The Italian nose, in aesthetic surgery practice, refers to the “Caucasian” type ideal nasal structure in which the nasal dorsum has a smooth and straight line, the nasal tip is defined with clear contours, and it establishes a flawless balance with the face. Frequently requested in rhinoplasty applications, this form offers a sophisticated appearance that is far from exaggerated curves and artificiality, with distinct plays of light and shadow. As a reflection of the high-definition aesthetic approach, this structure represents an elegant and timeless standard of beauty that achieves the ideal angle with the forehead and lips without disrupting the character of the face.
İçindekiler
What are the characteristics of the Italian nose, and why is it so in demand aesthetically?
The aesthetic form referred to as the Italian nose actually represents the most elegant version of the idealized Caucasian nasal structure. What makes this nose type so attractive is the balance and defined contours it possesses. The main motivation for our patients to want this form is the desire to give their faces a fresher, younger, and more “classy” expression. In an Italian-style nose, when light hits the nasal dorsum, it flows in an uninterrupted, straight line; the nasal tip, on the other hand, is distinct as if it came from the hands of a sculptor.
The main visual components that create this aesthetic structure are as follows:
- Straight or very slightly curved nasal dorsum
- Distinct and elegant nasal tip
- Ideal nose-to-lip angle
- Thin skin structure that reveals details
- Sharp transitions of the nasal alae
- Projection appropriate to facial proportions
The combination of these features creates a “high definition” effect on the face. In other words, the nose does not stand as a coarse mass independent of the rest of the face; on the contrary, it becomes an elegant focal point that brings out the other beauties of the face (the eyes, the cheekbones). Especially with the influence of social media and selfie culture, the desire for a flawless profile image has significantly increased the demand for this nose type in recent years.
What are the differences between the Italian nose and the Mediterranean nasal structure in our geography?
This is the point where, professionally, the greatest challenge arises and artistry comes into play. Türkiye and the surrounding geographies (the Middle East, the Mediterranean basin) genetically have a highly characteristic and strong nasal structure. When our patients come with a photo of the thin Italian nose in their dreams, there is usually a serious difference between their existing anatomy and their aspirations. The nasal structure in our geography requires more complex surgical planning because our tissues are more resilient and robust.
The typical nasal features we frequently encounter in our geography are as follows:
- Thick and oily skin structure
- Prominent hump
- Downward-drooping nasal tip
- Wide nasal dorsum
- Weak cartilage support
- Wide nasal alae
We can compare this situation as follows: the nose of an Italian or Northern European patient is as if it is covered with a thin silk fabric; even the smallest change underneath becomes apparent immediately. Our patients’ noses, however, are generally under a thick velvet cover. If the surgeon only reduces the nose and rasps the bones, that thick “velvet” skin cannot recoil and, instead of the desired elegant, sharp contours, a round and indistinct nose emerges. Therefore, bringing a Mediterranean-type nose to Italian aesthetics is not a simple “reduction” procedure but a serious “restructuring” (reconstruction) surgery.
Which surgical techniques are used to achieve Italian aesthetics in thick-skinned noses?
Thick skin is one of the most challenging parameters a surgeon must manage in rhinoplasty. In a thick-skinned patient, our strategy changes entirely in order to achieve the desired Italian elegance. Here, the concept we call “Structural Rhinoplasty” comes into play. The logic is this: if you want the shape to be apparent under a thick cover, you must build a much stronger and more defined underlying framework (like the poles of a tent). If we reduce the nose and weaken the framework, thick skin, with its “memory” property, tries to return to its former shape or droops downward under gravity.
The main technical approaches we apply in these types of noses are as follows:
- Use of strong cartilage grafts
- Advancing the nasal tip forward
- Thinning of the subcutaneous fat tissue
- Special suture techniques
- Sharpening the cartilages
In this process, thinning the skin from the inside is possible only to a certain extent and must be done very carefully, because it is vital not to compromise the skin’s blood supply. The real magic lies in keeping the skin taut with cartilage supports placed beneath it. Just as clothes look tighter on us and reveal contours when we gain weight, we also support the nasal tip and dorsum with cartilage to stretch that thick skin and allow it to reflect the delicate contours underneath. This is a process that directly depends on the surgeon’s cartilage-shaping ability and experience.
How is a natural and curved dorsum created in hump correction?
