Ethnic Rhinoplasty: Preserve Your Heritage
The beauty standards set and influenced by white supremacy and colonialism (which are nowhere near being eradicated from our society) continue to fuel our euro-centric beauty ideals to this day. And plastic surgery is one of the top industries that perpetuate and benefit from this practice.
When it comes to getting plastic surgery done, it’s no secret that there is a group of people who are so influenced by this propaganda that they’d dent their heritage, and get plastic surgery to fit into those euro-centric beauty standards. Or, people in places like Korea, where plastic surgery is widely available, and “fixing” your ethnic features such as monolids, or a low bridge is almost a rite of passage. And then there is what happens when those ethnic features are not respected.
When it comes to ethnic features and plastic surgery, we can assume that rhinoplasty has done the biggest damage when it comes to the destruction of ethnic features with plastic surgery. Because for a long time doctors weren’t trained to take care of ethnic noses in a respectful way, many ethnic people have suffered the consequence of a botched rhinoplasty.
Ethnic rhinoplasty, as a field developed as a response to these botched rhinoplasties, out of necessity. Ethnic noses cannot be put into a single category, but they have one thing in common: they cannot be operated on with the “tried and true” techniques applied to Caucasian noses.
In this article we will explain:
- What ethnic rhinoplasty is and how can it benefit ethnic patients
- Why there is such a thing as ethnic rhinoplasty in the first place
- What are the different types of ethnic rhinoplasty operations
- What the differences between “traditional” and ethnic rhinoplasty are
- What are some complications specific to ethnic noses
What is ethnic rhinoplasty?
Ethnic rhinoplasty (ER) has no single explanation. ER is a complex procedure. It protects the patients’ natural characteristics on their faces. And it is not completely different than traditional rhinoplasty (TR). They both aim for the aesthetic goals of the patient while preserving the functionality of the nose.
Any rhinoplasty surgery comes in with different challenges. So that is why only a skillful surgeon in rhinoplasty surgeries can achieve successful results in ER. Ethnic rhinoplasty needs a high level of dexterity. Most of the time it is advised to get the surgery from a plastic surgeon.
Ethnic rhinoplasty is not a monolith, as there are multiple ethnicities to consider, and multiple ethnicities to name, each with its unique features and necessities.
In short, if you are not a Caucasian descendant person, your surgery is called ER. Terminology here is a bit complicated. We generally do not use Caucasian Rhinoplasty, instead, we say traditional rhinoplasty, as the “common” techniques performed on Caucasian noses became the “standard”, thus traditional rhinoplasty.
The purpose of ER is to make sure that ethnic patients get the rhinoplasty procedures they truly deserve, that highlight their features and ethnic identity. ER is needed to provide patients with beautiful, functional noses, and also do more research to develop techniques that will benefit ER patients.
The goal of ER surgery is to provide patients with the desired alterations to their noses while taking into account their heritage, and ethnic features. The results preserve the facial harmony and the facial characteristics of their ethnic backgrounds. ER makes it possible for patients to not fall victim to botched nose jobs where their features are erased or disrespected.
With ethnic rhinoplasty, patients will get the nose they desire without resorting to TR, which will give uncanny results for ethnic patients. They’ll have the perfect, natural-looking result which also preserves the functionality of the nose.
Types of Ethnic Surgery
The type of ER you get will be named after your ethnicity, obviously. However, we can make up about 4 general types of ethnic rhinoplasty, based on geography, and genetic similarities of the people groups. Each group will have specific techniques that are catered to fixing their needs.
Each of these groups will have sub-groups, but as a general rule, they seem to have similar nasal structures, similar requests, similar challenges, and complications.
African or African-American noses have a lot of variations, and each variation needs a different technique or approach. However, we can list 3 main sub-groups; the African type, the Afro-Caucasian Type, and the Afro-Indian type.
The most common complaints patients of African descent present are; a large nasal tip, also known as a bulbous tip, large or flared nostrils, a wide and short nasal bridge, and the prominence of the forehead due to the short bridge. In general, with ER, noses with African ethnic features are reconstructed to have a stronger structure that can hold and define the contours of the nose.
Asian rhinoplasty mostly refers to east-Asian rhinoplasty. East-Asian noses are very similar and do not really have multiple sub-groups because most East-Asian groups share 75% facial resemblance with each other according to a study done in 2016. They also have similar nasal anatomy.
East-Asian noses are generally short and flat, with a wide bridge and a bulbous tip, with thick nasal skin draping over the nose. The short and wide appearance is due to having short cartilages which structures the nose for a more prominent appearance. With East-Asian noses, patients mostly ask for augmentation, where the wide bridge is reduced, heightened, and cartilages are placed vertically to provide structure.
Jewish & Middle Eastern Rhinoplasty
The Middle Eastern group covers multiple ethnicities; from Arabs, Persians, Ethnic Jews, Turks, and Kurds, to Egyptians and even South East Asians such as various ethnicities in India, Pakistan, etc.
