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 languages: Caucasian (or Paleo-Caucasian), Indo-European, Turkic, and Semitic. The Caucasian language speakers are thought to have been the first to occupy the territory, whereas the others migrated to the area afterwards.

The peoples are subdivided into a northern branch and a southern branch. The southern branch comprises the Mingrelians, the Laz, and the Svan, who make up the Georgians, who inhabit the western Transcaucasia, respectively the Republic of Georgia. The northern branch is formed by several peoples among whom the Chechens and the Kabardians are the most densely populated.

The classic physical traits of the Mediterranean nose that Rohrich and Ghavami described can be broken down by multiple presentations, depending on the region of origin. Patients of the Caucasus present with White, Asian, and/or Middle Eastern facial features and, depending on their regional presentation, this will determine what changes can be made to their nose. A White nose on a Middle Eastern or Asian patient makes their facial features present as “over operated.” The surgeon must avoid creating “racial incongruity.”

Skin color and thickness present in all ranges in the Caucasus region, but in general these peoples are fairer in complexion than Middle Eastern peoples.

The surgeon must be open minded to the different expectations, and the time spent in consult is crucial for the surgeon and patient to agree on the desired the surgical outcome. Most surgeons run into trouble at this stage. They can execute and deliver a perfect surgery from a medical and surgical standpoint, but if the surgeon fails to understand and execute the precise changes that the patient is requesting, the surgery has failed. The surgeon must have the courage to walk away if the patient’s expectations are not realistic and accomplishable in a safe manner. Language can be a barrier as well, and it is best that someone, if not the surgeon, communicates in the native language of the patient.

The request for Westernization of the nose is common. The surgeon must educate the patient on skin thickness and sebaceous distribution, skeletal differences such as nasal aperture width, and anatomical traits that are very difficult to change in order to achieve a Westernized presentation. The surgeon’s goal should be to bring out the positive facial traits in the Middle Eastern face. The surgeon must present the goal of the surgery as not to ultimately achieve a Western nose, but a nose that lets the other facial features present more boldly.

The Problem

The rhinoplasty techniques are classified into two common types: open and closed, with both types possibly having many modifications and variations. Every rhinoplasty surgeon operates using one or both techniques. In addition, the surgeon can change the technique from time to time.

The preservation technique or closed preservation technique, is slightly different than the classic closed approach. This technique alters the bones, cartilages, and soft tissues in minimal ways, preserving the natural anatomical structures. This technique, called “preservation rhinoplasty,” can help create a more naturally beautiful nose without seriously altering the natural anatomical structures. The healing and recovery periods are generally shorter, but this does vary from case to case and depends on the nose type.

In the classic or open rhinoplasty, the first step is to destroy many structures such as bone, cartilages, and soft tissues in order to be able to change the form of the nose with the goal of achieving the desired aesthetic result. The next step is usually that of rebuilding all the structures. In preservation rhinoplasty, the nasal structures are kept intact as much as possible, especially the keystone area (K-area), soft tissues, and ligaments.