No Major Visual Change After Surgery

Question

I am an African American who had rhinoplasty. I desired a Halley Berry type nose-more defined tip. The result was that there were no significant changes made. Eight months later my surgeon attempted revision. It has now been 15 months since the revision and 7 months since the revision. And there is a visually striking significant change. Everyone says that my nose looks the same. How could he do so little that there was no visually significant changes? What should I do?

Russell Kridel, MD · Answer

It appears from your before and after pictures that your nose is more narrow at the sides (the alar base) than before, so there is some improvement. Do you appreciate the improvement? Friends often do not even remember what your nose looked like before and so are not good judges. But what is most important is how you feel about the changes. Some of my African American patients don't want too much of a change because they don't want to lose their ethnic appearance; others want more significant changes. Often African Americans have thick nasal tip which sometimes limits the final result but also which can be made to appear more defined by the use of tip grafts and certain suture techniques. Discuss the results with your surgeon; compare the before and after pictures. You could always see another nose surgeon for another opinion. If you'd like more information on this, please see a paper I wrote with one of my former fellows: Patel, A. and Kridel, RWH, “African-American Rhinoplasty” In Ethnicity in Facial Plastic Surgery. Facial Plastic Surgery. Thieme Medical Publishers, 2010; 26 (2): 131-141

James Nachbar, MD · Answer

Certainly, by seven months since the last procedure, you should be starting to see some of the result, although it can take a year or longer for the maximum result.  Have you gone over your before and after photos with your surgeon?  Do you see the result?  If not, and if you are not happy with what your surgeon tells you, you might consider seeing another surgeon.  Be sure to bring copies of your operative notes and your photos.

	However, I would not put any stock in what your friends tell you.  I'm sure they don't really remember what your nose looked like a year an a half ago.

Mohsen Tavoussi, MD, DO · Answer

It very difficult to get a good result with African-American noses, but it is possible. The tip skin is usually thick and does not redrape well over the cartilagenous structure. And after surgery there is some differences from preop. but formation of the scar tissues masks the refinement made during surgery and the nose does not appears to have changed. Therefore, one needs to defatt the skin over the tip aggressively to help with redraping. Postoperative steroid injection reduces the effect of scar tissues.

David A. Bray, Sr., MD · Answer

Your surgeon should have warned you that thick skin does not always respond well to tip defining procedures Most African American patient have thick skin and small cartilages to work with. A second opinion is in order but, be cautious.

Peter E. Johnson, MD · Answer

For something that should have such a striking visual impact, it is peculiar how often friends and even family members fail to notice visual differences after rhinoplasty. Even with a huge hump reduction others may not 'get it'. This does not mean that your results are not real or significant. Only the before and after photos will tell for certain and you can have a look at them to reassure. Rhinoplasty is for you, and friends should always like what they see.

	Best of luck,

	peterejohnsonmd

Richard W. Fleming, MD (retired) · Answer

It is impossible for many African American ladies with thick skin to get a Halle Berry type nasal tip. Discuss your dissatisfaction with your surgeon. You may want to get a second opinion after obtaining pre-op pictures.

No Major Visual Change After Surgery

Answers (6)

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