Ethnic Rhinoplasty

 


Ethnic rhinoplasty refers to rhinoplasty performed on patients of non caucasian origins.

  • It therefore concerns patients of African, Caribbean, Asian, Middle Eastern, Indian or South American descent.
  • It is known that each of these origins has its specificities, and that the techniques must be tailored to these characteristics.
  • Ethnic rhinoplasty are numerous, because of the many existing ethnic specificities.

However, they often have some common characteristics:

  • Patients generally have thick skin, less strong cartilages, and bones that are rather short
  • The result is a nose that is broad, flat, and rather hollow with a poorly defined round tip and wide alar base
  • Correction requires an augmentation rhinoplasty

 

Every surgeon has his habits and each strategy has its advantages and disadvantages.

  • The prostheses (implants) made of silicone, Gore tex or Medpor have some popularity to raise the dorsum of a flat nose.
  • But any foreign body placed in the nose creates higher risk of thinning of the skin or mucosa.
  • Above all, an infection can occur at any time.
  • These infections on prosthesis can have a devastating effect on the nose and lead to deformations difficult to be corrected even after the prosthesis removal.
  • It is generally accepted that the prosthesis carry even greater risks on secondary rhinoplasty, on tissues that have been already thinned and are sometimes less vascularized.
  • We gradually loses the benefit of the augmentation, the skin can remain permanently inflammatory, and infections can lead to significant deformations of the nose.

Personally, I only use grafts taken from the patient to treat primary or secondary ethnic rhinoplasty, to avoid all these risks.

  • The counterpart is that the process is longer and more technical because it is sometimes necessary to resort to costal grafts, which is also the rule in secondary ethnic rhinoplasty.
  • A real improvement for these very broad and ill-defined noses goes through a global reinforcement of supporting structures of the nose, and the use of apposition cartilage grafts.
  • Postoperative edema is often extended for secondary ethnic rhinoplasty (over one year).

 

Ethnic rhinoplasties are particularly delicate and complex operations, and thus it is important to use a surgeon familiar with this type of rhinoplasty.


 

"Why have ethnic rhinoplasty?"


The majority of patients want to have a finer nose, that is narrower and better defined.
There are two main causes for this lack of finesse:

  • The thickness of the skin associated with the usual presence of a fatty compartment under the skin of the tip (between the domes).
  • The lack of support of the base of the nose

 

Rhinoplasty must therefore fix at best these elements:

  • only the thickness of the skin can be reduced with the help of defatting.
  • Trying to reduce a nose with all these features by cartilage resections rarely gives a good result.
  • It is therefore essential to make clear that only a structural augmentation rhinoplasty will actually refine the nose,
  • and one must accept to have a nose that is a little more projected, and also more rigid, to benefit from a real refinement.

What happens during a consultation?


The consultation for ethnic rhinoplasty takes place in the same way as for other types of rhinoplasty.

  • One should however be aware that computer simulations are very complicated to achieve in the case of ethnic rhinoplasty,
  • because many changes that the operation will generate are not shown with the simulation software.
  • So after a full examination of the nose, a simulation is still done to understand the concept of augmentation rhinoplasty,
  • then examples are shown, corresponding to the origins and morphological characteristics of the patient,
  • in order to visualize scarring and postoperative evolution to the final result.

The specifics of ethnic rhinoplasty:


Refinement ethnic rhinoplasty requires a very specific strategy and operating chronology.

  • This is essential to obtain a true change and results, while maintaining ethnic characteristics.
  • It is also necessary to strengthen the weakness of the base of the nose
  • rather than trying to refine it by a reduction rhinoplasty (which generally creates more problems than it solves).
  • The therapeutic strategy I created (adopted by many surgeons in ethnic rhinoplasty) is relatively long, 3-4 hours of operation.
  • Eleven successive operating times, based on the almost systematic harvesting of a rib fragment and a tissue below the scalp to strengthen the structure of the nose.
  • The scars are located in the hair, without any hair being cut, and in the crease under the breast for women or on the chest for men.
  • Moreover, it is quite common to have to reduce the nose, with a small scar in the crease around the nostrils.

What follows an ethnic rhinoplasty?


The aspects that differentiate what follows an ethnic rhinoplasty compared to other rhinoplasties are:

  • The extended duration of the postoperative edema.
  • Although it is not necessarily greater, it usually persists longer.
  • And it is not unusual that the final result can not be estimated until 2 years after the operation.
  • Medical and mechanical methods are used to reduce as soon as possible postoperative edema.
  • However, there is almost never blue (bruising) after ethnic rhinoplasty, and even less from the use of ultrasonic rhinosculpture.

The risks of ethnic rhinoplasty:


As with any rhinoplasty, and more specifically with ethnic rhinoplasty, the main risk is to not have the desired result.

  • This risk is primarily related to the techniques used,
  • and that's why I moved in 15 years to more complex and sophisticated techniques, which give significant results.
  • Conversely, simple reduction techniques, even if they are associated with the addition of graft (including the tip), do not often allow to obtain the same degree of refinement.
  • At worst, these reduction techniques make the tip of the nose wider, creating distortions of the nostrils.
  • Finally, we must remember that any foreign body placed in the nose, either silicone, Medpor, Gore tex, acellular dermis, etc... can become infected sooner or later, resulting in real aesthetic deformities of the nose, sometimes irreversible .
  • This does not mean that these techniques should be banned, but the potential risks must be well explained before.

That's why I only use grafts harvested from the patient, and not any foreign body.

Information Sheet SoFCPRE (Société Française de Chirurgie Plastique Reconstructrice et Esthétique)

Last update of this page : 06-06-2019