Generally, Middle Eastern noses are wide on the base, with a pointy tip, and a rather large bump on the bridge. Skin thickness may vary among certain groups. With Middle Easter noses, ER usually aims to reduce the bump and ascend the nasal tip without going overboard.
Latino & Hispanic Rhinoplasty
Hispanic people are from countries where Spanish is spoken, referring to the language. Whereas, Latino refers to the people from Latin America. These two words are mostly used interchangeably since the roots of these people are so close. Here we will use the general Central and South American terms.
Central and South Americans have shown a huge demand for nose surgery, especially in the United States. With this demand, came the supply and today here are various techniques developed to perform rhinoplasty on Central and South American noses.
Central and South American noses also have a number of variations, and each specific ethnicity can get a procedure suited to their specific characteristics. Generally, Central and South American noses have a droopy nasal tip, high dorsum, and moderate to highly thick skin.
Ethnic Rhinoplasty vs Traditional Rhinoplasty: The Difference
For a very long time in rhinoplasty history, people have been looking for ways to change the nose shape by working with traditional techniques. Yet, these techniques are not capable of dealing with all the needs of a non-caucasian patient. This is why we see the techniques and approaches developed to meet the needs of the patients with ER.
ER is significantly more difficult to perform. It requires subtle changes in cartilage grafting, suturing, reduction methods, etc. The surgeon himself must be knowledgeable and decide where to use a technique and where to forego another, as even one small stitch could end in a disaster.
Challenges Specific to Ethnic Rhinoplasty
We can group the challenges of ER in two categories; challenges relating to the specific ethnicity of the patients, and challenges related to the wants of the patient. In the end, the goal is to provide a harmonious result that will respect both.
Cartilage harvesting is not necessary for most TR, especially in primary rhinoplasty surgeries. With ER, on the other hand, surgeons might need a lot of cartilage during the surgery, especially in Asian rhinoplasty patients. So, while cartilage may or may not be required in primary surgeries in Caucasian patients, there’s a great chance that ethnic patients will have to get an ear or rib cartilage.
ER patients of Asian, Hispanic, and African descent generally have much thicker skin compared to Caucasian patients. Thin skin is “easier” to operate on and can showcase the work done under the skin easily. However, thick skin can hide the work done underneath, especially at the tip where the skin is the thickest. To make sure that the results are visible with ER, surgeons need a lot of experience and dexterity.
The dorsal hump is the convexity of the nose, also called aquiline, and is easily handled with reduction techniques. However, it is important to understand whether it is an actual hump or just an illusion of the underdeveloped radix, which is common in Hispanic, African, and Asian patients. The radix area is the upper part of your nose below the nasal bridge and could be deceiving, making you have an aquiline on your nose on your profile. Your surgeon must take it into consideration and make sure if it’s an actual hump or a pseudo-hump. This problem is not specific to ER, but we can say it is common enough amongst ethnic patients to be considered a general problem.
Most patients of Asian background and some African nose types have de-projected nose types. So, what is projection? The projection is the term used for the distance between the face and the nose. When the nose is closer and deeper into the face it is called a de-projected nose giving the person’s face a flat look. De-projection is corrected with augmentation techniques, by building structure via cartilage inside the nose, implants, or liquid fillers. The techniques used in augmentation are rather hard and require extensive experience and knowledge.
Good results from an ER require consideration and planning in advance. During the surgery, surgeons make incisions and reductions on the skin and cartilaginous. If these procedures are conveyed with vigorous maneuvers, with over reduction of the grooves and proportionally overcorrection of the nasal base, the nose might not fit into the patient’s facial harmony at all. For this reason, ER surgeons must carefully plan out and execute every step of the surgery in order to not overcorrect the nose where the result does not match the patient’s heritage.
Differences in Surgical Technique
In order to deal with the challenges mentioned above, specialized techniques were developed to work properly on ethnic noses. As ethnic noses are not a monolith, every different shape requires a certain technique that will help with the specific issues. The common goal of these techniques is to enhance the appearance of the nose while keeping the identity, and not compromising anything about the inner structure and functionality.
Most of the time, surgeons use cartilage with grafting techniques to augment the nose. But for those patients who have rather smaller noses, especially Asian patients, implants can be a better option. There are two types of implants used in augmentation; Gore-Tex and Sili-Tex. Both come in with advantages and disadvantages. Both are used to augment the nose in people who have rather short noses or deficiency of cartilage. Implants are not commonly used in traditional primary rhinoplasty.
Creating an Illusion
Instead of going against the nature of ethnic patients with thick skin, surgeons have developed an illusory technique for the tip of the nose. With this technique, the thick skin has an advantageous position, where surgeons are able to play with light and shade to give the illusion of a well-defined tip without compromising the underlying structure.
