aRTiCLE | RHInOplasTy | preserve some ethnic character when performing the
operation. This being said, the patient’s wishes and desires must always be kept in mind. It is sometimes said that it is the patient who decides whether the nose is abnormal or not. although understandable, this way of thinking may also be dangerous. It is necessary to warn against surgery that intends to make a ‘normal’ nose look more beautiful. The typical Caucasian nose is described as leptorrhine,
meaning long and narrow. It has been theorised that life in colder areas has led to Caucasians adapting to cold and sun deprived conditions, resulting in their characteristic nasal configuration4, 5
. The most common
problem faced by Caucasians is a larger sized nose. This makes procedures relatively simpler than working on other ethnic groups, in whom enhancement, narrowing and inserts are required. The Middle Eastern or arabic nose is characterised by
being long, slightly humped, and having a pendant tip with a small nasolabial angle and occasionally, a hanging columella (Figure 2). The tip is more caudal than normal and occasionally, under‑projected at the same time. This characteristic configuration may also be found in those of Turkish, Greek and Italian descent. It has been proposed that these characteristics are
the result of genetic, endocrine and environmental factors4, 5
. Dusty, hot climates — especially in the Gulf
region — lead to an increased incidence of allergic rhinitis. In an attempt to widen the internal nasal valve, excessive use of the lower nasal muscles, especially during development, may lead to such characteristic features. The arabic nose is often of little concern to males unless the features are markedly exaggerated. In females, it poses more of a problem and may cause psychological disturbances in teenagers. psychological counselling is of utmost importance for
the majority of patients seeking rhinoplasty. The patient must have a clear understanding of what the surgery entails and realistic expectations. It is very helpful to show the patient before and after pictures of other patients with similar appearances. The importance of obtaining informed consent cannot be overemphasised. Keeping in mind the huge variation in nasal shape and
perceptions with regard to beauty, the characteristics of the arabic nose can generally be corrected using simple endonasal techniques. To achieve the best possible results and patient satisfaction, both functional and
Figure 2 Typical Arabic nose in a female pre- (A and B) and postoperatively (C and D), demonstrating correction of nasal hump and pendant tip
Figure 1 Anatomy of the nose
aesthetic aspects of nasal surgery should be considered by the surgeon at all times.
Rhinoplasty techniques Reconstructive nasal surgery was first developed in ancient India. Rhinoplasty was used to reconstruct noses that were amputated as a punishment for crimes. The precursors to modern rhinoplasty were Johann Dieffenbach (1792–1847) and Jacques Joseph (1865–1934), who used external incisions for nose reduction surgery. In 1973, Wilfred s. Goodman helped to initiate the open
rhinoplasty technique. Before this time, all rhinoplasty surgeries where performed using the closed technique. and in 1987, Jack p. Gunter popularised the use of the open rhinoplasty to approach secondary rhinoplasty.
Closed rhinoplasty The main advantage of this technique is that there are no visible scars. although this surgery does not offer quite as much freedom as an open rhinoplasty, it still offers a number of possibilities.
Open rhinoplasty Using a columellar incision with skin elevation allows excellent visualisation of the nasal tip, and is especially useful in revision surgery.
Common rhinoplasty techniques There are a number of common techniques that the
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