Rhinoplasty is the main facial plastic procedure performed in Latin America. Mestizo or Latino patients tend to have noses with thick skin, bulbous tips with poor projection, and flimsy osteocartilaginous underlying frameworks. A technique is presented in which structural grafts are used to strengthen support structures of the nose. A gradual approach is used to obtain tip definition, rotation, and projection using sutures and grafts. Simple techniques are used initially, progressing to more aggressive and less predictable ones in patients who require greater changes. The result should be noses that look more refined, with greater definition, but without looking bigger.
Key points
- •
Rhinoplasty is the main facial plastic procedure that is performed in Latin America in all age groups independent of gender.
- •
Latino or Mestizo patients have noses with thick skin–soft tissue envelope; tips that are bulbous, undefined, and flimsy; and a poor underlying osteocartilaginous structure.
- •
A structural approach is used in which conservative tissue excision is performed and structural grafting is used to reinforce the support structures of the nose.
- •
A gradual approach is used to work on the nasal tip. Sutures and grafts are used to reshape cartilaginous structures by creating tips with greater refinement and definition without making them look bigger.
Introduction
In Latin America, rhinoplasty is the most frequently performed facial plastic procedure in both men and women of all age groups. All facial plastic surgeons should be able to perform this surgery properly.
Latin American patients are mixed-race patients commonly known as mestizo, Hispanic, or Latino people. Because of the intermixing of races, noses can have important structural deficiencies. This article shows how, by using a structural approach using sutures and grafts, consistent satisfactory functional and cosmetic long-term results can be achieved.
Concepts of Beauty and Mestizo Patients
Mestizo was a term used originally in Spain and in Latin America to describe a person of mixed European and Indian descent. Over time, and because of migration of different ethnic groups over the years to Latin America, pure races became less distinct and the mixing of ethnic groups more evident. This intermixing now comprises all the different racial groups that exist in Latin America and for this reason mestizo patients are considered mixed-race patients. Migration patterns have also changed, and in the last 50 years many people have migrated from Latin American countries to developed countries like the United States, Canada, and European countries (mainly Spain) looking for better job opportunities or for political reasons. In United States the biggest minority ethnic group is the Latin group. This group is commonly referred to as Hispanic or Latino people.”
There is now an increased awareness of cosmetic procedures that are being performed worldwide. Cosmetic surgery is no longer a privilege of the few and has become available to patients of all social groups and economic levels, independent of their race or ethnic group. Beauty standards have changed and patients usually want to fit in and be part of their social and cultural groups. Beauty is defined by what the models, sport icons, actors and actresses, and favorite rock stars look like. Most Latin patients consider their noses too broad and too big for their faces. Patients usually want noses that look more defined, with greater definition but without looking bigger
Mestizo Nasal Characteristics
Nasal characteristics in mestizo or Latino patients are those of mixed-race patients. Because of the intermixing of races it can be difficult to define predominant racial characteristics and it is crucial to be able to make an accurate anatomic diagnosis of the patient’s nasal findings. In general, mestizo noses have a tendency to have a thick skin–soft tissue envelope (S-STE), and a weak underlying bony and cartilaginous framework. Bones tend to be small and cartilages thin and flimsy. Tips have a tendency to be bulbous, undefined, with poor projection and rotation ( Fig. 1 ).
