Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

Houston is indeed a melting pot, blending many cultures into our daily life. We have a large Hispanic population as well as Asian. I am seeing more patients that are Hispanic, Asian and African-American who are interested in improving the appearance of their nose. Some want a gentle refinement, but still retain their natural appearance, whereas others want a more radical change to give their nose more Caucasian characteristics. By that I mean, a narrower nose with a straight dorsum, and a proportionate nasal tip.

It’s important, when seeing a patient in consultation, to carefully evaluate their physical characteristics, as well as their goals. The characteristics of an Asian nose are different from African-Americans and Hispanics. Within the Asian population, there are certain variations. Some patients have a shortened nose, as well as a concave or recessed nasal dorsum. The vertical deficiency is more prevalent in the Asian type of nose than it is in the African-American and Hispanic nose. There may be a depression, at the upper end of the nose between the eyebrows, which needs to be corrected. The columella, which is the skin bridge between the nostrils extending from the base of the nose to the tip, may be very short. In addition it may be recessed up between the nostrils. The nostrils may be flared or enlarged and the cartilage support for the nasal tip may be very thin.

In performing cosmetic surgery on the “ethnic nose” it’s often required to augment the nasal dorsum, and lend support to the tip, with grafts. I try to use the patient’s own tissue, either rib cartilage grafts or ear cartilage grafts, whenever possible. Sometimes it is necessary to use nasal implants to support the framework, but I prefer not to use these, since they are a foreign body and can be prone to infection or extrusion (rejection by the body). Some patients have a wide base to the nose so the nostrils have to be brought closer together and sometimes decreased in size.

It’s important to be conservative in the approach to treating the ethnic nose. I take a lot of time discussing what the patient’s goals are and what I think I can achieve. Patients need to understand, as with every surgery, that there are risks involved and the final outcome may not be exactly what they expected. This is particularly true in cosmetic nasal surgery than it is in other cosmetic facial surgery.