Ethnic Rhinoplasty Research Articles

Ethnic Rhinoplasty in the Brazilian Population: Current Concepts.

The large mixture of races in Brazil gives the nose its distinctive composition, which makes rhinoplasty difficult for these patients. Every patient should have their anatomy thoroughly examined on an individual basis, as there is no unique strategy that works for all situations. This is a narrative overview of the last 10 years' worth of literature that describes the ethnic traits of each nose, with a particular emphasis on the Brazilian nose, and talks about the major surgical approaches that can be applied in these situations. The low dorsum, broad nasal bones, thick skin, and bulbous tip are the primary features of the Brazilian nose. Many times, lateral osteotomies, root grafting, isotretinoin treatment for skin thickness, and neodomus formation are required. The Brazilian nose presents a surgical challenge that calls for the mastery of multiple procedures, not simply structured rhinoplasty. In certain cases, preservation rhinoplasty may even be used. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bringing Inclusivity to "Ethnic" Rhinoplasty: A Novel Anatomical Classification System.

"Ethnic rhinoplasty" is a term that historically has been employed to categorize patterns in nasal anatomy, possible procedures to change appearance, and patient and surgeon expectations for expected outcomes for the multitude of patients with features that belong to non-White groups. Categorizing anatomical structures based on broad definitions of race or ethnicity may not be an accurate representation, nor give an accurate depiction of nasal anatomical features. A shift is needed regarding how race and ethnicity are employed in describing nasal anatomy and rhinoplasty. We present a categorization system based on nasal anatomical patterns that may have more meaningful surgical implications without generalization into ethnic groups. Common anatomical nasal features such as projection, rotation, skin thickness, and anthropometric measurements were grouped into types, which may also help in patient education and remove any ethnic or racial terms.

Is the Ethnic Rhinoplasty the Most Aesthetic Option available for the Ethnic patient? A Survey Study

Is the Ethnic Rhinoplasty the Most Aesthetic Option available for the Ethnic patient? A Survey Study

Ethnic rhinoplasty: Preliminary results of our technique in the pursuit of the harmonious nose

According to the American Society of Plastic Surgery, cosmetic surgery procedures for "ethnic patients" are annually increasing. Ethnic rhinoplasty traditionally represents a difficult challenge for plastic surgeons. Herein, we describe our personal technique to ethnic rhinoplasty to achieve a harmonious nose maintaining the characteristics of individual ethnicity and identity. In this study, we retrospectively reviewed ethnic patients treated with rhinoplasty at our institution between January 2019 and October 2022. We described our personal rhinoplasty technique step by step. At a minimum follow-up time of six months, postoperative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry and shape and contour of the nose. Finally, patient satisfaction was investigated according to rhinoplasty outcomes evaluation (ROE) questionnaire. A total of 1321 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image, as indicated by the mean postoperative ROE score (92.12). No cases of nasal contracture were recorded. None of the grafts was extruded or collapsed. Wounds healed without reported major infection. This study demonstrated that our approach is a safe procedure that contributes to improved functional outcomes with a high patient satisfaction rate and a low rate of postoperative complication. The creation of a solid base structure, nasal skin preparation, and an integrated patient approach are key elements of this surgery.

Updates in Butterfly Graft Technique.

Nasal obstruction is a significant challenge greatly affecting individual quality of life. It is one of the most common presentations in the otolaryngology clinic, often persisting despite medical and, at times, surgical intervention. The butterfly graft has proven to be a veritable option addressing nasal valve collapse. Herein, we describe our most recent operative technique, highlight its application in ethnic rhinoplasty and revision cases, and discuss incorporation of dorsal preservation techniques in functional rhinoplasty.

Ethnic Rhinoplasty: A Middle East-Centered Patient Satisfaction Survey Using the FACE-Q Questionnaire.

Background Rhinoplasty is a common and complex plastic surgery procedure. The evaluation of surgical success in rhinoplasty is primarily based on patient satisfaction. The purpose of the study is to assess the characteristics of patients who underwent rhinoplasty and their satisfaction using the FACE-Q questionnaire. Methodology This was a retrospective, cross-sectional study of patients who underwent primary rhinoplasty, septorhinoplasty, or a revision rhinoplasty from 2010 to 2020 at a single center. Patients were asked to complete the FACE-Q nose score pre and postoperatively. Patients also provided information on their sociodemographic characteristics, smoking status, alcohol consumption, number of rhinoplasty procedures, cause of revision, and respiratory symptoms before rhinoplasty. Results This study included 183 patients who underwent rhinoplasty between 2010 and 2020. The mean (SD) age of patients at surgery was 25.92 (8.69) years. There were 156 female respondents (85.2%) and 27 male respondents (14.8%). FACE-Q nose satisfaction scores increased significantly after surgery with a mean of 67.21 ± 22.3 (p = 0.000). The most common reason for revision surgery was tip dissatisfaction. Conclusions The findings of this study show that ethnic rhinoplasty, although a complex procedure, can lead to aesthetically pleasing outcomes in a complex population such as the Middle Eastern population.

