The Spanish nose is a specific nasal morphology that we frequently observe in patients of Mediterranean and Latin origin in aesthetic surgery practice, characterized by a thick and oily skin structure, a round (bulbous) nasal tip with indistinct borders, and a generally wide nasal dorsum. Rather than a medical classification, this term describes structural features and points to a special patient group in rhinoplasty processes in which standard reduction methods are insufficient, and instead strong cartilage support and advanced shaping techniques are mandatory. Considered within the scope of ethnic rhinoplasty, this nose type requires an architectural surgical approach that will carry the weight of the skin and break its masking effect.
İçindekiler
What Are the Characteristics of the Spanish Nose Type?
The most fundamental factor that distinguishes this phenotype from others is the “cover,” meaning the skin, that overlies the nasal framework. In thin-skinned noses of Northern European origin, even the slightest curve of the underlying cartilages can be visible from the outside, whereas in Spanish or Latin-type noses, the situation is the opposite. Here, we are faced with a thick, oily, and porous skin structure. This thick skin is like a quilt that masks the details of the underlying cartilage and bone structure:
In addition, the nasal tip generally has what we call a “bulbous,” onion-like, round, and blunt appearance. The elegant light breaks and sharp lines that should be present at the nasal tip have become indistinct due to thick skin and weak cartilage support. The nasal dorsum is generally wide, and when viewed from the side, a humped structure stands out. However, the hump here does not always originate from bone; sometimes excess cartilage and soft tissue also contribute to this humped appearance:
The main features we frequently observe in this nose type are as follows:
- Thick skin structure
- Large pores
- Oily skin texture
- Weak cartilage support
- Wide nasal dorsum
- Broad nasal alae
- Round nasal tip
- Indistinct nasal tip contours
- Low nasal tip angle
Why Does a Thick-Skinned Nasal Structure Create Challenges in Surgery?
Thick skin is one of the most important variables a surgeon faces in rhinoplasty. When explaining this to my patients, I usually use a bedspread analogy. If you lay a very thin silk sheet over a bed, you can clearly see even the slightest wrinkle on the bed or the object underneath it. But if you cover the bed with a thick, fluffy quilt, it becomes difficult to understand what is underneath. That thick skin in the Spanish nose type is like that thick quilt:
No matter how much we surgeons thin the cartilages during surgery, no matter how much we shape them, if the skin over them cannot take and wrap this new shape, those elegant details will not be visible from the outside. In fact, the thickness and weight of the skin tend to pull the nasal tip downward over time with the effect of gravity. Therefore, focusing only on “reduction” in these types of noses is a major mistake. If the cartilage framework is weakened, the nose can collapse and lose its shape under the weight of thick skin. Accordingly, our strategy is not so much to reduce as it is to build a strong framework that will carry the skin.
What Are the Most Common Aesthetic Concerns Expressed by Patients?
In outpatient consultations, the complaints of our patients with this nasal structure are generally similar. The biggest discomfort is that the nose sits in the center of the face like an “undefined” mass. Especially when taking photographs, they state that the nasal tip does not reflect light, and that it remains too wide and broad relative to the overall facial contours.
Another important issue is the change that occurs during smiling. Due to the structure of the ligaments that support the nasal tip and the effect of the muscles, the nasal tip may droop downward when smiling, and the alae may widen further to the sides. This can make the patient’s facial expression look harsher or more tired than it actually is. “I’m not happy with my profile, but when I look from the front my nose looks even wider” is a typical complaint of this patient group. A wide nasal root can also cause the eyes to appear farther apart or the depth of the gaze to be lost.
The most common reasons our patients seek consultation are as follows:
- Coarse appearance
- Unlit nasal tip in photographs
- Nasal tip drooping when smiling
- Wide nostrils
- Size incompatible with the face
- Masculine expression
- Need for contouring with makeup
Is the Tip Rhinoplasty Method a Suitable Option for This Nose Type?
