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Rhinoplasty Bizrah: Black and Chinese Patients

January 31, 2017 by basharbizrah0

General considerations:

  1. Rhinoplasty on Black and Oriental patients require the finest surgical skills acquired by the surgeon. It is an augmentation procedure that involves tip refinement, dorsum grafting, bony pyramid narrowing, elevation and alar wedge resection.
  2. There are a few million expatriates living in the Gulf region. Many are of African and Chinese origin (Indonesians, Filipino, etc.). Most of the patients want refinement and wish to maintain most of their ethnic and racial characteristics, but others, in particular those who are living permanently in the Gulf region wish to have the Arab look. They request a high dorsum like the arabic nose and may request the double eyelid procedure.
  3. The limitations of surgery should be clearly discussed with the patient. The patient should sign a consent form and the possibility of secondary procedures should be made clear. Autogenous tissue is more advantageous for long term results. A sialastic implant may be required in patients with a flat dorsum.

Feature of Black and Asian noses:

  1. Wide, flat, depressed dorsum. (Figs. 12 – 1 to 9)
  2. Inadequate tip projection.
  3. Poorly defined tip: Flattened, bulbous.
  4. Excess alar flaring and wide nostril floor.
  5. Diminished nasal length and height.
  6. Low radix.
  7. Acute nasolabial angle.
  8. Short or retracted columella.

Anatomical Variations:

  1. Nasal bones:
    Short, wide, broad, flattened and depressed.
  2. Alar cartilage:
    Weak, flared, small and diverted with excess fibro fatty intercartilagenous tissue.
  3. Septum:
    Small and thin.
  4. Columella:
    Short and retracted.

 

Fig. 12 – 1. A 24-year-old man of Chinese origin requesting cosmetic nasal surgery. Situation was managed by osteotomies, dorsum graft, new dome creation, division, scoring, undermining, columellar strut, I-beam medial crura fixation, long tip grafts and nares narrowing.

 

  1. Skin:
    Thick.
  2. Alar base:
    Flared alar with wide floor.

Surgical goals
To achieve:

  1. Tip elevation, projection with more definition and refinement:
    By new dome creation, suture fixation, scoring, columellar strut and tip grafts.
  2. Nasal pyramid, narrowing and elevation:
    By dorsal graft augmentation and osteotomies.
  3. Reduce alar flare and nostril size:
    By alar wedge resection.

Surgical Techniques:

  1. Adequate conchal graft obtained. (Fig. 17 – 20)
  2. Closed rhinoplasty approach.
  3. Intercartilagenous and marginal incisions.
  4. Septal graft obtained.
  5. Alar delivery through marginal incision. (Figs. 17 – 12,13,14)
  6. Removal of alar and intra-alar fibro fatty tissue.
  7. Minimal tip defattening. (Fig. 17 – 13)
  8. Minimal cephalic trimming (refreshing) of lateral crus of the alar:
    Minimal trimming because the cartilage is usually soft and small. (Fig. 17 – 12)
  9. New dome creation:
    Two to three mm on the lateral crus is borrowed and added to the medial crus. This will achieve tip elevation, projection and narrowing. (Figs. 8 – 5,6,7 and Figs. 17 – 13,14)
  10. Undermining the borrowed segment with preservation of vestibular skin. This undermining will reduce the tension caused by pulling on the alar side walls, thus, reducing postoperative dimpling and pinching.
  11. Long columellar strut is stitched to the medial crura with the borrowed lateral crus segment in sandwich-like manner (I-beam medial crura fixation). This technique provides maximum structural support for the tip projection. In addition, it is very useful in cleft lip noses. (Fig. 17 – 28)

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