I'm African American considering a Rhinoplasty. I have 3 medium size keloids on my body (not my face). I met a surgeon who suggest it would be better I do not have nostril narrowing on my face to avoid my skin being cut & avoid keloids around my nostrils. I would like your expertise on this matter. Should I avoid at all cost having my nostrils narrowed (cut) since I am proned to keloids? My nasal bone is wide. If I only narrow the nasal bone & raise my columella, will the nostrils & tip look more wide/flared?
Risks of African American Rhinoplasty to Keloid Prone Patient?
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African American Rhinoplasty and Keloids
I have never seen a keloid form on the nose in my 12 years of performing African American rhinoplasty. Keloids tend to form mostly on the chest, earlobes, cheeks, neck, arms, abdomen, back and even legs. Keloids do not form on the midline structures of the face. Raising the tip and osteotomies should not have any effect on your nostrils.
Keloids and nasal incisions
Keloids seem to be exceedingly rare to unheard of on the columella and I have never seen one after rhinoplasty. There are, however, rare cases of keloids from piercings of the nasal ala (the outer part of the nostril) such as when studs or other jewelry are placed there. For that reason alone, I would probably avoid any lateral alar base excisions (e.g., Weir excisions).
As for whether narrowing the bones would create a disproportion, only an exam in the office would allow for any analysis of that concern.
All the best,
P.S. Interesting factoid: Weir described his technique for narrowing the alar base more than 100 years ago!
Keloids are rare after rhinoplasty
I have only seen one case of keloid after rhinoplasty. This was a photo shown to me by a colleague -- the patient had many prior surgeries.
I have performed rhinoplasty on many African American patients, and other patients that are prone to keloids, and have not had an issue. With proper surgical technique and postoperative care, you are at little risk for this complication. Most patients can barely see the incision after surgery.
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Keloids after Rhinoplasty is rare
Even in African American patients who keloid easily, keloid formation after a rhinoplasty is rare. That being said I have seen it occur. For that reason, if you are worried about keloids occurring I would avoid external incisions including narrowing of the nostrils or alar base. Raising the tip will narrow the nose. You may still have wide nostrils and you can always decide later if you want to do that separately. I hope this information helps.
Rhinoplasty incisions are not prone to keloid formation.
Keloids are benign, large, unsightly scars that exceed the boundaries of the original incision. You are more prone to get one if your skin is dark, but anyone can get a keloid scar.
The other important factor with keloid scarring is location. The ear is, by far, the most common body part to form a keloid. The skin over your breast bone also is prone to develop a thickened scar or keloid. I am not aware of any reported cases of keloid scarring after either circumcision or Rhinoplasty Surgery. Choose your Rhinoplasty Surgeon wisely, and keloid scarring should not be an issue.
I hope this is helpful for you.
Keloids should not happen with Rhinoplasty
You really should not worry about formation of keloid scars after rhinoplasty. I have never seen one nor have any other experienced rhinoplasty surgeons that I know of. That being said, poor scarring can happen after nostril reduction but that usually relates more to poor technique which should not be a concern in experienced hands. If you narrow your nasal bones and do nothing to your tip other than raise the columella, you may find that the bridge now looks narrower in relation to your tip, causing your tip to appear wider. During your consultation, your rhinoplasty surgeon should be able to show you with computer imaging what this can do for you, so you can get a better sense of whether tip refinement and nostril narrowing would be preferred. All the best.
I would not worry about keloid risks in African American Rhinoplasty
I have been operating on African Americans for over 30 years and do noses quite frequently. I have never seen keloid on a nose I have operated on. Let the doctor do what is needed on your nose.
Keloids and rhinoplasty in African-American patients.
In more than 30 years of rhinoplasty, I have never had a patient with a keloid from rhinoplasty--even when they have them elsewhere. Except for Murphy's law, I don't think you would have a problem.
Keloid and rhinoplasty (nose job)
In my opinion, the risk of a keloid is exceptionally low with rhinoplasty and almost reportable. That having been said, I understand you concerns. Raising the columella should make the width of the nose appear smaller.
Keloid scars are very uncommon on the nose
However, keloid formation on the nose is EXTREMELY rare and is almost unheard of after rhinoplasty. This is the case for incisions on the columella and also the alar base. The only exception may be the case of nasal reconstruction for major burns of the nose.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.