Long story short; this patient was born in the Middle East and was featured by a heavy, large and typically Arabic nose, including all the anatomical peculiarities of such noses like long, arced and convex hump, poorly defined and droopy tip, inverted or concave lateral cruras, large and broad dorsum, etc; he received an ethnic rhinoplasty of good quality, complying with his goals of having a more refined, Caucasian or European nose; then he regretted due to the social and personal issues this new nose carried to his life in his country; so he was seeking a surgeon anywhere in the world brave, creative and capable enough to rebuild a customized Arabic nose on top of the previous rhinoplasty, thus joining all the challenges of structure rhinoplasties, revision rhinoplasties and ethnic rhinoplasties, submitting the surgeon to the responsibility of developing from scratch such a technical return path to his original ethnicity.
Such a challenge is unique in a surgeon's career and not a technique that may be read in any book; in ethnic rhinoplasties it is quite studied and practiced the conversion from a deeply ethnic nose to a more canonically shaped and adapted to universal standards of beauty; therefore those aesthetic issues on the nose due to the ethnicity are addressed and corrected; in this case it is exactly the inverse way, a non ethnic nose, including dorsum, pyramid, alae and tip, is meant to be a fully ethnic one or even somehow hyperrealist among Arabic or Middle Eastern ethnicities.
For such purpose a surgical technique had to be, literally, invented, beginning with harvesting all the available amount of ear concha bowl cartilage donor site from both auricles; the cartilages were tailored, shaped, carved and sculpted to match the invented structure mimicking an Arabic nose skeleton.
The lateral cruras of the alar cartilages were replaced by two large and custom made new ones, inverted and flipped like in an Arabic nose would be, creating thus the typical concavity at the sides of the tip in these ethnicities.
A new tip was build of larger size and flatter shape, less defined and placed lower than the canonical standard like in Arabic noses is commonly found, to create the typical droopy look and hooked profile in such ethnic tips.
The supratip and the columella also required custom design grafting to be raised and made more prominent.
Finally and probably the most difficult part, a brand new dorsal hump of arced shape was built so that the nose would acquire the heavy and typically Arabic look the patient was dreaming of.
For the first time and unlikely ever again such a structure was designed and executed in a rhinoplasty, that's the reason why custom rhinoplasties are the most creative procedures few surgeons can be capable to perform with dignity and sufficient proximity to success.
The final outcome could not be more successful and closer, almost identical, to the idealized nose the patient sought: all the structural issues perfectly addressed and the nasal profile built as a typically Arabic or Middle Eastern nose.
The peculiarities of this case and the concerns arisen from such weird request to build up a brand new Middle Eastern Arabic nose on a previous rhinoplasty of successful result, made the negotiation with the patient a wholehearted exchange of impressions, advices, wishes and technical opinions in order to secure the reliability of patient's decision, the feasibility of his goals and prevent another post successful surgery regret; this is very well shown in the last of the images in this case, which compares, from left to right, the preoperative profile of the patient, the wish picture simulation supplied by the patient, the manual and physical simulation made by the surgeon with his own hands on patient's nose and, at the right end, the final custom rhinoplasty result achieved, the closest and even improved one it could be.
READ LESS