Risks of African American Rhinoplasty to Keloid Prone Patient?

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!

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.

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"

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.

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.

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.