Ethnic Considerations in Rhinoplasty: A Meta-Analysis of Outcomes and Complications in Caucasian Versus Non-Caucasian Patients

Hashemipour Y, Danesh HA.

PubMed 40906288 Publisher (DOI)Free full text (PMC)

What this paper says

Across 17 comparative studies, ethnicity-conscious rhinoplasty was associated with higher satisfaction (SMD 0.68) and lower complication (8.7% versus 17.4%) and revision (5.3% versus 12.1%) rates than conventional technique.

Overview

The authors searched PubMed, PROSPERO, DynaMed, EMBASE and Cochrane in April 2025 for studies comparing tailored, ethnicity-aware rhinoplasty with conventional approaches, and pooled 17 comparative studies from 2003-2023 (PROSPERO CRD420251045319) using random-effects models. Groups covered Hispanic/Mestizo, African-American, Middle Eastern, Indian-American, Asian and Caucasian patients.

Sections of note

Satisfaction favoured ethnicity-conscious surgery: SMD 0.68 (95% CI 0.63-0.73; p < 0.001).
Satisfaction effect by group: multi-ethnic 0.76, African-American 0.71, Middle Eastern 0.63, Indian 0.58, Asian 0.55, Caucasian 0.21.
Complications 8.7% with tailored approaches versus 17.4% conventional; revisions 5.3% versus 12.1%.
Heterogeneity reported as 0%; no publication bias detected.
Level of Evidence II.

What it means for a patient

Surgery planned around a patient's ethnic anatomy and preferences was linked to better satisfaction and fewer revisions in the pooled data.
The largest gains were in non-Caucasian groups; Caucasian patients showed a small effect.
A reported 0% heterogeneity across 17 varied studies is unusual and suggests caution in reading the precision of these estimates.

Why this paper matters

It is the first meta-analysis to quantify the benefit of ethnicity-aware planning. Limits: observational source studies, definitions of "ethnicity-conscious" vary, and satisfaction measures differed across studies.

Terms

Ethnicity-conscious rhinoplasty: surgery that adapts technique and goals to the anatomy and aesthetic norms of the patient's ethnic group.
Standardised mean difference (SMD): an effect size; 0.5 is medium, 0.8 large.
Random-effects model: a pooling method allowing for between-study differences.
I-squared: a measure of how much results differ between studies.
Newcastle-Ottawa scale: a quality rating for observational studies.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Introduction: This meta-analysis evaluates the impact of ethnicity-conscious rhinoplasty on patient satisfaction and complication rates. Traditional rhinoplasty techniques often overlook ethnic anatomical differences, leading to suboptimal aesthetic outcomes and higher revision rates. In contrast, individualised approaches aim to optimise both form and function by tailoring procedures to specific anatomical and cultural contexts.

Methods: A systematic search of PubMed, PROSPERO, DynaMed, EMBASE, and the Cochrane Library was conducted in April 2025. Seventeen comparative clinical studies (2003-2023) were included in a PRISMA-compliant meta-analysis (PROSPERO ID: CRD420251045319). Primary outcomes were patient-reported satisfaction, complication rates, and revision frequency. Secondary analyses assessed effectiveness of specific surgical techniques across major ethnic groups: Hispanic/Mestizo, African-American, Middle Eastern, Indian-American, Asian, and Caucasian. Statistical analyses used RevMan 5.4 with random-effects modelling and I2 for heterogeneity. Study quality was evaluated using the Newcastle-Ottawa scale and AHRQ criteria.

Results: Ethnicity-conscious rhinoplasty was associated with significantly greater patient satisfaction (SMD = 0.68 [95% CI 0.63-0.73]; p < 0.001). The highest satisfaction was observed in multi-ethnic (SMD = 0.76), African-American (0.71), and Middle Eastern (0.63) groups. Indian (0.58) and Asian (0.55) patients also showed favourable outcomes, while Caucasian patients had the lowest satisfaction (0.21). Tailored approaches resulted in lower complication (8.7%) and revision (5.3%) rates compared to conventional methods (17.4% and 12.1%). Heterogeneity was minimal (I2 = 0%), with no evidence of publication bias.

Conclusion: Ethnicity-conscious rhinoplasty enhances patient satisfaction and safety across diverse populations. These findings support the need for culturally and anatomically informed surgical planning in modern aesthetic practice.

Level Of Evidence Ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).