Another technique used in ER aims to reveal the beauty of the nose by eliminating the illusion of a dorsal hump (pseudo-hump) by augmentation technique. Instead of reducing the hump on the bridge, surgeons augment the concaved part of the nose with augmentation techniques and give the patient a straight-lined nose.
Grafting and Suturing Techniques
Cartilage grafts and suturing techniques are used almost in every rhinoplasty procedure. Compared with the TR suturing and grafting techniques, ER is not completely different, however, sometimes surgeons make subtle changes to achieve notable differences.
Some of these techniques require using columellar strut grafts, onlay tip grafts, and septal extension grafts combined, separately and sometimes with the same technique but in a different place regarding patients’ desires.
The need for different techniques also means new challenges for the surgeon. To prevent dead tissue or tension nose problems, surgeons consider subtle changes to grafting and suture placements every step of the way.
The nose alignment is an important and most noticeable factor on one’s face. In ER surgeries, most African patients’ nose type has a wide nasal base, requiring reduction or resection of the skin, sometimes accompanied by the cartilage arrangement. These changes must be done equally on both sides to protect the symmetry of the nose. By using tools like calipers and photography, this problem can be prevented.
Non-Surgical Ethnic Rhinoplasty
Some people might not want to go with surgical techniques including incisions and long-lasting healing periods. Your answer is non-surgical rhinoplasty. Especially with Asian patients, a filler rhinoplasty is a popular option. The fillers are injected through the skin and it does not require any incision or anesthesia. It is used for the refinement of the nose and makes it easy to preserve the ethnic shape while augmenting some features.
Revision Ethnic Rhinoplasty
Revision rhinoplasty itself is a challenging procedure, regardless of the patient’s background. Revision surgeries are notoriously hard to perform, hard to perfect, and hard to heal. Add that to the fact that primary ER is a difficult procedure itself, revision surgeries for ethnic patients can result in a disaster with just one small mistake.
On the bright side, a well-performed revision ER can be what actually saves the nose. If the patient had a nose job before, and the results weren’t aligned with their ethnic characteristics, revision surgery can help the patient get a more balanced result that harmonizes with their facial structure and cultural identity.
How's the recovery process different?
The skin type, surgical techniques, and different needs of the ethnic patients bring different problems to the ER recovery process. During the surgery, surgeons carefully reshape the nose to avoid any future problems that might come up. However, if the required extra care and diligence are not applied, it can lead to unwanted consequences during the healing process.
Because the structure of the nose and the skin type is different for each ethnicity, they won’t heal the same way Caucasian noses do, and can present unique problems like the following:
Longer Swelling Period
Swelling is common after rhinoplasty surgeries, however, the situation is a bit different in ER patients, especially patients with thick skin. Swelling or edema occurs after the surgery as a natural reaction of the body. It mostly subsides in the first month and fades away in a year. In thick-skin patients, this duration might be prolonged and the recovery process takes a longer time. To prevent this problem your doctor can leave your splints in for longer and might suggest the use of steroids.
Because of the techniques used in ER surgery, the blood supply might not be enough for your nasal tip, leading to a problem called tip necrosis or tissue death. Tissue death is mostly seen with the African nose type and might be a permanent problem, so it is a must for the surgeon to consider everything to prevent tissue death. To avoid tissue death, the suture techniques used in the surgery should be well planned and surgeons need to take into consideration some future problems and take precautions.
The typical Asian nose is generally under-projected. That is why people of Asian descent look for augmentation on their noses. Implants are used to fulfill these patients’ desires and it comes with risks like displacement of the material and infection. However, it is easy to prevent these problems. The surgeon must first warn the patient about the fragility of their nose after the surgery. Doing tests for allergic reactions also can help to prevent complications. Most of the time implant problems occur due to the use of high implants, so surgeons must choose the right implant with the correct dimensions to avoid complications in the first place.
The unique needs of ethnic patients and their cultural background in the realm of plastic surgery have been ignored for a long time. While there is still a case to be made about getting plastic surgery in the first place, we believe the fact that cosmetic surgeries that help patients accentuate and preserve their identity is available, and they don’t have to fit into European beauty standards to feel good about themselves. Ethnic rhinoplasty is one of those surgeries that makes it possible. In short:
- Traditional techniques developed on Caucasian noses cannot work on ethnic patients. Ethnic rhinoplasty was developed to cater to the specific needs of ethnic noses, and their specific challenges.
- Each people group will have specific challenges and desires; from skin type and thickness to structure, and ethnic rhinoplasty must be able to fix the patient’s problems while respecting overall facial harmony and cultural identity.
- Ethnic nose jobs present unique challenges and need specific techniques and special care to be performed successfully to avoid any complications that can occur such as collapses, necrosis, etc.
We hope that this article was informative enough on the subject and that we were able to answer your questions. If you are interested in getting ethnic rhinoplasty and have any further questions, you can contact us and get answers to your questions from one of our medical consultants.