Ethnic Rhinoplasty: What is important ?
Ethnic rhinoplasty denotes nose plastic surgery in all non Caucasians ethnic groups. The appearance of noses in Afro-American or Afro-Caribbeans, Asians, Hispanics, Mediterrenean and Persians or Arabs is strikingly different from the looks of a Western nose. However, it is very important to understand that for each of these ethnic groups there is an average or normal appearance. And this normal appearance is not that of a Western nose. Ethnic rhinoplasty is sought for the same reason as traditional rhinoplasty in Caucasians: to bring the nose closer to the aesthetic ideal or norm of the particular ethnic group. It is virtually never desired to achieve a Western looking nose through ethnic rhinoplasty.
Ethnic Rhinoplasty: What are the Differences ?
These differences in ethnic noses are produced primarily by a different configuration of the framework of the nose made of cartilage and bone and the often extreme thickness of the skin in ethnic patients, which does not permit the configuration of the framework to show through to the same degree as in Caucasians with thinner skin.
Several other differences compared to Western nose job surgery are well known in ethnic rhinoplasty. Each of these differences has profound implications on technique and subsequent appearance of the result and merits separate articles for a more in depth discussion. More often than not in ethnic rhinoplasty the bridge of the nose is very low, but also very wide. This is particularly true in Afro-American or Afro-Caribbean and Asian ethnic groups.
Ethnic Rhinoplasty: Designing Bridge of the Nose
While the width of the bridge can be decreased by the same means as in Caucasian rhinoplasty, namely by moving the bones and cartilages making up the bridge closer to each other and the midline, increasing the height of the bridge is a more difficult problem and one that sets ethnic rhinoplasty truly apart from traditional nose job surgery in terms of technical complexity. Except in cases of revision rhinoplasty, posttraumatic or congenital deformities it is rare to encounter the necessity for a major increase in height of the bridge in a Western rhinoplasty. For decades, the solutions to this problem have not been completely satisfactory. Artificial implants are still a popular option predominantly in East Asian countries. These implants come off the shelf, are relatively inexpensive and can be inserted with an endonasal rhinoplasty technique under local anesthesia. In absolute numbers, this type of rhinoplasty is probably the most frequently performed nose plastic surgery worldwide. Ethnic rhinoplasty using implants is unfortunately fraught with a myriad of problems, none of which can be solved without a revision rhinoplasty. The implants may show visible edges, be mobile in their pocket underneath the skin of the nose or slide into an unfavorable position and thus result in appearance problems. The biggest problem with artificial implants in ethnic rhinoplasty is the high risk of infection and extrusion through the overlying skin. This is a true catastrophe requiring removal of the implant, antibiotic treatment and an involved reconstruction with rib cartilage grafts.
Thus, in ethnic rhinoplasty as in all other types of nose job surgery, where an augmentation of the dorsum is required, only the body’s own tissues should be used. In the past, solid grafts primarily made of rib or cranial bone were used. The risk of infection and extrusion is very low under such circumstances. The aesthetic results were however often fraught with the same imperfections as mentioned in the context of artificial implants. Visibility of edges and malposition did occur with these solid grafts. The donor site, from which the graft was removed like rib cage or skull, was not met uniformly with a high patient acceptance rate.
Ethnic Rhinoplasty: the State of the Art Designer Dorsum
Fortunately, these drawbacks were substantially improved with the advent of so called diced cartilage in fascia grafts. Arbitrary pieces of cartilage can be used. They are diced into tiny pieces like one would dice onion and wrapped into a shell made from connective tissue removed through a small incision in the scalp. Cartilage itself is primarily harvested from the ears through an incision on the back of the ears similar to the one used for ear pinning. The shape of the ear remains unchanged. Ear cartilage is very soft and does not lend itself well to structural purposes like propping up the nose or forming solid grafts for the bridge of the nose. However, when diced and wrapped it makes a perfect graft to increase the height of the bridge. The hidden incisions and absence of deformities at the donor sites are perfectly fitting the cosmetic character of ethnic rhinoplasty. The only really drawback is the more limited augmentation possible. If more than six to seven millimeters of increase of height of the bridge of the nose are needed, solid rib grafts will be a better option. It is, however, rare to need such massive dorsal augmentations in ethnic rhinoplasty. The technique of diced cartilage in fascia also permits a very precise tailoring of the size and shape of the graft. The surgeon can create a true designer dorsum.
This technique has thus become the method of choice to treat the low bridge of the nose not only in ethnic rhinoplasty but also in nose plastic surgery performed to correct traumatic or congenital deformities.
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