Every nose is individual! While we in no way intend to arbitrarily force people into categories that would be biased and/or racist, there is no question that there are cultural, genetic, geographic, and historical influences that have changed nasal development around the world. Our goal is to treat every patient as an individual; however, we may be able to generalize certain anatomic characteristics and subsequent surgical options and furthermore explain the need for potential goals and/or complications to patients based upon these ethnic features. We therefore present the following characteristics of "ethnic features of noses" in order to help patients with preoperative planning and help us with surgical planning in order to give us the best chance to achieve a satisfied patient postop.
How are noses different around the world? Without meaning to generalize we will describe features that are not universal but are often characteristic structural concerns for different regions to best help you individualize your treatment of your nose regardless of your cultural, ethnic, or racial background.
Northern European "Anglo-Saxon"nasal features: Very narrow, high profile (narrow base and very tall elevation away from the lip and face with very thin skin, weak cartilages, small nasal tip with long, narrow nostrils that frequently collapse and can have nasal valve collapse.
Mediterranean NasalCharacteristics (Arabic, Greek, Eastern European): This constellation of nasal features typically reveals very thick cartilage, prominent bumps to the nose, with tips that hang down over the lip. Skin may be thick or thin but frequently the cartilage is so strong that it is visible in its entire outline or part of its outline through the skin of the nose. Typical repairs include reduction rhinoplasty, reduction cosmetic rhinoplasty surgery (taking the bump down, softening the bulges of the cartilage, lifting the tip slightly to change a hanging tip or hooked tip appearance, and in general making the nose smaller and closer to the face).
African-American Nasal Features (black nose, negro nose, African-American nose). The constellation of features described here have been so commonly discussed that they have been named "Plattyrhine features". In general, these features describe very thick skin with weak cartilage, broad nostrils often extending wider than the corners of the eyes, weak cartilage that has difficulty to supporting the tip of the nose. Common surgical corrections, which people are interested in, who have these features, include narrowing the nose and defining the tip, often narrowing the base. Every patient is, of course, individualized and we will address only those features that you are most interested in addressing. Often the weak cartilage and the thick skin limit our ability to make significant changes to the tip; however, we will discuss this with you and your nose with your individual anatomy regardless of your ethnic background at your consultation.
Asian Nasal Features. Understanding many people live in Asia and/or have Asian cultural influences, it is amusing to even consider lumping them (or any other racial group) into a constellation of features to describe them in a few sentences. With that said, there are many Asian people who tend to have low profile noses and rounded somewhat bulbous tips that lack definition. The most consistent surgical request in this group of patients with these very generalized features include nasal augmentation. Most of these patients would like a taller nasal dorsum that is narrower, and a tip that has more definition and is less broad and flat.
Hispanic Nasal Features. Latin-American culture tends to have a certain constellation of features with regard to nasal anatomy. We understand that we are generalizing, of course, since Latin-American culture has been shaped by the Native Americans who were present prior to Northern European and Mediterranean European colonization, as well as from the cultural and genetic influences of slave trade in the Americas. With that said, Hispanic noses often show features of weak, broad cartilages often with thin skin. Most Hispanic nasal issues are focused on nasal augmentation or defining the tip with better shape and support.
Ethnic Rhinoplasty
Nasal augmentation is a common feature in various corrective maneuvers performed in patients with ethnic nasal features. Typically a patient with broad, thick skin and an amorphous tip with weak cartilage will require more structure to give the tip shape. A good image for this is having a very thick blanket over a few books versus having a thick blanket over a tent pole. It is very difficult to see the books through the blanket; however, if you raise the tent pole high enough the blanket begins to take some shape beginning to narrow and appear smaller the higher it is lifted. This is the principle behind using augmentation and nasal implants in cosmetic rhinoplasty in order to make a nose appear smaller. Yes, by placing grafts and implants into a nose, the net effect can often be to make the nose appear smaller. Our favorite implant material for building up the bridge of the nose or dorsum of the nose in rhinoplasty surgery of the ethnic featured nose is Gore-Tex. Gore-Tex augmentation is one of our most reliable methods for nasal augmentation. They may become infected (as does any implant), however, the ability to fight infection without removal of the implant is present in a percentage of the patients with implants. This is because Gore-Tex has small pores that allow white blood cells to enter and fight infection. Furthermore, Gore-Tex has the ability to be trimmed to the shape that we would like and is therefore very easy for surgeons to work with. We can place small grafts in some areas or larger grafts across the entire nose. Gore-Tex is not a structural graft, (if it does not open the nostrils or lift the tip) but more of an onlay graft, which helps give the appearance of a taller nose without changing the structure.
Silastic Implants
Silastic or silicone implants are not our preferred method of nasal augmentation. There are many instances where these become infected and need to be removed. Silicone has no pores and our bodies form a capsule around it. If an infection gets inside this capsule then the implant cannot be salvaged with antibiotics and typically must be removed requiring further reconstructive surgery at some point in the future to restore an esthetic/cosmetic result.
Dr. Neal Goldman is a skilled, experienced, facial plastic surgeon who is specialized in cosmetic and reconstructive surgery of the face and neck. He is board certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolarnygology-Head and Neck Surgery.
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