Rohrich Rod J, Ghavami Ashkan
Dallas, Texas; and Beverly Hills, Calif. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2009 Apr;123(4):1343-1354. doi: 10.1097/PRS.0b013e31817741b4.
Rhinoplasty remains one of the most challenging operations, as exemplified in the Middle Eastern patient. The ill-defined, droopy tip, wide and high dorsum, and thick skin envelope mandate meticulous attention to preoperative evaluation and efficacious yet safe surgical maneuvers. The authors provide a systematic approach to evaluation and improvement of surgical outcomes in this patient population.
A retrospective, 3-year review identified patients of Middle Eastern heritage who underwent primary rhinoplasty and those who did not but had nasal photographs. Photographs and operative records (when applicable) were reviewed. Specific nasal characteristics, component-directed surgical techniques, and aesthetic outcomes were delineated.
The Middle Eastern nose has a combination of specific nasal traits, with some variability, including thick/sebaceous skin (excess fibrofatty tissue), high/wide dorsum with cartilaginous and bony humps, ill-defined nasal tip, weak/thin lateral crura relative to the skin envelope, nostril-tip imbalance, acute nasolabial and columellar-labial angles, and a droopy/hyperdynamic nasal tip. An aggressive yet nondestructive surgical approach to address the nasal imbalance often requires soft-tissue debulking, significant cartilaginous framework modification (with augmentation/strengthening), tip refinement/rotation/projection, low osteotomies, and depressor septi nasi muscle treatment. The most common postoperative defects were related to soft-tissue scarring, thickened skin envelope, dorsum irregularities, and prolonged edema in the supratip/tip region.
It is critical to improve the strength of the cartilaginous framework with respect to the thick, noncontractile skin/soft-tissue envelope, particularly when moderate to large dorsal reduction is required. A multitude of surgical maneuvers are often necessary to address all the salient characteristics of the Middle Eastern nose and to produce the desired aesthetic result.
隆鼻术仍然是最具挑战性的手术之一，中东患者就是例证。鼻尖轮廓不清晰、下垂，鼻背宽且高，皮肤包膜厚，这些情况都要求在术前评估时格外细致，并采用有效且安全的手术操作。作者提供了一种系统方法，用于评估和改善这类患者群体的手术效果。
一项为期3年的回顾性研究，纳入了接受初次隆鼻术的中东裔患者以及未接受手术但有鼻部照片的患者。对照片和手术记录（如适用）进行了审查。明确了特定的鼻部特征、针对各个部位的手术技术以及美学效果。
中东人的鼻子具有多种特定的鼻部特征，存在一定差异，包括厚/油性皮肤（纤维脂肪组织过多）、带有软骨和骨隆突的高/宽鼻背、鼻尖轮廓不清晰、相对于皮肤包膜而言外侧脚薄弱/纤细、鼻孔-鼻尖失衡、鼻唇角和鼻小柱-唇角锐角以及下垂/动态过度的鼻尖。解决鼻部失衡问题通常需要采取积极但非破坏性的手术方法，这往往包括软组织减容、对软骨框架进行重大修改（通过植入/加强）、鼻尖细化/旋转/抬高、低位截骨以及处理降鼻中隔肌。最常见的术后缺陷与软组织瘢痕形成、皮肤包膜增厚、鼻背不规则以及鼻尖/鼻尖上方区域的长期水肿有关。
对于厚且无收缩性的皮肤/软组织包膜，增强软骨框架的强度至关重要，尤其是在需要进行中度至大幅度鼻背降低时。通常需要多种手术操作来解决中东人鼻子的所有显著特征，并产生理想的美学效果。
