Systematic Review on Ethnic Rhinoplasty in Latin America and The Caribbean
Tristan Wesson, BS1, Alexander Karius, BS1, Wilmina N. Landford, MD2, Jonlin Chen, BS1, Stella M. Seal, MLS1, Carisa M. Cooney, MPH2, Kristen Broderick, MD2
1Johns Hopkins School of Medicine, Baltimore, MD2; Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
BACKGROUND: The mixture of predominantly African, European, and Native Amerindian ancestry in Latin America and the Caribbean has led to a wide variation in nasal morphologies that deviate from neoclassic ideals. While the field of ethnic rhinoplasty continues to grow, a lack of focus on Latin American and Caribbean populations exists, posing unique cultural and phenotypic challenges for practicing surgeons.
METHODS: We conducted a systematic review on ethnic rhinoplasty in Latin America and the Caribbean. We queried 6 databases: PubMed, Cochrane, Web of Science, and (limited to English) Embase, Scopus, and LILACS. Methods were registered on Prospero. All levels of review were performed by two reviewers; disputes were resolved by a third reviewer. Data were extracted to elucidate (1) ethnic populations studied, (2) cosmetic goals of these populations, and (3) surgical recommendations. Articles presenting original cases and techniques with unspecified study designs were coded as case reports/studies. Due to differences in racial and ethnic classifications in Latinx populations and the studies presented, papers were coded into broader racial/ethnic categories based on both the article’s authors’ definitions and contextual analysis to asses for similarities in cosmetic goals and techniques.
RESULTS: Our search identified 785 articles, of which 295 were duplicates. Following title, abstract, and full-article review, 54 articles were eligible for inclusion. A majority of studies were case reports and case studies (55.6%), followed by retrospective cohort (24.1%) and prospective cohort (9.3%) analyses. Thirty-four (63%) studies came from academically-affiliated research or medical centers; 20 (37%) were conducted in private practice/non-academic settings. Most studies were conducted in Brazil (29.6%), Mexico (18.5%), Colombia (18.5%), and the US (22.2%). Most articles focused on Mestizo, or mixed-race Latinx patients (36 articles). Among the surgical articles from the three most studied groups, Caucasian-oriented articles were more likely to discuss osseocartilaginous hump removal (5/6 articles), while Mestizo/Hispanic-oriented articles described osseocartilaginous frameworks with weaker cartilaginous support (28/33 articles) and methods for tip projection, rotation, and refinement (31/33 articles). Similarly, 12/13 African and Caribbean articles address tip refinement and projection.
CONCLUSIONS: Our review revealed the breadth of admixture contributing to the global Latinx population and demonstrated that general anatomic trends and patient goals exist. As current literature describing ethnic rhinoplasty comes from both academic and private practice settings, as well as studies inside and outside of the U.S., shared knowledge across these geographic and academic divides may lead to better patient outcomes, patient care, and innovations for Latinx patients.
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