What Makes Ethnic Rhinoplasty Different from a Traditional Nose Job

If you’re unhappy with your natural nose, rhinoplasty can be a good way to smooth a bump, reshape the tip, and adjust the nostrils for all-around symmetry and more proportionate size. But as with other features, the nose can have certain characteristics depending on your ethnicity, like a bump in the bridge (aka the Roman nose) or a large, rounded tip.

That’s where ethnic rhinoplasties come in. These types of nose jobs, which can be further categorized into Asian rhinoplasties, African American rhinoplasties, and the like, require a little more thought. They have to strike a balance between giving patients the results they want (and fixing what they don’t like) and respecting their heritage.

That said, this sort of prescriptive approach to the nose is becoming a thing of the past. “Historically, ‘ethnic rhinoplasty’ was used to refer to a specific relationship between cartilage stiffness and skin thickness—namely, cartilage that is very soft combined with skin that is very thick,” says Dr. Dara Liotta, a board-certified facial plastic surgeon based in New York City and Dubai; these days, she considers the term antiquated.

However, there’s still a need for some extra consideration, since many of the textbook goals of rhinoplasty generally center on Caucasian noses as the “ideal.” But the combination of thicker skin and softer cartilage—which tends to create a naturally wider, rounder, and overall softer look—requires different surgical techniques to get definition and angularity, which are the traditional goals, says Dr. Liotta. With that in mind, here’s what makes an ethnic rhinoplasty different.

What to expect during an ethnic rhinoplasty consultation

Being on the same page with your surgeon is always important, but it’s especially crucial in the case of an ethnic rhinoplasty. “Patient goals are a mix of how they see themselves, beauty ideals of their peers and culture, and their personal preferences,” says Dr. Liotta. “It’s the surgeon’s job to listen to and understand the goals of the patient—and use their experience and knowledge of anatomy to help the patient understand exactly what results are possible.”

This entails identifying the issue in the first place. While some ethnic rhinoplasty patients may have a clear understanding of what their concern is, it might not line up with the opinion of a surgeon who brings a more aesthetic vision to the table. “If you come to me and say, ‘I want a new nostril width,’ but your nostrils are fine and you have a big bump, I’m going to [suggest you] take your bump off,” says Dr. Ari Hoschander, a board-certified plastic surgeon in Rockville Centre, New York.

On the other hand, if someone requests something vague, like “a better version” of the nose they have, then your surgeon may try to get more specific. “I’ll say, ‘Your tip is wide, so let’s narrow it’ or ‘Your dorsum is low. Let’s raise it a little,’” says Dr. Hoschander.

One way to meet in the middle is with imaging programs like Vectra, which New York City board-certified plastic surgeon Dr. Jimmy Sung calls “the gold standard” for the 3D reconstruction of a facial model. “By using that, we have something like a digital image that we can talk about together,” he explains. “I can morph it and say, ‘Do you like it this way? Do you like it that way?’”

This hands-on collaboration isn’t just helpful for results that satisfy both the surgeon and the patient—it can actually make or break the success of an ethnic rhinoplasty. “I find imaging programs to simulate rhinoplasty results to be extremely necessary when traveling to different parts of the globe to operate,” says Dr. Liotta.

Dr. Sung, for his part, also requires two or three consultations before a patient can schedule their surgery. “The only way [to get a satisfactory result] is, the patient needs to be well educated before they get the rhinoplasty,” he says. “And I believe in a cooling-off period. This is not Vegas.”

How the ethnic rhinoplasty itself can differ

Ethnic rhinoplasties, rather than falling neatly into different techniques for each ethnicity, can rather be placed into two broader buckets: reductive rhinoplasty and augmentative rhinoplasty. “In reductive rhinoplasty, you’re taking a big nose and trying to make it smaller, and then there’s augmentation rhinoplasty, where you’re taking a smaller, flatter nose and making it taller,” says Dr. Edwin Kwon, a board-certified plastic surgeon in Beverly Hills, California.

When Asian, African American, and some groups of Hispanic people get a rhinoplasty consultation, they tend to fall in the augmentation category, according to Dr. Kwon. (lt’s worth mentioning that the diversity of noses within Hispanic people tends to be very wide, with one 2009 study calling out three different archetypes).