Subdorsal Cantilever Graft for Elevating the Dorsum in Ethnic Rhinoplasty.

Augmentation of the nasal dorsum is frequently required in the ethnic rhinoplasty patient to create a narrowing effect and to balance the upper two thirds of the nose with the desired increase in tip projection. The subdorsal cantilever graft (SDCG) provides a method to elevate the nasal dorsum to complement the increase in nasal tip projection. SDCG type A is situated below the bony dorsum and acts to raise the dorsum with limited elevation of the radix. The SDCG type B extends through a radix osteotomy site and raises the radix down to the supratip after complete release of the bony dorsum and middle nasal vault. Placement of the SDCG below the dorsum has many advantages, including preserving the features of the natural dorsum (dorsal aesthetic lines), controlled narrowing, and camouflage of the subdorsal graft. This is a complex procedure that requires a good understanding of dorsal preservation techniques. Use of the SDCG to raise the nasal dorsum in ethnic patients combines structure rhinoplasty with the principles of dorsal preservation for augmentation of the profile in patients with a low dorsum.

The Utility of Diced Cartilage Fascia Graft Augmentation of the Nasal Dorsum in Transgender Feminizing Rhinoplasty.

Facial feminizing surgery can have a profound impact on a transgender woman’s ability to “pass” as their identified gender. The brow-nasal complex deservedly gets much attention from facial feminizing surgeons because of well-established differences in male and female anthropometry. In general, these differences include the frontonasal angle (with femininity correlating with obtuseness), dorsal morphology (i.e., concave versus straight or convex, presence of supratip break), dorsal aesthetic line width, bony framework size, and nasal-lip relationship. Feminizing rhinoplasty is intuitively often focused on a “reduction” rhinoplasty, given the generally smaller dimensions of the female nose.1 The utility of the diced-cartilage wrapped in fascia graft has become well established for indications such as in Asian augmentation rhinoplasty and correction of iatrogenic and acquired dorsal deformities. We have been unable to find a previous article focusing on diced cartilage wrapped in fascia as a useful tool in transgender feminizing rhinoplasty, and believe that in select cases, augmentation of the nasal radix and dorsum using this construct serves as a valuable adjunct. We have been pleased with the results that we have seen in transgender facial feminization cases wherein the patient presents with a deep, masculine nasofrontal angle, low radix, and ill-defined dorsal aesthetic lines. This is especially valuable when standard facial feminizing surgery techniques such as a frontal sinus recontouring are inadequate to effectively blunt and soften the nasofrontal region. Of the past 50 transgender feminizing rhinoplasties performed by one of the authors (J.W.C.), seven (14 percent) have used diced-cartilage wrapped in fascia grafts, typically augmenting from the radix to the mid dorsum, while tapering to the supratip area. The surgical technique for this is already well described in the literature.2,3 All diced-cartilage wrapped in fascia cases were in African American transgender women. The indications for diced-cartilage wrapped in fascia graft in six of these patients was in primary rhinoplasty, with preoperative low dorsum and radix, acute nasofrontal angle, and broad, ill-defined dorsal aesthetic lines. In one patient, diced-cartilage wrapped in fascia graft was used in a revision rhinoplasty to replace a malpositioned silicone implant. Tip grafting was used in all cases to increase tip projection and augment harmony with the new dorsum and radix position. In the majority of these cases, the diced-cartilage wrapped in fascia rhinoplasty was performed in conjunction with frontal bone and sinus remodeling, in an effort to maximize feminization of the nasal-orbital-brow complex. Conveniently, a portion of deep temporal fascia can be easily harvested by means of the concomitant coronal approach to create the diced-cartilage wrapped in fascia construct. We have found the combination of these two procedures quite effective in improving feminine appearance and softening the frontonasal angle in appropriately selected patients (Figs. 1 and 2). (See Figure, Supplemental Digital Content 1, which shows the patient preoperatively before facial feminization surgery, https://links.lww.com/PRS/E243. See Figure, Supplemental Digital Content 2, which shows the patient 12 months postoperatively after frontal bone and sinus remodeling, and rhinoplasty with diced cartilage-fascia graft, https://links.lww.com/PRS/E244.)Fig. 1.: Preoperative view, before facial feminization surgery.Fig. 2.: Twelve months postoperatively, after frontal bone and sinus remodeling and rhinoplasty with diced cartilage-fascia graft, with feminized frontal-nasal relationship.It is worth pointing out that the transgender women in my practice who benefited most from diced-cartilage wrapped in fascia grafting were African American. There is a clear intersection in the goals of ethnic rhinoplasty and transgender feminizing rhinoplasty in obtaining nasal-facial harmony, a narrower appearing dorsum, and enhanced tip projection and definition,4 especially when starting with a masculine nose that falls on the platyrrhine spectrum. PATIENT CONSENT The patient provided written consent for the use of her images. DISCLOSURE The authors have no conflicts of interest to disclose.

