Most African American noses have certain common anatomic elements which require a special expertise. These include:
- Thick nasal skin
- Weak nasal cartilages
- Short and low set nasal bones
- Bulbous nasal tip
- Alar flaring and widened nasal base
- Short nasal septum (internal nasal structure) and large nasal turbinates
Given these anatomic variations, many African American patients interested in rhinoplasty are looking to gain the following changes to the nasal shape from surgery:
- Narrow and raise nasal bridge and improve its definition
- Improve definition and decrease width of the nasal tip
- Reduce alar flaring and nasal base
While these goals are not uncommon to rhinoplasty patients of other ethnicities, the specific variations in nasal anatomy in African American patients discussed above commonly dictate a totally different surgical approach to achieve desired results. For example:
- If the nasal bones are really short and shallow, trying to “squeeze” them together may not only fail to improve the definition of the nasal bridge, but sometimes may lead to bridge collapse and saddle deformity. Therefore, the correct approach to this type of nasal dorsum is placement of an onlay graft (cartilage from nasal septum or rib, and sometimes nasal dorsal implant).
- A combination of thick nasal skin and very thin and weak tip cartilages usually does not allow for the improvement of tip definition by a mere reshaping of the native tip cartilages (a common method for the improvement of tip definition in Caucasian patients). Since the cartilages a very weak and flimsy, they simply don’t hold the desired shape when modified by sutures only. Moreover, thick nasal tip skin unfortunately hides most of the refinements. Thus, in order to successfully define the tip, its structure usually needs to get reinforced by additional cartilage grafts (such as tip or shield grafts) and tip skin may need to be slightly thinned out on the undersurface.
- Also, having short nasal septum with short septal cartilages requires a rhinoplasty surgeon to be prepared to look for other sources of cartilage (such as rib or ear cartilage) as septal cartilage may not be sufficient enough.
- Large nasal turbinates may need to be surgically reduced as they may become more swollen as a result of the surgery causing difficulty breathing.
- One should always keep in mind a higher tendency of keloid (thick scar) formation in African American patients, especially when planning for alar base reduction which necessitates additional external incisions.
Taking into consideration all of the above, one should be careful when selecting a rhinoplasty surgeon. It is of paramount importance that a prospective surgeon understands all the intricacies of African American rhinoplasty and has had an extensive experience in ethnic rhinoplasty in order to be able to achieve great results.
Needless to say, many African American patients seek to improve the appearance of their noses without erasing their ethnic heritage and identity. It takes skill and sensitivity to achieve a cosmetic result that beautifies the face while respecting and preserving ethnicity. Dr. Ovchinsky has a very busy ethnic rhinoplasty practice in New Jersey and New York. We would be delighted to see you at a consultation in our office and to have an opportunity to create the nose you have always dreamed of!