Rhinoplasty


 

The first-time operation

The beauty of the nose is a fascienating and complicated topic. Although difficult to define, a few characteristics are found in every attractive nose. For example, all beautiful noses are symmetric, vertically alligned and exactly centred between the eyes. If these generally applicable features are missing, an otherwise beautiful nose may appear imperfect and less attractive, no matter the ethnical background. On the other hand, not all beautiful noses look the same. The opposite is true, beautiful noses come in a variety of different shapes and sizes and not two noses are exactly alike. In addition to that, regardless how attractive, not every nose shape fits in to every face.

In reality a nose that looks terrific in one face, may look weird and attractive in another. It seems like something else than the shape of the nose is responsible for the beauty of a nose.

Facial harmony

So why does a nose that looks fantastic in one face, looks unattractive in another? The answer lies in the harmony of the face. For a nose to look attractive it has to harmonize with the surrounding facial features. Facial harmony is gained when the nose fits the gender, origing and bone structure of the surrounding features in the face. For example, the dimension and shape of an attractive male nose are generally too masculine for a female face.

The opposite is true as well, as most female noses are too small and delicate for a male face. As well as gender compatibility, an attractive nose should harmonize with the surrounding facial bone structures. Long, narrow faces 

look best with long, narrow noses and short, wide faces require shorter, wider noses. Although beauty lies in the eye of the behorder, attractive faced tend to have coherent and flattering bone structures, whereas unattracitive noses usually disagree with the facial bone structures. A good rhinoplasty changes the existing nasal architecture to a more attractive shape, to harmonize with the surrounding characteristic features. A change, that doesn’t only require surgical but also artistic skills and an understanding for the facial harmony.

Patient satisfaction: The ultimate objective

Regardless the original nose shape, in todays surrounding environment of the rhinoplasty  it is especially important to assess the specific cosmetic goals of each patient, in order to avoid wrong assumptions regarding the cosmetic result. Some rhinoplasty patients might aim to maintain or emphazize ethnic characteristics, whereas other wish to minimize or eliminate ethnic specifics. No choice is right or wrong, only the patient knows whats best for him/her and patient satisfaction should always be the ultimate goal. Fortunately one can use the advantages of the computer simulation to change facial photographs in a way to visualize and precisely determine various changes in the shape of the nose or individual cosmetic preferences.

No matter if the goal is a complete ethnic preservation or complete westernization of nose, the computer simulation allows the patient to foresee certain cosmetic changes and to approve the visualized cosmetic objective. Nevertheless, despite this helpful communication tool, in the final analysis the surgion must have the needeed skills and experience to achieve the desired outcome, and the result should always be natural and harmonic.  

The evolution of rhinoplasty

Until recently cosmetic rhinoplasties were mainly done on non-ethnical (anglo-saxon) noses mit a hump and broad, hanging nose tips. The procedure was mainly done through cartilage- and bone removal, so called reduction-rhinoplasties, and only few to no techniques were available for noses that didn’t fit in that mould. With the explosive, worldwide increase of pupularity for nasal surgery, more and more coloured people desire rhinoplasty. Only recently the term ethnic rhinoplasty was coined, to describe cosmetic rhinoplasty on patients of non-anglo-saxon origin. Often these patients show nasal features, that greatly differentiate from these of traditional reduction-rhinoplasty patients. Whereas some ethnic groups represent anatomical challenges, that resemble these of traditional reduction-rhinoplastiy patients (fore example noses of the middle east or south asia), most ethnic rhinoplasty patients show distinctly different nose anatomy, that is not suitablle for tradional (reduction-)rhinoplasty 

techniques. White, flat noses with thick skin and weak cartilage (typical in patients of african or east-asian origin) where deemed inoperable and only a few surgeons could state satisfying results with these patients. However, since the sophistication of reconstructive and corrective techniques many of the basic princibles could applied on this growing patient population.

Although ethnic rhinoplasty is a non-word (as every rhinoplasty patient belongs to an ethnic group), this term has become a synonym for cosmetic rhinoplasty on patients of non-anglo-saxon origin. Todays ethnic rhinoplasty surgeon combines tradional rhinoplasty techniques with up-to-date reconstructive techniques to ensure an individualized treatment meeting the specific anatomical challenges and cosmetic goals of his/her patients. For some patients ethnic rhinoplasty means avoiding the use of aggressive traditional techniques to emphasize the nose while maintaining its native ethnic character.  However, for others ethnic rhinoplasty stands for the use of the entire spectrum of rhinoplasty techniques to remove strong ethnic features and to achieve a classic-european nose shape.

