Hispanic Rhinoplasty with Miami Plastic Surgeon, Dr. Bared
Dr. Bared takes a very individualized approach to each rhinoplasty. Although Hispanic rhinoplasty cannot be grouped as being all the same, there are certain considerations which Dr. Bared takes into account with his Hispanic patients. Being of Hispanic descent himself, Dr. Bared personally understands that within the Hispanic patient population, there are a multitude of different nasal types depending on the individual’s background. In some cases, Hispanic noses resemble the Caucasian nose in anatomy and skin thickness. These patients may tend to have longer nasal bones, adequate septal cartilage, and thin nasal skin. Their nasal tip cartilage may have strong, inherent strength. While in other cases Hispanic patients may have a more Mestizo-type nose where the nasal bones may be shorter, the septal cartilage may be smaller, and the skin may be thicker. These patients tend to have inherently weaker nasal tip cartilages.
Assessing skin thickness
Different approaches need to be taken for these different types of cases. While the more Caucasian Hispanic nose may need less tip support, a reduction of a hump, and strategies for the thinner nasal skin; the more Mestizo nose may need other approaches. Individuals with smaller nasal bones, a flatter dorsum, and weaker tip cartilages need adequate tip projection and support. Their rhinoplasty is more of an additive rhinoplasty than a reductive rhinoplasty. If a patient has thinner nasal skin, where the outlines of the cartilages can be made out before the surgery, the rhinoplasty surgeon needs to account for this in the surgery. Techniques need to be employed with either less use of cartilage grafts or the proper placement of cartilage grafts in order to prevent these from becoming evident after surgery. Tip grafting, if employed, needs to be performed with the use of the proper type of cartilage. Even the type of sutures used in the very thin skinned patient is important, as Dr. Bared elects to use more readily absorbable sutures in these cases.
In the very thinned-skinned patient, the procedure itself may even take longer in some cases as Dr. Bared makes every attempt to help prevent post-operative issues related to the thinner skin. Although not every issue can be predicted in the surgery, Dr. Bared tries to employ techniques where most variables can be accounted for. The post-operative management in these cases also varies. In the thin-skinned patient, Dr. Bared tries to avoid the use of steroid injections, relying more on pressure exercises and taping if warranted. In the thicker skin individual, Dr. Bared takes on an entirely different approach. He may elect to use certain types of grafts to help create refinements through the thicker nasal skin covering—grafts which he would not use in the thinner skin patient. The post-operative management is also very important in these cases. In the thicker skin patients, the final refinements often take much longer than the thinner skin patient. The thicker nasal skin needs time to conform and ‘shrink wrap’ over the new nasal anatomy. In these cases, it is not uncommon for refinements to be seen 18 months and even two years after surgery.
Facial plastic surgeon, Dr. Anthony Bared, MD, FACS, describes his techniques for a female Hispanic patient who desired to decrease the projection of her tip and bridge from the profile while preserving very natural appearing results from the frontal view of the nose.
*Each patient is unique and individual results may vary.
Dr. Bared’s practice consists largely of Rhinoplasty Procedure – 70%
The dorsum of the Hispanic patient varies according to each patient and their specific Hispanic background. In some cases, the Hispanic patient may have a hump that needs to be reduced to align their profile. In other cases, the alignment of the dorsum may be adequate. While in yet a third subset of patients, the dorsum actually needs to be raised to provide for proper alignment. Although there is no exact formula for proper dorsal height, the dorsum of the nose should start at about the level of the eyelashes on the profile view. In some cases this means reducing a hump while in other cases this means raising the dorsum. In yet another case, the appearance of a hump may not be due so much to an actual hump but rather to a poorly projected tip and a low radix. (The radix is the area between the eyes known as the root of the nose.) In these cases, Dr. Bared may elect to raise the radix and the tip only thereby “reducing” the appearance of a hump. The dorsum then has to be aligned with the tip to provide for the appearance of adequate tip projection.
During surgery, Dr. Bared takes a very systematic approach to the nasal refinements. Although each specific case is different, he elects to not vary this systematic approach in surgery. Dr. Bared refines the nose from ‘top to bottom.’ That is, he starts by aligning the nasal bones and the upper third of the nose. He then proceeds to align the middle third of the nose called the middle vault. Once these two areas of the nose have been aligned he then proceeds to make the necessary tip refinements. Tip refinement surgery has the most variability in all aspects of rhinoplasty. Adequate pre-operative assessment of the cartilages through the physical examination and proper photography gives Dr. Bared a generally good idea of what to expect in surgery as well as helps him to develop an operative plan. But final assessment is made intra-operatively. The size, shape and strength of the cartilages are assessed. Taking these assessments in to consideration, Dr. Bared then employs certain techniques to help create the desired tip shape and refinements. Hispanic patients with very weak tip cartilages may need adequate projection and grafting while patients with very strong and large cartilages may need suturing and careful reduction of their cartilages. In general, Dr. Bared employs a cartilage-sparing technique for tip refinement. In his thorough understanding of the nose, he makes reductions in very safe areas of the tip cartilages in order to help prevent long term problems while providing for natural appearing tip refinements.
Some Hispanic patients present to Dr. Bared with the complaint of the width of the base of their nose and the size of their nostrils. They come in with the traditional understanding that they need their nostril size reduced. Dr. Bared treads these waters very cautiously with his patients. He reserves actual nostril reduction surgery to only certain cases. In most cases, patients receive adequate nasal base narrowing simply with the projection of the tip. In the majority, of the remaining cases where an actual reduction is indicated, a flare reduction may suffice over and actual base reduction. A flare reduction involves small incisions hidden within the creases on the outside of the nostrils without entering into the nostrils. This has the effect of reducing the width of the base without reducing the size of the nostrils themselves. In an actual base reduction (traditionally referred to as Weir incisions), the incisions are actually carried into the nostrils thus reducing the size of the nostrils. On the occasion when Dr. Bared performs these incisions, he makes careful calculations using a caliper in surgery to help prevent asymmetries. These incisions are also beveled in such a manner so that when they heal they do not turn into depressed scars which are each the telltale signs of a poorly executed nostril reduction.