Special considerations in northern European primary aesthetic rhinoplasty

Primary aesthetic rhinoplasty in Northern European females presents particular challenges and pitfalls that the rhinoplasty surgeon needs to be aware of. The authors completed a prospective study of 57 consecutive female patients of Northern European descent who underwent primary aesthetic rhinoplasty, with a minimum of 18 months follow-up. The anatomic features and operative techniques used are presented. Pitfalls that make classical steps of reduction rhinoplasty inappropriate are discussed and illustrated by case reports. Attention is drawn to (1) the dorsal hump with an overprojected tip, (2) the enlarged anterior nasal spine and/or posterior septal angle and strong depressor septi nasi muscle, (3) the dorsal hump tension nose, and (4) the bulbous nasal tip with lateral crus recurvature. The authors emphasize the need to maintain structure in the nose to secure middle third and tip support while achieving a balance between dorsal projection and tip position. The limitations and risks of each surgical step versus their potential benefit must be balanced. The surgeon must diligently manage patient expectation and in this population explain that achieving a better nasal shape may take precedence over size reduction.