplasty is advanced surgery, on par with rhinoplasty in cleft lip and palate patients, correction of posttraumatic nasal deformities or secondary rhinoplasty / revision rhinoplasty, none being procedures for the faint of heart used to shaving off small humps in cute Caucasian teenagers …
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