Ethnic Rhinoplasty Virginia in Virginia, Washington D.C. and Maryland

Ethnic Rhinoplasty procedures involve special considerations because the nose should match the rest of the face, providing the improvements and enhancements sought in the nose. The goal is to achieve an aesthetic result while retaining a natural appearance for the patient. While some patients like to bring in photos of movie stars or other persons whose noses they admire, other patients simply want their nose straighter, more refined and balanced with their face. This can be achieved while maintaining one’s overall ethnic characteristics and facial harmony.

For many years, the “ideal nose” in rhinoplasty procedures performed in the United States was based on the Caucasian model. However in more recent times, rhinoplasty surgeons no longer use this cookie cutter approach where one nose fits all.

Some common techniques in ethnic nose jobs include bridge augmentation and nasal base reduction. Bridge augmentation can be performed using one’s own cartilage (nasal or ear cartilage) as well several well-tolerated implant materials. Nasal base reduction can reduce the size of the nostrils as well as narrowing the overall width of the base of nose. Learning surgical limitations is important in order to develop realistic expectations. If you would like more information about ethnic rhinoplasty, contact a rhinoplasty surgeon expert for a free consultation.

• African American (Black) Rhinoplasty
• Asian Rhinoplasty
• Caucasian Rhinoplasty
• Indian/Pakistani Rhinoplasty
• Latino/Hispanic Rhinoplasty
• Middle Eastern / Mediterranean Rhinoplasty
• “Italian Nose”
• “Jewish Nose”

African American (Black) Rhinoplasty Virginia

Much discussion surrounds the topic of African American Rhinoplasty, as it does in other areas of “Ethnic Rhinoplasty.”

Some surgeons think that African American patients seeking Rhinoplasty must necessarily be seeking “westernization” or “Caucasian-ization” Rhinoplasty. These surgeons essentially try to forcefully create unnaturally sharp, defined noses using plastic implants or by performing an overly aggressive Reductive Rhinoplasty.

Tragically, noses of celebrities like the late Michael Jackson and his sister Latoya Jackson are extreme examples of this ill-advised approach. These patients’ unfortunate Rhinoplasty results are clear evidence of the dangers of poorly guided patients relying on unskilled surgeons. Such deformities could likely have been prevented by proper education and counseling of patients, and by Plastic Surgeons who should have been able to refuse surgery to patients with unrealistic goals no matter what they were willing to pay. These Plastic Surgeons try to create noses that do not lend themselves to such extreme alterations, resulting in collapse and pinching, scarring, and obvious surgical deformity.

Other surgeons have argued that we should be sensitive to ethnicity and retain ethnic features and not try to change them. This is a better approach but it also paints with a broad brush. Although in theory this is a good guiding principle, I would point out to these same Plastic Surgeons the fact that there is a very wide-spread, rich and diverse aesthetic spectrum amongst African American or Black patients throughout the United States and the world. Not only are there significant variations in skin color and texture, there are abundant variations in facial features and noses as well. No two African American or Black patients have the same exact facial features, anatomic features or surgical goals. As in all other forms of Rhinoplasty, “the nose must fit” the face. This is the only true guiding principle in Ethnic as well as non-ethnic Rhinoplasty – THE NOSE MUST FIT.

Oprah Winfrey, Rihanna, Beyonce, Pharrell Williams, Halle Berry, Tyra Banks, Naomi Campbell, Tyrese Gibson, Tyson Beckford and Nelson Mandela all have very different faces and noses, and to group them all into a single type of ethnic Rhinoplasty and to carry out a similar African American Rhinoplasty on each, would be a huge mistake. The nose must fit the rest of the face and the above celebrities do not have the same facial features while they all are African American or Black.

Of course there are some features that are associated with many but not all African American patients. These anatomic features are crucial to diagnose and plan for before surgery so that there are no intra-operative surprises. These include:

• Low nasal bridge
• Washed out nasal bridge
• Short nasal bones
• Wide nasal bones
• Oily textured skin
• Medium to thick skin envelope
• Broad nasal tip cartilages
• Weak tip cartilages
• Flared nostrils
• Potential for hyper- or hypo-pigmented scars
• Potential for Keloid scars

However, there are significant variations from patient to patient. Some African American patients have very strong “Mediterranean” or “Caucasian” features due to location and origin of birth, while others are due to interracial marriages and so forth. It is important to make sure the new nose, as a result of Ethnic African American or Black Rhinoplasty, does not forcefully or inadvertently alter the heritage or identity of patients.

