Special Considerations in Northern European Primary Aesthetic Rhinoplasty

ABSTRACT

Primary aesthetic rhinoplasty in Northern European females presents particular challenges and pitfalls that the rhinoplasty surgeon needs to be aware of. The authors completed a prospective study of 57 consecutive female patients of Northern European descent who underwent primary aesthetic rhinoplasty, with a minimum of 18 months follow-up. The anatomic features and operative techniques used are presented. Pitfalls that make classical steps of reduction rhinoplasty inappropriate are discussed and illustrated by case reports. Attention is drawn to (1) the dorsal hump with an overprojected tip, (2) the enlarged anterior nasal spine and/or posterior septal angle and strong depressor septi nasi muscle, (3) the dorsal hump tension nose, and (4) the bulbous nasal tip with lateral crus recurvature. The authors emphasize the need to maintain structure in the nose to secure middle third and tip support while achieving a balance between dorsal projection and tip position. The limitations and risks of each surgical step versus their potential benefit must be balanced. The surgeon must diligently manage patient expectation and in this population explain that achieving a better nasal shape may take precedence over size reduction.

KEYWORDS

Rhinoplasty - nose - Anglo-Saxon - Northern European

REFERENCES

• 1 Roe J O. The correction of angular deformities of the nose by a subcutaneous operation.  Plast Reconstr Surg. 1970;  45 283-287
• 2 McDowell F. History of rhinoplasty.  Aesthetic Plast Surg. 1978;  1 321-348
• 3 Weir R F. On restoring sunken noses without scarring the face. 1892.  Aesthetic Plast Surg. 1988;  12 203-206
• 4 Snell G E. A history of rhinoplasty.  Can J Otolaryngol. 1973;  2 224-230
• 5 Joseph J. Nasenplastik und sonstige Gesichtsplastic nebst Mammaplastik. Leipzig, Germany; C. Kabitsch 1931
• 6 Bull T R. Rhinoplasty: aesthetics, ethics and airway.  J Laryngol Otol. 1983;  97 901-916
• 7 Patterson C N, Powell D G. Facial analysis in patient evaluation for physiologic and cosmetic surgery.  Laryngoscope. 1974;  84 1004-1019
• 8 Romo III T, Soliemanzadeh P, Choe K S, Sclafani A P. Reduction structured rhinoplasty.  Facial Plast Surg. 2003;  19 317-323
• 9 Davis R E. Rhinoplasty and concepts of facial beauty.  Facial Plast Surg. 2006;  22 198-203
• 10 Leong S C, White P S. A comparison of aesthetic proportions between the Oriental and Caucasian nose.  Clin Otolaryngol Allied Sci. 2004;  29 672-676
• 11 Leong S CL, White P S. A comparison of aesthetic proportions between the healthy Caucasian nose and the aesthetic ideal.  J Plast Reconstr Aesthet Surg. 2006;  59 248-252
• 12 Edler R J. Background considerations to facial aesthetics.  J Orthod. 2001;  28 159-168
• 13 Powell N B, Humphreys B. Proportions of the Aesthetic Face. New York, NY; Thieme-Stratton 1984: 1-72
• 14 Tomkinson A, Eccles R. External facial dimensions and minimum nasal cross-sectional area.  Clin Otolaryngol Allied Sci. 1995;  20 557-560
• 15 Franciscus R G, Long J C. Variation in human nasal height and breadth.  Am J Phys Anthropol. 1991;  85 419-427
• 16 Farkas L G, Katic M J, Forrest C R et al.. International anthropometric study of facial morphology in various ethnic groups/races.  J Craniofac Surg. 2005;  16 615-646
• 17 Farkas L G. Anthropometry of the Head and Face. 2nd ed. New York, NY; Raven Press 1994: 211-217
• 18 Nolste Trenite G J. Considerations in ethnic rhinoplasty.  Facial Plast Surg. 2003;  19 269-245
• 19 Daniel R K, Lessard M L. Rhinoplasty: a graded aesthetic-anatomical approach.  Ann Plast Surg. 1984;  13 436-451
• 20 Adamson P A, Litner J A. Open rhinoplasty. In: Papel ID Facial Plastic and Reconstructive Surgery. 3rd ed. New York, NY; Thieme 2009: 529-546
• 21 Cottle M H. The Cottle nasal syndromes. In: Rhinology: The Collected Writings of Maurice H Cottle. The American Rhinologic Society 1987: 189-190
• 22 Johnson C M, Godin M S. The tension nose: open structure rhinoplasty approach.  Plast Reconstr Surg. 1995;  95 43-51
• 23 Gunter J P, Friedman R M. Lateral crural strut graft: technique and clinical applications in rhinoplasty.  Plast Reconstr Surg. 1997;  99 943-952 discussion 953-955
• 24 Lo S, Rowe-Jones J. Suture techniques in nasal tip sculpture: current concepts.  J Laryngol Otol. 2007;  121 e10
• 25 Goode R L. A method of tip projection measurement. In: Powell N, Humphrey B Proportions of the Aesthetic Face. New York, NY; Thieme-Stratton 1984: 15-39
• 26 Guyuron B. Precision rhinoplasty. Part II: prediction.  Plast Reconstr Surg. 1988;  81 500-505
• 27 Tardy Jr M E, Walter M A, Patt B S. The overprojecting nose: anatomic component analysis and repair.  Facial Plast Surg. 1993;  9 306-316
• 28 Toriumi D M. New concepts in nasal tip contouring.  Arch Facial Plast Surg. 2006;  8 156-185
• 29 Daniel R K. The nasal tip. In: Daniel RK Rhinoplasty: Aesthetic Plastic Surgery. Boston, MA; Little, Brown and Co 1993: 227-234
• 30 Guyuron B. Predictive rhinoplasty. In: Daniel RK Rhinoplasty: Aesthetic Plastic Surgery. Boston, MA; Little, Brown and Co 1993: 109-111
• 31 Gruber R P, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty.  Plast Reconstr Surg. 2007;  119 1903-1910
• 32 Oneal R M, Berkowitz R L. Upper lateral cartilage spreader flaps in rhinoplasty.  Aesthet Surg J. 1998;  18 370-371
• 33 Byrd H S, Meade R A, Gonyon Jr D L. Using the autospreader flap in primary rhinoplasty.  Plast Reconstr Surg. 2007;  119 1897-1902
• 34 Gruber R P, Friedman G D. Suture algorithm for the broad or bulbous nasal tip.  Plast Reconstr Surg. 2002;  110 1752-1764 discussion 1765-1768
• 35 Daniel R K. Rhinoplasty. An Atlas of Surgical Techniques. New York, NY; Springer 2004: 132-136
• 36 Rohrich R J, Raniere Jr J, Ha R Y. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty.  Plast Reconstr Surg. 2002;  109 2495-2505 discussion 2506-2508
• 37 Gunter J P, Friedman R M. Lateral crural strut graft: technique and clinical applications in rhinoplasty.  Plast Reconstr Surg. 1997;  99 943-952 discussion 953-955