Palma Pietro, Bignami Maurizio, Delù Giovanni, De Bernardi Francesca, Castelnuovo Paolo
ENT Department, University of Insubria-Ospedale di Circolo/Fondazione Macchi, Varese, Italy.
Facial Plast Surg. 2003 Aug;19(3):279-94. doi: 10.1055/s-2003-43163.
Homogenization of world culture through communications media, refinements in surgical techniques, and improved rhinoplasty results have resulted in a more extended dissemination of rhinoplasty among non-Caucasians. This request has led to increasingly anatomic, morphologic, and anthropometrical studies of the non-Caucasian nose upon which surgical techniques have been proposed and addressed to create in these patients nasal features typical of a Caucasian-looking nose. There are few reports in medical literature concerning rhinoplasty that specifically address particular Caucasian ethnic groups (Anglo-Saxon, Germanic, Latin, and Slavic). Generally included within the Latin group are subjects presenting both paradigmatic nasal morphologies (typically, the classic "Greek," "Roman," and "French" noses) and important cultural differences that greatly influence the subjective perception of the defect and, therefore, the type of change requested. These challenging conditions require a highly "customized" approach, both in the phase of the preoperative planning and in the choice of surgical options. The authors, by means of a photographic analysis systematically used with all their rhinoplasty patients, have identified some archetypes of nasal pyramid configurations that are typical of the reference population (44% Northern Italy, 15% Central Italy, 41% Southern Italy) and, on the basis of a medium/long-term evaluation of the relationship between adopted surgical techniques and results, propose some surgical options that are specific for every nasal archetype. This categorization helps the surgeon carry out a structured preoperative aesthetical analysis and provides him/her with both an anticipation of what findings to expect and the ability to deal with already diagnosed problems. Every archetype shows strong similarities in terms of preoperative analysis, surgical solutions, and subjective perception of the success of the surgery. The surgical options used proved to be apt to modify some paradigmatic defects in a satisfactorily predictable way. Combining the different tesserae of this puzzle to reach the goal of a satisfied patient (and not necessarily a beautiful nose) makes rhinoplasty a true challenge that requires a special talent from the surgeon: combining analysis capabilities, surgical logic, and manual skills with artistic sensitivity.
通过通信媒体实现的世界文化同质化、外科技术的改进以及隆鼻效果的提升，使得隆鼻手术在非白种人中得到了更广泛的传播。这种需求促使人们对非白种人的鼻子进行越来越多的解剖学、形态学和人体测量学研究，并在此基础上提出手术技术，旨在为这些患者塑造具有典型白种人鼻型特征的鼻子。医学文献中很少有专门针对特定白种人族群（盎格鲁 - 撒克逊、日耳曼、拉丁和斯拉夫）的隆鼻报告。通常在拉丁族群中，既包含具有典型鼻形态（通常是经典的“希腊鼻”“罗马鼻”和“法国鼻”）的个体，也存在重要的文化差异，这些差异极大地影响了对缺陷的主观认知，进而影响所要求的改变类型。这些具有挑战性的情况需要在术前规划阶段和手术方案选择上都采用高度“定制化”的方法。作者通过对所有隆鼻患者系统地使用摄影分析，识别出了一些典型的鼻锥体构型原型，这些原型来自参考人群（44%来自意大利北部，15%来自意大利中部，41%来自意大利南部），并基于对所采用手术技术与结果之间关系的中长期评估，为每种鼻原型提出了一些特定的手术方案。这种分类有助于外科医生进行结构化的术前美学分析，并为其提供对预期发现的预判以及处理已诊断问题的能力。每个原型在术前分析、手术解决方案以及对手术成功的主观认知方面都表现出很强的相似性。所采用的手术方案被证明能够以令人满意的可预测方式改善一些典型缺陷。将这个难题的不同部分组合起来以实现患者满意（不一定是拥有一个漂亮的鼻子）的目标，使得隆鼻手术成为一项真正的挑战，这需要外科医生具备特殊才能：将分析能力、手术逻辑、手工技能与艺术敏感性相结合。
