Middle Eastern Rhinoplasty: nuances, surgical approaches and challenges

Nasal bone and cartilage

Middle Eastern noses usually have a wide bone and broad cartilage structure. This causes the dorsum of the nose to look wide from the front view. The lower lateral cartilages are weak in Middle Eastern patients, resulting in less tip support. According to studies, about 80% of the Middle Eastern population has a crooked nose. This is due to nasal septal deviation (2).

In the Middle Eastern population, generally, the cartilage structure is weak. This is due to an excessive amount of fibrofatty tissue between the cartilages. People that are coming from the Levant region usually have a narrow nasal base compared to other countries in the Middle East. That can be due to the historical occupying of the region by other nations.

Nasal bridge

A very common finding in the nose of Middle Eastern people is a big hump on the dorsum of the nose. The nose looks elongated and downward in the profile view. From the front view, the nose is usually crooked and broad. The nasal bridge in people of Middle Eastern heritage is high or over-projected.

Nasal tip

The nasal tip in Middle Eastern patients looks wide, bulbous, or amorphous on the front view. The tip of the nose is asymmetrical and the nostrils are imbalanced. The tip of the nose is downward and droops even more while smiling. This is due to the weak lower lateral cartilage and causes the nose to look even more elongated. Additionally, the tip of the nose is under-projected which gives the illusion of a high bridge.

Alar base

On the alar base, the ethnic features of Middle Eastern people are alar flaring and wide nostrils. People of Middle Eastern roots can show different degrees of alar flaring. This is a common finding, especially in the African population of the Middle East. The majority of people have hanging columella. This can be one of the factors contributing to a droopy nasal tip.

Skin

Generally, the nasal skin of people with Middle Eastern genetic heritage is thicker than Caucasians. Yet, the thickness of the skin differs among different subgroups of this vast area. People from Arab countries have the thickest skin texture in the region. The oily and thick skin-soft tissue envelope is another distinctive feature.

Surgical approaches for Middle Eastern noses

The correct surgical approach is crucial for the best aesthetic results. During the pre-op consultations, the surgeon examines the nasal structures thoroughly. A good surgeon tailors the best ethnic nose for each patient. Based on the patient’s unique features and desires, the best surgical techniques are chosen.

Nasal structures should be evaluated in relation to the other facial features and not in isolation. For the optimal aesthetic outcome, the surgeon might use several techniques. We would like to talk more about them. Before going into details, it is important to mention that In 80% of cases, the surgery is carried out through an open rhinoplasty approach.

• Dorsum refinement:
  The high dorsum of the nose is lowered and the hump is removed. To narrow the wide bridge of the nose, high and low osteotomies are done.
• Septoplasty:
  To address the nasal septal deviation, septoplasty, and grafting are performed. Sometimes the harvested septal cartilage is insufficient. Thus, the surgeon might need to get some cartilage from the ribs.
  
• Tip refinement:
  To improve the tip of the nose the surgeons use the new dome techniques. They put the cartilage in the desired shape and place by using sutures and stitches to stabilize them. For tip stability and strength, approaches such as cephalic repositioning and cephalic trim are performed. (3) (4) Another effective procedure for improving a droopy or plunging tip is to release the muscle. This also improves tip symmetry. Grafting might be needed to improve cartilage strength as well. To improve the bulbousness of the tip skin defatting is done. Via this technique, the excessive fibrofatty tissue is removed and the tip becomes narrower.
  
• Alar base refinement:
  For people with wide alar base or alar flaring, alar excision techniques are performed. The cephalic trim can also help with the correction of the alar cartilage position. If this doesn’t help, further grafts might be required.

Who is a good candidate for Middle Eastern ethnic rhinoplasty?

The first candidates to be put on the eligibility list are people who would like to address their concerns regarding their nose appearance and shape. Undeniably, Middle Eastern people who request nose shape modifications are potential candidates for this nose surgery to improve the way they look.

The second factor for Middle Eastern ethnic rhinoplasty is having realistic expectations. Sometimes a patient’s request might not be possible to achieve. That can be because of their nasal structures or their facial harmony. The surgeon will talk about possible changes. A realistic expectation prevents post-op disappointment.

