The term “Ethnic Rhinoplasty” is very broad and not a great descriptor. The word “Ethnic” refers to something belonging to a specific ethnicity, but does not indicate which one. However, when discussing “Ethnic Rhinoplasty”, it is often in reference to ethnicities with wider, more bulbous, thick-skinned noses. This can include Hispanic, Latino, African American, and Asian ethnicities, but in reality can be found in others as well.
As an expert in Rhinoplasty, Dr. Zhuravsky performs surgeries on a wide variety of noses across a range of ethnicities. He not only focuses on their ethnicity but also their own unique features and specific desires, keeping in mind to address each patient’s anatomy with the appropriate means. Dr. Z performs ethnic rhinoplasty for our Miami patients, as well as those that travel from far distances for his expertise. This page focuses on describing some of the important aspects associated with what many in the general public consider to be an “Ethnic nose”.
BEFORE & AFTERS
Peruse Dr. Ruslan Zhuravsky’s patient photo gallery to view his work and artistry on facial procedures like Ethnic Rhinoplasty, Facelift, and more.
before
after
As described above, many individuals from the African American, Asian, Latino, and Hispanic communities believe they have an “Ethnic nose”. Although each patient is unique, there are certain trends in nasal features that we see in these groups of patients. In the end, it doesn’t matter if you are characterized as having an ethnic nose, but rather the individual characteristics of the nose itself. Some of the common features that we see in these cases are as follows:
Wide nasal bridge: The top ½ to 2/3rd of the nose can be very wide, especially at the nasal bones. This includes the base of the bones, where they meet the face, as well as the top of the bridge itself. In some cases, it can even take up a majority of the space between the eyes.
Low Nasal Bridge: The upper part of the nasal bridge may not only be wide but also very low/flat. This is more common in Asian noses. Some patients may even have a “relative nasal bump”. That means the bridge of a nose has a bump, however, it is not because the bump is too high, but rather because the area above it (radix) is too low (or deep).
Wide / Bulbous tip: This is perhaps the most common complaint. The cartilages are usually broad, round, and/or wide apart, creating excess width of the nasal tip. In addition, overlying thick skin further adds to the fullness.
Wide/large nostrils: The base of the lower part of the nose is also typically wider, with nostrils that flare out. They may even be flared upward, revealing the inside of the nose and making them look even bigger. These types of nostrils are oftentimes significantly wider than the inner corners of the eyes.
Thick Skin: The thickness of the skin itself adds to the width and fullness of all the areas. It also adds weight to the cartilage, which has an important impact on the surgery itself. Imagine the skin as a thick heavy blanket and the cartilage as the support structures holding it up to give shape. It is hard to see the shapes under a thick blanket, and the support structures have to be strong enough to support the weight of the blanket above them.
There are two main challenges when dealing with ethnic noses; skin thickness and cartilage support.
This presents two issues for our ethnic rhinoplasty Miami patients. The first is that thick skin adds bulk and disguises the shape of the nose, making it appear bigger and less defined. Imagine a thick fluffy comforter placed over any objects, for example, wooden blocks. The exact shape of those objects would be hard to see due to the thickness of the cover over them. This is why the shapes we create underneath thick skin must be very crisp and defined. However, even when this is taken into account, the shape may still not be as defined as it would be under a thinner cover.
The second issue is that thicker skin is heavy and weighs down on the cartilage framework. Imagine using that same fluffy heavy comforter to make a tent. The poles or other items you would use to create this tent must be strong enough to support this cover, otherwise it will push down and deform it. This is why rhinoplasties that focus on making the cartilage smaller fail. They weaken the cartilage, which in turn gets “squashed” by the thick skin and fails to maintain the necessary shape.
In order to achieve the results of a “smaller” more defined nose, we have to make sure the cartilage of the nose are strong enough to support the skin and also has extra definition so that we will see the shape through the thickness of the blanket.
Adequate cartilage support is important in all rhinoplasty cases but must be especially strong in cases of the typical ethnic nose. As described above, thick skin will weigh down on this framework so it must be strong enough to provide shape and stability.
The shorter, wider tip cartilages of a typical ethnic nose have less support to begin with, as the “medial crura” are often very small. These medial crura are the pedestals that the tip cartilages sit on, and determine how strong and defined the tip can be. They are also partially supported by their loose attachments to the septum. Unfortunately, many ethnic noses have a short septum, which further reduces the amount of support available for the tip. Therefore, we often have to focus on strengthening and extending the septum, and then using it to hold up the medial crura and tip. This is more of a concept for surgeons, but it is still important for patients to hear so they can pick up on themes and ask the right questions during their consultations.
Achieving a strong cartilage framework is primarily based on using cartilage from other areas (ie the septum) to reinforce the areas of greatest importance. Taking cartilage from one area and placing it in another is called grafting. The septum is the best option as it is already in front of us when we are operating on the nose and typically has good strength. Unfortunately, in cases of ethnic noses, there may not be enough cartilage in the septum to provide us with the adequate amount of materials. In those cases, we may take cartilage from the ear, rib, or an outside source such as donated rib cartilage (more on that below).
