Nasal beauty is an intriguing and complex subject. Although nasal beauty is difficult to define, certain attributes are present in any attractive nose. For example, all beautiful noses are symmetric, vertically aligned, and centered between the eyes. When these shared characteristics are missing, an otherwise beautiful nose becomes flawed and less attractive, regardless of ethnicity. On the other hand, beautiful noses don't all look the same. To the contrary, beautiful noses come in a wide variety of shapes and sizes, and no two noses are exactly alike. Furthermore, no single nasal contour, no matter how attractive, will suit every face. In fact, a nose that looks terrific on one face may look awkward and unattractive on another. Clearly, something more than nasal contour is responsible for nasal beauty.
So how can a nose that looks terrific on one face seem unattractive on another? The answer is in facial harmony. For a nose to look attractive, it must blend favorably with the surrounding facial features. Facial harmony is achieved when the nose is compatible with the gender, ethnicity, and bone structure of the facial features which surround it. For example, the dimensions and contour of an attractive male nose are generally too masculine for the female face. The opposite is true as well, as most female noses are too petite and delicate for the prominent features that characterizes the male face. Like gender compatibility, an attractive nose must also be compatible with the surrounding facial bone structure. Long slender faces look best with long slender noses, and short wide faces require a shorter, wider nose. Although beauty is ultimately in the eye of the beholder, attractive faces tend to have cohesive and visually pleasing bone structure, whereas an unattractive nose is usually at odds with the facial bone structure. A good rhinoplasty will transform the existing nasal architecture into a more attractive contour that harmonizes with the surrounding features — a transformation that requires not only surgical skill, but artistry and an understanding of facial harmony.
Another key element in facial harmony is ethnic compatibility. For a rhinoplasty to succeed, the new nose must be compatible with the prevailing facial ethnicity. That's not to say the new nose must be representative of the original facial ethnicity in order to be attractive. To the contrary, there are a wide range of attractive nasal shapes that are compatible with any given ethnicity, even though some of these shapes may lack indigenous ethnic features. Moreover, because mixtures of different ethnic backgrounds are increasingly common, widely different ethnic traits are often intermingled in the same face resulting in many exotic but natural-appearing combinations. Clearly, ethnically appropriate and attractive noses come in a wide variety of shapes and sizes.
Although the classic Greco-Roman nose is seldom considered "ethnic", it is a naturally occurring ethnic nose common to many native peoples of northern Europe. It is also generally regarded as an attractive and desirable nasal contour. Because the northern European nose represents an intermediate nasal contour between the wide, flat nose on the one hand, and the narrow, humped nose on the other, it also constitutes a generic nasal contour that is generally compatible with most faces. In fact, cosmetic nasal surgery has traditionally sought to reshape noses into this classic intermediate nasal contour, and the overwhelming majority of rhinoplasty patients still seek this cosmetic outcome. However, in contemporary rhinoplasty, it is no longer a foregone conclusion that all ethnic nasal features must be eliminated. In fact, for a growing number of rhinoplasty patients, the goal is to modify nasal shape while retaining some or even all of the original ethnic features. Patients with slender humped noses often prefer to avoid aggressive lowering of the nasal bridge or dramatic rotation of the nasal tip. For these patients, such measures would result in an extreme departure from their original ethnicity and thus a disastrous cosmetic outcome. Likewise, many patients with broad flat noses seek narrowing and elevation of the nose, but the classic northern European nasal contour is often regarded as excessive and undesirable since it may eliminate ethnic identity and violate cultural norms. Without question, an increasing number of rhinoplasty patients seek to alter nasal shape while simultaneously preserving the original ethnic character of the nose.