Computer imaging allows detailed communication between the Rhinoplasty seeking patient and the Rhinoplasty Surgeon. If an African American patient with all of the 10 features and anatomic findings above desires to have a nose identical to Angelina Jolie’s, (which is nearly an impossible and an unrealistic goal) then it is much more fruitful for the Plastic Surgeon to educate and dissuade the patient from undergoing a disappointing Rhinoplasty. This is much more ethical than carrying out an aggressive destabilizing Rhinoplasty and compromising the structure of the nose (i.e. Latoya Jackson). It is also much more sensible to talk such a misinformed patient out of Rhinoplasty than to perform a Rhinoplasty and then tell the patient after the surgery that “this is the smallest or narrowest your nose can get.” Discussion, dialogue, education and informed consent must be provided by the Plastic Surgeon, prior to surgery. After the surgery, explanations are regarded as excuses and often result in disappointed or disillusioned patients.

• This is not to say that significant improvements or beautiful noses are not achievable in African American patients. On the contrary, very beautiful changes can be made to nearly any Black patient’s nose seeking Rhinoplasty; however, only when the Rhinoplasty is performed properly with safe structural technique by dedicated and highly trained Rhinoplasty Surgeons. This is an advanced operation that should not be performed by the novice or inexperienced Plastic Surgeon. Despite having carried out very successful Revision Rhinoplasties on African American patients who have had up to 4 previous unacceptable Rhinoplasties, Dr. Naderi will firmly tell you that the best time to get the best Rhinoplasty result is during the very first operation.

Actual African American patient of Dr. Naderi who had gone multiple unsuccessful previous ethnic rhinoplasties by Top Board Certified Washingtonian Plastic Surgeons. Dr. Naderi performed her 4th and final Revision Rhinoplasty using Rib Cartilage to replace and remove a crooked Gortex Implant placed by her last plastic surgeon.

Types of Ethnic Rhinoplasty

Asian Rhinoplasty Virginia

Asian Rhinoplasty is a very popular and yet controversial topic amongst Plastic Surgeons. The term “Asian Rhinoplasty” usually refers to an augmentative Rhinoplasty where the height of the bridge is built up and more definition and structure is provided to the nose.

However, to assume that all Asians have similar noses is a mistake. It is equally wrong to assume that all Asian patients desire a similar outcome for their noses. Therefore, I urge my Plastic Surgery colleagues to not think of an “Asian Rhinoplasty” as a certain “cookie cutter” surgery and I would urge them to stop thinking that “one nose fits all.”

In fact, after seeing and closely examining and operating on Asian patients for years, I have come up with the following pearls of wisdom for my fellow Plastic Surgeons.

• Many Plastic Surgeons in Asia and the United States do use silicone, Medpor, Gortex, or other “plastic” implants in the nose as a quick fix. These cases are usually very quick, inexpensive, with immediate results and minimal swelling and down time, often performed under local anesthesia in the office setting. While some patients do achieve great aesthetic results using these techniques, many end up with noses that simply look fake and imbalanced. Others end up with implants that are visible, clearly showing their edges. Some end up with implants that are mobile and shift. And a portion end up with horrific infections from their implants, resulting in extrusion or significant permanent scarring. Even the patients who achieve the nice immediate results are essentially sitting on “ticking time bombs” that could at any time in the future become dislodged, extruded, or even infected.

