African American Rhinoplasty

Management of the African American nose is a particularly challenging surgery that requires true expertise and experience in ethnic rhinoplasty. African American rhinoplasty necessitates a true appreciation of the African American nose so that the final result will look natural on the face. Unfortunately, all too often I will see African American rhinoplasty results by other plastic surgeons that look surgically overdone or have the stigma of being surgically altered. The common theme with these noses is that they appear ethnically inconsistent with the surrounding African American facial features. In order to create create a natural appearing nose on the African American face, a rhinoplasty surgeon must have a thorough understanding of the ethnic nose with dedicated experience in performing this surgery on a consistent basis.

As I have pointed out in other topics related to ethnic rhinoplasty, the goal with the African American rhinoplasty patient is not to create a Caucasian looking nose. Rather, it is to reshape the nose so that certain undesirable features are addressed while preserving other African American features in an effort to maintain ethnic consistency.

African American Rhinoplasty Evaluation

The following list includes a variety of features that are commonly seen in the African American patient seeking rhinoplasty surgery. As you will note, not all African American rhinoplasty patients exhibit all of these features. In some African American rhinoplasty candidates several of these features are more prominent than in others. That is precisely why it is so important to evaluate every African American rhinoplasty patient on an individual basis.

Thicker than average skin (particularly above the nasal tip) in combination with softer/weaker than average cartilage
Flatter, broader bridge with a low nasal starting point
Variable presence of a dorsal hump or bump as seen from the side view
Poor tip definition with a more rounded and bulbous tip shape
Wide nasal base that includes alar flaring as well as a wide sill with horizontally oriented nostril openings
Columella tends to be shorter than average with poor tip projection

So what do these features look like in real life? The following is provided to highlight the various African American nose features using actual patient photographs.

African American Nose Job Surgery

In a majority of African American patients, an open rhinoplasty approach is indicated in order to gain adequate exposure and visualization of the nasal framework and soft tissue. In some cases, a closed rhinoplasty approach can be used for African American rhinoplasty if there is mostly nasal bridge work being done.

Given the various issues noted in the list above, African American rhinoplasty usually involves one or more of the following maneuvers to achieve the desired outcome.

One of the first things that needs to be addressed when doing African American rhinoplasty surgery is the relatively thicker nasal skin and soft tissue. In some cases, the thicker skin requires more deliberate contouring of the underlying cartilage in order to reveal more definition and shape to the nose. In other cases, the skin might actually need to be carefully thinned in certain areas in order for the nose to become more defined.

In many African American nose job procedures, the nasal bridge usually requires reshaping. In some patients, the hump or bump is taken down to provide a straighter profile. In others, the nasal bridge is augmented (lifted) to bring the bridge higher on the face so that it appears more narrow when seen from the frontal view. Still in other African American noses, the nasal bones are so wide they need to be brought in closer to one another – also to give a more narrowed appearance. In the midst of these procedures, the nasal starting point may also be moved to a higher position.

In a good majority of African American nose jobs, the nasal tip requires reshaping to address the more rounded, poorly defined contour. Since the underlying cartilage structure is usually weaker than the average nose, this means that cartilage repositioning and grafting is typically necessary in order to achieve even moderate improvement in tip definition. Given the fact that most African American noses do not have a generous amount of septal cartilage that can be used for grafting, other sources of cartilage might be needed. This includes possible use of ear cartilage (also known as auricular cartilage) and even rib cartilage in some rare instances.

When considering the African American nasal base, you have to look at two different issues. The first is whether or not the alar base area is flared. The second is the width of the actual nasal sill region. Alar base flaring refers to how curved the nostril base might be, while sill width simply refers to how wide the nasal sill is between the columella and the outer border of the nostril. In a good number of African American rhinoplasty patients, both areas require narrowing. In some patients, only one or the other has to be reshaped. Regardless of what is being done to narrow the nasal base, it is vital that this area is not overdone during the rhinoplasty surgery. It happens to be one of the most unforgiving areas of the nose when it comes to cosmetic reshaping. Therefore, it is best to approach this area in a conservative manner. It must also be kept in mind that it is normal to have a slightly wide nasal base when you are dealing with an African American nose. Careful attention should be paid to preserve at least some of this ethnic identity when reshaping the African American nasal base. Yes, an excessively flared and wide nasal base is undesirable – but some of this is also what contributes to the beauty of the African American face.

With regard to a potentially short columella in the African American nose, this often times requires reshaping in order to help with nasal tip projection. In many African American rhinoplasty patients, the tip is underprojected – meaning, it does not stick out far enough. The consequence of this (in combination with the other tip issues) is a nasal tip that does not appear as narrow as desired. Therefore, restructuring the columella in conjunction with reshaping the nasal tip will aid in providing a more defined African American nose.

African American Rhinoplasty Examples

The following are case examples of African American rhinoplasty (nose job) surgery performed by me. These patients represent what is considered fairly typical results in my practice when it comes cosmetic nose reshaping in African American patients.

What you will notice when you review these cases is the fact that my patients look quite natural following their nose job surgery. In each case, there were maneuvers done to reshape certain features of the nose that were disliked or unwanted. But many of the African American features were preserved to maintain a natural looking nose. Could you opt for more tip definition, for instance, in some cases? You could. However, you then run the risk of making the nose appear too done and surgically altered – not the kind of change that most African American rhinoplasty patients are looking to achieve.