The non-Caucasian nose

George C. Peck, MD Steven M. Hoefflin, MD Christian I. Guzman, MD Ferdinand Ofodile, MD Dr. Peck: The first patient is a 25-year-old woman, seeking primary rhinoplasty, who complains of a wide nose and no tip projection (Figure 1). Dr. Guzman, how would you approach treating this patient? Figure 1. This 25-year-old woman complains of a wide nose and no tip projection. Dr. Guzman: This woman typifies African-American patients undergoing rhinoplasty. She has a low radix, decreased nasal length, foreshortened tip, acute columella-tip angle, and wide alar base. I would certainly use the open approach for a nose like this one. But her skin is very thick, so there are limitations to what can be achieved as far as shape or definition. The nose will need some dorsal grafting; for this, I would use septum, if possible. A tip graft would enhance projection. I would use a columella strut to reinforce the entire area, followed by an onlay graft. I routinely trim the lower lateral cartilage. Dr. Peck: What about infracture for this patient? Dr. Guzman: No, not on this patient. Dr. Peck: Would you modify the chin? Dr. Guzman: Her chin is a little recessed and would benefit from a small implant. Dr. Peck: Dr. Hoefflin, how would you improve this patient's appearance? Dr. Hoefflin: I think you have to have a very specific plan, or you will get into trouble midstream. Starting at the nasion, I would add a small amount of soft tissue. Usually, I like to isolate my donor sites to the retroauricular area. I take a large part of the conchal cartilage to create a “pea pod–shaped” tip graft; then I take a portion of the postauricu-lar fascia, which I will use as a small nasion-glabellar graft. For dorsal augmentation, my preference is septal cartilage, usually wrapped …