Dr. Mounsey of Toronto Performs Caucasian Rhinoplasty

This rhinoplasty is the traditional rhinoplasty patient. In fact many of the earlier pioneers of rhinoplasty surgery developedtechniques with this group of patients in mind. It is also known as Caucasian rhinoplasty. However, in our diverse society there may be patients within this group who have some characteristics of the other groups of rhinoplasty patients. The surgeon must have experience with rhinoplasty. Although it is impossible to characterize a group of people, some similarities may exist. The rhinoplasty surgeon must be familiar with these characteristics to have the potential to optimize the surgical outcome. The surgeon must have a fundamental understanding of the anatomic variations. The bone in the midline of the nose is called the nasal septum, based on its development the nose may protrude or be less prominent. It is not uncommon in patients this group of patients to have a well projected or over projected nasal tip. The nose may have a tip that is shaped like an equilateral triangle. The dorsal height (nasal bridge) of the nose may be higher. This appearance all have an anatomic underlying basis. The rhinoplasty surgeon must be aware of this and have techniques to restore the balance and proportion of the nose.

The skin and soft tissues can also vary widely between groups. The skin may be thinner and different techniques may be needed to make sure the rhinoplasty procedure is successful. Any shape changes under the skin may show and special techniques may be necessary to camouflage the surgery and create a natural result.

It is important that the surgeon not use a cookie cutter approach to the nose. In fact, many patients who are all considered of “Caucasian” heritage may have very different noses. They may have very different skin thickness. This must be recognized to obtain the best result. Failure to understand these nuances may lead to sub optimal results. The surgeon cannot simply lump all the patients into one group and perform the same procedure. Dr. Robert A. Mounsey holds the view that the rhinoplasty result should be natural, enhancing the physical appearance and improving the breathing. Surgery should not attempt to change the appearance of the nose by making changes so dramatic that it is obvious that a rhinoplasty surgery was performed. Aggressive over resection of tissue is avoided.

The most important role of the rhinoplasty surgeon is to make sure the nasal function is preserved or enhanced. This means the surgeon must understand nasal physiology and anatomy as it relates to the nose. The surgeon must obtain the aesthetic result desired, while maintaining the breathing. If possible breathing should be improved. The starting point of the nose in these patients is quite often at the level of the medial canthus. This must be understood. The skin between the nostrils (the columella) may be relatively long. Attempts to place cartilage in the tip (cartilage grafts) may lead to unsightly deformity if not camouflaged. This must be executed with precision and only in the appropriate circumstances.

The surgeon must have a good understanding of all the complexities of this surgery to inform the patient realistically of what can be achieved. The surgeon can then clearly communicate to the patient about what result to expect, and also tell the patient what is not possible. Rhinoplasty procedures can be the most challenging for an experienced surgeon to obtain the results the patient desires.