My goals are to reduce the long over-projection, refine my tip, and tame my wide flaring nostrils. During my consultation, my surgeon recommended a silicon implant to also build up my bridge, indicating that the silicon implant is tolerated well in African Americans, and has low rejection rate and subsequent complications. However I cannot find much information about the application of this type of implant for my ethnicity. Do you recommend it for me and/or at all? (pictures attached)
African American Rhinoplasty - Is Silicon Dorsal Implant Best?
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African American Rhinoplasty
Silicone implants work well if they are "custom carved for your nose". The "factory preformed implant", is a " one size fits all", this doesn't work well because every nose is different and each implants needs to be custom for each individual patient. I have used silicone implants for past 10 years with great results. You can see many examples on my website below. In my hands, custom carved silicone implants work the best but there are other materials that can be considered such as gortex. It all depends which material the surgeon is comfortable using.
Best option for dorsal augmentation in African American rhinoplasty
The risk of infection, extrusion and migration are always higher with a silicone implant than autologous tissue (your own body). This is because the silicone never becomes incorporated into your nose but remains as a foreign body. It's true that silicone implants are fairly well tolerated in Asians and African Americans because of our relatively thicker skin, but again, they are still not as safe as using tissue from your own body.
Refining nose and using Silicone Implants
Based upon your goals and the photos you included everything you're contemplating seems reasonable. As for the need to build up your bridge - that decision is made based upon your perception of your nose as well as what the surgeon thinks will enhance the overall result. Reducing the tip projection and rotating it will reduce the need for bridge augmentation but it still may be indicated. I personally have not had problems will dorsal silicone onlay implants. They need to be deep and secured well - separated as much as possible from the incision. If augmentation needs are not significant then oftentimes there is enough cartilage in the septum of the nose to make modest improvements in the bridge. You can probably get good results from varying techniques, depending upon your own goals and what is really important to you. Best of Luck Dr Harrell
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Silicone Implants and Rhinoplasty
Silicone implants are not as commonly used in African American rhinoplasty as in Asian rhinoplasty. I am not a big fan of silicone implants as they can extrude from the skin of the nose, causing permanent scarring to the skin and soft tissue envelope. If extra cartilage is needed, auricular or rib cartilage offers a safer option in surgeons with experience using these materials.
African American Rhinoplasty
your rhinoplasty will likely need to combine elements of caucasian reduction rhinoplasty and ethnic rhinoplasty. SInce you actually seem to have well developed lower lateral (nasal tip) cartilages, I would not recommend a silicone implant. You will probably benefit from an onlay implant over the top portion of your dorsum, but in my experience a customary Goretex implant made of several layers of Goretex provides much better results than silicone, with less risk of infection or extrusion, and more natural appearing results.
You will also benefit from tip reshaping and redefinement, possibly a tip cartilage graft, and alar reduction. The last portion is the part of surgery that will make your nostrils smaller and better balanced.
Wishing you best of luck,
Stella Desyatnikova, M.D.
Your biggest problem is your tip and it's projection as well as the dase width. An implant will reduce your curved dorsum and give a stronger nose. I don't favor silicone but am unaware of any ethnic differences
There are a variety of materials you can use for augmentation ranging from your own cartilage to banked cartilage to synthetics (silicone,gore tex, medpor). You will find arguments for and against each of these options. Go with what your surgeon has the best results with and has the most experience with. Just remember that even in the best hands there is still a slightly greater risk of infection or extrusion with a synthetic of any type compared to your own cartilage.
African American Rhinoplasty Implants
Cliquot- There are a variety of materials which can be used to shape the dorsum of the nose. These range from natural materials such as your own rib cartilage, cadaveric rib cartilage, to synthetics such as GoreTex and silicone. Another option is to use small pieces of your own cartilage from your nose or ear wrapped in a layer of tissue taken from near the ear (temporalis fascia). Silicone was widely used for implants in the past but has the problem of extruding (working its way out) over time. There are advantages and disadvantages to each of the other options I describe. My advice is to speak with several rhinoplasty surgeons and discuss your goals and concerns, then make an educated decision. Rhinoplasty is a wonderful operation and I hope you enjoy your new nose in the future.
If your problem is with your tip, implant does not make sense
In our experience most African American patients present wanting their tip to be better defined, less wide and unfortunately most surgeons do not focus on that issue but rather talk about building up the bridge. While building the bridge can be part of your goals, we find that in general there is no need for a silicone implant or rib, as these elements generally are too much. They may be safe though I have not seen long term studies with African American populations, but the real issue is that they do not address your main concern which is your tip.
Peyman Solieman, MD
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