Nasal Component African American Asian Middle Eastern Hispanic
Radix Shallow Shallow Shallow; Superiorly displaced Type I (Castilian): Normal
Type II (Mexican American): Shallow Type III (Mestizo): Shallow Operative
considerations
Augment Augment Augment cautiously due to
narrow inter-canthal distance
I: Nothing or reduced II: Augment III: May augment
Nasal bones Short; Wide; Flat Short; Wide; Flat Long; Wide I: Wide
II: Normal to wide III: Wide Operative
considerations
Avoid osteotomies or Low-to-low; Augment
Avoid osteotomies or Low-to-low; Augment
Low-to-low osteotomies;
Spreader grafts/flaps
I: Osteotomies typical II: Usually not needed III: Osteotomy
Dorsum Low; Small hump;
Recessed ASA
Low; No hump Large hump; High ASA;
Deviated
I: High (normal radix/low tip) II: Normal (low radix/tip) III: Normal, but varies Operative
considerations
Dorsal onlay graft Significant dorsal onlay graft
Hump reduction may reveal deviation
I: Reduction; Spreader grafts II: Avoid reduction, may smooth or augment
III: Variable
Nasal length Short Short Long I: Long
II: Normal, less often long III: Short
Operative considerations
SEG; Extended spreader graft; Infratip graft
SEG; Extended spreader graft; Infratip graft
Tip rotation; Caudal septal trim; CSS; Hump reduction
I: Caudal septal resection II: Resection typically not required III: CS
Mid vault Low Low Narrow; Long ULC I: High
II: Normal height III: Variable Operative
considerations
Deficient septal donor cartilage
Deficient septal donor cartilage
Spreader graft I: Lowered; Spreader grafts II: Often nothing III: Variable Tip Under-projected; Wide;
Ill-defined
Under-projected; Wide;
Ill-defined
Under-rotated; Under- projected; Bulbous
I: Normal projection, or over II: Under-projected; Dependent III: Wide; Under-projected Operative
considerations
Add support; CS; Tip graft;
Cephalic trim/turnover
Add support; CS; Tip graft; Cephalic trim/turnover
Projection dependent on dorsum; CSS; Tip sutures; CS;
Cephalic trim/turnover
I: Cephalic trim, +/-Suture II: Project; CS; Tip graft; Suture III: Project; Cephalic trim; Suture; CS;
Strong tip graft
LLC Wide; Thin Wide; Thin; Wide domes Weak; Mal positioned I: Often wide
II: Often weak
III: Often weak, wide dome Operative
considerations
CS; LLC turnover;
Lateral crural strut
CS; LLC turnover;
Lateral crural strut
CS; LLC turnover; Lateral crural strut; Reposition; Rim graft
I: Cephalic trim, +/- Suture II: Project; Add support
III: Project; Narrow; Support; Strong tip graft
Columella Short Short; Wide Hanging III: Short; Retracted
Operative considerations
Project tip; CS; SEG Project tip; CS; SEG Septal resection; CSS III: CS
Alar bases Wide sill (ill-defined) Wide sill (defined) Alar flare I/II: Variable III: Wide Operative
considerations
May treat at end May treat at end May treat at end I/II: May treat at end III: Wide undermining; Debulk;
Resection
Nostrils Horizontal, short Horizontal, short Asymmetry I/II: Variable
III: Large, Round Operative
considerations
Alar contour grafts Alar contour grafts Re-evaluate at end I/II: May treat at end
III: Wide undermining; Debulking;
Resection
Skin Thick; Sebaceous Thick; Sebaceous Thick; Sebaceous I/II: Variable
III: Thick Operative
considerations
Cautious fat resection;
Taping
Cautious fat resection;
Taping
Cautious fat resection; Taping I/II: Variable
III: Graft; De-fat; Wide undermining for re-drape
