I would like to have nose surgery to fix my crooked nose. One of my friends recommended the surgeon who did her nose surgery, but I am not sure if I should see the same doctor because my nose looks very different from hers. I am Egyptian and my friend is a caucasian American. Are there different ways nose surgery is performed on people of different ethnicities?
Does my Ethnicity Affect How my Rhinoplasty is Performed?
Doctor Answers 8
There are certain racial differences that exist in the appearance of noses.
In the past, too much emphasis was placed on making the nose look more caucasoid i.e., the "Michael Jackson" nose.
It is generally more accepted to enhance the nasal appearance rather than dramatically alter it. However, this is not typically what the paitent wants and this is where the sugeons's and patient's goals tend to diverge.
Overall, there is no "right" nose.
Find a qualified and certified surgeon with whom you feel comfortable. THEN discuss your goals, desires, and wishes.
No rhinoplasty is identical to another, regardless of the patient's ethnicity. This is because in order for the nose to appear natural and attractive, it must be in balance and harmony with that specific patient's facial features. Thus, every rhinoplasty is unique.
Ethnic patients often do require specific techniques. Noses in African American and Asian patients frequently require building up (augmenting) the nasal bridge and narrowing the nostril base via alar base resection. This involves removing a wedge shaped piece of tissue where the nostril walls meet the cheeks. The overall result is a nose that doesn't appear as wide from the front.
Hispanic and Middle Eastern noses typically require reductive techniques -- removal of bone and cartilage to give a more subtle appearance to the nose. The techniques used include hump removal, tip refinement (narrowing of the tip) and tip reshaping.
The goals of ethnic rhinoplasty should therefore address the patient’s desire for preservation or alteration of ethnicity, balance of surrounding features, and adherence to patient desires.
Ethnicity is very inter-linked with rhinoplasty
This is an excellent question and one that is very close to my heart.
Ethnicity is very inter-linked with rhinoplasty. The key is to not try to erase the beautiful features of each ethnicity, but rather to naturally refine the nose.
The nose is the center of the face. It needs to be balanced with the skin tone/color as well as proportionate with the rest of the facial features. This means that the ethnic features of the face need to be matched with the new nasal features created through rhinoplasty.
I have been invited to speak on this topic and have written several articles and chapters on the topic so I will go into some detail.
The term "racial incongruity" is an important one. This refers to the balance between nose-face-ethnicity that I mention above. However, just as with any cosmetic procedure, the wishes and personal desires of the patient need to be taken into account. I WILL advise against anything that I feel will create a fake, over-operated, and RACIALLY INCONGRUOUS NOSE.
This requires not only an intimate knowledge of rhinoplasty but a step beyond, an understanding of various ethnicities. These mainly consist of Asian, Hispanic, Middle Eastern and African-American. Each requires different evaluation, treatment, and techniques. For example, most Asian and African-American patients need augmentation to the dorsum (hump) while many Hispanic and Middle Eastern patients need reduction of the hump.
Middle Eastern Rhinoplasty
I have written on the Topic of Middle Eastern Rhinoplasty which reviews many of these points. While there is a variation between noses within each ethnic subgroup, each subgroup shares certain features.
One Ethnic Example: The Middle Eastern Nose tends to have long and wide nasal bones, thick/sebaceous skin, drooping and dynamic nasal tip, un-refined and bulbous/wide nasal tip, and moderate to severe dorsal hump. All these require different treatment and a step-wise approach so no irreversible changes are made in the WRONG direction. Each change is made step-by step and the nose is constantly re-evaluated during the surgery.
Another feature of ethnic noses, is that, for the most part, they require support and addition of cartilage. Cartilage preserving techniques (tip shaping through sutures) need to be used, and what cartilage is there should be shaped with minimal cutting or removal. Adding cartilage helps strengthen and refine the nose. The thick skin usually needs to be de-bulked also.
This is a complex topic, however if a patient goes to a surgeon that is experienced with "ethnic rhinoplasty" then a more natural, balanced result will be produced that matches with the patient's ancestry.
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Ethnic Nose Surgery
No two noses are the same regardless of racial or ethnic type. Therefore, a surgeon has to customize his/her surgical plan to meet the specific needs of the patient.
Different noses for different folks!
Every person is different and ethnic noses are also different. When choosing a nose surgeon it is imperative that you interview him or her about their experience with different ethnic nose surgeries. While techniques vary your surgeon should be adept at using both the open and the closed or endonasal approach. When interviewing your doctor make sure you see pictures of before and after results and above all make sure that he or she shows you pictures of similar noses like yours.
Ehnicity can affect the rhinoplasty technique
The technique used for your rhinoplasty is really dependent on your particular anatomy and your goals regarding your results. Certain ethnicities have characteristics that are common to that ethnic group but that is not a 100% rule. For example Asian people typically have low bridges that need to be built up but that is just a guideline and not an absolute. Your skilled rhinoplasty surgeon will be able to discuss your goals with you and the techniques that are required to give you the results you desire.
Differing Goals in Ethnic Rhinoplasty
There are certain basic principles common to all rhinoplasty surgieries, but no two rhinoplasties are the same -- just as no two patients are the same. As surgeons, we must individualize not only our approach to the specifics of your nose, but also what YOU dont like about it (this may be different than your surgeon or everyone else for that matter), how well you breathe and also how well your nose "fits your face."
One common issue that we see frequently, is that most of the common relationships taught to new surgeons, as well as those written about in text books are based upon a Caucasian ideal. There are many patients who want an improvement in their appearance, but not to "lose" their ethnicity. There are also surgical cultural "ideals" that deviate from a standard Caucsian "ideal."
All of this must be taken into careful consideration when approaching each and every rhinoplasty. It is of utmost importance that you communicate with your surgeon (often through imaging) so he/she understands your personal as well as "ethnic" goals.
Best of luck.
There are characteristic features of noses in people of different races and ethnic backgrounds. That is not to say that all noses within each group are the same. A good surgeon will use the techniques and combinations of techniques specifically selected for each individul nose.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.