Practicing in Miami and NYC for over 20 years, a time during which he has specialized in rhinoplasty, Dr. Epstein has been afforded the opportunity to develop unique skills in addressing the “Hispanic” nose- a term that is somewhat broad in its scope of people it includes. By recognizing the fact that there is no standard of beauty, and that every individual has her/his own concepts of how “ethnic” she/he wishes to appear, Dr. Epstein is able to obtain the information needed from the patient to help achieve the desired results and create a nose that complements the individual’s facial features. While many of the components of rhinoplasty are similar across all patients, there are a number of key steps that are essential to providing successful results in patients of various Latino groups.
Features of the Hispanic Nose
A study from 2011 suggested that there are 14 types of Caucasian noses, varying in terms of the size of the nostrils, the elevation of the tip, and the slope the nose. Generally, there are three types of Hispanic noses: Castilian, Mestizo, and Mexican-American. The features of each of these three types will now be described.
The Castilian nose is often found on people of Spanish descent. The tip of the nose has an average projection and the bridge of the nose tends to be high. This has some relation to the classic “Roman” nose, but not uncommonly the tip support tends to be somewhat less.
The Mestizo nose typically is characterized by weaker cartilage accompanied with thicker skin with prominent sebaceous glands. Compared to the Castilian nose, the nostrils are usually rounded, the columella and other features are shorter, and the bridge is shorter with the base of the nose being wider.
The third type, the Mexican-American nose, is often a combination of the Mestizo nose and the Castilian nose in terms of features. The bridge might be an average height, but the tip tends to droop.
Challenges and Goals of Hispanic Rhinoplasty
Certain features of a Hispanic nose can make rhinoplasty a challenging surgery, particularly with the importance of establishing a strong tip support. Utilizing a similar technique on the many patients who present with weak cartilages (African-Americans and Asians included), Dr. Epstein is able to take the stronger readily available cartilage from the septum and use it to support the tip and columella. This is provided by the advanced technique called the “caudal septal extension graft”, and it is the most powerful tool utilized in rhinoplasty to help achieve the primary important goal of strong tip support. Once the tip is supported, most of the other goals can be achieved: tip refinement, tip projection and rotation, and resistance to drooping as can occur with smiling and aging. Working from the tip, the other desired steps can be performed that can include taking down of a bump and or augmentation/building up of the profile, narrowing of the bridge, reduction of flaring or roundedness of the nostrils, and more.
To achieve the patient’s goals, the surgeon needs to be on the same page as the patient and to fully understand the differences between different noses.
Dr. Epstein’s Keys to a Successful Hispanic Rhinoplasty:
1. Retaining Ethnic Features and Compatibility:
Sometimes yes, sometimes no, but most patients seek to retain some of their cultural appearances, so that the goal is to enhance the nose while maintaining certain characteristics as desired.
2. Understanding – and Enhancing- Facial Harmony
Facial harmony is determined by a patient’s bone structure, facial dimensions, ethnicity, gender, and the aesthetic contours of the face. Facial harmony means that the nose is kept congruent with these other features. Dr. Epstein possesses both extensive technical and surgical skill, as well as the artistry and understanding of facial harmony needed to create a nose that visually appealing with the existing architecture of the face.
3.Maintaining Nasal Function
Given his board certification in facial plastic surgery and Otolaryngology (ear, nose, and throat) Dr. Epstein has extensive experience in also maintaining the strength of the nasal structures that is a requirement for good breathing. Utilizing the external approach permits the surgery to be done “structurally”, meaning it all starts with strong support of the nasal features, from which appearances will follow.
While the ideal nose is not typically a possibility, Dr. Epstein is committed to satisfying his patients’ overall desires for aesthetic results. To accomplish this, first at the consultation he will listen attentively to each patient’s concerns and goals and assess what is realistic. Next he will demonstrate what is recommended based on realistic outcomes, which is supplemented by the computer imaging photos that he will send to the patient by email several days later. This will allow the patient to provide feedback, to help educate Dr. Epstein on what are the actual goals as seen visually. Once he understand what exactly the patient seeks, Dr. Epstein is aable to take those goals into the OR with them as he is doing surgery.
To fully understand Dr. Epstein’s Keys to Hispanic rhinoplasty, it is first necessary to have a grasp of the entire surgical experience. The ethnic nose presents a unique physical structure and often a surgical process, as well as the fact that every patient has specific goals based upon his/her gender, age, race, and personal goals. Once understood, and the specific keys to a successful rhinoplasty are met, it is possible for Dr. Epstein to meet and even exceed the goals of his every patient, whether Latino, Asian, or other.
Unique Rhinoplasty Goals and Desires:
The decision to undergo a rhinoplasty is very personal decision. The shape and form of the nose is more than functional, as it plays a critical role in an individual’s overall aesthetics and can have an impact on one’s self-esteem. The nose must lend balance to the facial structures, as well as ‘fit in’ with a patient’s place in the social environment. Generally, most ethnic patients are looking for a narrowing of the nose, added tip definition, and a nasal bridge that complements the tip. All realistic rhinoplasty patients are ultimately seeking a nose that is proportionate and natural looking on their face.
