In the quest to perfect the nose, preserving cultural characteristics requires a customized rhinoplasty approach
WORDS Michelle Stephenson
Too long, too short; too wide, too narrow; too round, too flat. In a side-by-side comparison with Nicole Kidman’s perfect little button nose, arguably we could all find something wrong with our own. But the truth about that so called “perfect” nose? It’s not for everyone. Michael Jackson’s nose is the perfect example of what can happen when ethnic differences are not taken into consideration and a “standard” rhinoplasty (nose job) is performed. Today, surgeons are taking a customized approach to rhinoplasty and are making aesthetic improvements with the patient’s cultural heritage in mind.
“Celebrities like Michael Jackson and their terrible outcomes really spurred the movement toward ‘ethnic’ rhinoplasty,” says Jeffrey Raval, MD, a facial plastic and reconstructive surgeon based in Denver, Colo. “People always say, ‘I don’t want the Michael Jackson look; I want to keep my ethnicity.’ He did a lot for the industry in terms of changing the ethnic perception of what’s [considered] a beautiful nose.”
That was the case for Dr. Raval’s patient, Somin Park, a 38-year-old Korean medical sales rep who lives in Denver. “I had a broken nose when I was 19. I didn’t think my nose was really that bad, but there was room for improvement. I just wanted more of a bridge. Also, my nose kind of turned down and was a little bulbous, so he tweaked that a little bit, too.”
Dr. Raval used computer software to show Park what she would look like after surgery. He also injected filler into her nose to show her what her bridge would look like after surgery. “It really helped to have a preview of what I was going to look like,” she says.
De-standardizing the Nose Job
During the past 20 years, there has been a change in the paradigm of rhinoplasty from a destructive procedure to a more conservative operation. “The ‘standardized nose,’ one which was typically over-resected, over-rotated and lacked proper projection and dorsal height, was practiced by many surgeons,” says Tirbod Fattahi, MD, DDS, an oral and maxillofacial surgeon based in Jacksonville, Fla. “Today, patients are much more educated and savvy; they know exactly what they want before they even come to see the physician.
Today’s patients want a natural-appearing nose, one that blends in with other facial features and is harmonious with the overall facial characteristics of the patient.”
Dr. Fattahi notes that many patients in their 50s and 60s who had standard rhinoplasties 20 years ago want to undergo revision surgery today. “In my opinion, a properly performed rhinoplasty should add as much to the nose [structurally] as it should take away, while adhering to the patient’s wishes,” he says.
Dr. Raval agrees. He points out that surgeons have discovered that taking tissue out can destabilize the nose, and grafts are often required to maintain the strength and function of the nose.
Ethnic Experience
So how do you make sure you get the aesthetic nose improvements you seek without losing yourself in the process? The experts agree: Make sure the doctor you choose has experience doing ethnic rhinoplasties and can show you before-and-after photos of patients who are similar to you and have the results you are trying to achieve.
According to Dr. Raval, they should also be able to provide references, and you should be able to talk to other patients who have undergone similar rhinoplasties. “If they don’t have that, they may not have much experience, and experience plays a big role. You definitely want to check references. You should always inquire about how the rhinoplasty will affect the function of your nose,” Dr. Raval says.
Dr. Fattahi agrees. “Patients are more apt to seek a rhinoplasty from a surgeon who has performed proper ethnic rhinoplasty in the past and can show his or her results to the patient. Ethnic rhinoplasty can be demanding, because it requires modifying the nose without removing all of its ethnic characteristics. For example, a Middle Eastern rhinoplasty usually involves hump reduction and restructuring of the dorsal lines [the bridge of your nose]. While many Middle Eastern patients wish to have their nasal humps removed, they also will tell you that they do not want to have an over-rotated nose or a ‘Miss Piggy’ nose,” he says.
Rhinoplasty R&R
The rhinoplasty procedure is performed under general anesthesia and recovery generally takes about a week, although it can take longer for the bruising to fade away.
For Park, the procedure was done under general anesthesia. She says her recovery time was only three or four days.
“I just happened to be off work for a week, but I didn’t really
need to be. I really didn’t have pain. It was just pressure and
a little bit of discomfort. However, I did have some bruising and
swelling,” she says. She underwent rhinoplasty about a year and
a half ago, and today is very pleased with the results.
