Is there a difference in technique between ethnic and non-ethnic rhinoplasty?
The answer is double fold. Yes and No!
Lets clarify the “yes” answer first. When you look at African American, Asian, Hispanic and Middle Eastern noses, there are some important anatomic differences compared to Caucasian or northern European noses. These differences in skin thickness, cartilage size and strength, bone versus cartilage proportion on the bridge, nostril width, and septal cartilage size or abundance are important to recognize in order to plan the proper technique during rhinoplasty for the best outcome. Furthermore, the relationship between the nose, lips, chin and other facial structures must be recognized.
For example many Asian, Black, or Latino patients have thicker skin and weaker cartilages. This combination is not ideal for support and definition. However, if properly recognized pre-op and properly planned for, great aesthetic results are readily achievable in such patients. This often includes using more structural cartilage grafting and more suture techniques.
The mistake that I often see is surgeons who fail to recognize or plan for this anatomic situation and take the dangerous opposite approach by removing too much cartilage which results in further lack of definition and further lack of support. This results in a nose that is amorphous due to thick skin and scar tissue.
Now lets clarify the “no” answer. So with everything that I mentioned above, you may be wandering how could I possibly say that ethnic rhinoplasty is no different than non-ethnic rhinoplasty! Simply said, a successful rhinoplasty is impossible without proper initial diagnosis!
The most important skill any rhinoplasty surgeon has is the skill of diagnosis. The problem at hand must first be diagnosed before the solution can be reached. Diagnosis, diagnosis, diagnosis! I cannot emphasize this enough. No two noses are exactly the same. Each is different. Each needs its own individualized plan. A plan is impossible without initial diagnosis of the aesthetic issues needing correction. Furthermore, the nose is a three-dimensional structure and as such, any changes in one area or view will result in changes in other areas or views. Furthermore, correction of one problem surgically can result in creation of a whole new problem. These issues must be clearly planned out prior to the surgery. However, during the surgery, the skilled rhinoplasty surgeons must possess the knowledge and expertise to be able to successfully recognize and deal with new potentially unforeseen issues that may come up as a result of variations in tissue dynamics.
In this respect the ethnic nose is no different than the non-ethnic nose. Each and every patient’s nose must be examined thoroughly and an individualized proper plan devised. Rhinoplasty is an operation of fractions of millimeters. The surgeon must diagnose and recognize the nature and dynamics of the tissue (cartilage, bone, skin, scar, etc) with which he/she is working in order to be able to manage and predict these minute but significant changes.