Seattle Bellevue's Dr. Philip Young Discusses Rhinoplasty in the Ethnic, African American, Asian, Hispanic, and Middle Eastern Patient
Below Before and After Images - Ethnic Hispanic Rhinoplasty Side Image (see below for more):
Note there are some pictures below that are more graphic in order to illustrate what we do in certain situations for each ethnic group. We would like to warn you before you continue to read below.
Ethnic Rhinoplasty: Contouring and Reshaping the Nose for the Ethnic patient requires some special considerations. The African American, Asian, Hispanic, and Middle Eastern Patient each have some differences to consider to get the best results. A Rhinoplasty Surgeon must weigh the options and extremes of totally changing the appearance of the nose and the face in general versus maintaining ones ethnicity. The Ethnic patient tends to be more charaterized by a lower nasal bridge and wider nose. They are more likely to have thicker skin. Some Middle Eastern patients however may have a prominent bridge like the Caucasian patient. So variations exist among these populations and thus change your considerations for the surgical approach. We will go into detail with each group and mention the different nuances that are present.
In the below content, we are going to talk about Ethnic Rhinoplasty in this order: 1. Hispanic | Latino Rhinoplasty; 2. Asian Rhinoplasty; 3. Afrian-American Rhinoplasty; and then 4. Middle Eastern | Persian Rhinoplasty. So please scroll down to read about the partcular Ethnic Rhinoplasty topic you are interested in.
The Picture Below shows a Before and After Rhinoplasty Revision for a Young Hispanic Mexican American Male. We took down his dorsal hump. Part of this treatment is considering that there could be possibly a deficiency at the root of the nose. In this case, a cartilage graft (crushed) was placed in between the eyes to give a smoother transition into the bridge. Thus, less of the dorsal hump needed to be reduced. This contributed to a more natural look. See below for more photos:
The Hispanic | Latino Patient:
The Hispanic | Latino Patient: The hispanic latino patient is often characterized by larger nasal tip, and nostril tissue or alar tissue. Wide variation exists however. Many Hispanic Latino patients wish to make their tip and nostrils smallers. There are many patients in this population that also have more prominent bridges. Perhaps one of the most important considerations is working with the nasal tip and the thick skin. Reducing the thickness of the nasal tip skin is a challenging and precarious, risky maneuver. If done too extensively, one can lose tissue and skin. When we reduce the skin we are actually taking out a safer layer and not actually the superficial skin components that can place the skin of the nose in danger. In reducing the nostrils, sometimes tip elevation and refinement will make it so that you may not have to reduce the nose dramatically in the nostril | alae | alar region. Weir's excisions entail an incision on the outside. Below the image shows where the external Weir Excisions are placed shown in blue.
Below is a before and after for an Asian Client that had a Wier Excision to reduce the size of the tissue overlying and covering the nostrils and shape the nostril alar area.
Hispanic Patient Thick Skin and other considerations: Sometimes reducing the nose and making it smaller is not always the answer. When a rhinoplasty surgeon persists in this thought, your nose could actually look bigger after a rhinoplasty. If the structural elements of your nose are not able to fully take up all of the skin of the nose, the skin could essentially ball up and your nose can look larger and more bulbous. The answer to this situation is either reducing the total skin envelope of your nose or actually project and augment the nose to take up all of the skin. In this particular case, we augmented the nose and added things to the tip and top of the bridge to make the nose have a smooth transition. This is why the results turned out so well.
Hispanic Latino Rhinoplasty Testimonial: Here is what he said about his Rhinoplasty: "8/18/15 5 stars Perfect job! I was stunned with the results from Dr. young he made my nose look flawless. He kept in touch with me after surgery making sure that everything was fine and his staff is very kind. He changed my life hopefully he can change yours. I recommend this man he is definitely a game changer. ..."
Here are some more Before and After Rhinoplasty Images for the Hispanic Latino Patient Population:
The Asian Patient:
The Asian Clientele: This group can comprise a large group including the Chinese, Korean, Japanese, Vietnamese, Cambodia, Indian, Thai, Filipino, etc. With that there is a wide variation in nose and the anatomy that it presents. What is unique and most challenging to work with is the skin thickness and decreased strength and sometimes lack of cartilage supporting the nasal tip and nose as a whole. In these situations, the rhinoplasty takes on more of a reconstructive type of procedure. In some Asian Clientele, there cartilage elements are so weak and distorted that you are essentially building a whole nose.
The Asian Rhinoplasty is often an Augmentation Rhinoplasty Procedure: What this means is that the Asian patient typically has an underdeveloped nose. They typically have a nose that is flatter and less projected. Hence, many times, the Asian Patient comes to have their nose made bigger and augmented. Most Asian patients want their bridge higher and their tip higher and more projected. Most Asian Rhinoplasties are Augmentation Rhinoplasties where they require grafting material. The grafts are usually taken from the ear, rib or their own septum. Often the septum does not have enough cartilage tissue. In Asian patients, their noses and septum are usually lacking of cartilage. This is not always the case however. Most of the time, Asian noses and their septums will not provide enough tissue and a Rhinoplasty surgeon will need to acquire some grafting material. For the bridge, many surgeons have relied on implants such as silicone, goretex or medpor. This has been successful for many surgeons and their patients. In this situation, it is important from our standpoint that the implant remain in the bridge and not have any connection with the tip where you can get into trouble. Implants in the tip can cause the tip to erode. For the tip, it is better to use native cartilage to prevent erosion of the artifical implant through the nasal tip skin. We have a link describing this situation and you can read about it by clicking here: Asian Revision Rhinoplasty.
Building the Asian Nose: One of the keys to build the Asian nose is the projection of the tip. Some have advocated the Columellar Strut graft and even have placed artificial implants in this location. We advocate building it with native cartilage like ear, septum or rib cartilage. It is all based on the caudal extension graft. This graft is a separate piece of cartilage from the ear, rib or nasal septum that is used to support the more projected tip. The tip cartilages are advanced on to this caudal extension graft as much as tolerated and then further augmentation can get you what you want here. Below is a picture of the nose open through an Open Rhinoplasty Approach showing where the caudal extension graft is placed.
Asian Nose - After the base the Tip is further augmented with Tip Grafts: Once the tip cartilages are advanced on to the caudal extension graft, the tip cartilages grafts can further enhance the structure and appearance of the nose. Depending on what is needed the grafts are tailored to give you what you want (Total tip graft, cap graft, dome graft, columellar graft, Shield Graft, etc). Below is an example of a total tip graft seen from the side angle:
The African American Patient:
The African American Rhinoplasty Client typically presents with a wide flat nose with a low nasal bridge, bulbous tip, lack of nasal tip projection and rotation. What this particular ethnic group comes in for is to usually correct those ethnic traits. They wish to change some or all these elements. The African American Nose can have anatomic elements that predispose their nose to look the way it does and to present unique challenges to the Rhinoplasty surgeon. Some of these same elements are present in the other ethinc groups we just discussed as well (ie Asian and Hispanic Patient Population). The thick skin of the African American Patient can create challenges for the Rhinoplasty Surgeon in making their nose more refined. The tip cartilages fashioned in a refined form in a caucasian patient will look very different under the thick skin of an African America Patient.