Promoted Local Answer
The sidewalls of your nose do contribute to the width and bulkyness. However, your flat bridge also impacts the width, thats why many ethnic patients get some sort of dorsal augmentation to elevate the bridge making it appear more narrow. The best way to see this is to get computer imaging before the surgery.
Absolutely. The bones can be shifted inward to create a thinner bridge. You can certainly refine the tip and
the alar base as well. I think that rhinoplasty is really about listening to
what the patient wants and then having the technical skill to execute
Find a board certified plastic surgeon who performs rhinoplasties and rhinoplasty revisions every week. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results.
Kenneth Hughes, MD
Los Angeles, CA
There can be different contributions to this. Some of it can be illusion due to low bridge, some due to wide nasal bones tho typically this is a minor contribution, if any, to your area as the bones are typically very short in AfricanAmericans noses, and some can be due to the form/position of the portion of the maxillary bone that forms the nasal opening in the skull. These can all be dealt with, though each one in a different manner, during a skilled rhinoplasty.
The area of the nose that you are referencing can be referred to as the nasal vault sidewall. The nasal vault is essentially the middle third of the nose and has a dorsum (the top) also known as the bridge and a right and left sidewall which meet with the face at the naso-facial groove. From your photos it would appear that this area is particularly prominent and wide. This area can be reduced using bone cuts or osteotmies to narrow the bony portion of the sidewall at this location. In some cases it may be necessary to decrease the thickness of bone in this area. I have done this using a small incision in the oral cavity and accessing the naso-facial groove with a powered bone cutting burr.
Please keep in mind when planning your rhinoplasty, that overall balance and harmony between the nose and the rest of the nose is paramount. In the case of ethnic rhinoplasty, one needs to balance the degree to which the nasal features are modified versus preservation of ethnic appearance: more may not be better.
Mario J. Imola, MD, DDS, FRCSC, FACS.
It appears that you are concerned with the width of the bony vault of your nose. Some other common concerns that prompt black patients to seek rhinoplasty include the flat bridge and the width of the lower nose including flaring of the nostrils. Additionally, a flat, large, ill-defined tip may also accompany these other features. Increasing the height of the dorsum will help to balance the profile but also improve definition of the bridge from the front view. In the case of a wide bony vault, osteotomies (controlled fractures of the bones) can be performed to narrow the bony vault of the nose and narrow the point of inflection where the cheek appears to transition into the nasal sidewall of the nose. This change in the bony vault along with improving tip definition and projection can help to make the nose appear less flat and wide giving the nose more definition. Typically, alar base surgery is also required to decrease the flaring or an excessively rounded appearance of the nostrils as well as their size. Although it is possible to make the nose look significantly better with rhinoplasty, it is important that the resulting changes still appear in balance with the other facial features and remain ethnically congruent to avoid an unnatural result and stigmatizing result.
The goal of rhinoplasty surgery should be to create a nose that is best suited to your face both in proportion and shape so that you achieve the most natural looking result. If done well, it is possible to achieve a result after rhinoplasty that looks significantly better to you while making it not obvious that surgery was ever performed.
You would benefit from a consultation with a board certified plastic surgery that has significant experience with rhinoplasty in black patients.
The rhinoplasty procedure can address the bulbous tip with suture techniques to the lower lateral cartilages. The wide base is addressed with an alar plasty procedure and small wedges of skin are removed from the base of the nostrils. The dorsal sidewalls of the nose are narrowed with medial and lateral osteotomies. The height of the nose can be shaved down if there's a hump, or added cartilage grafting if it's too low.
You accurately describe the changes that you would like to make. Surgery in a nose like yours always includes narrowing the sides in the bony area. Select an experienced rhinoplasty specialist.
The issue of the upper nose being wide that you mention is a very common issue. Narrowing the sidewalls is accomplished by osteotomies (bone cuts) and then narrowing the nasal bones. If your case I would suggest perforating double lateral osteotomies for narrowing, since the frontal process of the maxilla is prominent in your case. I wrote a paper on this with Dr. William Lawson about 12 years ago. It was published by the archives of facial plastic surgery. If you can look it up and read it, you may find it interesting. There is also a brief explanation of the papers content on my website (newfaceny.com).
All the best.