Excerpt from Rhinoplasty, Multiracial

Synonyms, Key Words, and Related Terms: multiracial rhinoplasty, rhinoplasty, African American nose, Black nose, Negro nose, Asian nose, Latino nose, Hispanic nose, non-Caucasian nose, platyrrhine nose, mesorrhine nose, plastic surgery, nose job, nasal surgery, cosmetic surgery

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Distinctive anatomic differences exist between the nonwhite nose (platyrrhine, mesorrhine) and the white nose (leptorrhine). Surgeons who perform rhinoplasty in multiracial patients must recognize these differences and must implement specific surgical strategies to achieve the desired aesthetic and functional outcome.

History of the Procedure: The concept of rhinoplasty in nonwhite has evolved over time. In 1913, Schultz characterized the typical black nose as broad and flattened, frequently lacking dorsal projection. The tip was described as flat and round, with flared alae and an obtuse alar dome angle. A number of authors, including Malory and Falces, have commented on the predilection for nonwhites to have thick nasal skin with a large amount of subcutaneous tissue.

Despite such stereotypic features, authors have more recently pointed out the difficulty in categorizing individual patients. In 1976, Stucker noted that few African American patients possessed all the aforementioned racial characteristics. Ofodile and James performed an anatomic study on 24 alar cartilages in 12 black American male cadavers and documented considerable variability in morphology. They were able to divide subjects into 3 distinct groups and hypothesized that the considerable miscegenation among blacks, whites, and Native Americans in the United States could account for differences among these groups. Baker and Krause analyzed 8 external nasal surface measurements in 196 nonwhite patients and could divide their study population into 5 statistically significant groups. Interestingly, the so-called typical black nose did not typify the most common nasal configuration in black Americans.

Similarly, Aung et al used a laser surface scanner to perform anthropometric measurements in 90 subjects of Asian descent. The authors concluded that the Asian nose is generally broader in relation to height and has less tip projection, but they also noted 3 different subtypes. In a study of 206 Chinese adults of Han ancestry compared with 103 North American whites, Wang et al pointed out that the Chinese nose fit the dimensions of the nasofacial canon (the nose width is one fifth of the face width) significantly more frequently (51.5%) than did the white nose (36.9%).

The conceptualization of the ideal nonwhite nose has changed dramatically in the literature. In the past, many authors assumed that multiracial patients sought rhinoplasty to gain a more white appearance. Martin reported that both black and white men in the United States ranked black women with white facial features as more beautiful, while men in Nigeria preferred women with black features. Falces et al connected this perceived desire to appear more white to economic considerations. Patients may feel it necessary to fit the white ideal of beauty to succeed in Western society. Given the limitations of rhinoplasty in this context, Snyder suggested the need for increased preoperative consultations for the achievement of realistic goals and the occasional need for psychiatric evaluation.

In 1972, Pitanguy voiced the currently accepted perception that the nose must be in harmony with the rest of the face and the race of the individual. Stucker stressed the importance of eliciting patients’ desires and expectations, and he warned against imposing the aesthetic ideals of the surgeon on patients. This view was supported by Baker and Krause’s survey of 196 nonwhite employees and outpatients at the University of Michigan, Ann Arbor, Mich. This study revealed that the vast majority of black Americans considering rhinoplasty do not desire white-type noses. In view of the increased diversity of patients requesting rhinoplasty, Yellin commented that white normative standards of facial analysis are no longer sufficient in the new millennium, and he called for additional studies to define aesthetic ideals within the various racial groups.

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