What is ethnic rhinoplasty ?
According to recent research, we look in the mirror at least eight times a day, so if there’s a certain facial feature you’re unhappy with it stands to reason you’ll notice this each time you take a glance in the mirror. For some patients, it’s the size of their breasts, or the how ageing is affecting their face, but for many patients, it’s the shape and size of their nose. Rhinoplasty surgery remains one of the most sought-after cosmetic surgeries in Europe, but there’s also a growing trend emerging for patients seeking ethnic rhinoplasty surgery to improve their self-esteem.
Practising in London, Mr Chana sees a huge range of patients seeking rhinoplasty in one of the most culturally diverse communities in the world . This brings about unique challenges since dfferences between procedures can arise for patients of different ethnicities, and therefore rhinoplasty surgery will often be performed somewhat differently based on the anatomical variation of the nose between different ethnic groups.
An intricate surgical procedure, ethnic rhinoplasty – like all forms of surgical nose reshaping – requires a highly skilled surgeon to guarantee the best results. Aside from the technical skill of a plastic surgeon, finding one that understands the complexity and differences of ethnic rhinoplasty are important. In this respect Mr Chana has operated on patients from all backfrounds including Indian, Afro-Carribean, Asian/oriental and Middle-Eastern. Each type of ethnicity has a unique anatomy which needs to be understood as part of any rhinoplasty.
Initially conceived for patients looking for ‘Westernise’ their appearance, ethnic rhinoplasty is now a more refined surgical procedure, consisting of subtle work that maintains the racial identity of the patient whilst changing the structure of one or more areas of the nose. Rhinoplasty can no longer be considered a ‘one-size-fits-all’ form of cosmetic surgery, and the techniques used to alter the size and/or shape of a patient’s nose depends on various factors. Rhinoplasty differs between ethnicities due to the various subtle anatomical differences of nasal structure. For example, Asian patients often have a lack of support to the nasal tip which exaggerates the appearance of a dorsal hump. In order to correct this, a graft is often needed to provide tip support in such patients in addition to removing the dorsal hump. Afro-Caribbean patients will have a quite a flat nose with wide nostrils. In this group, grafts are often needed to ‘build up’ or augment the nasal bridge line combined with surgery to reduce the size of the nostrils.
What techniques are used ?
Open or closed rhinoplasty
Achieving a natural result that is suited to the face of the individual patient remains the end goal of rhinoplasty surgery; ethnic rhinoplasty is no different in that respect. A bespoke treatment plan is especially imperative during ethnic rhinoplasty, as each race and skin type needs a slightly different treatment. In most cases, ethnic rhinoplasty surgery is performed using an ‘open’ technique, which means the main incision will be made on the columella which is the skin bridge between nostril. The skin is then lifted to allow the surgeon full access for surgical restructuring to take place. Although some very minor hidden scarring may occur using the open rhinoplasty technique, it is widely considered the best option for precise results in most types of ethnic rhinoplasty. The reason for this is that in many types of ethnicity the support to the nasal tip is lacking and grafts are needed to improve the support to the nasal tip, provide definition and correct a droopy tip. Therefore the exposure required to place the garfts is more precise with an open technique.
However, this does not mean that a closed 'scarless' approach is precluded in every situation. There are certaibly situations where the anatomy is more straightforward with for example a small dorsal hump and minor tip refinements to be made and a closed approach can be considered. Each case needs to be assessed individually.
The modern techniques of ultrasonic rhinoplasty and the concept of preservation rhinoplasty is applied to ethnic rhinoplasty since these advanced forms of techniques enhance the recovery and long term stability of the result following a rhinoplasty
What are the main issues in various ethnicities ?
The Indian Nose.
The Indian nose is characterised by a dorsal hump and usually a droopy tip since the nasal tip cartilages are weak. The nasal tip is often bulbous and wide at the same time. Surgery involves reducing a dorsal hump and supporting the nasal tip to correct the droopy appearance. The aim is not to provide a ski slope or curve to the bridge line since this is completely out of keeping with the ethnicity. A straighter but reduced bridgeline provides a softer appearance which harmonises theface. At the same time the tip should not be overly rotated or upturned. Occassionally a nostril reduction may be required if this is of concern.