• Many Asian patients share these common features:
  • Small short nasal bones
  • Low “nasal starting point”
  • Short nose
  • Washed out bridge
  • Poorly defined nasal tip
  • Very weak tip cartilages
  • Very thin and small Septal cartilage
  • Medium thickness skin susceptible to hyperpigmentation

• Not all Asian patient’s noses fit the above criteria. I have seen and operated on many Asian noses with what many would equate to a “middle eastern patient’s nose”: a prominent nasal hump rather than a low bridge. What has always surprised me is the failure of many Plastic Surgeons to step back and diagnose the problem at hand before offering an “Asian Rhinoplasty” solution. I have seen many Asian patients who do not need any bridge or dorsal augmentation whatsoever. However, many of these same patients have been told by other Plastic Surgeons that they need implants or rib cartilage for their Rhinoplasty. Use of an implant or rib in such patients would be a disastrous complication ending up with a certain need for a Revision Rhinoplasty. The take home message here is that all patients regardless of their ethnicity need to undergo a thorough examination and facial analysis. Diagnosis is the most important step in the initial consultation process. No surgeon should ever simply categorize an ethnic patient and devise a plan for nose job purely based on the category. However, with experience, each Rhinoplasty Surgeon will learn and devise his/her own set of knowledge base to draw from.

• For example, while it would be wrong for a surgeon to automatically assume that an Asian patient needs or even wants a higher bridge, it would be equally foolish for the Plastic Surgeon to ignore the fact that many Asian patients do have weak tip cartilages, making the use of additional tip grafts for support often necessary.

  Asian rhinoplasty patient of Dr. Naderi. This patient came to Dr. Naderi with a silicone implant already in her nose (picture on left) from a previous surgeon’s Asian rhinoplasty but there was still inadequate tip projection and there was lack of tip definition and dorsal height. Dr. Naderi did an open revision Asian rhinoplasty and removed the implant, and replaced it with natural frozen rib cartilage.

• Proper pre-op planning in Asian patients does often involve the discussion for possible additional sources of cartilage. Since many have weak tip cartilages, additional cartilage grafts at the tip are often necessary to achieve aesthetic tip definition. Since the Septal Quadrangular cartilage of many Asian patients is often too thin and too small to be useful as a structural graft, discussions and planning for use of ear, rib, or frozen rib cartilage must be thoroughly carried out with each patient pre-op to avoid any intra-op surprises or shortcomings.

• Not all Asian patients require an Open Rhinoplasty and not all can be successfully carried out with a Closed Rhinoplasty technique. Each patient’s nasal reshaping surgery must be individualized and planned out properly.

  Asian male patient underwent closed Asian rhinoplasty with frozen rib (costal) cartilage by Dr. Naderi to build up his nasal bridge and lengthen his nose successfully.

Use of Computer Imaging is crucial in the pre-op consultation dialogue to ensure that what the Plastic Surgeon plans and what the Asian patient desires are achievable and one and the same.

Caucasian Rhinoplasty Virginia

We coined the term “Caucasian Rhinoplasty” as an alternative to “ethnic Rhinoplasty.” In fact, Caucasian Rhinoplasty and ethnic Rhinoplasty and Black Rhinoplasty and Asian Rhinoplasty and Hispanic Rhinoplasty and German Rhinoplasty and French Rhinoplasty and Swedish Rhinoplasty are all simply describing the exquisite plastic surgery operation that molds and changes one’s nose in order to improve it. All forms of Rhinoplasty simply unveil the beauty of the eyes and lips. A Rhinoplasty will not “make” a person beautiful. A Rhinoplasty will simply remove the distraction of an unattractive nose on an otherwise beautiful woman or handsome man.

Caucasian Rhinoplasty usually involves dealing with thin or medium thickness skin of Fitzpatrick 1 through Fitzpatrick 3 skin type, with the combination of strong cartilages. Closed Rhinoplasty as well as open Rhinoplasty are both options for Caucasian patients. Thin nostril skin predisposes white patients to alar notching or alar retraction and the plastic surgeon must be able to diagnose and correct this issue.

It is not rare for white Rhinoplasty patients to have nice or adequate nasal tips and all that is necessary is correction of the bridge or straightening of a crooked traumatized nose through a closed or external scar-less Rhinoplasty. For specific issues in Rhinoplasty please see the appropriate sections discussed by Dr. Naderi on this website.

