THE ETHNIC NOSE

Patients with noses that characterize an individual as the member of a particular race, religion, or ethnic group may wish to change that look so as not to be stereotyped and not have their own individuality potentially diminished or dismissed by others.14 For men, this may be particularly true in the business world, where fitting in is so important. It is not that these individuals resent their heritage; they just do not want to be labeled. Remember, it was Aristotle who said that something or someone is considered beautiful if all parts are working together in harmony so that no one part draws unjust attention to itself. An ethnic nose can indeed stand out, making its owner feel the “odd man out” when in the company of others not so endowed (Fig. 11).

	Fig. 11. A and C, This 50-year-old man had a severe nasal injury 20 years before his initial consultation. He had marked deviation of the whole nose off to his left side. He desired surgery in order to breathe better and return his nose to its preinjury state. He did want his dorsal fullness reduced but did not wish to erase his ethnic identity. B and D, The postoperative result, which illustrates preservation of strength and character to his nose.

Adolescent boys are often the most conscious of these ethnic identities and, because of their normal self-doubting, critical personal analysis, may rush to the facial plastic surgeon. It is up to the ethical physician to carefully screen out those with minimal deformities who may benefit more from tincture of time than from the action of the scalpel. What is unfortunately most disturbing about these young, sometimes shy adolescent boys is not the patient but a forceful parent (often the mother), who during the interview does almost all the talking and points out the undesirable qualities of the son’s nose right in front of him as if he were clothing that had a spot on it. One cringes at such destructive parental behavior that makes the boy feel that he is somehow defective in the eyes of that parent. It is often best to take this young patient aside and ask if indeed he truly wants something done to his nose at all and honor his desires over that of the parent without hesitation.

If generalizations are at all possible, especially with modern day racial and ethnic intermingling, the following is often espoused. The tip of the Arab nose is long and droopy. The Jewish dorsum is fully convex from nasion to tip, often with a tension septum, hanging columella, and rounded tip. The Mestizo nose is short, underprojected with a rounded tip and thick nasal skin. The French- Canadian nose often overprojects. The Black nose has a wide alar base with thick skin and a low nasal dorsum. The Asian nose has a rounded tip; an especially low dorsum with a very low starting point for the nasion; and vertically oriented, weak lower lateral cartilages. What is important here is establishing with the patient what he wants without dwelling on ethnic descriptions or stereotypes. Surgical goals and imaging should be formulated to make the nose fit the face, utilizing those aesthetic proportions as first described and illustrated by Leonardo da Vinci (Fig. 12).

	Fig. 12. A and B, This 18-year-old man wished to look better. He disliked his very prominent nose and weak chin. The goal of surgery was to give him a balanced and strong profile. A bony and cartilaginous dorsal resection was needed. Three millimeters of caudal septal resection and a tongue-in-groove technique were used with further excision of 3 or 4 mm of membranous septum bilaterally. The reduction of the tension septum allowed the tip to set back well in proper position and only required double-dome sutures after a minor cephalic trim of the lower lateral cartilages. This result would not have been as balanced were it not for the chin augmentation with a large anatomic silicone implant.