Ethnic Rhinoplasty

Prof Dr Nazim Cerkes, the President of The Rhinoplasty Society of Europe, Vice President of International Society of Aesthetic Plastic Surgery and Past President of Turkish Society of Aesthetic Plastic Surgery.

Prof Dr Cerkes has a large number of patients of ethnic descent who request rhinoplasty and revision rhinoplasty surgery from all over the world.

Every nose is different and unique to that individual. One of the most important elements to a well-balanced profile is harmony between the nose and chin.

Ethnic rhinoplasty is a nasal surgery where the nose is surgically altered to create a symmetrical, aesthetically pleasing nose that suits the individual patient’s face without diminishing the patient’s ethnic characteristics.

This is one such specialty that is extremely detailed and delicate.
During consultation, there will be in-depth pre-operative evaluation of the nose and the overall facial balance and photo simulation will be made for you.

There are lots of variations in ethnic groups and we must fully embrace the African American, Asian, Hispanic, Middle Eastern descent, Indian, Persian and Jewish noses, and manage each type differently.

There are some characteristics common to the different ethnicities that can make rhinoplasty more challenging and these must be addressed and taken into account in order to achieve an optimal result

• Thicker nasal skin
• Weak tip cartilages
• Dorsal hump
• Flat nasal bridge
• Wide appearing or Broad nose
• Bulbous or Boxy tip
• Drooping or Hanging tip
• Large or flared nostrils

If your nose is very wide,we will perform an alar base reduction and nasal tip reduction to give it more definition.

If there is need to build up the bridge of your nose your own cartilage preferably a rib can be used.
With open rhinoplasty, a small incision is made under the tip of the nose and possibly on the side if alar base reduction is needed. The incisions are minute and skillfully hidden deep in the creases. They are well-concealed and will fade with time.

Ethnicity has an important role in the structure, function and suitability to specific rhinoplasty techniques.

Caucasian nose

Caucasian noses often have thinner skin overlying the cartilage and bony structure and any underlying irregularities are easily seen.

There are a couple of characteristics that many non-white noses share in common: “weak” cartilage in the nasal tip, and thick skin. Rhinoplasty surgery in thinner skinned individuals requires specific finesse to ensure that there are natural curves and if necessary use innovative grafts to hide skin changes. The thickness of the skin is related to sebaceous glands and subcutaneous fat which reduces the nasal definition and angularity. Thick soft tissue can also result in a larger, more voluminous nose.

In contrast some ethnicities such as Middle Eastern and Afro-Caribbean noses tend to be thicker with broader cartilages. In these patients with thicker skin type, specific techniques are necessary to increase the definition of the cartilage underlying the nose.

As a result of these pronounced anatomical differences, the goal of ethnic rhinoplasty is slightly different from that of Caucasian rhinoplasty. The dimensions, the shape, and the projection of the nose are determined by the structural support of the osteocartilaginous nasal framework and also by the skeletal support of the midface. The proportions of the nose are related to the rest of the facial structures, mainly the maxilla, the mandible, the dental arches, and the lips.

These differences also relate to the shape of the facial skeleton; the thickness of the skin and its subcutaneous layer, and the configuration of facial muscles.

If you are not Caucasian, you should not request a Caucasian nose, because the result will not be aesthetically appealing. The goal of an ethnic rhinoplasty procedure will be to alter the nose in such a way so as to preserve your ethnic characteristics and still create harmony and maintain proportions with your facial features.

Non-Caucasian noses usually have a low radix, broad base, flat dorsum, thick and short lower lateral (alar) cartilages, and round nostrils. These differences alter the projection of the nasal tip and result in a different nasolabial angle.

Middle Eastern Nose

The term Middle Eastern commonly refers to people of Turkish, Persian, Arabic and North African descent. Although a large variety of nasal features can be seen, the population in Turkey usually represents with a mixture of Middle Eastern and Mediterranean nasal morphology.

Middle Eastern-Mediterranean patients possess a varied combination of the various nasal characteristics. They frequently demonstrates a significant dorsal hump and poorly defined nasal tip. Nasal bones are usually thick and long. Septal deviation is common and often visible externally. Nasal length is often disproportionally long relative to tip projection, and droopy nasal tip with acute columellar-labial angle is seen frequently. Alar flaring and increased inter alar width is also common. Thick nasal skin with highly sebaceous texture frequently seen particularly at the nasal tip, lobule and alar rims.

In vast majority of Middle Eastern-Mediterrannean patients reduction of dorsal hump is required. Dorsum reduction and reestablishment of dorsal aesthetic lines is one of the most important steps of the surgery at Middle Eastern-Mediterranean patients. The open rhinoplasty approach provides better visualization of nasal dorsum anatomy and easier execution of maneouvers.

Most of the Middle Eastern-Meditarranean patients request a conservative dorsal reduction. Excessive hump reduction may produce a racial incongruity.

Another common problem in Middle Eastern patients is underdeveloped alar cartilages with loss of tip projection and ill- defined nasal tip contours. An ill defined nasal tip with overlying thick skin mandates more aggressive tip modification. In these patients, cartilage grafting is usually required to increase tip projection and improve tip contours.

In Middle Eastern-Mediterranean patients increased interalar width and alar flaring is also common. In these patients excision from nostril sills will correct alar flaring and shorten interalar width.

The Ethnic andAfrican American Nose

The Ethnic and African American nose presents several key anatomical differences when compared to the Caucasian nose. While every patient has a completely unique facial anatomy, there are three main anatomical distinctions between Caucasian and African American/Ethnic noses.

First, the Ethnic African American nose does not generally have a prominent bridge (yet typically does not suffer from the same bony hump concerns that Caucasian noses do). To bring an African American nose with a low or depressed bridge into proportion with the rest of the nose, nasal bridge augmentation may be required.

Second, the Ethnic African American nose is typically wider at the nostrils than that of a Caucasian nose and with a lower tip projection. Wide nostrils can sometimes create or contribute to the appearance of an oversized nose. Nostril narrowing helps to balance the nostrils with the rest of the nose and face.

Third, African American noses tend to have very thick skin and additional fibro-fatty tissue at the tip of the nose ,along with weak cartilages. Extra fatty tissue can give the nose a rounded and swollen appearance while weak cartilage contributes to the poor nasal tip definition. To remove the fatty tissue correctly ,and simultaneously for refining and reinforcing the nasal tip cartilage, the advanced Open Rhinoplasty technique is advised.

With the open rhinoplasty technique, the nasal structures may be directly visualized, thus enabling us to excise the fibro fatty tissue precisely , and at the same time support and sculpt the nasal structures.

‘’Rhinoplasty is one of most precise surgery in the human body’’

Dr Cerkes’s has developed some latest surgical techniques

Dr Cerkes utilizes specialized techniques when performing an ethnic rhinoplasty. He described a different concept of nasal dorsum dissection: “the perichondro-periosteal flap’’ and have been using this method since 2005 . Some plastic surgeons prefer to use synthetic implants due to the ease with which these can be placed. Dr Cerkes only uses tissue from patient’s own body to have the safest and longest lasting result.