Ethnic Rhinoplasty in Istanbul

Thick Skinned Nose Job

"Ethnic Nose Aesthetics" is a type of "rhinoplasty" which is planned for usually of African and other different places origin noses and is applied to nose with thick skin structure, which involves different and more difficult operations.

Definition of ethnic nose

The term "ethnic nose" is a colloquial or non-medical term used to describe a nose that exhibits characteristics typically associated with a particular ethnic or racial group. It's essential to note that the concept of an "ethnic nose" is subjective and may perpetuate stereotypes. In medical and scientific contexts, the shape and features of a person's nose are influenced by a combination of genetic, anatomical, and environmental factors.

Ethnic Nose Types

Ethnic nose types are simply divided as Mediterranean, African, Asian, Caucasian and Hispanic nose types. All of them are different and each nose can be subdivided within itself. Very nice article about "14 nose types" was published at "Daily Mail Online" and you can look at the this link >> There are 14 types of nose... which one is yours?

Why Ethnic Rhinoplasty Is Different From Classical Nose Esthetics?

During Ethnic Rhinoplasty operation, different procedures are required depending on the following different anatomical features:

In the photo above, there are images before and 1 year after the ethnic rhinoplasty operation of the patient with a very thick skin structure.

Thick Skinned Nose Structure

In patients with thick skin, it can be noticed that the skin is very thick and the nose skin seems to be more oily (skin thickness can be secondary to sebaceous overactivity), especially when it is closely observed (in nose tip part) and when it is stuck with two fingers. The different procedures for the Thick skin rhinoplasty operation can be listed as follows:

• Open technique can be choosen to nose tip skin elevation with "bilevel dissection" maneuvers include and underskin tissue can be removed to achieve to thinner skin (trimming redundant nasal skin)
• Removing the fat tissue that overlying and between the alar cartilages domes
• Additional cartilage grafting to creating a firm cartilaginous frame of nose tip. Depending on the thick skin "camouflage effect" may occur and cartilage grafting may be necessary in the nose tip area to avoid the appearance of a "round shaped nose".
• Eliminating dead space between the cartilages using the suture techniques
• Avoid excessive thinning of alar cartilages. Because thick and oily skin is normally heavier and can cause it to collapse on the nose wings.

Wide and Flat Nose Holes

In the case of the African nose type, it may be necessary to perform "alar base resection" operations, which can be done from the inside and outside to reduce the nose wings. Care must be taken during this operation and excessive resection must be avoided to ensure that the nose functions of the patient are not impaired.

Flat Nose Bone and Nasal Root

In some parts of African countries, patients have a fairly flat nasal root and nasal bone; large and wide nose tip can be found. That is, when there is insufficient volume in one part of the nose; the other part is normally thick and wide. It may be appropriate to use a combination of different techniques, including augmentation rhinoplasty with reduction of nasal tip volume. In these patients, additional cartilage that can be taken from outside the nose may be needed to increase nasal volume during surgery (from the patient's own rib cartilage or ear auricle cartilage or cadaveric irradiated rib cartilage).

In the photo above, there are photos of the female patient with very thick skin before the surgery, 1 week after the surgery and 3 years after the surgery. In the patient's 3rd year photograph, as a result of the complete disappearance of the thinning and edema at the tip of the nose, a much more elegant and thinner nose tip emerged than before the surgery.

Different Healing Properties Depend on Thick and Oily Skin Structure

In thick-skinned noses, more auspicious edema (and an exaggerated rounded appearance due to it) after aesthetic nose operations and a longer duration of edema can be seen (up to 2 years). Unfortunately, cream applications involving herbal remedies, natural oils, massage treatments, cortisone injections, or vitamin a derivatives, which are used to reduce the ophthalmia seen after a thick skin rhinoplasty operation, especially at the tip of the nose, are not always effective.

Skin Incision Healing Line  Can Be More Visible in Patients With Dark Skin Color

In dark skinned patients, the surgical skin junction made to the columella region at the tip of the nose can heal in a more visible color after healing. Patients with pre-existing skin scarring may be advised not to contact the nose with sunlight for a few months after open technique nose aesthetics, and if necessary, use a hat, sunscreen cream, trace-relieving products on the incision area.

