The art of ethnic rhinoplasty: A nose job that preserves your cultural identity

Image Here — People of color seeking rhinoplasty need the support of a plastic surgery team with expertise in refining ethnic noses.

Rhinoplasty has been available for decades. But for people of color in the U.S., getting a satisfying outcome often proves challenging because best practices were developed around the general facial shapes and aesthetic standards of Caucasians, who make up the largest patient demographic.

Approximately 74 percent of patients who get rhinoplasty, commonly referred to as a nose job, are white. But a narrow, one-size-fits-all focus on the “American nose” fails to preserve patients’ ethnic identity, and it doesn’t take into account the rich diversity of facial shapes and characteristics in today’s society.

Applying Caucasian rhinoplasty guidelines to the face of an African-American, Asian, Native American, or Middle Eastern patient may result in potential breathing issues and an increased risk for needing multiple or revisional surgeries.

People of color seeking rhinoplasty need the support of a plastic surgery team with expertise in refining ethnic noses. UT Southwestern is the No. 1 aesthetic plastic surgery teaching hospital in the nation.

Prior to joining the UT Southwestern Plastic Surgery team, I spent six years in the United Arab Emirates, where ethnic rhinoplasty was by far my most-performed procedure. I am also board-certified and fellowship-trained in ear, nose, and throat surgery, which translates into greater expertise in treating the entire nose, not just the external, cosmetic aspects.

Rhinoplasty surgery is a popular reason we see patients at UT Southwestern. The best ethnic rhinoplasty outcomes are based on the unique characteristics and goals of an individual patient. Depending on the relationship of the forehead to the nose, width of the nose, shape of the eyes, cheeks, and mouth, we can create a more harmonious look.

Types of ethnic rhinoplasty procedures

The nose is probably our most prominent facial feature, and so it’s only natural that people of all ethnicities tend to scrutinize it whenever they look in the mirror.

The underlying structure of the nose is comprised of cartilage and bone, which hold up the skin. When those elements are not harmonious in size and shape, a nose may appear narrow, wide, flat, bulbous, or even bumpy.

Sometimes, patients bring in photographs of celebrities, saying, “I want my nose to look like this.” Your face is unique, and it is unrealistic to base your expectations on someone else’s facial characteristics. Also, drastic alterations often require multiple procedures, which will be expensive and bear greater surgical risk.

Your plastic surgeon may recommend one of these types of procedures:

Dr. Al Aly discusses his approach to his areas of expertise, including ethnic rhinoplasty.

Augmentation (rearranging): Augmentation is common across all ethnicities. Rather than adding or taking away from the nose, we make subtle changes in the angles and definition of certain areas to balance the nose proportionality. We do this by rearranging cartilage, for example:

Creating more defined or softer lines around where the nostrils meet the bridge of the nose to create the illusion of a narrower tip.
Pointing the tip of the nose up (rotation) or down (de-rotation) to increase or shorten its distance from the lip. This changes how close the nose appears to stick out from the face and can balance out a prominent bridge.

Revision rhinoplasty: Some patients may benefit from revisional surgery to correct or refine a past procedure. Revisional ethnic rhinoplasty is one of our specialties, and it requires ample expertise for the best chance at a good outcome. Each procedure results in scar tissue, which increases the complexity of the rhinoplasty approximately tenfold.

Reduction (taking away from): Reducing the physical size of the nose by taking cartilage and bone away from the underlying structures. The goal is to bring previously protruding features closer to the rest of the face. This is more common in Middle Eastern patients.

Projection (adding to): Enlarging the physical size of the nose by grafting cartilage from the patient’s septum and/or ribs to the underlying structure in flatter areas of the nose. Projection makes those areas of the nose stick out farther from the face which gives the appearance of a narrower, more elegant, and more balanced look. This is more common in African-American, Asian, Pacific Islander, Native American, and Hispanic patients.