Regardless of the cosmetic goal, in comparison to tradiontal rhinoplasty, ethnic rhinoplasty claims a broad spectrum of surgical skills and not a single method or technique can be transfered for every single patient.  Furthermore, even within a specific ethnic group, one has to consider individual variations and not one single surgical strategy will suit every patient. On that note, ethnic rhinoplasty is a midleading concept, that tends to attribute similar surgical complexity only on the base of ethnic origin. In reality noses are not challenging on the base of their ethnic origing, but due to individual physical features, that make a nose more accessible or resistant to structural changes. The fact that these features emerge in cummulative number within familiar or ethnic groups leads to the generalization that deceptively suggests that patients of a certain ethnis origin have to be treated in the same way.

Expert for ethnic rhinoplasty – Dr. Berkei

As people of various ethnic backgrounds often have noses with distinct features, ethnic rhinoplasty demands a highly individualized approach. The expert for ethnic rhinoplasty, Dr. Julia Berkei, has extensive work experience with a diverse spectrum of patients. With her particular delicacy of feeling for the various aesthetical demands and preferences of patients of afro-american, middle-eastern, asian and other non-caucasian background, Dr. 

Berkei can help to achieve the result, that harmonizes best with the remaining facial features of almost every single patient.

Contens of ethnic rhinoplasty

Like in other types of rhinoplasty, ethnic rhinoplasty is successfully accomplished through removal or reshaping of cartlage and bone under the skin. In some cases cartilage grafts are added to change the structure of the nose and to improve its overall appearance. The changes can be subtle or spectacular, depending on the demands and wishes of each patient. Common techniques used in ethnic rhinoplasty contain enlargement (buildup) of the nasal bridge, elongation and refinement of the tip of the nose, and narrowing of the base of the nostrils. With consideration and preservation of the ethnic heritage of the patient, these methods can be used to improve the appearance of afro-american, middle-eastern or asian noses.

The development of international rhinoplasty

Up to 20 years ago, cosmetic rhinoplasty was mainly performed on anglo-saxon noses with a hump and broad, hanging tips. The procedure was achieved primarily achieved through cartilage and bone removal, so called reduction rhinoplasties and only a few to no techniques were available for noses, that didn’t fit into this typical pattern.With the explosive worldwide growth of education through the internet and the massive increase in popularity of aesthetic rhinoplasty, more and more people from the most diverse countries desire rhinoplasty.

Within germany, Frankfurt has a very broad spectrum of people from various backgrounds and a well functioning, big airport close to the city for international patients. In this respect, the use of complec surgery techniques for arabic, asian, african, afro-american and european nose shapes are standard procedure .

To describe rhinoplasty on people of non-anglo-saxon origin, especially in the USA the term ethnic rhinoplasty was coined. These patients show nasal features that greatly differ from those of tradional reduction-rhinoplasty patients. While some ethnic group represent anatomical challenges, that are similar to those of tradional reduction-rhinoplasty patients (for example noses of the middle-east or south-asia), most international patients show a distinctly different anatomy of their nose, that is unsuitable for the tradional (reduction-)rhinoplasty techniques. Broad, flat noses with thick skin and 

weak cartilage are common with people of african or east-asian origin. These were considered inoperable and only a few surgeons could state satsifying results with these patients. But with development of sophisticated reconstructive and corrective techniques, many of these principles could be applied to this growing patient population.  Common techniques used in ethnic rhinoplasty contain enlargement (buildup) of the nasal bridge, elongation and refinement of the tip of the nose, and narrowing of the base of the nostrils. With consideration and preservation of the ethnic heritage of the patient, these methods can be used to improve the appearance of afro-american, middle-eastern or asian noses.

Dr. Berkei nevertheless, in conformity with the european scientific consensus, prevers a classification of surgical techniques based on the shape of the nose and not the ethnic background.

Based on the cartilaginous-bony nasal bridge:

  • Beak nose
  • Long nose
  • Broad nose
  • Saddleback nose
  • Crooked nose
  • Short nose

Based on the tip of the nose

  • Boxy tip= broad tip
  • Asymmetric tip
  • Hoisted tip
  • Based on the columella:
  • Hanging columella
  • Retracted columella

Based on the nostrils:

  • Asymmetrie
  • broad nostrils
  • narrow, long nostrils
  • broad bottom of the nose

Based on skin thickness:

  • Thick skin
  • Medium thickness skin
  • Thin skin

As people of various ethnic backgrounds often have noses with distinct features, ethnic rhinoplasty demands a highly individualized approach. The expert for ethnic rhinoplasty, Dr. Julia Berkei, has extensive work experience with a diverse spectrum of patients. With her particular delicacy of feeling for the various aesthetical demands and preferences of patients of afro-american, middle-eastern, asian and other non-caucasian background, Dr Berkei can help to achieve the result, that harmonizes most beautifully with the remaining facial features of the patient. 

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