Risks of African American Rhinoplasty to Keloid Prone Patient?

Question

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?

David C. Pearson, MD · Answer

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,
--DCP
P.S. Interesting factoid: Weir described his technique for narrowing the alar base more than 100 years ago!

Jamil Ahmad, MD · Answer

Keloid scars are excessive scars that form not only in the area of the trauma or injury but abnormally extend to the surrounding tissues. They are more common in areas such as the shoulder or sternum (over the breast bone), and can also occur at the ear lobes and nape of the neck. There seems to be a genetic predisposition as people with darker skin tend to form keloids.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.

Joe Gryskiewicz, MD, FACS · Answer

I believe you are correct in that if you narrow the nasal bones and leave the nostrils wide, you will look disproportionate. We call this the "bowling-pin" nose. The risk of a keloid on the nose or after alar narrowing is very, very, very rare. Despite the fact you have three keloids elsewhere on yourself, you risk of bad scarring, assuming meticulous surgical technique, would be very low. All the best, "Dr. Joe"

Jennifer Parker Porter, MD, FACS · Answer

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.

Scott Trimas, MD · Answer

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.

Eric M. Joseph, MD · Answer

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.

Toby Mayer, MD · Answer

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.

Otto Joseph Placik, MD · Answer

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.

Raja Mohan, MD · Answer

African American rhinoplasty is a cosmetic surgery procedure that reshapes the nose to improve its appearance and function while preserving the patient's ethnic features. It's also known as an ethnic rhinoplasty, a term used by many plastic surgeons to describe nose surgeries for non-European patients. The goal of African American rhinoplasty is to achieve a natural-looking result that complements the patient's other facial features. It can address a variety of concerns, such as:A wide nasal bridgeFlared nostrilsA deviated septumThe size, shape, or function of the nose The type of technique used depends on the patient's goals and specific characteristics. Some common techniques include:Alarplasty: Narrows the nostrils by removing soft tissueDorsum surgery: Narrows the cartilage and bone that runs down the nasal bridgeTip rhinoplasty: Reshapes, refines, or lifts the nasal tip Patients who are good candidates for African American rhinoplasty are usually in good health, non-smokers, and have realistic expectations.

David C. Mabrie, MD · Answer

Hi Heather,

	Great question and a valid concern.  While no absolutes can be given, in general, the incident of keloid scaring after rhinoplasty is very rare.  For some unknown reason, keloids don't form after treatment on the nose.  As you may know, the most common places for keloids are the ears, neck, and chest.  I wouldn't let the fear of keloids stop you from having rhinoplasty surgery.

	Best wishes for your surgery.

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