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African American Rhinoplasty for Tip Projection Without Cutting Columella?

asked 2 years ago by rita-marie in Montreal
Latest answer by Jon F. Harrell, DO
Question viewed 1,723 times
Tags: nose, nose tip, droopy, columella, keloid scar

I am African American. I recently consulted a surgeon for a Rhinoplasty. I have a bit of a droopy nose and want a tip projection and refinement of the nose. The surgeon says he won't cut my columella. He would instead take a piece of cartilage off my ear and insert it in the front of my nose to create a tip projection. Is this procedure okay? Please note I tend to develop keloids and he would rather not take a piece of cartilage off my ear because of that. Thank you for your help

19 answers to African American Rhinoplasty for Tip Projection Without Cutting Columella?

Closed versus Open African American Rhinoplasty

In my opinion, almost every surgical maneuver that can be done in an open approach can be done using a closed technique. If a surgeon does a significant number of closed surgeries, then it should not be a problem. A variety of grafts - columellar strut, premaxillary filler, shield/cap , extended tip-shield, etc - can be placed using closed or endonasal technique. I am wondering why the ear cartilage is needed, rather than septal cartilage. Did you have a septoplasty before? Is your septal... more

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon

Increasing tip projection can be done with closed rhinoplasty

Increasing projection of the nose can be done quite easily through a closed rhinoplasty with no need for doing an open rhinoplasty or cutting across the columella. This eliminates the risk of developing keloids. Any type of cartilage grafting would not be taken from the ear but only from the inside of the nose to create more tip projection.

William Portuese, MD
Seattle Facial Plastic Surgeon

Rhinoplasty surgery with a columella-strut may improve your droopy nose.

African-American Rhinoplasty Surgery has several limitations since your skin tends to be thick, and your cartilage tends to be weak. I prefer to use septal cartilage in the nasal tip, and I prefer an open-approach. A tip graft along with a columella-strut may be necessary to get the most refinement, narrowing, and rotation of your nose. I have not seen keloid scarring in any of the incisions made in the columella of my patients of color. I've attached a link demonstrating tip rotation... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

African American rhinoplasty

Your questions and concerns are valid. I have not found problems with keloid formation in either the columella or from the auricular harvest site during rhinoplasty in darker skinned individuals. I have also found that septal cartilage is significantly more substantial that auricular cartilage and what your nose needs most is structure and support. I prefer the use of septal cartilage first and then auricular cartilage if there is not enough septal cartilage in order to create tip support... more

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon

You don't need an 'open rhinoplasty' with a scar to make your tip more prominent.

Your tip can be made more prominent in several ways aby adding and advancing cartilage without make a cut across the columella in a open rhinoplasty. You don't need a visible, external scar. Find a plastic surgeon with a lot of nose surgical experience, and all the scars will be inside your nose where they can't be seen.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Ethnic Rhinoplasty

Hello, This is really an open vs closed approach. Keloid won't occur. Best result for an open procedure would be a columellar incision. You may perform a closed and obtain okay results. You may use septum, ear or rib cartilage. Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon

No visable nasal scar

Your question is difficult to answer with certainty without seeing you. However, in many Afro-American patients tip rhinoplasty surgery can be performed closed, not requiring a scar over the columella. The important suggestion is to get interviews with plastic surgeons that have alot of experience with this surgery.

Rodger Wade Pielet, MD
Chicago Plastic Surgeon

Septal cartilage from inside your nose would seem to be a better choice.

if you have never had any surgery on your nasal septum and it is still intact most surgeons would prefer to use cartilage from your septum. It comes from inside your nose, no external incisions are needed, a straight piece of it can can be havested and it is stronger than ear cartilage and able to give better support. The only reason I can think of not to use septal is if none is available. Jack P. Gunter, MD

Jack P. Gunter, MD
Dallas Plastic Surgeon

African-American rhinoplasty

Hi, you can certainly have this surgery done through the "closed" approach, which means that the columella is not cut. Using cartilage from another part of the body, such as the septum or ear, is very standard. Developing a keloid on the back of the ear would be unusual, but it is possible. Most surgeons have a preference about doing this surgery through the open or closed approach, and no one approach is correct. It all depends on the skill and experience of the surgeon. I... more