Thick Skin Structure + Thin and Soft Cartilage Structure

In some ethnic noses, besides thick and oily skin structure; it can be gentle and thin cartilage structure. In these cases, the possibility of "alar collapse" should not be overlooked when the cartilage grafts prepared to support the skin is applied in several layers, the alar cartilages are not thinned too much and the nose wings are narrowed.

As large, long and wide buildings require thicker and larger construction materials than thin and light buildings, Thick-skinned and heavier than normal nose should be supported with more support cartilage tissue.



Nose Aesthetics Simulation Made Before Ethnic Nose Aesthetic Operation May Not Reflect Real Result!

Patients with thick and oily skin features may experience exaggerated subcutaneous edema after nasal surgery and, consequently, larger, wider and rounded nose than expected. This can vary depending on the healing properties of the patient and whether the operation is performed according to the "Thick skin rhinoplasty algorithm" mentioned above.

Longer Nose Tip Swelling Time and Medical Treatment Controversies in Thick Skin Rhinoplasties

In patients with thick skin lesions, subcutaneous tissue resection with an open technique preference and two-level skin dissection is recommended. Despite the techniques proposed in Thick skin algorithm; In patients with thick skinned nose structure, a post-operative rounded appearance of exaggerated nasal edema and nasal tip "like a ball" can emerge.



It can help to pay attention to the following suggestions for edema and swelling after ethnic nasal aesthetic operation (almost all are controversial):

• Nasal massage with natural oils
• Use of anti-edema gels and creams
• Use of retinoid-containing skin products
• Cortisone injection
• Use of oral swlling and bruism herbal tablets (arnica, bromelain, quercetin tablet ...)

Apart from these, it may be appropriate to pay attention to suggestions such as avoidance of temperature, avoidance of spicy foods, avoidance of sun, sauna and solarium, which may lead to increase of tissue swelling in general.

Open Technique Can Be More Suitable for African American Nose Esthetic Surgery

In Africa-type noses, the thick nasal skin is usually prominent and it is recommended that the subcutaneous tissue be removed and deeply dilated during surgery (bilevel skin dissection). In order to be able to do this, a 5-point incision made to the columella region at the tip of the nose is required. Additional round cartilage grafting may also be required to correct the round ball shape at the tip of the nose.

In some patients with very flat nasal roof or revision operation is needed additional rib cartilage grafting or cadaveric rib cartilage may be needed. In this way additionally about 1000 - 1100 US Dollars may be added to total surgery price.

Ethnic Revision Rhinoplasty in Istanbul

Ethnic Revision Rhinoplasty is an operation that is more difficult than classical aesthetic nose operations and may require different techniques during surgery. As in the photograph shown above and below, it is not always easy to obtain a thin and delicate nose tip in patients with some thick skin features and a "heavy" nose type section. It is important to protect the cartilage support tissues, to insert a sufficient amount of nasal type cartilage grafts and to cover dead spaces. Again after the ethnic revision rhinoplasty, patients should be informed that there may be more edema and edema time than expected, and long-lasting round appearance at the tip of the nose.

Before and After Videos For Ethnic Revision Rhinoplasty in Istanbul 

Cost of Ethnic Rhinoplasty in Istanbul

Ethnic rhinoplasty operation cost in Istanbul, (one day staying in hospital, all tests, all instruments, all doctor fees are included in this price) varies according to the hospitals. Total cost of ethnic nose aesthetic surgery is about 3500 US Dollars at affordable hospitals. Prices may rise in JCI (Joint Commission International) accredited more luxurious hospitals as about 4500  US Dollars. However, sterile operating conditions, experienced anesthesia team,quality surgical equipment are enough to successful rhinoplasty surgery.

Is There A Difference in Terms of Patient Care After Nose Aesthetic Surgery?

It may be appropriate to pay attention to the following features in terms of patient care after ethnic nasal aesthetic operations with thick skin structure characteristics:

- It may be appropriate to hold the nasal bandage and thermoplastic splint longer than normal. Generally, in patients with oily skin, the external splint spontaneously falls off the skin surface within 2-3 weeks.