Alar base symmetrization suture in ethnic rhinoplasty

Alar base surgery has been widely studied in modern rhinoplasty. After the equalization of the dorsum-tip relationship and the improvement of the nasolabial, nasocolumellar and nasofrontal angle, also alar base, needs to be harmonized also. Several classifications of alar base deformities have been described, as well as many techniques for correcting them. This work aims to demonstrate that alar base symmetrization suture (abss) is effective in keeping the nasal wings symmetrical immediately after alar wedges resection and also permits maintenance of the symmetrization during time. It is a simple technique to perform with long-lasting esthetic results. Level of evidence: Level V, therapeutic study.

Ethnic Rhinoplasty.

Ethnic rhinoplasty traditionally has been used to define this surgical procedure performed on non-Caucasian patients. Because of globalization, massive migrations, and interracial mixing, ethnic patients today are considered mixed race patients. Surgical techniques should be based not on what ethnic group they belong to but on anatomical findings and patients' needs and wishes. Preservation techniques are presented and structural approaches are discussed using sutures and grafts. The final objectives of rhinoplasty are better definition, more refined appearance, and compliance with patients' aesthetic ideals while preserving function.

Quantitative Measurements of the Bulbous Tip in Ethnic Rhinoplasty.

Refinement of the bulbous nasal tip continues to be one of the more challenging aspects of ethnic rhinoplasty. Better objective measures are necessary to quantitatively assess changes in surgery of the bulbous tip. We propose the use of a new nasal anatomic landmark in the subnasal vertex view, designated c, in conjunction with previously described landmarks to offer an improved means of characterizing the bulbous tip. Together, these landmarks form a pentagon, allowing for measurement of its angles and distances to quantitatively evaluate the nasal tip in the subnasal vertex view. We hypothesize that this method will provide a means of demonstrating a decrease in tip bulbosity postoperatively. An institutional review board-approved retrospective analysis of 44 nonwhite patients undergoing ethnic rhinoplasty was undertaken and preoperative and postoperative photographs in the subnasal vertex view were subjected to the proposed analysis. All patients underwent an open approach rhinoplasty with a combination of tip defatting and cartilage graft placement. Using the polygonal construct, several angles, distances, and areal indices were measured from the preoperative and postoperative photographs and comparison was made for statistical significance. All but 1 of the 8 parameters examined demonstrated statistical significance comparing preoperative and postoperative values. These measures, thus, allow the surgeon to objectively assess and ascertain a reduction in tip bulbosity of postoperative ethnic rhinoplasty patients. This article presents a new anatomic landmark c seen from a subnasal view of the tip. This landmark can be combined with previously established landmarks to create a polygon that allows for a simple yet objective method for measuring the reduction and contouring of the ethnic bulbous tip.

