Defining regional variation in nasal anatomy to guide ethnic rhinoplasty: A systematic review

Background: Recently, there has been increasing focus on understanding nasal anatomy in ethnic populations and using it to guide rhinoplasty techniques in non-Caucasian patients. Many disparate groups have historically been inappropriately clustered based on geography. However, there has been little attention on describing regional differences within these populations. Methods: A systematic review was conducted according to PRISMA guidelines. The search terms “African”, “Asian”, “Indian”, “Middle Eastern”, “Hispanic OR Mestizo”, “rhinoplasty”, “nasal”, “anatomy”, and “ethnic” were used in combination with the Boolean operators “AND” or “OR” to identify the initial search results. Papers were included if they originated from the specific geographic region of interest, if they specifically discussed patients of one particular nationality or sub-ethnicity, or if they discussed multiple anatomical subtypes within a specific ethnicity of interest. Results: A total of 81 papers were identified overall. The search identified 40 articles discussing Asian nasal anatomy, 8 articles discussing Indian nasal anatomy, 6 articles discussing African nasal anatomy, 9 articles discussing Middle Eastern nasal anatomy, and 19 papers discussing Latin American nasal anatomy. Numerous regional variants were described within each historic geographic phenotype. The majority of descriptions of Asian nasal anatomy were consistent with the classical definition, whereas nasal anatomy among the other ethnicities was more variable. Very little has been written about the geographic variation of nasal anatomy across the African continent. Several established sub-classification schemes exist for the Latin American nose. Conclusions: Awareness of the heterogeneity of ethnic nasal anatomy is critical for surgeons performing rhinoplasty on non-Caucasian patients.