The Afro-Carribean nose
This type of nose is characterised by excessive width especially in the lower half with wide nostrils and a flat bulbous nasal tip. Also, the nasal bridge tends to be low. The commonest request is for aan alar base reduction ( nostril reduction ) which can be performed on its own in isolation without carrying out other changes to the nose. However, depending on individual patient expectations other changes may be requested for example to refine the tip or to augment and raise the bridge. This will require grafts. For the nasal tip a graft from the nasal septum is usually used along with an alteration in the shape of the tip cartilages to narrow the nasal tip . This will provide tip definition and a narrower refined tip with more projectio
If a dorsal bridgeline augmentation is requested then a rib cartilage graft is needed . This involves a short scar on the chest to obtain some pieces of rib cartilage. These are then used to raise the bridgeline. Of course if the bridgeline is raised then the tip needs to be increased in proportion to maintain the aesthetics.
The Oriental Nose
In some types of noses for example of Oriental descent the nasal bridge is also very low and flat and again rib cartilage grafts may be needed to augment the nasal bridge and provide a stronger definition to the nose. Although, silicone implants are often used in China and Japan to achieve the same effect , these have a higher complication rate from extrusion and infections. Therefore using your own material is preferred and this can then may carved and customised in a more intricate fashion to achieve the desired shape. Similarly, nasal tip surgery can involve improving the definition and projection.
One further factor in Oriental noses is the fact that noses are short. The nose can be lengthened . This is achieved by adding a graft to the septum to effectively lengthen it This is called a septal extension graft.
The Middle-Eastern nose
Patients from the Middle -East have noses characterised by a high radix (where nose takes off from the forehead) , a dorsal hump with a hanging tip. The radix and bridge line is reduced and lowered in height in the standard manner which involves work to lower the bone as well the cartilage of the bridgeline. The nasal tip requires modification of the shape of the tip cartilages to produce refinement and to elevate and rotate the tip to correct a hanging tip. A cartilage graft from the septum is needed to provide support and stability to the tip.
Often Middle-Eastern noses have very thick skin. In this respect improving the nasal tip projection with a graft helps place the nasal skin on some tension which aids the overall refinement. Otherwise the thick nasal skin may remain soft and collapse over the newly modified tip cartilages and obscure the definition.
The nasal skin may be thinned to a degree from beneath which helps to achieve better definition to the nasal tip.
A typical ethnic rhinoplasty in a patient of Indian origin
Watch the video below of a patient who has undergone a rhinoplasty. The typical features of a dorsal hump and lack of nasal tip support were addressed. At the same time a bulbous tip refined. The surgery has been performed to maintain overall facial proportions so that the nose 'fits' her face and to appear totally natural after surgery in a way that enhances her natural beauty:
What are the main challenges in ethnic rhinoplasty ?
Apart from the artistry involved in maintaining an underlying cultural identity the main challenge is the fact that many ethnic noses have thick skin. This thick skin tends to obscure the definition being produced. This occurs in two areas. One is the width of the nasal tip which may fail to contour adequately around the refined tip cartilages. The second is the area above the tip which is called the supratip. In the supratip the thick skin may elevate and cause a slight convexity which detracts from a straight bridgeline. and may fail to settle even though a perfect profile is achieved at the time of surgery. In these situations steroid injection help to overcome these difficulties.
What is the recovery from Ethnic Rhinoplasty ?
Once your rhinoplasty surgery is complete there will be a detailed aftercare plan to follow, as with any other form of nose reshaping surgery. A cast or a dressing to wear is common after this form of surgery and you should avoid vigorous movement for several days to reduce any swelling or bleeding. It’s advised you also sleep upright for the first few days, as this helps reduce swelling and improve healing time.You can read more about the recovery from rhinoplasty on the related main webpage on rhinoplasty
Ethnic rhinoplasty to reshape your nose and next steps
A consultation with Mr Chana will give you a chance to understand more about ethnic rhinoplasty and also meet him before surgery. He will be able to give you information specific to your individual needs and wishes, and he will be happy to answer any questions or concerns about the surgery or recovery process you might have. Email the clinic today for more information or fill out the contact form on this website.
More information is available on following page dedicated to ethnic rhinoplasty and further information on Instagram and facebook pages
Watch the video below to view a typical result from such surgery in a patient of Indian descent :