Rhinoplasty, the Procedure:
Rhinoplasty is typically considered the most challenging plastic surgery procedure, involving sculpting and other maneuvers on the cartilage and bone that are intended to create changes to the overlying skin so that the desired results are achieved in a constant manner. Success requires a surgeon adept at being able to work on the delicate, important nasal structures, performed through multiple steps.
Hispanic rhinoplasty can include one or more of the following correctional procedures:
- stablishing tip support so that it does not droop.
- Reducing the flare of the nostrils and or narrowing the nostrils
- Creating a more aesthetic profile, sometimes if desired eliminating a nasal bump
- Refining the nasal tip, primarily by sculpting it but if indicated by removing some of the nasal cartilage.
- Narrowing the nasal bridge by resetting the nasal bones.
- Improving breathing while reshaping the nose by working on the septum as needed.
External or “Open” Rhinoplasty:
This is the technique Dr. Epstein utilizes in nearly every nose surgery he performs, for the external approach allows for full visualization of all the nasal structures, permitting the cartilage and bone to be sculpted all in its original position so that it not only looks more natural but also keeps its strength. Performed through a tiny incision across the middle of the columella (the bottom of the nose that divides the two nostrils) that connects with additional incisions inside of the nose, external rhinoplasty is unsurpassed in its ability to provide natural appearing results.
Rhinoplasty procedures are one of the most common performed, and while complications are low (especially when the surgery is carried out by an experienced competent surgeon), they can occur. This complications and problems can include infection, poor healing, bleeding, and loss of sensation, and less than desired cosmetic outcomes.
By choosing a board certified surgeon experienced in the procedure you are having, you can help minimize the chance of complcations and problems
Hispanic Patient Rhinoplasty Consultation:
The consultation – whether done in the office in person or by email and photo review- is an important part of the entire rhinoplasty experience. The consult provides the patient with the opportunity to discuss goals and concerns, and to learn what Dr. Epstein recommends. The consultation is an opportunity to develop a mutual trust and to educate both patient and doctor. There are extremely diverse facial features across the Hispanic patient population; Dr. Epstein uses this one-on-one time to individualize each procedure.
Whether the consultation is done in person or online, this step in the Hispanic patient’s rhinoplasty course is invaluable.
Surgical Course and Recovery:
Dr. Epstein performs virtually all of his rhinoplasty surgeries in his accredited office operating room on an outpatient basis. He is assisted by his team of nurses and assistants who work with him every day, while twilight sedation anesthesia is administered by the same CRNA with whom Dr. Epstein has worked since 1996. Usually no packing is placed inside the nose, permitting most patients to breathe the very same day as the surgery. For the first several days, there is typically some swelling and bruising around the eyes- the swelling is usually gone by the third day while the bruising can take 7 to 10 days to resolve. There is surprisingly little pain, rather some discomfort for the first few days, that is treated with appropriate pain medications. A splint goes over the nose which supports the healing of the nasal bones, which is removed usually on the sixth to seventh day, with all sutures removed by the eighth to ninth day. Most patients are fully presentable without any obvious signs of having had surgery, and may resume light activity by the eighth day. Full exercise is permitted within 2 weeks, with the exception of activities that risk hitting the nose which must be avoided for the first 6 weeks.
All rhinoplasty patients should understand that the complete healing process can take up to a full year. Most swelling of the tip in particular can take four to six months to fully resolve, with subtle changes occurring with the nose for as long as a year or longer. The occasional patient is a candidate for a refinement procedure- such as further narrowing of a nostril or a bit more elevating of a nasal tip. While these revisions are not common, they are occasionally indicated, and in most cases are performed under just an oral sedative and local anesthesia.
Through careful consideration when choosing the most appropriate rhinoplasty surgeon, Hispanic patients can expect excellent, long-lasting results. Independent of ethnicity, rhinoplasty patients typically share a common goal of wanting to eliminate unwanted attention from their nose. After rhinoplasty, the nose can be made to properly enhance the face, while allowing for more focus on other features such as the eyes and skin. As long as the key components of Hispanic rhinoplasty are kept in mind, the final product will look natural and organic, not artificial or manipulated. Patients will be happy to continue looking like themselves – only better.
More About Dr. Epstein:
Jeffrey Epstein, MD, FACS has been specializing in rhinoplasty since 1990 starting with his training in Otolaryngology (Ear, Nose, and Throat) at the University of Miami, followed by his completing a one-year fellowship in facial plastic and reconstructive surgery in San Francisco. A Fellow of the prestigious American College of Surgeons, he earned the highest score in the nation on his facial plastic surgery board exams. A leader in the most advanced, result-driven procedures, in addition to his busy private practice, Dr. Epstein is an Associate Clinical Professor at the University of Miami, and has been featured in such magazines as Elle, Vogue, and Ebony.
Consultations with Dr. Epstein are available in his Miami and NYC offices. Online consultations are also provided. All surgeries are performed in the Miami office. Call Dr. Epstein’s office at 212.759.3484 (NYC) or 305.666.5884 (Miami) to speak to a patient advisor and receive more information.