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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.…

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.…

African American Nose

The Problem The patient desires an aesthetic change of the African American nose. The Background The African American nose has unique features such as a wide nasal base with a wide nasal sill, flaring alar, wide nasal bridge, and weak nasal tip. With more acceptance in cosmetic surgery in the African American community, there is a desire to change the facial structures to more closely resemble…

The English Nose

The Problem The common presentation is of a young woman, with a simple nasal hump in mid-profile and with a straight septum and normal tip. Many would consider these to be excessive concerns ( Fig. 66.1 ). Usually there had been systematic bullying during their adolescence at school, being hurtfully called variants of “big nose.” All that these women want is a gentle curve to their…

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…

Russian Nose

The Problem Aesthetic rhinoplasty for the nose that fits the typical Eastern Slavic face. The stereotype of a Slavic young woman is as follows: wide round face; widely spaced big eyes; straight or concave dorsum with the nasal tip rotated up. On the West the actual Russian appearance is recognizable (Corpulence, “Blood and Milk”). Representatives of the Eastern Slavic group are usually fair-haired with gray or…

Rhinoplasty in the Caucus Nose

Background The Caucasus is a complex geographical area that includes a wide variety of landforms from mountains and plateaus to rivers, lakes, and marshes. There are 50 distinct peoples that inhabit the area and who form various communities, numbering anywhere from a few hundred to millions in the area between the Black Sea and the Caspian Sea. The languages spoken are classified into four families of…

Grecian Nose

The Problem From the outset, one might have a predisposed perception, based on Hellenistic period artifacts and images of a straight-lined nose joining the forehead to the nasal dorsum when seen in profile view. Or one of a feature distorted by folk art paintings or caricatures. Actual real-life evidence shows differently. Depending on which part of Greece they originate from, Greeks can have different physical characteristics.…

Latino Nose

The Problem The term “mestizo” means mixed. In Colombia, although the term initially meant the mixture of European and Native Indian blood, today, mestizos are considered a mixture of European (White), native Indian, and Black African descent people. In the medical literature, the term “mestizo” is used interchangeably with Latino or Hispanic and generally refers to patients coming from any of the countries of Latin America.…

The Persian Nose: Characteristics and Management

The Problem The Persian nose is characterized by a distinct shape and appearance that has been retained across several millennia. Constructed during the reign of the Achaemenid Empire 2500 years ago, the faces of stone engravings on Southern Iran’s Persepolis palace invariably include the typical large hump and droopy tip of Persian noses ( Fig. 60.1 ). These features persist today ( Fig. 60.2 ), which…

The Middle Eastern Nose

The Clinical Problem The presentation is of a young man, with a nasal hump in mid-profile and with a relatively straight septum, ptotic tip, and medium to thick skin; he presents no complaints of airway issues. Patient is in his late teens and has always thought his nose was too large for his face. He will be entering college and would like to make his face…

Indo-Aryan Nose

The Problem The elements of beauty are universal and generally involve harmony, balance, regularity, and poise. The tenets of rhinoplasty that provide a basis for any surgical plan remain the same, regardless of the ethnic origin of the patient. The nose is the center stage of the face, that can appear larger, wider, thicker, longer, or higher than what is considered an accepted norm, and it…

Dorsal Augmentation Using Glued Diced Costal Cartilage With Fascial Cap in Asian Nose

The Problem Small nose. The Background Asian people tend to have weak cartilage framework and thick skin, which is commonly associated with low dorsal height and poor tip projection. Due to its strength and capability of providing ample graft material, autologous costal cartilage plays an important role in Asian rhinoplasty. Costal cartilage is particularly useful in patients whose nose has an underprojected and weak lower two-thirds,…

Medical Aesthetic Rhinoplasty—Liquid Rhinoplasty

Introduction Liquid rhinoplasty is a modern term used to describe the use of hyaluronic acid fillers to augment, contour, and reshape the external appearance of the nose. The types of defects involving a clinical problem and anticipated outcomes are described in Table 56.1 . Table 56.1 Demonstrating the Range of Contour and Functional Defects That Can be Improved by Liquid Rhinoplasty. Clinical Problem Anticipated Outcome 1.…

Fat Grafting for Rhinoplasty

The Problem Despite more than 100 years of progress, there is still no consensus about the best way to augment the nasal dorsum. Local deformities of the nasal dorsum range from subtle, such as a slight convexity, and more severe, as those seen in saddle noses affected by vasculitis. The Background In the dorsum, multiple approaches and techniques are used to correct deformities. Frequently, defects of…

Dorsal Preservation in Rhinoplasty: A Deviated Nose

The Background Most patients requesting rhinoplasty will focus on the position and shape of the bridge first, and the form and shape of their nasal tip second. “I don’t like the bump” is a familiar request for rhinoplasty and traditionally a convex profile or a high bridge has been removed by direct excision using rasps, osteotomes, or a scalpel. This type of reduction was popularized by…

K-Area Preservation in Primary Rhinoplasty

The principle of conservative rhinoplasty, called “preservation rhinoplasty” by Daniel, is to improve the shape of the nose while preserving its main anatomic structures, especially the osseocartilaginous vault, and protecting or, even better, improving its main function of ventilation. It is better to lower the dorsum of the nose than to resect it, then to reorient the cartilaginous arch by reshaping the junction between the nasal…

Preservation Rhinoplasty (Tip Plasty)

The Problem A wide nasal tip occurs when the dome and lateral crura are wider than normal. The area between the nostrils and the lateral crura (i.e., the facet polygon) is usually narrow. The overgrowth of the dorsal cartilage and nasal bone leads to an aesthetically unappealing nose with a dorsal hump. The nose consists of mobile and immobile parts. The mobile tip is formed by…

Lateral Crural Turn-In Flap (Preservation Tip Plasty)

The Problem Deformed lateral crura. The Background When modern rhinoplasty was first introduced, it was usually reduction rhinoplasty as championed by Jacques Joseph. Rhinoplasty has gone through different stages of development throughout the years, resulting in two additional schools of thought: structural rhinoplasty and preservation rhinoplasty. Structural rhinoplasty has introduced many different types of grafts to support the nose both functionally and aesthetically in order to…

Nasal Base Modification

The Problem The nasal base is an important aspect of the nose that frequently needs to be changed in aesthetic nose surgery. Wide nasal bases that are exacerbated by facial movements are the subject of this chapter. The Background There are numerous techniques to modify and reduce the nasal base. The main goal of most of these techniques is to find the best way to remove…