Nazih Haddad, M.D., who has extensive experience in treating Asian noses, explained his techniques for achieving consistent outcomes and happy patients.

A clear recognition of challenges with Asian nose is necessary, he advised, to develop a good surgical plan. "Asian skin is thicker and less elastic than Caucasian skin, making it less easy to remodel," he said.

What's more, cartilage is softer and thinner compared with Caucasian noses, so it is somewhat less reliable. Attempts to sculpt cartilage fail because "it does not take shape you want due to its softness, in addition to warping and possible absorption," said Dr. Haddad, aesthetic plastic surgeon in Newport Beach, Calif.

To further complicate matters, bony framework, in general, is tiny. This means that patient's bone structure itself does not help surgeon to reshape nose.

Building bridge The Asian nose is often saddle-shaped: bony structure is disproportionately small with a wide tip. If patient wants a Caucasian nose, then surgeon must build upper and middle portion of nose and reduce lower part of nose (the tip and alae). The latter techzique sometimes requires making an incision in skin, and this can be challenging, warned Dr. Haddad, who is also a clinical associate professor of facial plastic surgery at Uiversity of California, Irvine.

Asians, Dr.Haddad said, prefer to have a strong nasal profile. A quick and easy way to achieve this - at least as a first-line treatment - is by using Silastic implants. "I suggest using larger rather than smaller implants because I have found my patients prefer this look. They also want a more narrow ala."