Northern European Nose

The Problem

Slightly deprojected Northern European nose with boxy tip, ill tip definition, middle vault hump, bony and cartilaginous, and incontinuous dorsal aesthetic contour lines.

The Background

Rhinoplasty is recognized by the majority of facial plastic surgeons as one of the most difficult procedures from a technical standpoint. It possesses the steepest learning curve and the greatest need for surgeon intuition. Achieving predictable results is always a challenge and requires a thorough understanding of nasal anatomy and physiology, state-of-the-art technique, and sound knowledge and appreciation of facial aesthetics.

In past decades “ethnic rhinoplasty” was a term used to describe the procedure performed on individuals whose nose was not identified having the specific characteristics of nasal anatomy that describe the White or Northern European nose. This outdated trend was evoked by the globalizations of Western beauty standards through the mass media and resulted in many people with non-European characteristics desiring to have their nose “Westernized”.

However, the standards of beauty have been gradually changing, and are much more multicultural than in the past. In many ways, White versus ethnic is an outdated differentiation. Moreover, inside each ethnic group—including the typical European or White nose—there is a great level of variation that should not be underestimated. This fact, in combination with a diminished desire for “Westernization” of characteristics of the non-White patients implies that it would be much more accurate to consider the European nose as another type among the vivid variety of “ethnic noses”. Such a point of view, in our opinion, could result in a better understanding of the nasal aesthetics, better planning of the operation, happier patients, and a lessening of the reoperation rate due to diminished satisfaction with the result.

European or White individuals are defined as having Fitzpatrick skin types 1 through 3 and being of European descent. The facial proportions are characterized by equally spaced vertical fifths and horizontal thirds. Sebaceous characteristics can vary and, consequently this can affect skin thickness; however, the skin of the Northern European nose is usually thin.

On anteroposterior view, when dividing the face into equal fifths, the axis of the typical White nose should be exactly in the middle of the central fifth while the nasal base, measured as the distance between the lateralmost point of each ala, should be exactly the width of the central fifth, which in turn should coincide with the intercanthal distance. The bony base should ideally be 75% to 80% of the alar base width, whereas the dorsal aesthetic contour lines should be continuous and diverge symmetrically. The tip-defining points are symmetric and should form a diamond shape, composed of equilateral triangles formed between the interpoint line and the center of the supratip break and the columellar–lobular angle, respectively. On the alar rims, the outline of the infratip break point should resemble a “seagull in gentle flight”.

On basilar view, the alar rims of the ideal European nose should form an equilateral triangle, in other words, nostril inclination should be approximately 60 degrees.

On lateral view, the nasofrontal angle should be located at the level of the supratarsal crease and its angle should ideally be approximately 140 degrees. It is extremely important to stress that this angle correlates directly to the perception of nasal length. A deeper radix with a steeper nasofrontal angle gives the impression of a shorter nose, whereas the opposite applies for a shallow nasofrontal angle that is wider than 140 degrees. The curvature of the dorsum is examined in relation to a straight line drawn from the radix to the tip-defining points. On females, the dorsum should lie 1 to 2 mm posterior to this line and should form a gentle supratip break at around 2 to 3 mm cephalic to the tip-defining points, whereas on males, it should be exactly at the line or even slightly anterior to it. Tip projection is defined as the vertical distance from the anterior-most point of the upper lip to the tip of the nose. In the ideal European nose this distance should be 50% to 60% of the distance between the alar-cheek crease or 0.67 times the nasal length. Tip rotation is determined by the nasolabial angle and should equal approximately 90 to 95 degrees in men and 95 to 100 degrees in women. The nostril should create an oval, which is bisected when a line is drawn through the long axis of the nostril.