Although I am frequently asked about “ethnic” rhinoplasty by patients, the definition of an ethnic rhinoplasty is relative and varies greatly based on perspective. What someone in Chicago considers an ethnic rhinoplasty may be different from what is thought to be “ethnic” in Los Angeles, Miami or Maine. Recently I was in Tokyo and Seoul discussing my techniques for Asian rhinoplasty, and when my colleagues asked me about ethnic rhinoplasty, they were referring to a Caucasian nose. Cosmetic rhinoplasty has its roots in the early part of the 20th century and began as an operation that would allow someone to hide their ethnicity. It was on operation popularized in Germany by Dr. Jacques Joseph for Middle Eastern, Eastern European and Russian descendants who wanted a more German looking nose. The operation quickly caught on in America when pioneering and forward thinking American surgeons including my great uncle Sam Fomon, went to learn from Dr. Joseph. They brought back this curious image altering procedure, and it gained popularity in NYC especially among the Irish and Jewish immigrants wanting to appear more American. The “American nose” was shorter scooped out tiny tip nose typified by twiggy the American iconic star of the 50’s.
The goal was still to hide one’s ethnicity. However, America started to change as many more immigrants moved to this country and the appearance of what is beautiful also changed. Beauty in a population is defined by what is the average of all the people in that group. So as America absorbed more peoples from Africa, South America and Asia our definition of what is beautiful also migrated. Today what is beautiful is no longer a turned up nose, wide open eyes or well defined lips rather it is fuller eyes (Catherine Zeta Jones), a slightly wider nose (Halle Berry) and fuller lips (Anjolie Jolie). Our goal today is rather to create a more symmetric nose that blends with the average of society but still allows for identity of one’s original ethnic roots. It is uncommon for a person to ask for a race-changing nose today although on occasion it happens. Most patients just want their nose, but better, one they can feel proud of whether at their family reunion or at their multicultural college campus. The aesthetics of the nose do vary based on region and culture, so it is critically important to be very sensitive and understand the goals of each individual.
My first 5 years of performing rhinoplasty were on patients of African American and Asian descent. Over the last ten years, I have gained enormous experience operating on such noses and have developed unique techniques to preserve ethnicity and keep the procedure a secret. It seems especially important for my patients who are in the media spotlight whose career could be ruined if the fact they had a rhinoplasty became public.
Patients of African, Hispanic and Asian descent tend to have thicker skin, wider nasal bases, limited caudal septal support and a lower dorsum (bridge). A common request is a higher bridge (dorsum), narrowed tip and narrowed nostril base. However the techniques that would achieve such results in a Caucasian nose are completely different for an ethnic nose. The bridge while appearing wide will not be narrowed by breaking the nose, (lateral osteotomies) rather the bridge has to be augmented. In Asia, foreign body grafts such silastic implants and fillers are popular. In the United States, however, these are less popular as we tend to be concerned about the infection and rejection rates associated with these products. We tend to use cartilage and soft tissue materials that come from the patient’s nose, ear or rib. Therefore there is no chance for rejection. Yes it does take more time but in the long run it may be a better solution.
The nasal tip in order to be narrowed needs more projection and support. “Ethnic” noses tend to have thin lower lateral (tip) cartilages and weak support to the tip. In other words if you push on the tip it is easily depressed almost all the way down and springs back slowly. In order to provide thinning and more definition to the tip it will need support usually achieved with a caudal septal extension graft and tongue in groove maneuver. These are stabilizing grafts that use the patient’s own septal cartilage. For more information on these grafts see my lecture to the Australian Society of Facial Plastic Surgeons. Often the lower lateral cartilage and tip will need additional augmentation and this can be achieved with soft tissue and fascia taken from behind the nose or if additional is needed from behind the ear.
Because the “ethnic” nose tends to have thicker skin and is at higher risk for swelling and scaring, a closed rhinoplasty approach with all incision hidden on the inside of the nose is particularly favored and beneficial. Nothing could be worse than a nicely shaped nose ruined by a horrible scar on the columellar (skin between the nostrils). Additionally keeping swelling to a minimum is essential. Excess swelling can lead to permanent changes in the nose such as poly beak formation (nose looks like a parrot beak). It is my opinion that the closed approach with less surgical dissection and quicker operative times is very important to reducing the risk for post operative swelling.
There are multiple other measures that I use during surgery to reduce the risk of swelling from smaller instruments, to specific medications given during surgery and special stitches. All of these seemingly minor steps are very important swelling reduction maneuvers that I have learned and developed over years from performing and teaching of ethnic rhinoplasty.
If you are considering undergoing a rhinoplasty and are of ethnic descent, make sure your physician is very experienced with treating people with noses similar to yours. Ask to see photos, talk to other patients and ask for your doctor’s philosophy on “ethnic rhinoplasty.”
questions to ask before undergoing ethnic rhinoplasty, in addition to “The 15 Rhinoplasty Questions.”
- How many ethnic noses have you done?
- What measures do you use differently from Caucasian noses?
- Do you use grafting material that is a foreign?
- Will you break my nose?
- Are you worried about scarring in my nose?
- What will you do to prevent excessive swelling?
- Do you do the closed approach and if not why?
Contact Dr. Steven H. Dayan about ethnic rhinoplasty.