Narrowing the Broad Nasal Dorsum in Ethnic Rhinoplasty

It is common for many Asian and African American female patients to come to my office requesting that their nose be narrowed. Traditionally these patient often are very happy with the appearance of their face, but find that the dorsal nasal lines are not appreciated in photographs. Quite often I hear the comments, "Dr. D I hate my nose in photographs!...Can you help me?"

The question then is how to narrow the ethnic nose while maintaining it's ethnic proportion and look. I find that the nasal dorsum can be effectively narrowed with medial and lateral osteotomies to produce a very elegant contour and dorsal nasal line. If a patient wants further augmentation of the dorsum, for the placement of eye or reading glasses, then the dorsum can be augmented with rib cartilage and temporalis fascia.

It is becoming more common in my practice for women to come in wanting their nasal dorsum corrected. It common that we then harvest rib cartilage through their previously made breast augmentation incision. Often women use this operative time to exchange their saline breast implants for silicone breast implants. We are finding more women who also wish to undergo their first breast augmentation at the time of their rhinoplasty.

Narrowing of the ethnic nasal dorsum is a procedure that needs to be done with great care in order to maintain the ethnicity of the original nose.


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Aesthetic "Ethnic Rhinoplasty" & Septal Deviation.

The management of the ethnic rhinoplasty can be very challenging in the face of significant septal deviation and airway obstruction. Typically, if patients have had trauma to their nose they can damage both the nasal bones as well as the cartilage components of their nasal structures.

Often patients require a septoplasty to repair a significant deviation as well as spreader grafts to straighten and reinforce the septum. Occasionally an onlay graft of crushed cartilage can be used to define certain points of the nose to make it more aesthetically pleasing.

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Aesthetic Management of "Ethnic Rhinoplasty"

One of my favorite aspects of Plastic & Reconstructive Surgery is Rhinoplasty & Airway Surgery. And, within rhinoplasty, one of my favorite surgical challenges is the aesthetic management of the "Ethnic Rhinoplasty". The term "Ethnic" in these cases is used to denote an aesthetic terminology and proportion that differs from those angles and distances used to define a "Caucasian" nose.

People of different ethnicities often have noses with different characteristics. Often it is the desire of the patient to slightly alter the shape of their nose, but retain the ethnicity of their nose.  Valuable tools in these cases are cartilage, temporalis fascia, and careful osteotomies. However, the most valuable tools to an optimal outcome is the surgeon’s ability to listen to the patient's desires and goals.

In the above photograph the patient wanted to narrow the dorsum of the nose to facilitate definition on camera and on film. The patient however wished to maintain the alar base width. It is important when performing these procedures, to not make the nose “Ethnically Disproportionate”.


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Rhinoplasty & Airway Reconstruction

In nasal airway surgery, it is a great compliment when involuntarily the patient closes her mouth and breathes through her nose in the post operative photograph.

One of the more interesting observations in my patients is the ancillary findings on physical examination. Usually, I appreciate an unintentional open mouth smile in my post-operative photographs. However, for airway reconstructions, I am most pleased when the mouth is involuntarily closed. In these cases, I am convinced that the nasal airway is patent and the airway surgerywas successful.

At this point in my career, I have found that an optimal view of a deviated septum and it's correction with spreader grafts is best obtained via an open rhinoplasty incision. This approach allows separation of the lower lateral cartilages, visualization of the entire septum, and an optimal view through which to perform septoplasty. The harvested septum is then used for spreader grafts to support the internal nasal valve. I have been very happy with the use of septal cartilage for lateral crural strut grafs to stabilize the external nasal valve.

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