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Hispanic Nose
The Problem
In the author’s primary rhinoplasty practice, at least 40% of patients are of Hispanic origin. There is a large diversity of presenting issues as well as requisite surgical techniques. Rather than classify by country of origin, I will discuss the most common presenting origin I encounter in my practice, which is the Mexican-American. In addition, the mestizo nose will be discussed in another chapter. In general, Hispanic patients are challenging with regards to operative analysis and surgical planning.
The Background
Mexican-American patients can present with a range of deformities. When asked what three things they do not like and want to have changed about their nose, they often list a dorsal hump, plunging tip on smiling, and bulbous tip. To the patient it appears that they have a convex dorsum whose reduction would solve the problem. However, this fundamental problem is actually a “pseudohump” that is accentuated by a hypoplastic radix and thick skin with an underprojected tip. Trying to make a smaller, cuter nose is often met with very disappointing results. These patients are best managed with a small reduction of the nasal bridge, combined with a rigid septal extension graft after superficial musculoaponeurotic system–ectomy (SMASectomy) of the nasal tip lobule. Radix grafting is often required as is alar base reduction.
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