Asian rhinoplasty differs from traditional rhinoplasty approaches in preoperative analysis, patient expectations, nasal anatomy, and surgical techniques used. Platyrrhine nasal characteristics are common, with low dorsum, weak lower lateral cartilages, columellar retraction, and thick sebaceous skin often noted. Typically, patients seek augmentation of these existing structures rather than reductive procedures. Autologous cartilage, in particular use of costal cartilage, has been shown to be a reliable technique, which, when executed properly, produces excellent long-term results. An understanding of cultural perspectives, knowledge of the nasal anatomy unique to Asian patients, and proficiency with augmentation techniques are prerequisites in attaining the desired results for patient and surgeon.
Cosmetic rhinoplasty in the Asian patient population differs from traditional rhinoplasty approaches in many aspects, including preoperative analysis, patient expectations, nasal anatomy, and surgical techniques used. Platyrrhine nasal characteristics are common, with low dorsum, weak lower lateral cartilages, and thick sebaceous skin often noted. Typically, patients seek augmentation of these existing structures rather than reductive procedures. Patient desires and expectations are unique to this population, with patients often seeking improvement and refinement of their Asian features, not radical changes toward more characteristic White features. Use of alloplastic or autologous materials is necessary to achieve the desired results; the use of each material carries inherent risks and benefits that should be discussed with the patient. Autologous cartilage, in particular use of costal cartilage, has shown to be a reliable, low-risk technique, which, when executed properly, produces excellent long-term results. An understanding of cultural perspectives, knowledge of the nasal anatomy unique to Asian patients, and proficiency with augmentation techniques are prerequisites in attaining the desired results for patient and surgeon.
Preoperative evaluation
Preoperative counseling of the Asian rhinoplasty patient demands attention to cultural concerns in addition to cosmetic concerns and functional complaints. Commonly, patients describe their desire to achieve elevation of the nasal dorsum, refinement of the nasal tip, narrowing of the nasal base and correction of their columellar or premaxillary retraction.
Characteristics of the Asian nose include: low nasal dorsum with caudally placed nasal starting point, thick, sebaceous skin overlying the nasal tip and supratip, weak lower lateral cartilages, small amount of cartilaginous septum, foreshortened nose, retracted columella, and thickened alar lobules ( Fig. 1 ).
Each patient’s desire to balance augmenting their Asian nasal features with maintenance of the appearance of an Asian nose is unique for each individual and should be elucidated during the initial consultation and preoperative visits. Demonstration of the proposed changes to the patient with a computer-imaging program can aid communication between patient and surgeon of the proposed changes ( Fig. 2 A, C). Fulfillment of the patient’s stated wishes may produce a modification of the patient’s ethnic identity, and computer imaging helps the patient to better understand the possible outcome. When available, preoperative and postoperative results of previous patients may help demonstrate the spectrum of changes possible and aid the patient in deciding on the desired postoperative result.