The vast majority of our patients complain about the hump on the nasal dorsum. However, when aiming for Italian aesthetics, simply “cutting off” the hump is not enough. In old-fashioned surgery, when the hump was removed, the nasal dorsum was sometimes over-scooped and an artificial “ski slope” appearance occurred. In the modern approach, our goal is a profile in which there is no hump, but the nasal dorsum flows in a natural straightness or with a very slight, pleasing curve that is harmonious with the face.
After the hump is removed, the nasal roof opens (this is called an open roof deformity), and this roof must be closed again with a natural curve. At this stage, the method we use is not only to remove bone but also to reshape the bone and cartilage tissue. Sometimes, after the hump is removed, millimetric irregularities may remain. To achieve this smoothness, we resort to “camouflage” techniques.
The auxiliary materials we use during this procedure are as follows:
- Bone dust paste
- Crushed cartilage pieces
- Tissue sleeves (Fascia)
During surgery, the surgeon can process the removed bone and cartilage through special steps to obtain a paste-like consistency and use it to fill millimetric gaps on the nasal dorsum. In this way, when healing is complete, there are no irregularities you can feel by hand, and light flows smoothly over the nasal dorsum without breaking. These techniques not only correct a humped nose, but also add that desired sophisticated aura.
How is a low nasal tip lifted and brought into the Italian nose form?
One of the most prominent features of the Middle Eastern and Anatolian nasal structure is the nasal tip that droops downward, especially when smiling. In the Italian nose, however, the nasal tip stands confident, firm, and at an ideal angle. Lifting the nasal tip (rotation) and adjusting its forward protrusion from the facial plane (projection) completely changes the overall balance of the face and gives the person a more dynamic air.
Simply suspending a low nasal tip upward with sutures is unfortunately not a permanent solution. Gravity and facial expressions (especially the muscles that pull the nose downward while speaking and smiling) can loosen sutures over time. That is why we approach the nasal tip with the mindset of a “civil engineer.” We must create a solid foundation at the very tip of the nose.
The supports we apply to keep the nasal tip in the ideal position are as follows:
- Columellar support graft (Strut)
- Septal extension graft
- Teeter-totter technique
- Nasal tip shield graft
The essence of these technical terms is this: we place invisible cartilage columns into the central pillar between the nostrils (the columella). These cartilage columns function as braces that prevent the nose from drooping over time. Thus, even when the patient smiles, speaks, or years pass, the nasal tip maintains its elegant and elevated stance from the first day. The characteristic “diamond” shaped nasal tip highlight in Italian aesthetics is also achieved thanks to the special shapes given to these cartilages.
Why are additional materials such as rib cartilage needed during surgery?
One topic that our patients sometimes fear the most, but that can be unavoidable for the success and durability of the result, is the use of “rib cartilage.” As mentioned above, to bring a thick-skinned nose with structurally weak cartilage into the Italian form, we must build a very strong internal framework. However, the patient’s own septal cartilage may be insufficient due to a previous surgery, trauma, or congenital reasons.
If we do not have enough bricks (cartilage) to build the structure, we need to obtain spare material from another part of the body. Ear cartilage is soft and curved, so it is generally excellent for nasal tip shaping, but it is sometimes not strong enough to keep the nose upright or to straighten the dorsum. This is where rib cartilage provides us with an unlimited and very solid building material.
The sources from which we obtain cartilage are as follows:
- Septal cartilage
- Ear cartilage
- Rib cartilage
- Cadaver cartilage (Allograft)
Today, rib cartilage harvesting is not a painful and major procedure as our patients fear. With a small 1–2 cm incision hidden in the inframammary fold, this cartilage can be obtained in about 15–20 minutes. This material strengthens the surgeon’s hand tremendously. In models like the Italian nose that require sharp contours and a strong stance, rib cartilage acts almost like “insurance”; it prevents the nose from collapsing or bending over time. This is an advanced-level approach that demonstrates not only the surgeon’s aesthetic but also reconstructive (repair) surgical competence.
How important are facial harmony and functional breathing in Italian nose planning?
As an ENT Specialist and Facial Aesthetic Surgeon, my philosophy is this: a nose that cannot breathe is unsuccessful, even if it is the most beautiful nose in the world. When planning Italian aesthetics, focusing only on the external appearance of the nose would be a major mistake. The nose is the entry gate of the respiratory system, and aesthetic interventions should never impair this function; on the contrary, they should improve it.
