Hispanic Ethnic Nose Reshaping by Rhinoplasty Specialist Dr. John Hilinski

Hispanic rhinoplasty is a particular type of cosmetic nose reshaping involving noses with very specific ethnic features. Hispanic rhinoplasty has also been referred to as Latin rhinoplasty or Latino rhinoplasty by many patients. For purposes of this discussion, the term Hispanic rhinoplasty includes patients from Spain, Mexico, Portugal, Puerto Rico, Cuba, Central America, and South America who are considering cosmetic nose reshaping. Like all other types of ethnic rhinoplasty, management of the Hispanic nose requires a thorough understanding of the common issues encountered within this particular patient population. It should be noted that there is a fairly wide variability in the appearance of the Hispanic rhinoplasty patient. This is based on the fact there are distinct intra-ethnic differences within the Hispanic population. For instance, Hispanic rhinoplasty patients with ancestry based more in Central and South America tend to have noses that look somewhat different from those with more of a Spanish heritage. That being said, there are many common features of the Hispanic nose that are encountered regularly by the experienced rhinoplasty surgeon.

Common Features of the Hispanic Nose

Thick Nasal Skin

One of the most common features in the Hispanic nose is moderately thick skin. In many cases, the Hispanic nose will have thicker than average skin with more concentrated sebaceous glands. This often times translates into a nose that looks less defined in terms of the surface anatomy. This is largely because the thicker skin does not allow the underlying cartilage and bone to show through as easily as thin skin.

Weak Tip Cartilage

In addition to thicker skin, the Hispanic nose tends to have weaker tip cartilage. This further compounds the problems related to thick skin since the underlying native cartilage is frequently too thin to adequately shape the overlying soft tissue. This concept is shown in the adjacent rhinoplasty patient photo. This young Hispanic female from San Diego, CA has very thick nasal skin as can easily be appreciated. She also has fairly weak, thin nasal cartilage that is insufficient to provide a well-defined supporting shape to the nose. The end result of this combination of thick skin and thin cartilage is a lack of definition of the nose. In this instance, it makes her nose look too wide, particularly in the region of the nasal tip. Many rhinoplasty surgeons refer to this as a bulbous nasal tip – as it looks more rounded than desired, like a bulb.

Dorsal Hump

Another common characteristic of the Hispanic nose is a dorsal hump, or convexity. This is a feature that is best seen from the profile view but is also appreciated on the oblique (45 degree angle) view. This is shown in the adjacent photo diagram of another Hispanic rhinoplasty patient from San Diego, CA. As you can see, her nose has a curvature along the bridge, which is commonly referred to as a hump or bump by many rhinoplasty patients. In this particular patient, the bump is composed of both cartilage and bone and extends along the entire length of her nasal bridge. In some male Hispanic patients the dorsal hump is mostly bone with very little cartilage prominence. In many cases, the dorsal hump or bump will create the appearance that the nasal tip is drooping down more than desired. If a ptotic (pronounced ‘tot-ik’) nasal tip also exists (also known as a drooping tip), the dorsal hump will make it look even more obvious.

Wide, Flared Nostril Base

Many Hispanic noses also have an excessively wide nostril base. The nostril base refers to the bottom of the nose where it attaches to the upper lip. This is shown in the adjacent rhinoplasty diagram as indicated by the double arrow spanning the two nostrils. When measured across, a good number of Hispanic noses are found to have an excessively wide nostril base. In addition to being wide across, many Hispanic noses are also flared, which refers to an excessively rounded shape at the nostril base. This is represented by the red curve in the adjacent diagram, showing how this particular Hispanic rhinoplasty patient has a flared nostril base.

Hispanic Nose Reshaping

One of the key considerations when performing Hispanic rhinoplasty is overcoming the relatively thick nasal skin. This typically means that more effort has to be put forth to reshaping the cartilage framework in this type of nose.

To better understand this concept, you can think of the nose as a classic tent structure. The nasal skin would be analogous to the covering of the tent, while the cartilage framework of the nose would be similar to the structural supporting poles holding the tent up. As you can see in the adjacent photo, the tent gets its general shape from the underlying poles holding the outer covering in a certain position. If the outer covering of the tent was made to be excessively thick and heavy, the tent would likely not have the same defined shape and angulation as is seen in the photo. And if the supporting tent poles were inherently weak, they would provide even less structural support for the thick, heavy outer covering. The end result would be a tent that did not prop up as high, thus appearing broader and perhaps more rounded. In order to give the thick, heavy outer covering of the tent (Hispanic nasal skin) a more defined shape, the underlying supporting poles (nasal cartilage framework) need to be reinforced by making them stronger.

In the Hispanic nose, this is accomplished with use of cartilage grafting often times taken from the septum, ear or rib. In a majority of these cases, it is the nasal tip that requires grafting in order to achieve better definition and refinement. In these patients, cartilage grafts are strategically placed on top of the native tip cartilage. Some of the more common grafts used for this purpose include shield-shaped tip grafts and lateral crural rim grafts. Once the nasal skin redrapes over the newly rebuilt tip cartilage framework, it should have more shape and definition than before.

