Aesthetics and the Hispanic rhinoplasty.

OBJECTIVES/HYPOTHESIS: Current aesthetic standards for rhinoplasty have been formulated for an Anglo-American population. Nevertheless, these standards vary, and it is doubtful that these norms are universally applicable to Anglo populations, much less Hispanic ones.

STUDY DESIGN: A retrospective study was carried out to determine how the Western norms apply to rhinoplasty populations of Anglo and Hispanic background. The effectiveness of rhinoplasty techniques used in Hispanic rhinoplasty were assessed.

METHODS: The open approach was used frequently to augment the nasal skeleton in this population with thick skin. Techniques were primarily aimed at achieving symmetry, straightening the dorsum, and improving projection, since these Hispanic patients were less interested in tip definition or alar base narrowing.

RESULTS: Hispanics were significantly more likely to have dorsal humps, saddle deformities, dependent alae, retracted columellae, and poor tip projection. The nasolabial (columellar-labial) angle method of assessing tip rotation was not accurate in the Hispanic population. Tip definition was better in Anglos, and skin thickness and base width were greater among Hispanics. Rhinoplasty can be effective in achieving aesthetic norms: As a group, the Hispanic profile was brought into greater conformity with the aesthetic norms than their Anglo counterparts who did not have surgery.

CONCLUSIONS: Thick nasal skin does not adapt well to a small osteocartilaginous framework, and it is better to augment and strengthen the skeleton with cartilage grafts. Even among Anglos, the Western artistic canons are merely guidelines. Good communication with the patient is more important than adhering to aesthetic norms.