Our approach is “Functional Septorhinoplasty.” In other words, in the same surgery, we both eliminate aesthetic concerns and open up internal obstructions. In fact, we often use aesthetic maneuvers to open the airway. For example, the cartilage patches that support the nasal alae (valve surgery) both prevent the nose from collapsing from the sides and widen the airway inlet angle.
The functional problems we address in this comprehensive surgery are as follows:
- Septal deviation (Cartilage curvature)
- Turbinate hypertrophy (Enlarged nasal turbinates)
- Nasal valve insufficiency
- Chronic sinusitis problems
In addition, the issue of facial harmony is vital. The Italian nose does not mean a “small” nose; it means a “proportionate” nose. If the patient’s chin is retruded, the forehead is wide, or the cheeks are full, the size of the nose must be adjusted accordingly. On a wide face, an overly reduced nose gets lost in the center of the face and does not look natural. The surgeon’s duty is to analyze the patient’s facial features and create a “customized” Italian interpretation that suits that face best and looks as if it has been there from birth.
What is the healing process like, and when does the Italian nose take its final form?
The part of the aesthetic journey that requires the most patience is the healing process. With advances in technology, the postoperative period is now much more comfortable. The meters-long gauze packs used in the past are now history; instead, we use slippery silicone sheets that allow breathing through them. In this way, our patients can breathe immediately after surgery, and removing these silicone sheets is a painless procedure that takes seconds.
The surgery performed under general anesthesia takes an average of 3 hours, and our patients are usually hosted in the hospital for one night. Swelling and mild bruising on the face in the first days are the body’s natural response and are temporary. At the end of the first week, the protective splint and silicone sheets on the nose are removed. From that moment on, the patient can return to social life.
The main outlines of the healing process are as follows:
- Swelling peaking in the first 3 days
- Removal of the splint and sutures on days 7–10
- Bruising completely resolving within weeks
- Coarse swelling subsiding after months
- Fine details settling between months and 1 year
Especially in thick-skinned noses in which we perform Italian-style shaping, it can take 1 year, and sometimes 1.5 years, for the nose to take its final form and for those elegant details to emerge. During this process, the nasal tip gradually refines, swelling on the dorsum disperses, and the skin adheres to the new underlying framework. It is very important for our patients to be patient during this period and to follow the massage or care routines recommended by their surgeon for the perfection of the result.
Prof. Dr. Murat Songu – Burun Estetiği (Rinoplasti) Uzmanı
Prof. Dr. Murat Songu, 1976 yılında İzmir’de doğmuş, tıp eğitimini Ege Üniversitesi Tıp Fakültesi’nde tamamladıktan sonra Celal Bayar Üniversitesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2005–2006 yıllarında Fransa’nın Bordeaux kentinde Prof. Vincent Darrouzet ve Dr. Guy Lacher gibi rinoloji alanının önde gelen cerrahlarıyla çalışarak rinoplasti, fonksiyonel burun cerrahisi ve kafa tabanı cerrahisi üzerine ileri eğitim almıştır.
Burun estetiğinde doğal görünüm, nefes fonksiyonunun korunması ve yüz estetiği dengesini ön planda tutan Prof. Dr. Songu, açık teknik rinoplasti, piezo (ultrasonik) rinoplasti, revizyon rinoplasti, burun ucu estetiği ve fonksiyonel septorinoplasti operasyonlarında ulusal ve uluslararası düzeyde tanınan bir cerrahtır. Yurt içi ve yurt dışında çok sayıda rinoplasti kongresinde eğitici ve konuşmacı olarak yer almış; yüz estetiği ve burun cerrahisinde modern tekniklerin yaygınlaşmasına öncülük etmiştir.
100’den fazla bilimsel yayını, kitap bölümü yazarlıkları ve 1700’ü aşkın uluslararası atfıyla rinoplasti alanında Türkiye’nin en saygın akademisyenlerinden biri olan Prof. Dr. Murat Songu, doğal, yüzle uyumlu ve fonksiyonel sonuçlar hedefleyen cerrahi yaklaşımıyla hem bilimsel hem estetik başarıları bir araya getirmektedir.
