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Ethnic Rhinoplasty/Thick Skin
INTRODUCTION: The United States has become a melting pot of increasing numbers of different ethnicities compared to the past where the population and "rhinoplasty surgery" was more homogeneous, giving the same "stamped" thin nose with pointy tip to every perspective patient. Dr. Sam Rizk, a New York City double board certified rhinoplasty specialist, sees a large number of ethnic rhinoplasty patients from around the globe and the United States and has developed "ethnic preservation rhinoplasty" techniques which give each patient a unique nose in harmony with their differing facial features. Dr. Sam Rizk explains, "I have a keen sense of beauty in a nose. Beautifying an ethnic nose is as much an art as it is a science and that is why every nose I sculpt has its own unique attractiveness, without losing ethnic identity. I invite you to look at my photo gallery and blog pictures to see this concept in pictures." The results can be dramatic or subtle, depending on the patient's desires and the size of their current nose.
NOTE: DR. SAM RIZK DOES NOT PERFORM BODY PLASTIC SURGERY. HIS PARK AVENUE PRACTICE FOCUSES ONLY ON RHINOPLASTY AND FACIAL PLASTIC SURGERY.
WHAT IS ETHNIC RHINOPLASTY?
Ethnic rhinoplasty describes nose jobs on an African American or patients of African descent, Hispanic/Latino, Middle Eastern/Mediterranean, Asian/Indian, and any other ethnicity without the typical Caucasian white nose. Rhinoplasty in these patients requires unique techniques which Dr. Rizk has developed and will describe below to deal with thicker skin consisting of more fat, wider nasal bridge or dorsum, weak tip cartilages and lack of tip and dorsal bridge definition. Common features and techniques needed to achieve superior results in ethnic patients will be summarized on this page. For more detailed analysis of the different ethnicities, Dr. Rizk has provided separate categories on this website menu.
What are the characteristics of Ethnic Noses?
These noses have a wider bridge, lack of tip and bridge definition, are generally flatter, have thicker skin with abundant fatty tissue in the tip. The thick skin and weak cartilage in the tip are a major factor for bulbous noses. The contour of the nose depends not only on the strength of the underlying bone and cartilage skeleton but also on the skin envelope. Thin skin can highlight the structure of underlying hard tissue and thick skin can effectively camouflage the underlying hard tissue definition.
What techniques does Dr. Rizk use to define and refine ethnic noses?
1. First, to achieve superior definition and refinement, Dr. Rizk deals with the weak nasal tip by grafting cartilage grafts to support and define the nasal tip. To define the bridge sometimes, he will add cartilage grafts or implants. Dr. Rizk has pioneered powered instrumentation technology which is used to sculpt the implants and grafts in the dorsum and nasal tip. The old techniques involve cutting grafts and shaping them with the surgical knife. Dr. Rizk’s technique involves rotating smoothing high powered instruments which smooth the edges of grafts, creating natural round edges, rather than sharp pointy edges of older methods of sculpting grafts.
2. Second, once the nasal architecture is created, Dr. Rizk de-fats and changes the thick soft tissue envelope which camouflages the structure, he de-fats it with his 3D technology to achieve precise results. This 3D technology is accurate to within a millimeter of soft tissue and enables Dr. Rizk to accurately thin out this covering soft tissue envelope safely.
3. Lastly, Dr. Rizk does a nostril reduction if the base of the nostrils is wide. His incision for nostril reduction is needed on the inside part of the nostril to hide the scar (see the nostril reduction section of this website for more detail). Dr. Rizk does not make cuts on the outside part of the nostril or in the nostril curvature itself as this will leave visible scars which are difficult to hide.
What is the key to maximizing tip definition without getting a pointy tip?
Dr. Rizk explains that the key to tip definition is the use of a rounded sculpted graft which Dr. Rizk sculpts (not with older knife technology) but with his patented high powered micro-sanding powered tools, which smoothes out the pointy edges of grafts. This innovation results in a defined and rounded tip, not the old pointy and sharp tips. To further define the tip, defatting the thick skin is needed and is done with 3D high definition telescope technology developed by Dr. Rizk.
What if I had a nose job and I am not happy with the tip definition?
Dr. Rizk’s methods have been very successful in many patients who have had a previous nose surgery where the tip is still bulbous and now there is not only fat but also scar tissue in the tip and thick skin. Dr. Rizk has been very successful doing revision rhinoplasty on bulbous nasal tips. (Please refer to his blog and see the 31 year old Indian male doctor story). Also see article in Plastic Surgery Journal in "in the Media "section of this website for more information on 3D technology for Revision surgical procedure.
What about defining the nasal dorsum (bridge)?
If the nasal bridge is low, Dr. Rizk has special grafts and implants which he sculpts to augment (raise) the bridge to achieve definition. Dr. Rizk also does sculpting of the patient's nasal bones on the side to narrow the bridge further in addition to the implant. Dr. Rizk has a special way of sculpting the nasal bridge by bringing the bones in low near the nose connection to the face to get the most definition. Simply placing a dorsal or bridge implant without doing the additional bony sculpting is inadequate to achieve superior definition.
