All of these types of nose are seen in the central Mediterranean and are characterized by large, curved nasal bones, large nasal tip cartilages and thick skin.

All of these features render the Mediterranean nose rather difficult to work with, from the cosmetic surgeon’s point of view.Refinement of the nasal dorsum and tip in order to reach a nose whose proportions are harmonious to each other is rather demanding, especially if there is an associated sideways bend.

In such cases the nose may have to be practically ‘rebuilt’ starting from straightening of the internal nasal septum, refining the profile, hump removal and narrowing of the nasal bones and tip refinement. Having a thick skin means that many of the refinements carried out on the nasal skeleton are not so easily appreciated in the final result. This is like operating under a quilt instead of a sheet-the sheet is much thinner and underlying changes easier to detect externally.An advantage of thick cartilages and bones, however is that good quality grafting material is provided by the nose itself. Grafts are often used in the tip area to help provide support and projection. Removal of too much cartilage, especially in the tip area may lead to collapse of the ala, or sides of the nose, during breathing.

All of these points mentioned above are considerations that the nasal surgeon has to bear in mind, and there has to be a ‘trade-off’ between the cosmetic expectations of the patient and good function of the nose in terms of breathing.

©Mr. Adrian M Agius