They share commonalities not only in their characteristics—like a low bridge—but also in their dissatisfaction. There are usually three universal complaints among these patients. First, “they feel like the bridge of the nose is too flat, so it makes their overall nose look flat,” says Dr. Kwon. “Sometimes they have trouble wearing glasses because the glasses don’t fit well.” Secondly, the shape of the nose tends to be round, bulbous, and relatively large for the face. Finally, “the third most common complaint is that their nostrils are wide,” he says. (That being said, there are still some differences. For instance, African Americans tend to have a wide alar base—alar being the nostril region—while Asian Americans have a narrower alar base and smaller openings, says Dr. Hoschander.)

The primary technique to address these concerns is called structural rhinoplasty, in which you create a framework for the nose using cartilage or some other biomaterial. “You’re adding cartilage to build a tip, a bridge, and a stronger alar rim.” (The alar rim is the outer side of the nostrils.)

This is where seeing a provider who specializes in ethnic rhinoplasty is key. Clearly, anatomy can vary widely across ethnicities, and someone who isn’t seeing a lot of, say, Asian American patients might not account for these differences. For instance, “Asian or smaller noses tend to have less or weaker cartilage,” says Dr. Kwon. “If [a surgeon] anticipates taking the septum and using it as a graft, they’re not going to have enough—and the results are going to be not great.” (These days, rib cartilage is used to supplement it in these cases.)

The good news? In the case of rhinoplasty among this group, implicit features, like thick skin, can determine the final result. For example, “that thickness of the skin on the nose can be a big factor, in terms of how refined and how sharp you can make it,” says Dr. Kwon. Which is to say, not very—and that’s actually an advantage, since this aspect can help the nose retain more of a rounded shape, albeit less rounded than the patient started with. “It tends to help preserve some of their natural ethnicity,” says Dr. Kwon.

Meanwhile, Middle Eastern and South Asian rhinoplasties tend to involve a hump and a drooping nasal tip, which call for the reductive rhinoplasty. “Middle Eastern people tend to have bigger noses that are humped, and they’re trying to make them smaller so they fall more in line with European or Mediterranean noses,” says Dr. Kwon. Maybe not surprisingly, new techniques intended to make rhinoplasties less invasive, like the ultrasonic nose job or preservation rhinoplasty, cater to this type of nose job.

That said, beauty ideals can also factor in here versus simply maintaining one’s cultural identity. Dr. Liotta points to Lebanon as an example, where “the beauty ideals are heavily influenced by French and European culture—think a slight slope to the nose, a turned-up nasal tip,” she says. 

Meanwhile, in Dubai, patients prefer to keep a small dorsal hump and prefer the look of a longer, more narrow nose without a turned-up tip, she says. “But again, even within one culture, each patient is different and there’s no one-size-fits-all look.”

How ethnic rhinoplasty recovery differs

An ethnic rhinoplasty will vary in post-op care too. With Asian and African American patients, “they tend to get a lot more swelling, and the swelling is a lot more persistent,” says Dr. Kwon. This means it can take much longer than it does their Caucasian counterparts to see the final results, although it depends on the exact case. “In general, I tell patients that about 80% of the swelling that you’re going to have will resolve within three months,” he says. For the other 20% though, he says that the swelling can persist for anywhere from a year to a year and a half.

An ethnic rhinoplasty can also take longer to heal. For instance, one common side effect among Asian patients is swelling and scarring of the supra tip area, which is right above the nostrils, just north of the tip of the nose. And since Asian skin is thicker, there can be a “separation of the skin from the cartilage or the new graft, and the area can easily swell up and scar,” says Dr. Sung. This requires taping (which is typically used to control swelling) as well as possible steroid injections throughout the recovery period, to keep swelling to a minimum.

All to say: patient cooperation and follow-up are crucial for the best results, as is finding a skilled provider who works with your ethnicity in general—since it’s their skill and familiarity with different nose types that will determine the best outcome. Ultimately, “every nose is like a unique snowflake, with no two exactly alike,” says Dr. Liotta. And a good, experienced surgeon should know how to handle each one.