How do I know or look for a surgeon that has experience with ethnic noses?
Make sure first that your surgeon does a multitude of ethnicities, not just white noses or just Asian noses, even if you are Asian. Your surgeon has to have experience with a variety of ethnicities such as African American, Asian, Latino, Middle Eastern, etc. Ask to look at your surgeon's photo gallery and make sure your surgeon is a board certified facial plastic surgeon with extra specialization in nose surgery, versus a general plastic surgeon who does body and breast work as well.
What are the goals of ethnic rhinoplasty?
1. Achieving an optimal aesthetic result and retaining a natural appearance by avoiding pinched, scooped or sharp angles.
2. Creating a nose that is in harmony with other facial features and does not detract from a person's individuality.
3. Achieving a defined nasal tip and nasal bridge.
What kind of results should I expect?
Dramatic and subtle results are both possible and depend on the patient's requests and on the size of the patient's current nose. Some noses just need a subtle improvement while other larger noses might require a more dramatic change.
To summarize, ethnic rhinoplasty requires a unique set of surgical skills and an individualistic artistic view of beauty across many cultures, respecting the different ethnic faces and yet attaining a significant improvement in the nose and in facial harmony.
Click here to read more about finding a rhinoplasty specialist.
Patient came from London for rhinoplasty and sent us a follow up picture 1 year after open rhinoplasty with banked rib cartilage and alar base reduction
25 year old Indian/middle eastern patient with typical ethnic rhinoplasty characteristics of thick tip skin, wide nostrils, drooping nasal tip and weak tip support. Patient also has frontal asymmetry of the nose. Patient underwent septorhinoplasty and nostril reduction. Cartilage grafts were placed in the patient's tip from her own nasal septum to support and define her tip. The nostril reduction was performed from an incision on the inside rather than the outside of the nostril. The right nostril was much larger than left nostril before rhinoplasty. The bump was removed conservatively. Ethnic rhinoplasty patients do not like major nasal rotation up or a very low nasal bridge. Results are shown postoperatively at 1 year.
29 yo female ethnic rhinoplasty patient with thick skin who had previous rhinoplasty who requests improvement in symmetry, breathing and definition. Patient underwent revision rhinoplasty with multiple cartilage grafts into tip and middle nasal vault to correct her breathing and cosmetic appearance. Patient is shown one year after revision procedure.
22 year old Middle Eastern female underwent 3D endonasal minimally invasive rhinoplasty to remove the nasal bump and refine the nasal tip. This Middle Eastern rhinoplasty patient has a typical tip drop found in Middle Eastern rhinoplasty patients and the tip was also elevated. Dr. Rizk's aesthetics is a feminine but natural profile as shown. Every nose Dr. Rizk performs is different as is every profile which must be in harmony with the rest of the face. Patient is shown post-surgery at 6 months.
28 year old Indian male who complains of his bump and drooping nasal tip. In indian and ethnic rhinoplasty it is important to support the nasal tip with cartilage grafts. In this case, the patient's tip was lifted and supported with a columellar strut as well as 2 tip grafts under his thick skin. The bump was reduced very conservatively and he even has a slight convexity of the bridge on postoperative profile. Indian patients are very sensitive to the scooped or very low dorsum so it is very important to create a very natural profile that is masculine. Patient is shown one year after nose surgery.
A female patient in her mid twenties is shown here before surgery. The two other postoperative images show the successful outcome six months and two years after the surgery. The drooped end of her nose was lifted and the overall shape was modified to look more natural.
22 year old female who underwent endonasal 3D nose surgery to lift her tip, remove her bump and narrow the tip. Patient is shown postoperatively. Note that patient has a history of using a nose ring on the left side and has a slight indentation asymmetry from the nose ring.
23 year old Asian patient wanted to add definition to her face by undergoing a rhinoplasty. Dr. Rizk performed the rhinoplasty with auricular graft to give her more definition. The auricular graft was necessary as the patient’s own septum was too thin for creating sufficient definition in her nose. The set of pictures is shown one year after her procedure.
This 30 year old female Dominican patient concerned with the appearance of her nasal bump, wide nostrils and nasal tip visited Dr. Rizk for a rhinoplasty. In order to achieve a natural outcome, Dr. Rizk had to use structural nasal grafts which is different from the traditional techniques of excision of cartilage. Overall the patient was satisfied with her results, shown in the picture 4 months after surgery.
25 yo female wishes to improve drooping nasal tip, bump and bulbous nasal tip. Patient underwent open rhinoplasty with tip support with her own septum cartilage to achieve a better long term result of tip support. Tip was also refined with cartilage reduction and suture techniques, and bump was removed naturally. Patient is shown 1 year after nose surgery.
18 yo African American patient who underwent rhinoplasty with medpor implant and nostril reduction. Patient is shown 6 months post-surgery and although there is still some tip swelling, the general structure of tip and dorsum is much more refined. Additionally the incisions of the nostrils are on inside of nostril rather than on outside where it joins the face.