Demographics and scope

In the United States, the estimated size of the Middle Eastern diaspora ranges from 1.2 to 3.5 million people, depending on the census source. Most of this ethnic group (94%) reside in large metropolitan areas, particularly in the cities of Los Angeles, Detroit, and New York.

Patients of Middle Eastern extraction can trace their roots to 1 of the many countries in a vast geographic area of the Middle East. As ethnic and cultural borders of this part of the world have been blurred over the centuries by migration and intermixing of various populations, it is not surprising that people living in the Middle East and neighboring countries (Afghanistan, Pakistan, and India) have many of the nasal characteristics found in the Middle Eastern nose.

Because Middle Eastern extraction implies a wide range of ethnicities and religions, aesthetic needs and desires for rhinoplasty vary subtly between various geographic regions of the Middle East (and, by extension, within the diaspora presently living in the United States). For instance, people living outside the Arabian Peninsula and Gulf regions (Saudi Arabia, Kuwait, Qatar, UAE, Oman, and Iran) desire a greater change with rhinoplasty, in terms of dorsal reduction and tip projection.

The Middle Eastern nose

Several distinct surface features define the Middle Eastern nose ( Table 1 ). These features can be readily identified on photographs of people of Middle Eastern descent ( Fig. 1 ).

Examples of the Middle Eastern nasal appearance, highlighting typical visual features outlined in Table 1 . Well-known political figures in the Middle East: ( A ) Pervez Musharraf; ( B ) Shimon Perez.

The upper two-thirds of the Middle Eastern nose is dominated by a high radix and a strong dorsum, with an associated dorsal hump. The dorsal hump is almost always accentuated by an under projected, hanging nasal tip, which creates the illusion of increased dorsal height. As a result, tip elevation is an important surgical maneuver in reducing this illusion and visually lowering the dorsum.

The cartilaginous framework of the lower one-third of the nose consists of weak lower lateral cartilages, resulting in varying degrees of nasal tip ptosis. The medial crura are typically thin and add minimal structural integrity toward nasal tip support. The lateral crura tend to have a cephalic orientation and contribute variably to supratip and supra-alar fullness. Overactive depressor septi nasi muscle and alar flaring can also be seen.

A thick overlying skin–soft tissue envelope (SSTE) covers the osseo-cartilaginous framework of the Middle Eastern nose. This property of the SSTE significantly influences the appearance of the lower one-third of the nose by blunting tip definition and adding fullness to the supratip and supra-alar regions. Around the nasal tip, numerous pilosebaceous units give the skin an oily texture and further contribute to increased skin thickness. In the postoperative period, pilosebaceous content of the SSTE promotes tissue scarring and pollybeak formation, caused by increased vascularity in the region.

The Middle Eastern nose

Several distinct surface features define the Middle Eastern nose ( Table 1 ). These features can be readily identified on photographs of people of Middle Eastern descent ( Fig. 1 ).

Examples of the Middle Eastern nasal appearance, highlighting typical visual features outlined in Table 1 . Well-known political figures in the Middle East: ( A ) Pervez Musharraf; ( B ) Shimon Perez.

The upper two-thirds of the Middle Eastern nose is dominated by a high radix and a strong dorsum, with an associated dorsal hump. The dorsal hump is almost always accentuated by an under projected, hanging nasal tip, which creates the illusion of increased dorsal height. As a result, tip elevation is an important surgical maneuver in reducing this illusion and visually lowering the dorsum.

The cartilaginous framework of the lower one-third of the nose consists of weak lower lateral cartilages, resulting in varying degrees of nasal tip ptosis. The medial crura are typically thin and add minimal structural integrity toward nasal tip support. The lateral crura tend to have a cephalic orientation and contribute variably to supratip and supra-alar fullness. Overactive depressor septi nasi muscle and alar flaring can also be seen.

A thick overlying skin–soft tissue envelope (SSTE) covers the osseo-cartilaginous framework of the Middle Eastern nose. This property of the SSTE significantly influences the appearance of the lower one-third of the nose by blunting tip definition and adding fullness to the supratip and supra-alar regions. Around the nasal tip, numerous pilosebaceous units give the skin an oily texture and further contribute to increased skin thickness. In the postoperative period, pilosebaceous content of the SSTE promotes tissue scarring and pollybeak formation, caused by increased vascularity in the region.