Asian Rhinoplasty

Cultural Issues

The first priority for surgeons should be to understand the patient before trying to understand the operation. What has emerged as a frequent comment from my colleagues is the failure to comprehend the enigmatic nature of the Asian patient and that miscommunication has led to surgical failure even when the surgical result may have been deemed a technical success. This lack of clear communication may only be partly blamed on the language barrier of some first-generation immigrants. There are two glaring failures that may in fact underscore the miscommunication: a lack of cultural sensitivity and a lack of understanding ethnic identity. This section will cover the former aspect of the purported problem.

Some of the folkloric cultural beliefs that inform Asians—who either live abroad, who have recently immigrated to the West, and even for those who are several generations later born and reared in the West—should be explored herein. As alluded to in the introduction, some Asian patients may desire undergoing aesthetic rhinoplasty solely for nonaesthetic reasons. For instance, the larger nose has been regarded as a sign of wealth and fortune for the bearer of this feature, or by turns offers the individual who acquires this attribute even via surgery to attain that level of monetary gain. I clearly recall a Chinese chef who ascribed his job promotion to his higher nose bridge and was more elated with his enhanced fortune in life brought on, in his view, by his higher nasal dorsum, than with the aesthetic outcome of his rhinoplasty surgery. However, with regard to the height of the nasal dorsum, the surgeon should always respect the parameters that would preserve a natural result. This topic will be discussed in the following section. The second most common request or desire that may have cultural underpinnings is to have less visible nostril show from a frontal view. Accordingly, anything that would lead to greater nostril show (no matter how narrow the nostrils are to begin with) could lead to patient dissatisfaction. That is why a dome-binding suture that leads to nasal tip refinement may not be a wise surgical option in many Asian patients. Besides the unaesthetic feature of widely visible nostrils, the motivating factor for the Asian patient may be the folkloric belief that visible nostrils may engender monetary loss. I recall a Vietnamese patient of mine who was born and raised in the United States but who wanted to have a higher bridge and less visible nostrils because a fortuneteller had informed him of the importance of doing so to change his fortune in life. He also desired nasal enhancement for aesthetic reasons and with preoperative imaging appeared to have realistic goals. However, the surgeon who is contemplating proceeding with surgery in the patient who is profoundly motivated by cultural beliefs risks the uncontrollable outcome that a patient has not attained the desired station in life perhaps due to a surgeon's failure to accomplish sufficient structural change to the nose. These cultural elements should almost always be explored to determine the candidacy for undertaking rhinoplasty based on mutually aligned and attainable goals.

Other examples of folkloric beliefs related to the face may be illustrative and impart further insight for the Western surgeon who desires to work on the Asian patient. Freckles may be considered an endearing feature in the West, but any skin blemishes for the Asian patient may be remarked as unattractive and further thought to affect adversely one's good fortune. Like a large nose, large ears are also believed to designate the bearer as an individual who holds great wealth and wisdom. Consequently, reductive otoplasty is less commonly undertaken in the Far East. Dimples are thought to impart fertility and increase one's marriage prospect. Exploring these complex and multilayered motivations may help establish and align realistic objectives with the patient.