Indian/Pakistani Rhinoplasty Virginia

The diagnosis and rhinoplasty techniques of Indian or Pakistani Rhinoplasty are very similar to Persian or Middle Eastern Rhinoplasty. There are great variations in skin thickness and cartilage strength so that broad generalizations should not be made. However, a very common scenario is an Indian or Pakistani patient with very thick skin and very weak cartilages. Occasionally acne scars overlying the nasal tip will make the skin even less pliable.

Very nice improvements and results can be achieved and with the aid of computer imaging the Rhinoplasty surgeon can demonstrate these aesthetic improvements to the Rhinoplasty patient.

The two most important issues to consider and discuss with the Indian or Pakistani patient are:

1. Expectations
2. Degree of Cosmetic Change

These two issues are the opposite ends of the same computer imaging spectrum.

Lets discuss “expectations” first. Often an Indian male patient, with very heavy and bulbous nasal tip, as a result of thick skin, and old acne scars on the nasal tip, in addition to very broad and weak nasal tip cartilages, will come in for Rhinoplasty consultation. Many of these Indian male patients have a tough time accepting the limitations of just how narrow the nose can be made and how much additional definition can be achieved safely. When realistic computer imaging is done showing the potential cosmetic improvements after a Rhinoplasty, the patient’s expectations must be revised or adjusted. Otherwise, the patient may be unhappy after the Rhinoplasty and it’s always best to avoid undergoing Rhinoplasty in these situations until the realities and limitations of Rhinoplasty have thoroughly been understood. If the patient likes the significant improvements shown on the computer screen then almost always, he or she will be a happy post Rhinoplasty patient. Adjustment of expectations usually refers to the realization that perhaps the individual’s nose cannot undergo the extreme change that he or she had envisioned in his/her own mind for many years.

The second issue with many Indian and Pakistani patients is “the degree of cosmetic change.” Indian or Pakistani patients struggling with how much cosmetic change they desire is usually the opposite problem of “adjustment of expectations.” Basically many, but not all, Indian or Pakistani female patients struggle with the degree of cosmetic change acceptable to them and their families. There is an internal fear that the nose will change too much, and while they may clearly see on the computer imaging screen that the changes result in a very natural and cosmetically appealing nose, the internal fear that the nose may get too small or too defined exists within them and must be thoroughly addressed before any surgery. I have seen female Indian patients with very large dorsal humps or very droopy tips or very bulbous tips who I end up seeing over a span of many months for multiple consultations until they are completely at ease with their Rhinoplasty goals and our collaborative surgical road map. Despite this, occasionally after the nose job they continue to struggle with their pre-op decision by wishing they had actually asked for a smaller and more defined nose. Initially though, many times, they ask for their hump not to be completely removed and to simply make a larger hump into a smaller hump. I have seen Indian female patients who did not want to correct their droopy nasal tip even though they were shown a very natural looking nose on the computer imaging – a nose that was by no means up turned nor over rotated but since for so many years they had been used to visualizing themselves with the longer, ptotic (droopy) tip, adjusting to a new look proved to take time and be complicated. Under no circumstance should a patient be offered or undergo a Rhinoplasty until they are completely satisfied with the computer imaging – as a depiction of the surgical goals and road map. Again, this does not apply to all female Indian or Pakistani patients but after many years and seeing hundreds of patients every year, certain conclusions and generalizations can be drawn and these are simply “pearls” to take note.

So in summary, the actual Rhinoplasty in an Indian or Pakistani patient is not that different from that of a Middle Eastern or Mediterranean patient, but the pre operative dialogue as far as expectations and degree of change is often unique and must be thoroughly addressed.

Italian Rhinoplasty Virginia

The Italian nose or the Roman nose is characterized by a strong prominent nasal bridge or dorsum often with a high radix or nasal starting point. This nose often fits male Rhinoplasty patients better than female Rhinoplasty patients who desire a more cute and feminine nose. However, it is extremely important to have a thorough pre-operative consultation dialogue, using computer imaging so that the male as well as female Italian Rhinoplasty patient can see his or her new nose job goals and be able to give input and suggestions. If a plastic surgeon does not allow or encourage this precise dialogue to occur, he may perform an over aggressive reductive Rhinoplasty and end up with a very unhappy post-Rhinoplasty patient who cannot identify with the new facial changes and perceives the results as a “botched nose job”. These Italian patients will want to “go back” to their old nose and end up regretting their initial decision to undergo a nose job. They seek augmentative revision Rhinoplasty to build their nose back up. All of this could easily be avoided if the patient had sought out a Rhinoplasty Specialist that had partaken in computer imaging in order to end up with a nose similar to the patient’s initial goals.