Nina S. Naidu, MD
New York Plastic Surgeon

African American Rhinoplasty

Hi Rita, African Americans typically ask for tip support and refinement. In my opinion, african americans rhinoplasty can only been done well through an open approach through a collumelar incision. The open approach allows the surgeon to see the undersurface of the tip skin where excess fat may need to be trimmed in order to reduce the bulbosity of the tip. Also to resupport the tip, cartilage grafts need to be placed precisely in between the center cartilages of the collumela.... more

Oleh Slupchynskyj, MD
New York Facial Plastic Surgeon

Consider septal cartilage instead of ear cartilage for tip projection

Yes, that should be possible. However, I might consider using septal cartilage to increase your tip projection instead of ear cartilage. Septal cartilage is the cartilage that is from the septum which is the part inside your nose that divides the nose into two nostrils. The advantages are that septal cartilage is usually much stronger and more straight, leading to a nicer result and better long term stability. Also, there is is no visible scar as the cartilage is harvested from inside the... more

Lane Smith, MD
Las Vegas Plastic Surgeon

Closed rhinoplasty and tip graft

Rhinoplasty can be performed via an "open" approach by making an incision along the "waist" of the columella or performing it "closed" Either way is Ok.

Steven Wallach, MD
Manhattan Plastic Surgeon

Rhinoplasty for tip projection without Open technique

Dear Rita, Although there are 3 types of INTERNAL nose incisions in relation to the lower lateral cartilages (which make up the tip of the nose), there are several ways to get at the front of the nasal septum. Incisions limited to the sides of the columella are lumped as CLOSED techniques while joining these incisions across the waist of the columella is termed an OPEN rhinoplasty technique. Can your procedure be done without a transcolumellar (open) incision? Yes. Will it afford the same... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

You are requesting a closed rhinoplasty

In a closed rhinoplasty technique, a tip graft can be inserted to achieve increased tip projection. Other surgeons favor the use of sutures to add pojectio using the tongue and groove texnique. Your desires can be achieved using a closed rhinoplasty technique.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

African American Rhinoplasty in Keloid Prone Individual

I am always concerned about getting the cartilage from the ear and starting a keloid. A lot of cartilage can be obtained from the nasal septum and used for tip augmentation. It can be done through a closed approach without cutting the columella. If you keep searching in your area you should be able to find someone who can do the whole procedure without cutting the columella. Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon

It might work

Auricular or ear cartilage is not as strong and not as easily shaped as septal cartilage. Septal cartilage in hispanic, asian, and african races tends not to be as strong as caucasian septal cartilage but it will be stronger then auricular cartilage. A tip graft is not the only way to gain tip projection and definition. Using the existing cartilages a great deal of tip projection can be obtained. Making a columellar incision rarely causes a keloid formation, but if your nose is relatively... more

Samson Lee, MD
Seattle Facial Plastic Surgeon

Maybe

Hi, African American patients most often have weak tip cartilages and heavier skin. Placing a tip grafts from the ear will occasionally work but its not the best approach. 80% or more of African Americans need an Open Rhinoplasty with tip sutures and tip grafts. Some patients can undergo a Closed Rhinoplasty with whats known as "dome division" which is an older technique but it works well for some patients. Ear cartilage is only rarely necessary when doing a primary Rhinoplasty... more

Shervin Naderi, MD
Washington DC Facial Plastic Surgeon

Open Rhinoplasty vs. Closed Rhinoplasty for Nasal Tip Elevation

First - there are many ways to perform Rhinoplasty and each surgeon will favor a particular approach that he finds predictable. In most cases, particularly first time surgery, good results can be achieved by either the closed or open approach. However, not all surgeons have significant experience with the closed approach when it involves cartilage grafting. It is rare to see a bad columella scar as long as it's closed properly. I would want to know what your 'keloids' look like.... more

Jon F. Harrell, DO
Miami Plastic Surgeon

www.westonsurgery.com

Open VS. Closed Rhinoplasty

Increasing tip projection in a typical African American nose can be done with a closed rhinoplasty, although most surgeons would probably say that the open approach would be easier and more effective. Most would also use the cartilage from the septum of the nose, not the ear. I wouldn't worry about keloid formation in the columellar scar. I have never seen a keloid in that area (or in the eyelids for that matter). A very skilled surgeon could get a... more

Kevin F. Hagan, MD
Nashville Plastic Surgeon

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