Ethnic Rhinoplasty in Iranians: The Oral and Maxillofacial Surgery Experience

Rhinoplasty is a common esthetic procedure in Iran. The aim of the present study was to evaluate Iranian patient satisfaction. The role of ethnicity in surgical planning was assessed. This cross-sectional study examined participants aged between 18 and 45 years who underwent primary rhinoplasty. Patients' photographs were analyzed for tip projection, nasolabial angle, and nasofrontal angle. The surgical methods were chosen on the basis of the anatomic part of the nose treated. Patient satisfaction was assessed. Of 279 participants, 210 (75.53%) had a chief complaint of a large nasal tip. A hump nose was a problem for 230 (82.44%) of the participants. Tip droop was a problem for 248 participants (88.89%). The number who wished to have a natural nose was 213 (76.34%), and 66 (23.66%) preferred to have an exaggerated nose. For the recall phase of the study, 248 patients (89 men, 159 women) agreed to participate. Men were more satisfied than women 1year after rhinoplasty. Patients with an elevated tip had a higher satisfaction rate than others. The satisfaction level of patients increased when nose projection decreased. It seems that tip defining and elevation were major concerns of Iranian surgeons. Iranian patients were satisfied with an elevated and low-profile tip.

Septorhinoplasty for the Arabic nose: simple endonasal techniques

EnAbstract Introduction Individuals from the Middle East or of Middle Eastern origins are increasingly seeking cosmetic nasal surgery as their traditional societies gradually become more exposed to the media. This is especially evident in the tribal communities of the Gulf, where financial issues are less of a concern. The Gulf States have also witnessed a rapid influx of foreign migrants over the last 30 years or so. This has resulted in a more racially and ethnically diverse population. The concept of ethnic rhinoplasty is gaining popularity. This entails resculpturing the nose to make it more acceptable within the patient’s own ethnicity and not to overcorrect or alter its characteristics to that of another ethnicity. The characteristic features of the Arabic nose, when exaggerated, are a good example where ethnic rhinoplasty techniques may be of value. Aim The aim of this study was to identify patients with exaggerated features of the characteristic Arabic nose, which are a long nose with a dorsal hump and a pendant tip. Subjective as well as objective measures including the clinical nasal index and the projection index were used to identify and quantify these anomalies. We will review some simple endonasal techniques for the correction of these perceived abnormalities for the best cosmetic as well as functional results. Patients and methods Sixty four patients with typical Arabic nasal features underwent septorhinoplasty using simple endonasal techniques. Results The majority of patients were very satisfied with their appearance after surgery. There were few minor complications with the techniques used. Conclusion Exaggerated features of the Arabic nose can be adequately corrected using a few simple endonasal techniques.

Septorhinoplasty for the Arabic Nose: Simple Endonasal Techniques

Abstract Individuals from the Middle East or of Middle Eastern origins are increasingly seeking cosmetic nasal surgery as their traditional societies gradually become more exposed to the media. This is especially evident in the tribal communities of the Gulf, where financial issues are less of a concern. The Gulf States have also witnessed a rapid influx of foreign migrants over the last 30 years or so. This has resulted in a more racially and ethnically diverse population. The concept of ethnic rhinoplasty is gaining popularity. This entails resculpturing the nose to make it more acceptable within the patient’s own ethnicity and not to overcorrect or alter its characteristics to that of another ethnicity. The characteristic features of the Arabic nose, when exaggerated, are a good example where ethnic rhinoplasty techniques may be of value. The aim of this study was to identify patients with exaggerated features of the characteristic Arabic nose, which are a long nose with a dorsal hump and a pendant tip. Subjective as well as objective measures including the clinical nasal index and the projection index were used to identify and quantify these anomalies. We will review some simple endonasal techniques for the correction of these perceived abnormalities for the best cosmetic as well as functional results. Sixty four patients with typical Arabic nasal features underwent septorhinoplasty using simple endonasal techniques. The majority of patients were very satisfied with their appearance after surgery. There were few minor complications with the techniques used. Exaggerated features of the Arabic nose can be adequately corrected using a few simple endonasal techniques.

Rhinoplasty in the Hispanic Patient

In the United States, rhinoplasty has traditionally been performed in Caucasian patients. Ethnic rhinoplasty is often thought of as a procedure done to reshape the nose of a black or Asian patient. Little attention has been paid to rhinoplasty in Hispanic patients. There has been a large increase in the Hispanic population of the United States, and plastic surgeons will see a concomitant rise in requests for rhinoplasty among this population. In an effort to increase our understanding of Hispanic rhinoplasty, a retrospective review of a senior surgeon's experience was performed. A retrospective chart review was done examining the senior author's (S.S.) rhinoplasty practice over the past 10 years. Hispanic patients presenting for aesthetic and corrective rhinoplasty (cleft patients were excluded) were analyzed. The Hispanic nose was divided into three archetypes. Type I is characterized by a high radix and prominent vault; these noses should be corrected by dorsal reduction and resection of caudal septum. Type II is characterized by a dependent tip with inadequate projection; dorsal augmentation with diced cartilage and tip support with cartilage grafts are important. Osteotomies should generally be avoided in this group. Type III noses are characterized by a broad nasal base with thick skin and a wide tip; rhinoplasty in this group requires correction of the dorsum-base disproportion using several techniques including columellar struts, tip grafts, and dorsal augmentation. Hispanics are projected to become the largest minority population within the next 10 years, and rhinoplasty in this population will become more frequent over time. It behooves plastic surgeons to become familiar with the different archetypes of Hispanic noses and appropriate corrective techniques for each.