Jewish Rhinoplasty Virginia

The term “Jewish nose” is a commonly used term by Jewish patients to affectionately describe a nose usually with a large dorsal hump and prominent over-projected nasal tip. Perhaps the only other term in Rhinoplasty used with such endearment is “the Italian nose” used to describe a nose with a very strong and high bridge. Many Jewish patients and many Italian patients respectively use the phrases “my Jewish nose” or “my Italian nose” to describe not only their nose but a nose that characterizes their family traits and even race and ethnicity. Often times I hear patients struggle with a desire for a more refined nose while at the same time trying to not offend their families by “erasing” signs of their particular family heritage.

While the Rhinoplasty techniques for the “Jewish nose” & / or the “Italian nose” are no different than the Caucasian nose or the Middle eastern / Mediterranean nose, the pre-operative dialogue and Rhinoplasty goals must be clarified in order to end up with a happy post-Rhinoplasty patient. While the plastic surgeon can create a beautiful and natural looking nose for the Jewish or Italian patient, without pre-operative computer imaging, the results may be too drastic (or occasionally not drastic enough) for the particular patient. Again, this highlights the importance of computer imaging and the unmistakable value of thorough and unrushed Rhinoplasty consultation. The plastic surgeon must respect each individual patient’s wishes and while guiding the patient, never force the patient into choosing a certain type of Rhinoplasty result. A rhinoplasty specialist surgeon has the diagnostic tools as well as the operative capability to help guide the patient and end up with a beautiful post rhinoplasty nose, respecting each patient’s wishes, heritage, and ethnicity.

Latinx/Hispanic Rhinoplasty Virginia

Hispanic Rhinoplasty is a very diverse and exciting topic. The Hispanic or Latin culture is very broad and rich, with the common bond of the Spanish language. The people and their anatomy and aesthetic standards are also very diverse with unique features found all over Europe, North, Central and South America. So to group the entire race into one would be a mistake aesthetically and surgically for the skilled Rhinoplasty Surgeon.

A broad variety of hair colors, facial features, body heights, skin colors, skin thickness, and nasal “types” are seen within the Latinx or Hispanic race. As in any other form of Rhinoplasty or Ethnic Rhinoplasty, “the nose must fit the face.” That is the predominant aesthetic rule of Rhinoplasty in any race or culture.

Facial analysis to ensure a proper diagnosis of the ideal balance, as well as the cosmetic and/or functional issues needing correction, is crucial to a successful Hispanic Rhinoplasty outcome.

Latina nose job patient of Dr. Naderi, underwent a closed Hispanic Rhinoplasty to unveil the beauty of her eyes.

Here are some facts and pearls about Latinx Rhinoplasty:

Many Plastic Surgeons do use silicone, Medpor, Gortex, or other “plastic” implants in the nose as a quick fix. These cases are usually very quick, inexpensive, with immediate results and minimal swelling and down time, often performed under local anesthesia in the office setting. While some patients do achieve great aesthetic results using these techniques, many end up with noses that simply look fake and imbalanced. Others end up with implants that visibly show their edges. Some end up with implants that are mobile and shift. And a portion end up with horrific infections of their implants, resulting in extrusion or significant permanent scarring. Even the patients who achieve the nice immediate results, are essentially sitting on “ticking time bombs” that could at any time in the future become dislodged, extruded, or infected.

Dr. Naderi has performed Revision Rhinoplasty on Latinx patients who had no idea their previous surgeon had used any form of plastic implants in their nose. Some Plastic Surgeons, unfortunately, think this is an acceptable surgical option to be used during surgery as a substitute for inadequate pre-op planning.

