Created on 20th September 2011
Rajan Uppal of the West London Clinic explains how rhinoplasty has become increasingly popular among ethnic minorities
Nose reshaping is one of the most common operations performed in the world and is extremely popular in the Middle East. As accurate figures are not available, we often underestimate the extent of cosmetic surgery being undertaken in the Middle East. There is a renowned surgeon in Tehran who performs 7,000 nose reshaping procedures per year.
In the UK, nose jobs have become more acceptable in different cultural groups. Not only is it due to a more affluent society but also due to the loss of stigma associated with cosmetic surgery. Mostly, as a result of media attention.
Increasing numbers of Asian and Middle Eastern women as well as men are undergoing this procedure. Most patients feel reluctant initially as they do not want to be judged by their family or cultural group. However, these patients are some of the happiest who often wish they had had surgery years ago.
The issues relate to the bump on the top of the nose as well as to the width of the nostrils. Although initially the temptation may be for the surgeon to completely Westernise the nose, this can cause an imbalance in the facial features for that individual. Therefore, a thorough appraisal of the patient's wishes is required to put their final result in context with their ethnic origin.
Balance is the most important thing for improving the shape of the ethnic nose. These patients often require an 'open' approach to their surgery which results in a small 3 mm scar at the base of their nose. This is to allow complex tip-work to be performed. In addition, further scarring may result if the base of the nose is narrowed. The benefits of narrowing the base of the nose has to be balanced with the fact that scars will result. As the scars are hidden, however, most patients will be happy to proceed with this. The ethnic nose is no doubt a much more complex procedure than the more common reducing of a 'hump' performed in most Western noses. For this reason, over many years as the nose changes in shape and size, patients who have undergone nose-reshaping may request further surgery to refine the nose further. This is slightly more common in the ethnic nose.
Most ethnic patients will require a longer operation as the bones need to be reset, the middle third of the nose needs to be corrected and the tip needs significant attention surgically. This surgery therefore can take over an hour to two hours to perform which is slightly longer than a standard rhinoplasty.
An example of the results following nose reshaping can be seen in the pictures. This patient of Iranian and Jewish origin was concerned about the uneven appearance of the tip of her nose as well as the width of the tip of the nose. She also requested slight narrowing of the nose and a subtle reduction of the small bump on the top of the nose. This presents a typical challenge in terms of correcting tip asymmetry and more importantly achieving a balanced appearance for the patient.
Other important issues to consider include the relationship of the nose to the eyes, lip and chin. A small chin can make the nose appear more prominent than it actually is. Conversely, a prominent chin can make the nose appear less 'strong'. However, in the ethnic patient reducing the 'strength' of some of these features (i.e. nose or chin) can radically alter facial appearance to such an extent that the natural balance of the face becomes less pleasing.
This patient underwent an open approach which involved a small scar measuring 3 mm underneath the nose. The bump was reduced and the nose narrowed at the top by breaking the bones. The middle third of the nose which is made of cartilage was slightly reduced. Half the operation time, of one hour and twenty minutes in total, was devoted to the tip itself. There are four cartilages in the nose, of which the lower two determine the tip shape. These measure approximately 1.5 cm each and are L-shaped. The tip of these cartilages was trimmed to narrow the nostrils and then very fine stitches were used to further narrow the tip and hold the position long-term. The 3 mm piece of cartilage removed was used as a supporting strut in the middle of the nose tip to maintain long-term stability and a straight nose. A plastic bandage was worn on the nose for five days and stitches were removed after this time. Although the patient was initially nervous about the pain that would be involved, she found this to be nominal following her surgery. There was bruising under the eyes which lasted a few weeks but which is easy to cover with make-up. The patient was very happy with the result and it contributed to increased confidence. As with many patients, she wished she had done it years ago.
The perception from patients is sometimes that they feel that nose-reshaping is not for vanity only but often there are genuine aspects of the nose that need correction and in doing so contributes to the well-being of the patient. Some patients that feel uncomfortable about telling their close friends and family about wanting to have surgery will often say that a doctor advised the treatment for breathing difficulties. They may feel more obliged to justify the surgery.
CSMUK
