Ethnic Rhinoplasty performed by Dr. Robert Kotler
Human beings come in all sizes and shapes. Likewise, noses come in all sizes and shapes and they may have certain features that are particular to their ethnic group. Understand that skin thickness and skin color is often reflective of one’s ancestry. There is a major difference between the thin, light-colored skin of a person who hails from England or Scotland or Finland versus the thick, heavier, darker skin of someone whose family migrated from Southern Italy or the Middle East. There are consequences of both – good and bad – that the surgeon must have experience dealing with. Ethnic rhinoplasty is no place for amateur cosmetic plastic surgeons.
Likewise, the consistency of the cartilage and thickness of the bone is often related to one’s ethnicity. Some people, particularly Asian and Hispanic people, tend to have softer cartilages.
The width and shape of the nostrils can depend on one’s ethnicity. Asians and Hispanics often have horizontally-oval nostrils with a wide floor or sill, and the walls of the nostrils may be thick. Some of these problems can be corrected and others can’t be corrected.
Middle-Eastern noses are often longer, droopier, with a prominent convexity on profile. Smiling may cause the tip to drop even further and that activity, plus the downward force of gravity, can make the nose become longer with aging.
This is important because you need to understand that not all imperfections or undesirable features of noses can be corrected by surgeons regardless of their talent, level of experience and degree of specialization. It is important to know what can be done and it is equally important to know what can’t be done. Even the most sophisticated and veteran superspecialists are not magicians.
While most noses need shaving, slimming, or reduction in one or more dimension, some noses need an “add on.” Most often, the bridge is too low. This is typical of some Asian and patients. The bridge needs to be raised. This can be done with either the transplantation of natural tissue including bone or cartilage from the patient’s own body, or insertion of a solid man-made implant. For some patients, satisfaction can be provided with often injections of the classic permanent filling material, medical-grade liquid silicone. For them, a trip to the operating room may be avoided entirely.
The great rhinoplasty surgeons have always recognized that no two noses should be created the same, regardless of the patient’s ethnicity. The nose must fit the face. The rhinoplasty operation must yield a natural appearance that appears unoperated, lest the patient be dissatisfied and the surgeon having failed.
The key to a natural rhinoplasty and a satisfactory result is that the common error of radical and overzealous tissue removal did not take place. Less rather than more.
The appearance in the nose after a properly performed rhinoplasty should look natural and has the following features: The bridge is straight or has a very slight tilt towards the tip. The bridge is not too low. On the front view, the tip is not pinched and the nostrils are not turned up.
A natural nose’s best compliment is when the patient is told: “I would have never guessed you had your nose done”.
Rhinoplasty, as an artform, has matured such that today most practitioners are aware of the previous generation’s surgeons’ overzealous surgical techniques which did yield the over-scooped, over-pinched, over-turned up nose which carried a sign that said “I just had a nose job.”
So, it is important to understand one’s ethnicity and what role that may have on the outcome. Ask your doctor what the prospects are for success and what he sees as some of the challenges that may be involved. Most importantly, inquire how much experience the cosmetic plastic surgeon has with ethnic noses. The most narrowly-focused offices, the superspecialist practices will most likely serve you best. The best barometer of the doctor’s talent is his before and after album. You need to see the doctor’s style and taste and when you review the albums, you should encounter many photographic examples where some patients had the very changes that parallel your particular needs.