To be eligible, the person should be physically and mentally healthy. Before the surgery, the doctor must know the whole medical history of the patient. Also, the patient should be an adult. The best Middle Eastern rhinoplasty outcome is when the nose growth is completed. For this purpose, female patients should be over 16 years old while male patients should be at least 18 years old.

Middle East is the home to a wide range of people with differences. People with Middle Eastern roots are the main group to benefit from this cosmetic surgery. Middle Eastern people live in one of the following regions:

• Persian Gulf countries: Iran, Saudi Arabia, Kuwait, Qatar, Bahrain, and the United Arab Emirates
• North African countries: Egypt, Libya, Algeria, and Morocco
• Regional Groups: Turkey, Afghanistan, Iraq, Syria, Armenia, Palestine, Israel, Lebanon, and Pakistan (5)

Usually, there’s no major difference between the people of these three groups. Yet, minor differences and variations can be seen. The practice of rhinoplasty in these specific countries is Middle Eastern Rhinoplasty.

While researching, you might have seen or heard the terms Jewish nose and Persian nose. 

• Jewish nose: In popular belief Jewish nose is referred to as a big hooked nose with a dorsal hump and a downward tip. The classification for the Jewish nose is more cultural and historical than anatomical. So, the Jewish nose job is not a different branch of Middle Eastern rhinoplasty.
• Persian nose: Persian rhinoplasty pops up when one searches for Middle Eastern nose surgery. The reason is simple. Rhinoplasty rates are extremely high among Iranian and Persian people. Some unofficial reports claim it to be 7 times more than the U.S. No wonder Iran is called the capital of rhinoplasty. According to Google, Iran has the most nose jobs per capita.

Why should I consider Middle Eastern rhinoplasty?

People of non-caucasian origins do not wish to have a Caucasian nose. A Caucasian nose might ruin their facial balance and harmony. Many people might even prefer the final result to look so natural that no one can be able to tell if they have had a nose job. The most requested changes by patients through a Middle Eastern ethnic rhinoplasty are:

• A smaller nose:
  They usually ask for hump removal without over-reducing the nose bridge. Different genders ask for different nose shapes. Female patients ask for a slight curvature while male patients request a straight nasal dorsum. A narrower nose is highly requested by people of this region. Friendly reminder that the bridge should not be too low. Otherwise, it would give a very unnatural appearance.

• A straight nose line:
  Patients ask for the improvement of a crooked nose, septal deviation, and subsequent breathing problems.

Challenges of Middle Eastern Rhinoplasty

Middle eastern rhinoplasty is a complicated branch of nose surgery. The post-op period can be quite challenging as well. Here are some difficulties patients might face after a Middle Eastern ethnic rhinoplasty:

• Longer-lasting swelling:
  Swelling is a common complaint among patients after a nose job. It usually takes two to three months for the swelling to subside. However, due to thick skin, this period can be longer for patients with Middle Eastern roots and can even last for a year. Proper post-op care and avoiding heavy activities help with a fast recovery and swelling problems. In cases of prolonged swelling, the surgeon can help by injecting some steroids.

• Polly beak deformity:
  Skin thickness can cause the possibility of Polly beak deformity. It is the accumulation of excess tissue due to improper tissue and cartilage removal. This is more common among people in the southern regions such as Egypt or of Arabian descendants. Skin thickness also increases the chances of scarring. This situation is easily preventable. An experienced surgeon who performs surgical techniques for different skin types prevents this. Steroid shots after the surgery are also useful for preventing this deformity.

As we mentioned earlier, Middle Eastern rhinoplasty is challenging. It requires years of experience and skillfulness. Choose a skillful surgeon who listens to you and knows the best surgical maneuvers. An experienced surgeon has a deep understanding of what each patient desires.

We made it to the end of the comprehensive Middle Eastern ethnic rhinoplasty article. Now, you know the differences between Middle Eastern rhinoplasty and other types of rhinoplasty.

We hope you got the answer to every single question about the art of Middle Eastern nose jobs. If you have any further questions or ask for more pieces of information, we will be glad to assist you. Do not hesitate to contact us. A professional consultant will reach back to you in no time. They help you get the perfect nose harmonious with your precious ethnic identity.