Patient Satisfaction: The Ultimate Goal
Regardless of the starting nasal contour, in today's rhinoplasty environment it is vitally important to assess the specific cosmetic objectives of each patient and to avoid assumptions regarding the cosmetic outcome. Some rhinoplasty patients may seek to preserve or emphasize ethnic characteristics, while others may desire to minimize or even eliminate ethnic features. Neither choice is right nor wrong — only the patient knows what look is best for them and patient satisfaction should always be the ultimate goal. Fortunately, with the advent of computer imaging, facial photographs can be modified to demonstrate various changes in nasal contour and individual cosmetic preferences can now be determined more precisely. Whether the goal is complete ethnic preservation or total Westernization of the nose, computer imaging allows the patient to preview various cosmetic changes and to visually confirm the cosmetic goal. However, despite these helpful communication tools, in the final analysis, the surgeon must still have the skills and experience necessary to achieve the desired outcome and the result must always be natural and harmonious. While the final result may not please everyone, pleasing the patient is what matters most, and a good rhinoplasty surgeon will cater to patient preferences regardless of their ethnic heritage.
The Evolution of Ethnic Rhinoplasty
Until recently, cosmetic rhinoplasty was performed mostly upon non-ethnic (Anglo-Saxon) noses with a humped bridge and a broad, droopy nasal tip. Surgery was accomplished largely through cartilage and bone removal — so-called reduction rhinoplasty — and few if any techniques were available for noses that did not fit the prototypical shape. However, with the explosive worldwide growth in the popularity of cosmetic nasal surgery, people of color are seeking rhinoplasty in ever increasing numbers. Recently, the term ethnic rhinoplasty has been coined to describe cosmetic nasal surgery in peoples of non-Anglo-Saxon ethnic heritage. Often these patients possess nasal characteristics far different from the traditional reduction rhinoplasty patient. While some ethnic groups present anatomic challenges similar to traditional reduction rhinoplasty (e.g. Middle Eastern or South Asian noses), most ethnic rhinoplasty patients possess far different nasal anatomy unsuited to traditional (reduction) rhinoplasty techniques. Broad, flat noses with thick skin and weak cartilage (common in people of African or East Asian descent) were formerly regarded as inoperable and few surgeons claimed satisfactory results in such patients. However, as reconstructive and revision rhinoplasty techniques have become more sophisticated, many of these same principles have been applied successfully to this emerging patient demographic.
Although ethnic rhinoplasty is a misnomer (since all rhinoplasty patients are ethnic), the term has become synonymous with cosmetic nasal surgery in any patient of non-Anglo-Saxon origin. Today's ethnic rhinoplasty surgeon combines traditional rhinoplasty techniques with contemporary reconstructive techniques to achieve individualized treatment according to the specific anatomic challenges and cosmetic goals of the patient. To some patients, ethnic rhinoplasty means avoiding aggressive traditional techniques to enhance the nose while preserving the original ethnic character. For others, ethnic rhinoplasty means utilizing the full spectrum of rhinoplasty techniques to eliminate strong ethnic features and achieve a classic European nasal contour. Regardless of the cosmetic goal, ethnic rhinoplasty demands a broader range of surgical skills relative to traditional rhinoplasty and no single method or technique will apply equally to all patients. Moreover, even within a particular ethnic group, individual variation is considerable and no one single surgical strategy will suit all patients. In that sense, ethnic rhinoplasty is a misleading concept that tends to assign similar surgical complexity merely on the basis of ethnicity. In reality, noses are not surgically challenging because of ethnicity, but rather because of the individual physical characteristics that make a nose amenable, or resistant, to structural change. The fact that these characteristics tend to cluster within families or ethnic groups promotes generalizations which mistakenly suggest that patients of a particular ethnic group must all be treated alike.
Elements of a Successful Ethnic Rhinoplasty
In summary, surgery on the non-Anglo-Saxon nose may be easier or more difficult than a traditional rhinoplasty, depending upon the individual tissue characteristics and upon the desired cosmetic outcome. In extreme cases, dramatic modifications of the original nasal contour are prohibited by stubborn tissues, but properly executed reconstructive rhinoplasty techniques offer cosmetic improvement in virtually any healthy patient. Surgeons with a well-rounded and diverse surgical skill set are better equipped to successfully treat the ethnic nose relative to those with a limited surgical repertoire, even those accomplished at traditional reduction rhinoplasty. Only a thorough assessment of the individual tissue characteristics, combined with a precise determination of the desired cosmetic changes, can determine the prognosis for a successful ethnic rhinoplasty.