Just as no two people are created the same, no two noses are created the same. The size and shape of the cartilage is different. The nasal bones are different. The skin is different. The trick is to match your techniques to the nose to achieve a good, lasting effect. You can’t use the exact same set of techniques on everybody- there is no such thing as a cookie-cutter rhinoplasty!
Traditional rhinoplasty techniques were developed in the early to mid-twentieth century starting in Europe. American surgeons trained in Europe brought these techniques to the United States starting in New York and Chicago. The techniques involved cutting the nasal cartilages and then sewing them together in ways to achieve the desired changes. These techniques disseminated across the United States over the years. Unfortunately, the results tended to not last. Some patients’ noses collapsed on themselves with time resulting in nasal obstruction and a pinched look (think Michael Jackson after his second nose job).
Non-caucasian rhinoplasty patients were particularly prone to collapse. Keep in mind that the initial techniques were developed in Europe- full of caucasians! It turns out that the techniques that work for caucasians aren’t always appropriate for non-caucasians because of differences in the skin and cartilage.
Hispanic rhinoplasty as a field of study has really evolved over the last twenty years. There REALLY is no such thing as a cookie-cutter hispanic rhinoplasty. The mix of peoples that came together over the centuries to create the hispanic race has led to a lot of variability in noses. Some have noses that are more European with thinner skin and stronger cartilage, others have noses that are more African or Native American with thicker skin and weaker cartilage.
When I consider a nose, I look at its overall shape and the relative proportions of the different parts of the nose- how the tip relates to the nasal bridge, for instance. I also consider how the nose relates to the patient’s face and body. I then try to plan a surgery using techniques that I know will achieve the desired effect. When I’m consulting with a prospective hispanic rhinoplasty patient, I try to keep the following things in mind:
1) Try not to cut any cartilage. If a patient’s cartilage is weak to begin with, you wouldn’t want to weaken it any more by cutting it.
2) Use cartilage grafts from the septum to reinforce the existing cartilages.
3) Avoid suture techniques to change the shape of the nose. Thick skin will hide the effect of these techniques.
4) The healing process may take longer; thick skin holds onto swelling much longer than thin skin.
5) Be sure to preserve their ethnic identity!
The bottom line is this: there is no such thing as a cookie-cutter rhinoplasty and this is particularly true of hispanic rhinoplasty. If you’re considering nasal surgery, be sure to check your surgeon’s experience and credentials to maximize your chance of getting a good result that will stand the test of time.
Triana, R. Jacques Joseph Surgical Sculptor. Arch Facial Plast Surg. 1999;1(4):324.
Simons, RL. Irving B. Goldman (1898-1975): Master Rhinoplasty Surgeon. Arch Facial Plast Surg. 2000;2(2):151-152.