7.1 The Mainstream and the Individual

Where different cultures, religions, and ethnic groups converge in the metropolitan regions of the world, new questions are arising with regard to facial plastic surgery ( Fig. 7.1 ).

The problem of altering the size and shape of the nose becomes particularly acute in planning rhinoplasties for patients of different ethnic origins because the surgery may either eliminate or preserve key ethnic features. ¹ An Asian nose may be changed to a European type, with considerable impact on the face, or its Asian character may be preserved despite the rhinoplasty. Aside from any desire to alter ethnic features, there is no such thing as an “ideal nose.” Yet there are aesthetic features that transcend all ethnic and cultural boundaries, such as a straight nasal dorsum or a harmonious brow-tip aesthetic line. ²

The rhinosurgeon should have an appreciation for the distinctive features of ethnic nasal variants and for the motivations and desires of the candidates who seek rhinoplasty. Intensive counseling is essential, preferably with visualization aids that will show patients the often-underestimated effect of the rhinoplasty on facial appearance. The risk of a postoperative identity crisis because a technically successful outcome nevertheless proves unacceptable must be avoided. It always stems from a lack of preoperative communication.

Patients who are dissatisfied with their profile, for example, after a primary rhinoplasty pose a special challenge. It is our experience that some of these patients will want to refine the appearance of their nose while preserving their ethnic traits, while others will seek improvement without regard for those traits. As an example, we were once consulted by a set of twins. The brother wanted to keep his distinctive ethnic features while the sister did not. Fig. 7.2 shows a patient who wanted her profile changed by rhinoplasty but also wanted to preserve her convex nasal dorsum as a desired ethnic trait.