One must keep in mind that the goal with nasal tip reshaping in the Hispanic nose is to simply move away from looking too round and wide. The goal is not to create a nasal tip that is markedly narrowed and more fitting for a Caucasian face. Of course the patient would like to see a definitive change in the shape of the tip, but this has to be done while maintaining ethnic consistency.

When it comes to reducing the height of the dorsal bridge in the Hispanic rhinoplasty patient, one must avoid aggressive change in this regard. The goal in Hispanic rhinoplasty patients should be to straighten the bridge on profile view and provide a gentle transition into the nasal tip region. In fact, some Hispanic rhinoplasty patients even request that a slight convexity be left intact when reducing the bridge. Over aggressive bridge height reduction in the Hispanic patient can easily result in a nose that simply does not harmonize with the surrounding facial features.

Management of the wide, flared nasal base in the Hispanic rhinoplasty patient usually involves removal of the excess soft tissue volume contributing to the excess width. In some patients this requires what is called a sill incision. The sill of the nose is the bottom border of the nostril when looking at it from under the nose. By removing a segment of this tissue and suturing the edges back together, the nostril base can be brought in closer to the midline, thus narrowing the base. In other Hispanic patients, a wedge of soft tissue is removed from the outer border of the nostril base, which more directly addresses the flaring component. And then there are certainly those patients that require a combination of the sill and wedge incisions to appropriately narrow the nasal base.

Hispanic Rhinoplasty Results

Below are examples of Hispanic rhinoplasty performed by Dr. Hilinski.

Hispanic Rhinoplasty Example 1

This female Hispanic patient is the one featured above in the discussion section. She underwent an open septorhinoplasty to help reshape her nose. As you can see in her before and after rhinoplasty photos, there has been a significant improvement in the overall shape of her nose. More specifically, her nasal tip has been narrowed so there is much less attention now drawn to this area. This is best appreciated on her frontal view. What made this particular case so difficult was the thickness of her skin. Since we typically do not remove skin during rhinoplasty surgery, other measures were required in the recovery period to ensure her skin would shrink-wrap down on the newly reshaped cartilage. Over time a series of steroid injections were performed into the tip region to counteract unwanted scar tissue formation while encouraging the skin to shrink down appropriately. On the oblique and profile views you can appreciate how the dorsal hump deformity was reduced and the bridge height was brought down. As you will also note, her face still appears ethnic – as it did prior to the rhinoplasty procedure. However, her nose is now much more proportional for her face without unwanted attention being drawn to the midface region.

Hispanic Rhinoplasty Example 2

This female Hispanic patient is another one featured above in the discussion section. She underwent a cosmetic rhinoplasty procedure primarily to address the dorsal hump and to narrow the tip. As you can see in her before and after photos, her dorsal hump was brought down appropriately without creating a scooped appearance. This is vital when performing Hispanic rhinoplasty. On the frontal view, take a close look at her nasal tip. Prior to nasal reshaping, she had a somewhat wide tip for her face. But this was not a case where the nasal tip was considered grossly out of proportion for her face. During the rhinoplasty procedure, the tip was narrowed, but only enough to provide improved definition. Careful attention was paid to avoid creating a nasal tip that was too sculpted or pinched, which would clearly not be fitting for an ethnic face. Overall, you can see that her nose is improved and the bothersome features have been addressed. And most importantly, she still looks like herself and her Hispanic ethnic features have been preserved.

Hispanic Rhinoplasty Example 3

This patient from San Diego, CA is a good example of Hispanic rhinoplasty in a male patient. His main issue was a prominent dorsal hump although he also desired to have his tip reshaped at the same time. With regard to his bridge, a radix graft was placed to elevate the upper portion of the dorsum at the same time the hump was reduced. The radix graft is a small segment of septal cartilage that was strategically positioned in between the eyes. This was done to preserve a strong, masculine bridge height – which is even more important in the Hispanic male rhinoplasty patient. Had we chosen to simply reduce the bridge height even more (without placing the radix graft) to create a straighter profile, there would have been a risk of making his nose appear too small for his face. The nasal tip was then reshaped to create more definition and symmetry. Overall, you can appreciate that he has not lost any of his true Hispanic facial features, yet his nose is clearly improved in terms of the shape and size.

Hispanic Rhinoplasty Example 4

This patient from San Diego, CA is a good example of base reduction in the Hispanic rhinoplasty patient. As you can see in her preoperative photograph, her nasal base is wide with unwanted flaring. She underwent cosmetic nose reshaping to address this issue as well as to refine her nasal tip region. As you can easily appreciate, she has a nice improvement in the appearance of her nasal tip and base region. There is definitely more refinement and shape, but without looking pinched or too narrowed. When looking more specifically at her nostrils, the nasal base has now been narrowed and looks less flared overall. The end result is an ethnically consistent nose that still looks as if she could have been born looking just like this.