Middle Eastern / Mediterranean Rhinoplasty Virginia
Perhaps no other part of the world embraces Rhinoplasty as much as Middle Eastern and Mediterranean countries do. More Rhinoplasties are performed, per capita, in Tehran – Iran, and Beirut – Lebanon, than any other country in the world. Not only is Rhinoplasty embraced and sought after in these countries, it is at times held as a sign of affluence with patients proudly displaying post-operative casts on their noses even if they have never had a Rhinoplasty!
Middle Eastern and Mediterranean patients, here in the United States, continue the same tradition with some notable exceptions. The predominant Rhinoplasty technique used in the Middle Eastern Rhinoplasty abroad is the “closed Rhinoplasty” with “dorsal reduction,” “tip grafts,” and “alar reduction.” Tip grafts can change the tip into a new shape – the shape of the tip graft. Each Middle Eastern or Mediterranean Plastic Surgeon has his or her own favorite tip graft shape and size. Therefore, in Iran or Mediterranean & Arab countries, it is very common to be able to identify each post-operative Rhinoplasty result by its own particular Plastic Surgeon! It’s essentially as if the Plastic Surgeon has “signed” his name on his work! While some of these noses can look very pretty, most, if not all, undoubtedly will look “operated.” Furthermore, this common Rhinoplasty technique often ends up feminizing male Rhinoplasty noses and creating unnatural pinched tips and bridges and nostrils – all with telltale signs of Rhinoplasty & Plastic Surgery. These statements are obviously generalizations, but they are the predominantly noted and accepted tendency in Iran, Mediterranean & Arab countries. There are certain exceptions to these generalizations and that should be noted and appreciated as well. Some fantastic nose jobs have been done for decades and continue to be done in Iran and the middle-east but there are many more poor outcomes for each beautiful and natural nose.
The pleasant exception that I notice here in the United States is that the vast majority of Iranian, Lebanese, Arab, Saudi, Afghani or other Middle Eastern and Mediterranean patients seek beautiful but natural looking noses. Some still do seek the unnatural “operated” look but it is the responsibility of the ethical Rhinoplasty Surgeon to inform and educate these patients and steer them away from unnatural and fake looking noses. While you can argue that “this is elective surgery and patients are entitled to their wishes,” I would argue that the tragic stories of patients like Michael Jackson also followed similar paths which could have been averted by ethical and responsible Plastic Surgeons. As physicians we must first do no harm!
This is not to say that tip grafts are bad or should not be used. It’s also not to say that alar reduction should be avoided at all costs. On the contrary – these are fine Rhinoplasty maneuvers. However, as in any other Rhinoplasty technique, these maneuvers should be individualized in order to achieve beautiful yet natural and unique results for each and very patient.
Probably the most common feature associated with Middle Eastern or Mediterranean noses is the “nasal hump.” However, there are many unique features seen in Middle Eastern or Mediterranean noses:
- Nasal humps or bumps (but not always present)
- Over projected tips (tip that is too long)
- Under projected tips (tips that are too short)
- Bulbous nasal tips
- Thick skin
- Medium thickness skin
- “Meaty tips” – combination of thick skin with wide and weak tip cartilages
- Droopy tips (ptotic tip)
- Flared nostrils
- Skin color variations from very light to very dark
There is no “best Rhinoplasty approach” for Middle Eastern or Mediterranean Rhinoplasty patients. Similar to Caucasian Rhinoplasty patients, each nose must be examined carefully, problems and potential problems diagnosed, and an individualized Rhinoplasty surgical plan devised. This may lead to a Closed Rhinoplasty or an Open Rhinoplasty. It may include slight to significant tip work, or none at all. It may include alar reduction (nostril narrowing) or it may not. It often includes nasal hump or bump reduction, although not all Middle Eastern or Mediterranean patients have nasal humps or bumps. At the end of the Rhinoplasty, the nose should look beautiful and natural. In women this means feminine, cute and natural. While in men this means refined, strong and natural. It is important to realize that dorsal humps are in relationship to the nasal tip. A droopy nose with a hump will look droopier and longer if the plastic surgeon only removed the nose bump and does not correct the ptotic tip.
- Middle eastern Rhinoplasty patient underwent open structure rhinoplasty by Dr. Naderi to correct her tip shape and position and reduce her dorsal hump to reveal the beauty of her eyes. While to the casual observer is may appear that her aesthetic nasal issue was simply the dorsal hump, the nose job changes involved significant changes to the tip location and shape.
And like any other Rhinoplasty, the Middle Eastern or Mediterranean Rhinoplasty starts with the proper consultation, examination, computer imaging, and dialogue in order to achieve the best Rhinoplasty result. No two noses are identical. During surgery is not the time for by the Plastic Surgeon to make “initial plans.”
The surgeon should have made plans:
- The very first time he laid eyes on the patient
- Then again after examining the patient
- Then again during the computer imaging
- And again the night before surgery as he/she reviews the pictures and plans
- And again during the morning of surgery in the “pre-op holding area”
- And finally right before injecting local anesthetic into the patients nose, prior to making incisions.
This way, the surgeon has planned out and rehearsed the Rhinoplasty in his “mind’s eyes” at least 6 times prior to the actual Rhinoplasty surgery. Similarly, after surgery is not the first time the patient should be seeing his or her potential results. Computer imaging should have taken care of this mystery and prepared the Rhinoplasty patient for the possible new nose and the potential new look.
- As you can see, I did not mention anything about performing Rhinoplasty in Middle Eastern or Mediterranean patients to either change their ethnicity or retaining their ethnicity. The discussion and planning should be about “a nose that fits.” If it looks good and natural, it will fit the face.