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
African American Rhinoplasty for Tip Projection Without Cutting Columella?
Doctor Answers (19)
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African American Rhinoplasty
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. Further cartilage grafts must be placed in the tip for create tip refinement.
As far as the source of cartilage for grafting, the septal cartilage in your nose is the best source grafting. That being said, I have performed many revision rhinoplasties in African Americans using ear cartilage. Even in those patients that had a tendency to keloid, not one of them developed a keloid from the incision site. Keloids do not tend to occur in this area of the ear.
Best of Luck!
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 cartilage gone? Also, septal cartilage tends to be stronger. If you have medium to thick skin and are looking for nasal tip refinement, septal cartilage will be better in achieving this correction.
If you have a tendency to keloid, then I would avoid an ear cartilage harvest in this case.
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.
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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.
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 and projection with a columella-strut in one of my African-American Patients.
I hope this is helpful to you.
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 and possibly dorsal (bridge) augmentation.
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.
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.
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
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 personally would use an open approach with cartilage from the septum, but if you are comfortable with your surgeon and he or she has shown you good results of other patients with a similar nose, you should be fine. Good luck, /nsn.
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