The Mixed Race Nose (Mestizo Nose)

The Problem

The mixed race nose, also called mestizo nose or Hispanic nose, is a term that refers to nasal characteristics that include thick skin, a bulbous tip, and weak and flimsy cartilaginous structure. Patients frequently exhibit Fitzpatrick skin types III to V. Mixed race noses are more likely to present dorsal humps, saddle deformities, and retracted columellae.

The sebaceous and relatively inelastic skin associated with increased subcutaneous fibrofatty tissue (average thickness of 3 mm) contributes to poor tip definition. The management of the nasal skin of mestizo noses is a challenge. The poorly contractile skin is linked to prolonged postoperative edema with increased scar formation. Tip cartilage grafts are important resources utilized to improve tip definition in thick skin patients.

The Background

The term “Hispanic” is related to the people, speech, or culture of Spain or Portugal. The Spanish term mestizo derives from the Latin word mixticius , which means mixed and was first documented in English in 1582. The Portuguese cognate mestizo (mestiço, in Portuguese) refers to people originated by any mixture of Portuguese and local populations (Amerindians).

The expression “Hispanic nose” was first presented in a symposium of rhinoplasty held in Boston in 1997 and is used to refer to mixed-raced patients coming from Latin America, descending from White European colonizers and native indigenous peoples from South America. Anthropologically, the ethnic background is incognito, and the leading phenotypes vary enormously according to the predominant heritage traits.

Mestizo noses present softer osteocartilaginous framework and thicker skin–soft tissue envelope. The complaints usually derive from the comparison with the White nose with a well-defined tip.

Major anatomic features of the mixed-race nose include:

• Sebaceous, frequently thick skin envelope with reduced elasticity

• Alteration of the underlying osteocartilaginous framework with thin and flimsy cartilages

• Bulbous, not well-defined and usually underprojected nose tip

• Wide alar base and ala with varied degrees of flaring

• Normal or low radix height and short nasal bones

• Dorsum projections vary from small humps to a flat nasal appearance

As the thickness of the skin–soft tissue envelope is the pivotal characteristic to be considered before planning the surgical treatment, Pitombo presents a classification, detailed in Table 70.1 , based on the degree of thickness of the skin. This classification guides the surgical planning.

The Indications

Mestizo nose is a term commonly used to refer to nasal characteristics of Latino patients, individuals who are the result of intermixing of races. Usually, patients presenting with mestizo nose search for more refined thinner noses. The surgery aims at achieving harmony and balance of nasal structures while keeping some ethnic features.

The Patient

The patient is a 22-year-old female with Mestizo nose Type 2 according to Pitombo’s classification (skin with a medium degree of thickness). The patient complained about a “ball-like tip” and wide alar base ( Video 70.1 ). FLOAT NOT FOUND