Rhinoplasty for the Mediterranean nose.

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.