Brazilian Nose

The Problem

Massive immigration started in the colonial period and a consequent high degree of miscegenation made rhinoplasty in the Brazilian population a challenge that requires handling and mastering different techniques. Due to the racial mixture, patients of predominantly White origin may not present an aquiline dorsum and exhibit large nasal dorsum instead. Furthermore, the tip can present with characteristics typical of African or Indigenous noses. A bulbous tip accompanied by a large dorsum is the most common complaint.

The Background

In contemporary Brazil, all non-Indigenous people are part of a single ethnicity, called Brazilian people. The great genetic ancestry diversity results in different phenotypes. The expression Brazilian nose refers to noses that result from the combination of ethnic features related to the racial mixture. ^(1-4)

Furthermore, nasal predominant features depend on geographic zone. Patients from the north present more predominantly African and Indigenous characteristics. In the central area, miscegenation between Whites and Africans originated patients with Fitzpatrick skin types III to V. These patients usually exhibit wide piriform aperture, low dorsum, moderate to excessive alar flaring, short columella, and inadequate tip projection are typical. The skin is thicker and lacks elasticity. The fibrofatty tissue in the subcutaneous layer presents around 3 to 4 cm, which contributes to a lack of definition of the tip. ^(2,3)

In the south and southeast regions, where the cold weather instigated the permanence of European German and Italian immigrants, the population is predominantly of White origin. Long faces and noses with narrow piriform aperture, prominent anterior nasal spine, inclined nose bridge, and crooked noses with their major component, a deviated nasal septum, are commonly found.

Additionally, Brazil is home to the largest population of Japanese origin outside Japan, with about 1.5 million Nikkei. Asian descendants tend to present a short face, flat nasal root, and unobtrusive, broad, short noses.

The Indications

A bulbous tip accompanied by a large dorsum and normal nasal radix is the most prevalent indication for the surgical procedure. The choice among closed, open, and semi-open approaches is mainly related to the tip alterations and the necessity of tip refinement. ^(2,3,5)

The Patient

The patient is a 26-year-old female with Fitzpatrick’s skin type I, White phenotype, presenting thin skin, bulbous tip and enlarged dorsum, features compatible with Type I patient of the Pitombo classification, which has been described in the Mestizo Nose chapter. The patient’s request included a well-defined tip and delicate nose.