Related reading: What to expect before and after a ‘nose job’

Common nose traits and procedures by ethnicity

Within each ethnic group there is a rich diversity of physical traits and facial shapes. There are also four common nose conditions or characteristics that lead patients to consider rhinoplasty.

Bulbous tip: The end of the nose is large and fleshy.
Flat or broad tip: The internal cartilages that creates the external appearance of the tip are splayed too far apart, leading to a wide tip.
Wide, narrow, or humped bridge: The bridge the nose is disproportionately large, narrow, or bumpy.
Breathing problems: Structural issues such as a deviated septum and/or a droopy tip can make it difficult to breathe.

This general overview shows the most typical concerns of ethnic rhinoplasty patients, based on our experience and expertise. Any plastic surgeon should offer you options based on your unique features and goals.

Patient	Common Concerns						Types of Procedures
Ethnicity	Thick Skin	Thin Skin	Bulbous Tip	Flat or Broad Tip	Wide Bridge	Narrow Bridge	Augmentation	Reduction	Projection
African American	X			X	X		X		X
Asian, Pacific Islander, Native American	X			X		X	X		X
Hispanic	X	X	X	X	X		X		X
Middle Eastern	X		X		X		X	X

African American

Nose characteristics: Weak internal structures combined with thick skin tend to create a less-defined tip of the nose that appears under-projected (broad and/or flat).
Procedures: Augmentation, projection.
What to expect: We can’t decrease skin thickness, so we work around that by increasing the projection of the rest of the nose and creating new angles and definitions to balance the overall shape. It’s an optical illusion that produces satisfying results without drastically changing the sensitive tissue in the tip of the nose.

Asian, Pacific Islander, or Native American

Nose characteristics: Thick skin, with a bridge that is often under-projected leads to both the bridge and the tip appearing wide and flat. Many have visible angles and definition at the tip of the nose.
Procedures: Augmentation, projection.
What to expect: By increasing the projection of the nose, we can create a more balanced look, with a gentle slope from forehead to tip rather than a flat bridge and flat tip.

Middle Eastern

Nose characteristics: Thick skin; over-projected; bulbous tip of the nose that complicates breathing, which is often paired with deviated septum – commonly seen in individuals with lineage from the Gulf Region of the Middle East. During maturation from child to adult, the skin of the nose does not expand as fast as the internal cartilages and bones, causing buckling of the septum (the middle wall of the nose). This leads to significant breathing difficulties.
Procedures: Augmentation, reduction.
What to expect: If the nose is small, we can project it to balance it out. However, if the nose is large, with a prominent bridge and tip, we must reduce it by removing cartilage and/or bone, then coordinate the proportions of all the features. However, the reduction often must be conservative because excessive reduction will lead to collapse of the nose and breathing difficulties.

Hispanic

Nose characteristics: Similar to Caucasians, Hispanic patients have a range of nasal features. Skin may be thin (Castillian/Spanish) or thick (especially in Mestizo patients with European and Native American lineage). Many have a wide bridge and bulbous tip, creating a flat, under-projected look.
Procedures: Augmentation, projection.
What to expect: Building up the less projected areas of the nose and changing the angles/definition of the tip of the nose can result in a more balanced, proportional look.

Recovery from surgery

Your recovery experience will depend on the extent of your procedure. Bruising and swelling of the face is common, and most patients return to normal activities within two to three weeks.

Most patients will not see a drastic change in the total size of their nose if measured in actual distances, but the improvement in looks is often dramatic. The subtleties of ethnic rhinoplasty create different angles and proportions, de-emphasizing the areas of your nose you disliked.

Before rhinoplasty, we take time to discuss your goals and set realistic expectations. We want you to be satisfied, and a big part of that involves understanding what’s possible and what to expect. Your facial features represent your cultural heritage. We can help you achieve a look that meets – or even exceeds – your expectations, but ultimately we want you to feel comfortable in your own skin.

To visit with Dr. Aly about ethnic rhinoplasty, call 214-645-2353 or request an appointment online.