Technical Principles for Preserving Mediterranean Identity in Rhinoplasty
Start with ethnic proportions, not a template
Ethnic rhinoplasty literature consistently emphasizes respecting the native nasal–facial relationships, including radix position, dorsal height, tip projection and rotation, and nasal width, rather than applying a standardized “ideal” nose.
The goal is to improve proportion within the patient’s facial identity, not to replace it with a generic shape.
Dorsum strategy: preservation when appropriate, component reduction when needed
Modern dorsal preservation techniques (pushdown and let-down techniques) are increasingly discussed in the literature for their ability to maintain natural dorsal aesthetic lines and avoid an over-operated appearance.
However, these techniques are not universal. Proper case selection remains essential, and some noses still benefit from traditional component reduction.
Practical principles:
Preserve dorsal lines when anatomy allows; avoid pursuing an excessively low dorsum.
When reducing a hump, maintain middle vault stability to prevent inverted-V deformity and dorsal irregularities.
Choose the least identity-erasing approach: in many cases, less reduction with better contour creates a more natural result.
Middle vault (upper and middle third) protection to avoid the “over-narrow” look
Over-reduction and middle vault collapse are common causes of a nose that appears narrow, pinched, or surgical.
Practical principles:
Conservative osteotomies with controlled narrowing rather than routine aggressive narrowing.
Structural midvault support when indicated, using spreader grafts or flaps to preserve dorsal width and airflow.
Tip strategy: support first, refinement second
Ethnic rhinoplasty literature highlights that technique choice must be based on anatomy, including skin thickness, cartilage strength, and baseline support, rather than on aesthetic labels (I mean trends).
In many Mediterranean noses, definition is achieved not by making structures smaller, but by supporting and reshaping the framework so the skin envelope drapes more predictably.
Practical principles:
Establish strong tip support with cartilage grafts to maintain stable projection and rotation.
Refine shape through structural framework design rather than excessive cartilage reduction.
Thick skin: managing the envelope and prolonged swelling
Thicker nasal skin (common in Middle Eastern rhinoplasty) is associated with slower resolution of swelling and delayed definition.
Recent reviews focus on addressing the soft-tissue envelope and dead space (where swelling can accumulate), not only the cartilage.
Responsible strategies include:
Pre-operative skin preparation (retinoids) in selected patients.
Conservative and selective surgical soft-tissue thinning when appropriate.
Careful dead-space control and postoperative taping to guide healing.
Targeted postoperative edema management (corticosteroids, retinoids and doxycycline) when clinically indicated.
Preventing overcorrection by treating what truly matters
Mediterranean rhinoplasty literature describes common archetypes and emphasizes refinement while maintaining recognizable relationships between the radix, dorsum, and tip.
Overcorrection happens when the focus is only on reduction. The objective is not to reduce every feature, but to:
Correct the dominant disharmony (such as a hump, drooping tip, deviation, or excessive width).
Excessive narrowing, over-lowering of the dorsum, or aggressive tip rotation can remove defining features and weaken facial harmony.
Preserve key ethnic cues, including dorsal strength, appropriate width, and facial proportion.
The most successful results are often subtle where people notice you look better, but can’t say exactly why.
