Like all rhinoplasty surgery, this cosmetic procedure can be performed either under general anesthesia or local anesthesia with sedation.Â
Every case is different, but common rhinoplasty techniques performed on Black patients may include the following:Â
- narrowing and/or elevating the nasal bridge or dorsum
- removing a bump on the bridge of the nose
- performing an alar base reduction, to narrow the width or flare of the nostrils
- shaving and narrowing the nasal bones, to reshape the nasal structure
- refining or projecting the nasal tipÂ
- improving the angle between the nose and upper lip
âFor African American noses that often have thick skin, we create tip definition by adding a graft of your own cartilage,â explains Dr. Steven J. Pearlman, a facial plastic surgeon in New York City.Â
Surgeons may also conservatively âdebulkâ the tip of the nose by removing excess fat under the skin.Â
Dr. Ok notes that itâs not possible to actually remove excess nasal skin, so the underlying structure must be contoured in a way that most elegantly supports it. Thick skin is less elastic, which can make it more difficult for it to adapt to changes in the shape. It can also lead to âtip dropâ over time, if the skin isnât properly supported. Â
Dr. Okâs approach is often determined by the width of the apertura piriformis, the bony opening below the nasal structure. For example, âmost patients who have a wide nasal aperture need whole bridge augmentationâ with cartilage grafts, often taken from the back of the ear, nose, or rib.
When cartilage grafting is involved, plastic surgeons often recommend an open rhinoplasty approach, which provides the best accessibility and visibility. Open rhinoplasty requires an incision along the columellaâthe narrow strip of skin separating the nostrilsâso the skin can be lifted to expose the interior of the nose. Surgeons typically make a stair-step or V-shaped incision across the columella, because these types of scars are less noticeable than a straight line.
Another advantage of open rhinoplasty: it allows surgeons to use the Piezo method, commonly called an ultrasonic nose job. The Piezo device precisely shapes the nasal bone with ultrasonic vibrations, a much more precise method than using rasps or chisels. This delicate technique results in less bleeding and trauma to the surrounding tissue, so patients have less bruising and a faster recovery than traditional rhinoplasty.
However, a closed rhinoplasty technique can also work well for patients with thick skin and a large nasal tip. This method tends to help preserve the blood vessels, and patients tend to have less swelling and numbness, with a relatively quick recovery.
During your initial consultation, ask your surgeon to thoroughly explain their treatment plan for achieving your desired results, without making your nose look too âoperated on.âÂ
Rhinoplasty is widely considered the most difficult type of plastic surgery to perform well, and even very experienced rhinoplasty surgeons may not have the artistic eye or surgical technique required to achieve a balanced, culturally sensitive result for Black patients.
