Ethnic Rhinoplasty

Matthew R. Kaufman

Reza Jarrahy

Michael Jones

The demand for cosmetic rhinoplasty within ethnic populations has risen dramatically in the last two decades. Evidence of this trend was provided by a 2005 survey conducted by the American Academy of Facial Plastic Surgery, which revealed that African Americans and Hispanics were more likely to seek rhinoplasty than any other facial cosmetic procedure.¹ Concomitant with this increasing interest in rhinoplasty among ethnic populations has been a shift in the surgical approach to the ethnic nose by rhinoplasty surgeons.

The surgeon attempting to successfully treat the ethnic rhinoplasty patient must appreciate that variations exist not only between Caucasian and non-Caucasian noses, but also between each of the non-Caucasian ethnic groups. In fact, the term ethnic rhinoplasty is too simplistic; it tends to group together individuals with vastly different features. A detailed understanding of nasal anatomy and the specific differences that exist between all non-Caucasian groups (African American, Asian, Hispanic, Mediterranean, and Middle Eastern) is the only way to effectively treat these patients. Even within the African American population, morphological differences have been subcategorized into three groups: African, Afro-Caucasian, and Afro-Indian.²

Among the most challenging aspects of rhinoplasty surgery is the ability to precisely identify any structural abnormalities that exist and reconcile these anatomic realities with the patient’s perception of what the problem is. No two rhinoplasty procedures are the same; each intervention must be customized to the anatomy and desired outcome of each individual patient. However, there are some general surgical approaches to different nose types—often categorized by ethnicity—that may be broadly applied. For example, one relatively common goal of the Caucasian rhinoplasty is to decrease the overall nasal size in the pursuit of an aesthetic ideal. This may be accomplished, for example, by reduction of the dorsal hump or trimming of the lower lateral cartilages.

Historically, the Caucasian model of nasal reduction was applied to the African American nose. Results were often unsatisfactory, reflecting a lack of sensitivity to the impact of ethnicity on “ideal” outcomes in rhinoplasty. A misunderstanding existed regarding the disparity between excessive bulky soft tissues and deficient osteocartilaginous support.³ As surgeons came to understand that it was rarely desirable to create the ideal Caucasian nose in an African American patient, but rather to correct structural abnormalities while preserving favorable ethnicity-specific features, a unique set of rhinoplasty techniques for this patient population evolved. For example, rather than prioritizing reduction of the size of the nose to achieve an aesthetic ideal, rhinoplasty in most ethnic groups today often incorporates some degree of augmentation to achieve desired aesthetic outcomes.

The primary lesson to be learned—and the underlying principle behind all truly successful rhinoplasty surgery—was eloquently elaborated by Pitanguy in 1972, who stated that the nose must be in harmony with the rest of the face as well as the race of the individual.⁴

Nasal Anatomy

Nasal anatomy may be divided into the internal framework and the external soft-tissue envelope. The osseocartilaginous structures that make up the internal framework include the paired nasal bones and bony septum in the upper third of the nose, the upper lateral cartilages in the middle third, and the lower lateral cartilages in the lower third Fig. 26-1. The midline cartilaginous septum provides structural support to the midvault and lower third of the nose. It is also functionally important in regulating nasal airflow. The soft-tissue envelope consists of the subcutaneous tissues and overlying skin. Skin quality varies among different parts of the nose (e.g., nasal skin is thicker and more sebaceous at the tip than over the dorsum). Variations in both osseocartilaginous and soft-tissue elements seen in ethnic groups, although not uniformly present, are common enough to distinguish the particular ethnicities from typical Caucasian noses.

The literature is replete with detailed descriptions of and comparisons between Caucasian and African American nasal anatomy.⁵^,⁶^,⁷, Fundamental differences are noted in both structural and coverage components. For example,

Only gold members can continue reading. Log In or Register to continue