In many Spanish nose cases, there may actually be no major deformity in the bony vault. In other words, if there is no massive hump or deviation at the nasal root, the patient’s main problem is the coarseness and shapelessness of the nasal tip. This is where the surgical approach we call “Tip Rhinoplasty” or “Tip Plasty,” focused only on the nasal tip, comes into play.
Tip rhinoplasty is often an ideal starting point for this phenotype because it focuses on the center of the problem, namely the lower lateral cartilages (alar cartilages). During this procedure, without needing to fracture the nasal bones, only the cartilage structures and soft tissue of the nasal tip are redesigned. The nasal tip can be refined, lifted upward (rotation can be achieved), or its forward extension (projection) can be brought under control. Being less traumatic than a full rhinoplasty, a lower risk of bruising, and a rapid return to social life are major advantages. However, because the width on the nasal dorsum can also accompany the picture in Spanish nose characteristics, additional maneuvers such as rasping or narrowing the nasal dorsum are also frequently included in the procedure in addition to tip plasty.
Why Is the Open Technique Preferred During Surgery?
In a nose type that is this complex, thick-skinned, and requires structural support, the surgeon does not have the luxury of “working in the dark.” Therefore, we generally prefer the “Open Technique Rhinoplasty” approach. The open technique involves lifting the nasal skin through a small incision made in the little strip of skin between the nostrils (the columella):
This method gives us the chance to see the anatomy of the nasal tip, cartilage asymmetries, weaknesses, and excesses with the naked eye in full detail. Especially in cases like the Spanish nose, it is not enough to simply cut and remove cartilage; it is necessary to reshape them with millimetric sutures, change their angles, and most importantly, to fix the support grafts (cartilage patches) we will place in a flawless way. In the closed technique, performing such precise structural work and achieving millimetric symmetry is much more difficult in thick-skinned patients. The open technique offers us the opportunity to manage this complex “construction” process with full control.
Why Are Cartilage Grafts and Structural Support So Important?
Here we need to return again to the “heavy skin” factor. The biggest mistake made in the past in Spanish nose aesthetics was the excessive removal of cartilage in order to reduce the nose. When the cartilage framework is weakened, while postoperative healing tissue (scar) contracts and thick skin presses downward, the nasal tip cannot resist this force. As a result, noses appear as if clamped with a clothespin, with breathing problems and a drooping tip.
In modern surgery, our approach is built on “Rebuilding,” not “Demolishing.” We use pieces of cartilage taken from inside the nose (the septum) or, if necessary, from the rib to strengthen the foundation of the nose. The cartilage struts we call “Columellar Strut Grafts” are placed between the two nostrils to prevent the nasal tip from drooping over time. In addition, by placing shield-shaped cartilages on the nasal tip—what we call “Shield Grafts” or “Cap Grafts”—we create a sharp and defined tip point that will be visible even beneath thick skin. In other words, because we cannot thin the skin, we strengthen and define the underlying framework so that the skin adopts this new and sharp shape.
The main cartilage grafts we use are as follows:
- Columellar strut graft
- Septal extension graft
- Tip grafts
- Cap grafts
- Rim grafts
- Spreader grafts
How Are a Wide Nasal Dorsum and Nasal Alae Managed?
When the nasal tip is refined and made more delicate, if the nasal dorsum and nostrils are left wide as they are, a major imbalance occurs on the face. In the Spanish nose phenotype, the nasal dorsum is generally wide. In this case, controlled cuts are made on the side walls of the nasal bones (osteotomy) to bring the bones closer together and narrow the vault. This makes the front view of the nose appear thinner, more elegant, and “pencil-like.”
The same sensitivity applies to the nasal alae as well. When the nasal tip is set back or shaped, the alae may tend to spread laterally. To prevent this and narrow the nasal base, we perform the procedure called “Alar Base Resection.” From the crease where the nasal ala meets the cheek, a wedge- or crescent-shaped piece of tissue is removed in accordance with the patient’s anatomy to reduce the nostrils. The goal here is not a stuck-on appearance that looks “operated,” but a width that preserves natural curves, does not hinder breathing, and is not aesthetically conspicuous.
