Tent Pole/Teepee in Ethnic Rhinoplasty

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In this podcast, I’m going to be talking specifically about one element of the ethnic rhinoplasty. There are so many things I could talk about and as well as focusing on different types of ethnicity to Hispanic, Asian, African American, etc. Basically the term ethnic rhinoplasty is a very broad term that encompasses all ethnicity other than white. So it is not very descriptive in many respects, but there are some commonalities in certain ethnicity that are not white. Basically it’s oftentimes a thicker skin envelope and a thinner framework. In other words, the cartilages are a little bit thinner flimsier not as strong. And this combination of thick skin and then cartilage can also exist in Caucasians or whites. So it is not universal in nature. However, there’s one element or one image that I will discuss with you and I have discussed in the past and a video on ethnic rhinoplasty that I think is helpful to communicate to you as a prospective patient or someone interested in ethnic rhinoplasty to understand how I deliver on it.

So it, I call it the tent pole analogy. So if you think of a teepee or a tent pole, the teepee has a fabric on the outside and then it has the poles on the inside. So the poles inside represent the cartilage or the bone structure. And we’re going to say cartilage, cause most of the lower two thirds of the nose is cartilage. And that’s what you’re really reshaping. And the bones are oftentimes very similar nature anyways, across the many of the ethnicity. But the cartilage is the inside of the tent poles and the fabric outside the skin. So to use that analogy, in a standard Caucasian or white rhinoplasty the fabric on the outside is very thin or thinner sometimes it’s thick, but for the sake of argument here is oftentimes thinner and then the tent poles inside are very strong.

So when you can easily reshape the poles inside and you can see through that fabric the result. But the exact opposite is the case in an ethnic nose where if you try to over shave down the inner cartilage, the problem is that that outer thick fabric never sits down on it and it weakens the whole framework. So the whole thing sort of moshes or collapses. So you can also, you can build up actually more scar tissue and have a worst result. I remember very clearly about five years ago, this Hispanic lady came into me who had her rhinoplasty done in El Paso and said, why does my nose look bigger now after my surgery instead of smaller? And so I did a little scar dissolve and her nose got better, but it’s because the doctor over reduced the cartilage inside. So a technique that I do for these thick skin inside flimsy tentpoles is instead of weakening the tentpoles by shaving down the cartilage and refining the inside of nose, I actually push those poles out to create better structure to push through the car, excuse me, push through the thick skin or thick fabric.

So you want to thicken those poles. Now, if you did that in someone with very thin skin and you push those poles out with huge grafts, those graft will show up over time. So you don’t want to do that in someone with very thin skin. But if you have someone with very weak poles or weak cartilage inside and you try to over resect it and you and you are going to lead to a lot of scar tissue inside the nose that’s not outside. I’m not talking about an external scar. I’m talking about just collagen, a scar tissue that builds up between the skin and the cartilage, which will then oftentimes make the skin actually thicker, the tip bigger, and you get the exact opposite result that you wanted. So this analogy of the 10 poles or or TP is one mechanism by which I explained to patients about the difference between an ethnic rhinoplasty and a Caucasian rhinoplasty and how I approached those patients differently.