Yes, there are ways to thin out the skin, but these can be tricky.
There are two main ways to make nose skin thinner. The first is to physically thin it out during surgery. We can cut down some of the thickness from the deepest layer with a scissor during surgery. This can be a risky maneuver as the blood supply to the skin runs through these layers, and if we slice a little too deep, it can lead to necrosis (skin death). Many surgeons stay away from this altogether, some will do this when there is a very obvious safe layer visible, and a few will do this more often for their thicker skin patients.
The other method to thin nasal skin is by taking a medicine called Accutane after surgery. This medication is usually a last resort for the treatment of acne, as it can have some unpleasant side effects in certain patients. If it is well tolerated by the patient, Accutane can decrease the size of sweat glands and result in thinning of the skin, especially around the nose. The choice to use accutane must be weighed very carefully due to the medication’s potential side effects and should be managed by an experienced dermatologist.
Following up with your surgeon is definitely important as they will help guide you based on your specific needs. Taping the nose at night can help reduce the amount of swelling that occurs at night and expedite the reduction in fullness. Avoiding sun exposure and extreme heat can help prevent additional swelling, especially during the first year after surgery. Injections of steroids or another medication called 5-FU can also be used to reduce specific areas of swelling or scar tissue formation. Lastly, oral steroids can help reduce general swelling of the nasal area.
The most common issue that we see when taking on revisions for ethnic noses from our Miami practice is that the prior surgery focused on making the nose “smaller” simply by reducing the size of the cartilage. As mentioned above, the key to achieving great results with an ethnic nose is to create a strong and defined structure. If the cartilages are merely reduced or cut, they will weaken and result in either no improvement or worsening in the shape with potential deformities. When discussing surgery, the focus should be on how we can build the desired shape, not how we can reduce into that shape. A well-qualified Rhinoplasty surgeon should know and understand these concepts very well. From a patient’s perspective, it really comes down to choosing the correct surgeon. Understanding and discussing these issues during your consultations will help you with the selection process, as you will begin to hear trends in their answers and approach to your nose.
In cases of a low nasal bridge, we are focused on building and adding rather than reducing and taking away. This is called dorsal augmentation. Below are a few of the ways that we can accomplish a higher nasal bridge.
Synthetic Implant: This is the least popular method in the US. Implants made from silicone and other materials are used successfully throughout the body and other areas of the face without many issues, however, they can be particularly problematic in the nose. The nose has relatively thinner skin compared to other areas of the body (even thick skin noses), so these implants can start to extrude, working their way out through the skin. Other concerns include displacement of the implant over time, infection, and deformities.
Cartilage onlay graft: A piece of cartilage can be placed along the entire bridge, or sometimes just the radix (the upper part between the eyes) in order to add height. This is more typically used for the radix as the thicker skin in this area can disguise the graft. When used along the entire bridge, it can sometimes result in irregularities where the edges of the graft are visible. This is a popular augmentation technique that is still used by some surgeons, but many have moved away from it to avoid these issues.
Diced Cartilage & Fascia Grafts: These have become the more popular ways to augment the nasal bridge. Fascia is a connective tissue in our body. It is like a thin blanket that usually covers muscles or connects various organs. Imagine rolling out play dough into a thin flat sheet. We can roll this up and place it into the nose to give a mild increase in height along the bridge. If more height is desired, cartilage is diced into fine little pieces, then placed inside of the fascia. Imagine making a taquito by rolling diced meat into a rolled-out piece of dough. These grafts have the advantage of being made from your own tissues and being soft enough to conform along the bridge, avoiding odd edges or step-offs. Fascia can easily be taken from the temporalis muscle by making a hidden incision above or behind the ear.
Diced cartilage and Fibrin Glue Grafts: This is another popular method. Cartilage is diced and placed into a mold. A special medical glue is applied and the pieces conform to the desired shape, which can be further modified and placed into the nose. This has the advantage of also being made mostly from your own tissues and can be shaped to avoid irregular edges and step-offs.
The main things that you should get from consultation is that your surgeon understands your goals, is able to achieve those goals with a high-quality approach, and is willing to put in the necessary effort.
The first part is achieved by a thorough consultation process, where the surgeon listens to your desires and communicates them back through computer-morphed images. I call this a collaborative process because the surgeon creates images based on what they think the patient is describing, while also providing input along the way. This way, the end result is a photograph of the goals that both the surgeon and patient agree upon.
The second part is much harder for patients to assess, and not as simple as merely picking a board-certified surgeon, or one from any particular training background, or even a specific level of notoriety. It requires the patient to have some understanding of nasal anatomy and basic rhinoplasty concepts, such as those described above. This knowledge helps patients determine if the surgeon has a reasonable plan or a quick generic approach that will lead to problems. Some important questions to ask are:
* Before asking these questions, review our video on nasal anatomy to have a basic understanding of what gives our nose its shape. This will help you understand these questions and their answers. It will also help you be an active part of the consultation discussion, rather than simply listening and being sold.