How Is the Bulbous Nasal Tip Appearance Corrected?
A bulbous nasal tip results from the lower lateral cartilages being excessively large, wide-angled, or convex. In addition, excess subcutaneous fat and connective tissue in this area also contributes to the ball-like appearance:
To correct this, we apply a multilayered procedure during surgery. First, the excess soft tissue and fat layer over the cartilages is removed extremely carefully without disrupting the skin’s blood circulation (defatting). Then, a measured removal (cephalic resection) is performed from the edges of the cartilages facing the head side. However, the main change is achieved with “suture techniques.” The wide and broad cartilages are folded onto themselves, brought closer together, and flattened with special permanent sutures. In this way, the round and blunt nasal tip is transformed into a more triangular, prismatic, and pointed form. Because it is difficult to achieve this definition in thick-skinned patients, we usually create light break at that point by gently stretching the skin with additional cartilage pieces placed on the cartilage tip.
Can Non-Surgical Nasal Filler Be a Solution for This Type?
Under the influence of before-and-after photos they see on social media, many patients consider nasal filler as an option to avoid surgery. However, as a physician, I must clearly state that filler is generally a wrong choice for patients with Spanish nose characteristics, and it can sometimes even make the situation worse.
The logic is very simple: filler materials (hyaluronic acid) are, by nature, volume-adding materials. In the Spanish nose, however, the main problem is already excess volume, width, and coarseness. When filler is injected into a wide, fleshy, and bulbous nasal tip, the nose grows and swells even more. A hump may be camouflaged in profile, but from the front the nose can become enormous. In addition, because fillers have a gel consistency, they do not have the mechanical strength to lift, shape, or narrow the heavy and dominant structure of thick skin. Refining the nasal tip, shaping the cartilages, and providing lasting elegance are only possible with surgical methods, through the physical repositioning and reduction of tissues.
What Should Be Expected Regarding the Healing Process and Swelling?
The issue that my thick-skinned rhinoplasty patients need to show the most patience with is the healing process. It is very important to discuss this from the outset and manage expectations. Thick skin, by its nature, responds to surgical trauma with more edema (swelling), and lymphatic drainage is slower.
In the first week after surgery, there is a thermoplastic splint and tapes on the nose. When the splint is removed, the nose will look swollen; this is completely normal and should not frighten the patient. The result we see in 6 months in a thin-skinned patient, we see in 1 year in the Spanish nose type, and sometimes even in 1.5 years. Over time, the nasal tip becomes smaller, and details gradually become more defined over the months. In the mornings, with facial swelling, the nose can also swell, and it can go down during the day. These fluctuations are a natural part of the healing process.
What we recommend to support the healing process are as follows:
- Being patient
- Restricting salt intake
- Sleeping with the head elevated
- Not neglecting nasal massages
- Night taping
- Drinking plenty of water
- Avoiding hot environments
In some stubborn cases, we can accelerate the process by administering very low-dose, controlled corticosteroid injections under the skin to help swelling resolve faster and the nasal tip take shape.
How Are Facial Proportions and Surgical Planning Performed?
The key to a successful aesthetic result is seeing the whole face, not just the nose. Simply reducing the nose does not always mean looking better. In a patient with Spanish nose characteristics, the forehead structure, chin tip position, cheek fullness, and the distance to the lips must also be evaluated.
For example, in a patient with a retruded chin, no matter how much the nose is reduced, it may still be perceived as large in the profile view. In this case, instead of trying to reduce the nose further, achieving balance with a chin filler or implant yields a much more aesthetic and natural result. The surgeon’s aim is not to completely erase the patient’s ethnic origin and characteristic features and “attach someone else’s nose” to them. The aim is to create a natural, proportionate, and functional nose that suits the face best and does not “shout” that it is there. Therefore, preoperative simulation studies and detailed consultations are vital so that what the patient envisions and what can be done surgically (the limits of thick skin) overlap.
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.