Many Latinx patients have noses and faces that are similar to either Caucasian noses or Mediterranean noses. While there is lots of diversity amongst the Latin or Hispanic race, there are some common anatomic features associated with the noses many consider a “Latinx Rhinoplasty patient:”

– Small short nasal bones
– Low “nasal starting point”
– Short nose
– Washed out bridge
– Broad nasal tip (“meaty tip”)
– Very weak tip cartilages
– Wide nostrils
– Ptotic or a “droopy” nasal tip with poor tip support creating the appearance of a short upper lip
– Thick sebaceous skin susceptible to hyper-pigmentation

Not all Hispanic patients’ noses fit the above criteria. Many have Caucasian or Middle Eastern or Mediterranean features and noses. What has always surprised me is the failure of many Plastic Surgeons to step back and diagnose the problem at hand before offering a “Latinx Rhinoplasty” solution.

The take home message here is that all patients regardless of their ethnicity need to undergo a thorough examination and facial analysis. Diagnosis is the most important step in the initial consultation process. No surgeon should ever simply categorize an ethnic patient and devise a plan purely based on the category. However, with experience, each Rhinoplasty Surgeon will learn and devise his/her own set of knowledge base to draw from.

For example, while it would be wrong for a surgeon to automatically assume that a Hispanic patient needs or even wants a higher bridge, it would be equally foolish for the Plastic Surgeon to ignore the fact that many Latinx patients do have weak tip cartilages with very heavy thick skin making the use of additional tip grafts for support often necessary.

Proper pre-op planning in Latinx patients does often involve the discussion for possible additional sources of cartilage. Since many have weak tip cartilages, additional cartilage grafts at the tip are often necessary to achieve aesthetic tip definition. This counter intuitive idea of adding more cartilage to make the nose look smaller and more defined and refined needs to be fully explained to all Hispanic patients. Often the Septal Quadrangular cartilage is adequate for Latinx rhinoplasty patients but discussions and planning for possible use of ear, rib, or frozen rib cartilage must be thoroughly carried out with each patient pre-op to avoid any intra-op surprises or shortcomings.

Not all Hispanic patients require an Open Rhinoplasty and not all can be successfully carried out with a Closed Rhinoplasty technique. Each patient’s nasal reshaping surgery must be individualized and planned out properly.

– Hispanic patient of Dr. Naderi underwent open latina rhinoplasty to elevate a droopy nasal tip and enhance the appearance of her lips and eyes
-Use of Computer Imaging is crucial in the pre-op consultation dialogue to ensure that what the Plastic Surgeon plans and what the Latino patient desires are achievable and one and the same.

Middle Eastern / Mediterranean Rhinoplasty Virginia

Perhaps no other part of the world embraces Rhinoplasty as much as Middle Eastern and Mediterranean countries do. More Rhinoplasties are performed, per capita, in Tehran – Iran, and Beirut – Lebanon, than any other country in the world. Not only is Rhinoplasty embraced and sought after in these countries, it is at times held as a sign of affluence with patients proudly displaying post-operative casts on their noses even if they have never had a Rhinoplasty!

Middle Eastern and Mediterranean patients, here in the United States, continue the same tradition with some notable exceptions. The predominant Rhinoplasty technique used in the Middle Eastern Rhinoplasty abroad is the “closed Rhinoplasty” with “dorsal reduction,” “tip grafts,” and “alar reduction.” Tip grafts can change the tip into a new shape – the shape of the tip graft. Each Middle Eastern or Mediterranean Plastic Surgeon has his or her own favorite tip graft shape and size. Therefore, in Iran or Mediterranean & Arab countries, it is very common to be able to identify each post-operative Rhinoplasty result by its own particular Plastic Surgeon! It’s essentially as if the Plastic Surgeon has “signed” his name on his work! While some of these noses can look very pretty, most, if not all, undoubtedly will look “operated.” Furthermore, this common Rhinoplasty technique often ends up feminizing male Rhinoplasty noses and creating unnatural pinched tips and bridges and nostrils – all with telltale signs of Rhinoplasty & Plastic Surgery. These statements are obviously generalizations, but they are the predominantly noted and accepted tendency in Iran, Mediterranean & Arab countries. There are certain exceptions to these generalizations and that should be noted and appreciated as well. Some fantastic nose jobs have been done for decades and continue to be done in Iran and the Middle-East but for each beautiful and natural nose, there is a higher ratio of poor outcomes.