Ethnic Rhinoplasty: A Universal Preoperative Classification System for the Nasal Tip

Ethnic rhinoplasty is a complex procedure, particularly with respect to the nasal tip, that has a revision rate that is significantly higher than the rate for Caucasian surgery. Multiple authors have discussed what they propose as the ideal technique combinations in non-Caucasian rhinoplasty. The demand for rhinoplasty is increasing in these patient populations, but their facial features continue to diversify with the combination of characteristics from other ethnicities. This factor further complicates the preoperative thought process. We present a universal nasal tip classification system that emphasizes skin thickness and cartilage strength, rather than ethnic background, to overcome this challenge. This concept will aid surgeons in preoperative planning and will enhance their ability to communicate technical ideas to other surgeons.

Incidence of Alarplasty in Primary and Revision Rhinoplasty in a Private Practice Setting

To evaluate the incidence of alarplasty in primary and revision rhinoplasty during a 3-year period. We conducted a retrospective medical record review of patients undergoing primary and revision rhinoplasty between January 1, 2004, and December 31, 2006. Patients were divided into the following categories: primary or revision rhinoplasty, alarplasty, and ethnicity. The incidence of alarplasty was calculated and compared for primary vs revision rhinoplasty and for ethnicity. Statistically significant differences were confirmed using the chi(2) test. A total of 168 patients underwent rhinoplasty with minimum follow-up of 6 months; 116 patients had primary rhinoplasty and 52 revision rhinoplasty. All alarplasties were bilateral. Of 50 alarplasties performed, 35 were in the primary group and 15 in the revision group. The incidence of alarplasty was 30.2% in the primary group and 28.8% in the revision group. Nonwhite patients had a higher overall incidence of alarplasty (63.0%) than did white patients (25.4%). Each ethnic category identified had a higher incidence of alarplasty than the white group. Alarplasty is an important technique in rhinoplasty. The high incidence of alarplasty in revision rhinoplasty procedures suggests that alarplasty is underused by many surgeons currently performing rhinoplasty. One should consider alarplasty for all patients' noses, not just those of nonwhite ethnic rhinoplasty patients.

Ethnic rhinoplasty

There are three main factors that the rhinoplasty surgeon must consider when planning and executing ethnic rhinoplasty—dorsal height, tip projection, and alar base width. The purpose of this article is to provide the surgeon with the techniques and adjunctive maneuvers to address these factors that will aid in obtaining the optimum result in ethnic rhinoplasty. There are three main factors that the rhinoplasty surgeon must consider when planning and executing ethnic rhinoplasty—dorsal height, tip projection, and alar base width. The purpose of this article is to provide the surgeon with the techniques and adjunctive maneuvers to address these factors that will aid in obtaining the optimum result in ethnic rhinoplasty.

Porous polyethylene implants in rhinoplasty: Surgical techniques and long-term outcomes

Rhinoplasty is a reduction-restructuring procedure. Proper skeletal support is necessary to maintain long-term aesthetic framework. We describe the senior surgeon’s (T.R.) experience with implants in the 3 types of rhinoplasty: primary rhinoplasty, revision rhinoplasty, and ethnic rhinoplasty. Techniques and the long-term outcomes are discussed.

The ethnic nose.

There are distinctive anatomical differences between the non-Caucasian (platyrrhine, mesorrhine) nose and the Caucasian (leptorrhine) nose. In general, non-Caucasian patients requesting aesthetic rhinoplasty desire improvement and refinement of their noses with preservation of defining ethnic characteristics. Surgeons who perform rhinoplasty in this patient population must be familiar with the variations in nasal anatomy and implement augmentation rather than reduction techniques to achieve the desired aesthetic and functional outcomes. We provide a brief review of recent historical trends in ethnic rhinoplasty, highlight relevant anatomical differences, and describe our strategy for addressing the challenges of ethnic rhinoplasty.