History of the Procedure: The concept of rhinoplasty in nonwhites has evolved over time. In 1913, Schultz characterized the typical “black nose” as broad and flattened, frequently lacking in 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 stereotypical features, authors more recently have pointed out the difficulty in categorizing individual patients. In 1976, Stucker noted that few African American patients possessed all of 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. The two researchers could divide subjects into 3 distinct groups. Ofodile and James hypothesized that the considerable miscegenation among blacks, whites, and Native Americans in the US could account for differences between 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 Negroid nose did not typify the most common black American nasal configuration.
Similarly, Aung et al used a laser surface scanner to carry out anthropometric measurements of 90 subjects of Asian extraction. The authors concluded that the Asian nose generally was broader in relation to height and had less tip projection, but they also noted 3 different subtypes. In a study of 206 Chinese adults of Han ancestry compared to 103 North American whites, Wang et al pointed out that the Chinese nose fit the dimensions of the nasofacial canon (ie, nose width = .25 of 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 nonwhite 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 did 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 racia .....