What doctors are comfortable using the rib cartilage method for african american patients?

You are very well informed and conducted, never ever, under no circumstances, a synthetic (alloplastic) implant should be used in nose surgery, typical and tempting (time and money saving, supplementary to dr's technical limitations too) in african and asian rhinoplasties to rebuild their common issue: tha lack of dorsum/bridge (massively).Yes, in slightly low bridges a ear cartilage made dorsum can work perfectly and suffice, but no more than 2-4 mm can be raised that way; for strong, thick and supportive dorsal reconstruction (raise) it is totally required the use of rib cartilage; but that is not enough, there are more requirements:-the cartilage has to be from the core of the shaft, to prevent its warping (cortex of the rib cartilage bends, unlike the core or central portion)-it is not a matter or harvest-and-insert, the piece has to be tailored very meticulously and with the greatest artistry, IMHO and based or my own hands-on experience this is the most creative and difficult maneuver in a nose: building a custom made new dorsum out of a cubic block of cartilage, it is real sculpting-the dorsum has to be engages to an L shaped strut for the columellaVery often africanamerican noses need other maneuvers, like alar cartilage and tip reinforcement/replacement, nostril reduction, alar reduction, defatting of tip (a must), etc.Seek the advice and hands of a serious professional who offers to you
a time-consuming and expensive procedure; stay far from minimally
invassive snake-charming procedures, synthetic implants, fillers,
wrapped diced cartilage, etc.
Difficulty 8 out of 10 in ethnic rhinoplasties, surgical time about 6 hours (in expert hands, could be even longer).
If you wish better grounded opinion well lit, focused and standard
images have to be assessed: frontal, both lateral and both oblique
views, also underneath the nostrils.
Feel free to request any additional information from me.

There are many options to build up the bridge of the nose. Fillers can be used in the office. Implants can be used. If you choose a nasal implant, I have found that the dorsal ones work very well, however I would advise against a "L" shaped implant unless you have no other option. Ear, septal, or rib cartilage can all be used.

African American, Asian, or "Ethnic" rhinoplasty involve several characteristic differences between Caucasian rhinoplasty, including thicker skin, less nasal bone projection, less available septal cartilage available to harvest, and a wide and flat nasal tip. These characteristics almost always require the operation to involve both augmentation of the dorsum, projection of the nasal tip, and alar base reductions to reduce nasal width. The best natural substance to produce these results is rib cartilage as 1 incision can easily produce 1 or 2 pieces of rib, enough to completely reconstruct the nose. The trade off to rib is that the nose will be firm and hard after the operation. Silicone is a popular option, but it is not natural, and if it is used aggressively to increase nasal tip projection, it can cause thinning of the skin and eventual exposure. The advantages are it is much simpler to place and it is softer than rib cartilage. Most surgeons who frequently perform revision rhinoplasty are comfortable with rib graft harvest and usage.