- Long-term use of edema-relieving herbal products may be appropriate, as nasal swabs are more prominent than patients with thin skin structure. It may be appropriate to use gels and creams that can be sprayed onto the skin, oral pills containing vitamins and various herbal mixtures.

- It may be appropriate to avoid nasal edema for longer than hot movements and exercise exercises to increase blood pressure (such as 2-3 weeks)

- Patients with a particularly thick skin structure may need to be more cautious in avoiding the effects of sun rays on wound healing (in the case of dark skin color, more pronounced skin in the area of ​​skin incision)

- Retinoid-containing skin creams may be recommended for excessive tissue edema, which may result in some fatty and thick skin disease. This topic is controversial.

- Some patients require injections of cortisone in order to be able to reduce the usually obvious edema of the nose tip. Patients need to be informed about possible side effects of cortisone injection (deep color changes, atrophy of subcutaneous tissue, eye-related side effects ...).

Asian Ethnic Rhinoplasty

People of Asian descent have a flattened nasal bone, thick skin and a broad nasal tip. In general, additional grafts such as cartilage powder, muscle membrane, fascia may be required for augmentation of the nasal hump region. Alar base resection is required for the treatment of wide and flat nostrils. Even if patients have primary rhinoplasty, sometimes cartilage tissue obtained from the auricle or rib cartilage may be required due to the need for additional cartilage grafts. Asian Ethnic Nose Job Operation was performed on the patient seen in the video above and in the photos below, and underskin tissue obtained by bilevel skin dissection from the nasal dorsum and supratip region was used.

During Asian rhinoplasty, it is very important that the cartilage support of the nasal tip is strong enough and that there is no dead space under the skin. Resection instead of augmentation of the nasal dorsum causes a flat nose appearance. For this reason, it is ideal for physicians with surgical experience to perform this operation.

Ethnic Asian Revision Rhinoplasty - Dislocated and Crooked Rib Cartilage Cooreected With Micromotor System

The patient, who had previously undergone ethnic rhinoplasty using rib cartilage in another country, was admitted to our clinic with prominent nasal arch, dislocated and twisted rib cartilage, and asymmetric nasal deformity. It was understood that the patient's fresh rib cartilage, which was taken in the previous operation, was bent and then dislocated after insertion into the nose. Normally, fresh rib cartilage is frequently used in rhinoplasty. Here, a split thickness incision is usually made to reduce the possibility of subsequent bending of the rib cartilage. The protruding areas on the nose were marked for our patient, whom I shared here, using a dental needle, and these areas were flattened with the help of a micromotor. A graft was taken from the patient's left temporal fascia and placed on the root of the nose. You can find the before and after images of the patient in the video above and in the photos below.

Images of the 1st week after the operation:

Before and After Photos For Ethnic Rhinoplasty in Istanbul:

Before and After Photos For Primary Ethnic Rhinoplasty



































Before and After Photos For Ethnic Revision Rhinoplasty











 











 



























































Tertiary Revision Ethnic Rhinoplasty Before and After Photos

































 



 

Before and After Photos For Ethnic Rhinoplasty in Men



"Filling Root of The Nose With Subcutaneous Tissue + Limited Nasal Hump Removal + Nose Tip Plasty - Rhinoplasty Without Brekaing The Bone" Video

Thick Skinned Natural Female Rhinoplasty

In the video above, there are images before and after the rhinoplasty operation performed on the patient with a thick skin structure in order to obtain a natural, non-upturned nose that cannot be easily understood.

Source links:

• An Effective Algorithm for Management of Noses with Thick Skin. - NCBI
• Ethnic Rhinoplasty - Medscape Education
• African-American and Ethnic Rhinoplasty
• Ethnic Rhinoplasty Surgery for Asians, African Americans & Hispanics
• Rhinoplasty: A Multispecialty Approach, An Issue of Clinics in ...
• Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques ...
• Cosmetic Surgery in the Ethnic Population: Special Considerations ...
• Rhinoplasty for African American Patients: A Retrospective Review of ...
• Facial Plastic Surgery Gains Popularity with Racial and Ethnic ...

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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