By Dr. Mark Ginsburg, triple board-certified facial plastic surgeon and cosmetic surgeon
Is there an ideal nose shape? I would say no. You can look up ideal angles and proportions of the nose in rhinoplasty textbooks, but what each person views as the right nose shape for themselves is very unique. While one patient may view a high nasal dorm as a problem, another may view the same thing as an important characteristic of their ethnicity that they would not want to lose.
What is Ethnic Rhinoplasty?
Ethnic rhinoplasty requires special consideration. Ethnic groups carry certain characteristics which require attention. It is also important to evaluate which of these characteristics the patient wishes to hold on to and which ones they may want to change. Caucasian noses typically have thin to moderate skin, moderate alar width, various tip shapes and dorsal heights. Most of the rhinoplasty ideals are written with Caucasian noses in mind.
Asian noses typically have thick skin. The dorsum is usually low and wide. The tip of the Asian nose is normally broad and flat as well as under projected, due to short medial crura. Alar can be round and wide commonly. Common challenges with Asian noses involve elevating the dorm and achieving tip projection and definition. Dorsal grafting and tip grafting techniques are common maneuvers employed in Asian Rhinoplasty.
Dar-skinned patients with African descent typically have thick skin on their nose with a low wide dorm. Tips are commonly under projected and lack support due to short nasal septums, and thick lateral crura and thin medial crura. Tips are broad and flat compared to Caucasian noses and are understated due to poor tip support. The nostrils are round and usually have wider alar. This flaring of the alar is usually wider than Asian noses., The dorsal is very wide and low.
African patients who request narrowing of their tips typically require tip grafting and caudal septal extension grafts to support tip grafting. Alar base modification may require nasal oil excision. Alar flare reduction is also commonly necessary to achieve the desired result. Occasionally dorsal augmentation may also be necessary.
People of South American descent have very thick, sebaceous skin on their nose. They also have thick tip cartilage and a low nasal dorsum. Alar can be wide but typical not as wide as an African nose. Tips commonly have good projection and rotation, but can be over-rotated at times.
The biggest challenge with a Mestizo nose is skin thickness. The analogy I usually give patients is to imagine a cardboard box on a bed. If you cover the box with a thin sheet, you will still be able to tell that there is a box under the sheet. You can see sharp corners on the box and typically make out the sides and shape of it. If you cover the same bed with a down comforter, you will be able to tell that there is something under the comforter in the shape of a box, but you will not see the angles and not be able to make out sharp lines of the object.
The box scenario is similar to thick skin that hides what is underneath in rhinoplasty. Improved tip definition is one of the most common requests with rhinoplasty. It is more difficult to obtain with thick skin common in ethnic rhinoplasty. Skin can be thinned to a certain extent, but when thinning skin there is a layer of muscle which is typically deeper than the undersurface of the rhinoplasty flap in the dermis of the skin. This can be thinned as well, but cartilage needs to be taken out. This is due to over-aggressive thinning that can give a mottled appearance. Edema can also be a consequence of thinning skin. This could lead to more scar tissue under the skin that tends to be counterproductive for tip definition.
Schedule a Consultation with Dr. Ginsburg Today
The key to ethnic rhinoplasty is informed consent and surgical planning. Listening to patients’ desires and finding out what ethnic characteristics they may want to change and what they want to keep is important. Good informed consent is important in regards to the extent of surgery. Special consideration such as alar incision, the need for grafting cartilage, prolonged edema from skin thinning and limitations associated with thick skin is also important.
Are you interested in one of our ethnic rhinoplasty procedures? Contact Providence Facial Plastic & Cosmetic Surgery. We are happy to serve patients in the greater Philadelphia area and surrounding communities.