Rhinoplasty for East Asian patients: key features and considerations

What is different about rhinoplasty for East Asian patients?

The shared goal of rhinoplasty is to create a natural, attractive nose that is in harmony with the rest of the face ^[1]. However, the East Asian nose differs from the Western nose in its anatomy and aesthetic standards, so surgery is described as needing its own approach that reflects those differences ^[1].

Skin is often cited as a key difference. The East Asian nose has thick layers of skin and soft tissue, and rhinoplasty in East Asian patients is regarded as one of the more difficult forms of rhinoplasty across ethnic groups ^[2]. When the skin is thick, the visible change can be limited even if the structure underneath is altered.

A review of rhinoplasty in non-Western patients stresses that understanding how culture, race, and ethnicity are intertwined is necessary to properly identify the aesthetic ideal a patient has in mind and the surgery it requires ^[6].

What are the goals of rhinoplasty?

A review of rhinoplasty in East Asian patients sets out three goals: patient satisfaction, an aesthetically pleasing result, and preserving a natural look ^[2].

The authors considered patient satisfaction the hardest of the three to achieve ^[2]. This is because there is often a gap between the look a patient wants and the result that is actually possible. For this reason, the authors stress that a careful review of the preoperative examination, records of any previous surgery, photographs, nasal analysis, a list of problems, and the surgical plan is essential ^[2].

Materials for raising the bridge of the nose

In surgery to raise the bridge of the nose, your own cartilage is still regarded as the standard ^[3]. However, synthetic implants are also widely used in East Asian rhinoplasty, and one review notes that combining several materials can improve results while reducing complications ^[3].

In Asian countries, rhinoplasty to raise the bridge of the nose is a common cosmetic operation, and silicone implants are described as the most widely used material ^[4]. In Western countries, by contrast, synthetic materials are often not recommended because of the risk of infection and of the implant pushing through to the surface (extrusion) ^[4]. Long experience built up in Asia is given as the reason silicone rhinoplasty is commonly performed there ^[4].

Complication rates with silicone implants vary greatly depending on the surgeon's experience, the surgical technique, and the implant design, and silicone is described as an option for augmenting the bridge when precautions are followed ^[4]. Every material has pros and cons, so the choice should be discussed based on the condition of your nose.

When a short nose is corrected at the same time

Surgery to raise the bridge has been widely performed to correct the short East Asian nose, which has a low bridge, a short columella (the strip of tissue between the nostrils), and a poorly defined tip ^[5]. More recently, simply raising the nose has been considered inefficient, and many surgeons are reported to lengthen the nose while raising it ^[5].

Factors that affect how much the nose can be lengthened include the condition of the cartilage, the condition of the lining and skin, and whether there is fibrosis (scar-like stiffening of tissue) and how severe it is ^[5]. It is also stressed that the amount of lengthening should be decided before surgery, based on aesthetic considerations ^[5]. If fibrosis is present, how far the nose can be lengthened and the surgical plan may change depending on its severity ^[5].

A consultation that aligns expectations with reality

According to a review, many patients have unrealistic goals, such as an overly narrow Western-style nose, or bring photos of celebrities or models and expect the same result ^[2]. However, that look may not suit their face, or the nose may end up looking overly reduced and pinched ^[2].

The authors considered it an important part of the surgeon's role to explain that such results can cause functional problems, may not suit the face aesthetically, and are hard to achieve with the patient's skin ^[2]. They also note that discussing the desired look, the expected results, and possible complications in detail can reduce misunderstandings between surgeon and patient ^[2].

What to ask during your consultation

The results of rhinoplasty vary from person to person depending on skin thickness, the condition of the cartilage, any previous surgery, and the proportions of the face as a whole. For non-Western patients, an integrated approach that considers both medical and surgical options has also been proposed ^[6]. Consider checking the points below during your consultation.

• How your skin thickness and soft tissue will affect the result
• Whether an implant, your own cartilage, or a combination of materials will be used, and why
• Whether lengthening or tip correction is needed in addition to raising the bridge
• Possible complications, such as infection and implant extrusion
• The surgeon's opinion on whether the look you want suits your face and nasal function