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Indian Rhinoplasty in New York
Indian patients from many countries and US states seek out and travel to Dr. Rizk’s Park Avenue center in new york to undergo rhinoplasty and revision rhinoplasty surgery. Dr. Rizk not only has specialized techniques for these types of ethnic noses but also understands their aesthetics. Dr Rizk is a double board certified specialist and not a general plastic surgeon. He also has a high percentage of ethnic patients in his practice. Dr. Rizk’s high definition telescope system for hump removal results in a much more accurate profile with the least amount of bruising and swelling post-surgery. This system gives an internal high definition view of the areas of the nose on the bridge to be reduced so this internal view is much more accurate than judging the result by looking at the nose from the outside during the surgery. Also this internal view high definiton view enables Dr. Rizk to avoid structures such as muscles and blood vessels which decreases swelling and bruising. In order to obtain a good result in ethnic Indian rhinoplasty patients, the cosmetic surgery must be done conservatively with the use of sculpted cartilage grafts to support and define the nasal tip. Dr. Rizk has developed techniques to sculpt cartilage grafts using micoscopic powered tools (rather than the traditional knife). The use of powered micro-instrumentation in cartilage grafts and hump removal gives a smoother and natural outcome, avoiding scooped or ski-sloped noses as well as pointy or pinched tips. The traditional way to remove a hump is with a back and forth mechanical movement over the bump with a filing instrument. This back and forth motion over the bump causes rubbing against the skin and muscle and can tear blood vessels and is not as accurate as the micro-powered sanding instruments which work in a circular motion over the area of the bump (eliminating the rubbing and trauma to the muscle and skin). Furthermore, the accuracy in hump removal is within fractions of a millimeter, whereas the older mechanical methods can cause overresction of a hump. To read more and see videos of Dr. Rizk’s techniques, see other areas of this website.
Although there is great variability in Indian patients, the noses are typically characterized by a high bridge, thick skin, drooping tip, and lack of tip support. There is variability in skin thickness and tip definition depending on whether the patient has a heritage from North versus South India.
Ethnic Rhinoplasty Information
Northern Indians tend to have thinner skin. Still Indians are categorized as an ethnic type of nose. It is very important not to change the ethnic identity or appearance of the patient, but rather to do a conservative nose job to create a natural looking nose that is not pinched, too short or scooped (sloped bridge). Dr. Rizk sees so many Indian patients who have had their nose overshortened, scooped, or pinched and who are seeking revision rhinoplasty. To correct these deformities, Dr. Rizk uses grafts from the septum, ear, or a rib bank in order to make the nose appear natural again.
Removing too much cartilage from the nose in thick skinned Indians can actually produce a result that looks more bulbous since the thick skin may not contract adequately on the smaller architecture and scar tissue can develop in the empty space that develops between the smaller nose skeleton and the covering thick skin. Dr. Rizk instead uses customized sculpted grafts (from the patient’s own nasal septum) or implants to achieve definition and support in these noses.
The postoperative care of Indian noses is different than a regular Caucasian rhinoplasty. Kenalog (steroid) injections as well as 5-FU injections into the nose post-surgery can both be used to decrease the swelling and also to prevent the formation of scar tissue. This is usually done every 4-5 months in the first year after surgery. Most patients typically look presentable in 1 week post-surgery, when cast is removed and they can usually return to work. However, patients are advised to avoid contact sports for 6 weeks and strenuous exercise for 3-4 weeks, depending on the individual healing process.
Dr. Rizk customizes the nose to the patient’s face and may give a smaller nose to a petite female and give a larger nose to a male with a larger face. The nose has to be in balance with the face, forehead, and chin. Projection of the nose (distance from the face) has to be balanced with the chin, and the deep nasofrontal angle (very often due to a prominent forehead) may need a graft to make transiton between the nose and forehead smoother. Very often Dr. Rizk will use cartilage grafts to support the droopy nasal tip of Indian noses (columellar strut) and well-sculpted grafts (using the powered sculpting system) in the nasal tip to create more tip definition. Plastic surgery in the Indian patient is therefore not treated as in the Caucasian patient where mainly a reduction surgical procedure is performed because the Indian nose will end up looking more bulbous and amorphous. Indian noses can be predisposed to scar formation in the area of the tip and above the tip ( called pollybeak deformity) and this can be treated with kenalog injections.
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 plastic surgery patients do not like major nasal rotation up or a very low nasal bridge. Results are shown postoperatively at 1 year.
28 year old Indian male who complains of his bump and drooping nasal tip. In indian and ethnic surgical procedure 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.
26yo Indian female who underwent rhinoplasty and septoplasty to correct a crooked nose and to correct a breathing problem. Patient’s nose was made straighter with various cartilage grafts and tip lifted as well.
31 yo old male Indian doctor who underwent previous surgery in Beverly Hills who is dissatisfied with his lack of definition and his scooped feminized nose. Patient is shown only 1 week after revision rhinoplasty with multiple sculpted grafts in his tip and bridge to masculinize his nose and successfully define it despite having very thick skin with underlying scar tissue. Additionally, the nostrils were asymmetric and were adjusted. Patient is still swollen as he is shown only 1 week after surgery.
25 year old female interested in reducing her hump and also shortening her nose as well as refining her tip slightly. Patient of ethnic descent seeking ethnic surgical procedure such as Indians do not generally like ski-slope noses or pinched nasal tips-it is a stigma in their society. This patient, although she is not a revision rhinoplasty, interestingly has 2 indentations in her tip, which were corrected with cartilage grafts from her septum. The lower lateral cartilages were concave creating these indentations. Result is shown 8 months following surgery.
25 year old Indian female who wanted a front view improvement in her nasal tip with more definition. Patient underwent rhinoplasty to refine her nose bridge, tip and a conservative nostril reduction and is shown 1 year after rhinoplasty.