The pleasant exception that I notice here in the United States is that the vast majority of Iranian, Lebanese, Arab, Saudi, Afghani or other Middle Eastern and Mediterranean patients seek beautiful but natural looking noses. Some still do seek the unnatural “operated” look but it is the responsibility of the ethical Rhinoplasty Surgeon to inform and educate these patients and steer them away from unnatural and fake-looking noses. While you can argue that “this is elective surgery and patients are entitled to their wishes,” I would argue that the tragic stories of patients like Michael Jackson also followed similar paths which could have been averted by ethical and responsible Plastic Surgeons. As physicians, we must first do no harm!

This is not to say that tip grafts are bad or should not be used. It’s also not to say that alar reduction should be avoided at all costs. On the contrary – these are fine Rhinoplasty maneuvers. However, as in any other Rhinoplasty technique, these maneuvers should be individualized in order to achieve beautiful yet natural and unique results for each and every patient.

Probably the most common feature associated with Middle Eastern or Mediterranean noses is the “nasal hump.” However, there are many unique features seen in Middle Eastern or Mediterranean noses:

• Nasal humps or bumps (but not always present)
• Over projected tips (tip that is too long)
• Under projected tips (tips that are too short)
• Bulbous nasal tips
• Thick skin
• Medium thickness skin
• “Meaty tips” – combination of thick skin with wide and weak tip cartilages
• Droopy tips (ptotic tip)
• Flared nostrils
• Skin color variations from very light to very dark

There is no “best Rhinoplasty approach” for Middle Eastern or Mediterranean Rhinoplasty patients. Similar to Caucasian Rhinoplasty patients, each nose must be examined carefully, problems and potential problems diagnosed, and an individualized Rhinoplasty surgical plan devised. This may lead to a Closed Rhinoplasty or an Open Rhinoplasty. It may include slight to significant tip work, or none at all. It may include alar reduction (nostril narrowing) or it may not. It often includes nasal hump or bump reduction, although not all Middle Eastern or Mediterranean patients have nasal humps or bumps. At the end of the Rhinoplasty, the nose should look beautiful and natural. In women this means feminine, cute and natural. While in men this means refined, strong and natural. It is important to realize that dorsal humps are in relationship to the nasal tip. A droopy nose with a hump will look droopier and longer if the plastic surgeon only removed the nose bump and does not correct the ptotic tip.

Middle eastern Rhinoplasty patient underwent open structure rhinoplasty by Dr. Naderi to correct her tip shape and position and reduce her dorsal hump to reveal the beauty of her eyes. While to the casual observer is may appear that her aesthetic nasal issue was simply the dorsal hump, the nose job changes involved significant changes to the tip location and shape.

And like any other Rhinoplasty, the Middle Eastern or Mediterranean Rhinoplasty starts with the proper consultation, examination, computer imaging, and dialogue in order to achieve the best Rhinoplasty result. No two noses are identical. During surgery is not the time for by the Plastic Surgeon to make “initial plans.”

The surgeon should have made plans:

• The very first time he laid eyes on the patient
• Then again after examining the patient
• Then again during the computer imaging
• And again the night before surgery as he/she reviews the pictures and plans
• And again during the morning of surgery in the “pre-op holding area”
• And finally right before injecting local anesthetic into the patients nose, prior to making incisions.

This way, the surgeon has planned out and rehearsed the Rhinoplasty in his or her “mind’s eyes” at least 6 times prior to the actual Rhinoplasty surgery. Similarly, after surgery is not the first time the patient should be seeing his or her potential results. Computer imaging should have taken care of this mystery and prepared the Rhinoplasty patient for the possible new nose and the potential new look.

• As you can see, I did not mention anything about performing Rhinoplasty in Middle Eastern or Mediterranean patients to either change their ethnicity or retaining their ethnicity. The discussion and planning should be about “a nose that fits.” If it looks good and natural, it will fit the face.