Ethnic rhinoplasty refers to rhinoplasty for patients that are not Caucasian. Certain populations including Latin, Asian, Indian, Middle Eastern, and African (this list is not exhaustive) can present special challenges because of differences in skin oiliness, quality and texture. Also, the tip cartilages in particular can be very weak/flat and often the patients have different objectives. For example, I have a large portion of my practice from Asian backgrounds and most want a higher nasal bridge and radix (area between the eyes). This is very different from our patients from the Middle East who usually want this area to be smaller and narrower. Thick skin in all of these populations presents unique challenges as more structure must be used in the nose to create definition. To treat these patients and to offer the best rhinoplasty possible, we utilize surgical techniques to manage thick skin and to treat wide amorphous tips, low bridges, and wide nostrils. Most recently, I have begun to use ultrasound to measure the thickness of the skin of the nose. This information is used to not only to plan the actual operation, but also to start patients on regimens before surgery to optimize their skin for surgery. Often, these regimens are continued after surgery and even oral medication is sometimes used to shrink the skin envelope. This work has been presented in 2016 in Las Vegas and Italy at international rhinoplasty meetings, and will also be presented in New York and Paris in 2017.
I lecture on average 1 week per month both nationally and internationally and often get asked to speak on Ethnic Rhinoplasty . Due in part to our location in Southern California, we have expertise in treating Latin, Asian, Indian, Middle Eastern, and African American patients. In 2003, my retired partner Dr. Daniel wrote an article entitled “Hispanic Rhinoplasty in the United States” and followed it up with 3 major articles on “Asian Rhinoplasty in the United States,” “Middle Eastern Rhinoplasty in the United States,” and “Indian American Rhinoplasty.” Prior to Dr. Daniel’s breakthrough articles, most surgeons approached Rhinoplasty on Hispanic patients based on the patient’s nationality rather than his/her deformity. After reviewing a huge series of his Hispanic patients, treatment protocols could be based on the following 4 types of Hispanic patients: 1) Castilian, 2) Mexican American, 3) Mestizo, and 4) Creole. Patients of a Castilian or Mexican American background often have a nose with a dorsal hump and a wide tip with little definition. In contrast, the Creole-Hispanic patient often has a low bridge and very thick, oily skin.
Another example of this expertise is seen in treating Asian American patients who desire rhinoplasty. Traditionally, silicone implants were used to achieve a higher bridge and a more refined tip. Although effective in many patients, infection and visibility occurred in 10-20% of patients leading to removal of the implant. In 2017, I am lecturing at the FACE and Rhinoplasty meeting in Las Vegas on Asian rhinoplasty and will be publishing my experience in using the patient’s own tissues to achieve the higher bridge and more refined tip that most Asian patients want. This revolutionary approach has eliminated the use of silicone and other foreign bodies to achieve an aesthetic nose in Asian rhinoplasty. In addition, these same techniques can be used in many Asian patients with infected implants allowing for immediate reconstruction. Most recently in 2016, I lectured on treatment of the soft tissue envelope of the nose, utilizing advanced skin care, lasers, and oral medication to treat difficult skin envelopes and enhance the aesthetic improvements that were once impossible with rhinoplasty alone. This culminated in a landmark article titled “Management of the Difficult Soft Tissue Envelope in Facial and Rhinoplasty Surgery,” that was published in the Aesthetic Surgery Journal with world-renowned Dermatologist Dr Zein Obagi.
Because of our practice in Southern California, and specifically Orange County, I am comfortable with the differences in each subset of patients and know how to deal with these unique challenges. These challenging cases are exciting to us, and we would estimate that 60+% of our rhinoplasty practice is on patients of non-Caucasian descent. It is very important that your rhinoplasty specialist understands the differences between different ethnicities in order to get the best rhinoplasty possible. The problems are often different, the techniques are very different, and the desired results by the patient and surgeon can also be different.