Do I have to have a implant for my rhinoplasty to be successful?

Judging from your photographs and having performed many rhinoplasties on both African American noses and Asian noses, I seldom if ever recommend implants in a primary rhinoplasty. For augmentation of the nose, I recommend septal cartilage, ear cartilage and rib cartilage as a better option for both the short term and long term. Implants can be used but they carry a higher infection risk. Also, narrowing can be done by reducing the base of the nose and augmenting the tip region. Good luck in your area.

Any answer is limited by your submission of only a frontal view. By a smaller nose I assume you mean a narrower bridge and tip. The broadness of the bridge is due to flatteniing and deficiency of the nasal bones. The standard approach to narrowing it is moving the bones toward the midline and augmenting the bridge with bone, cartilage or synthetic material. I doubt you would have enough ear cartilage or septal cartilage to give you sufficient graft material so you will need rib cartilage or cadaver cartilage. If you go with bone the options are olecranon (used more in the far east), iliac crest or outer table of skull (more common in the US). If you go with synthetic material your options are goretex, medpor or silicone. Each of these options has its own pros and cons and you should take an active part in choosing the augmentation material with as much care as choosing your surgeon. You also need to take into account that different surgeons are more comfortable and more skilled with specific augmentation materials so choosing a surgeon and choosing the material go hand in hand. Afro-americans can also have problems with scarring such as keloids at donor sites so you need to take that into account if you choose to use your own tissues.With respect to the tip the usual alar base reduction consisting of removal of skin at the outer base of the nostrils may be insufficient in Afro-americans if the nostril rim is wider than 3 to 4mm. Your surgeon should be able to easily address that.I can understand your wanting to maintain your ethnic features which would likely mean keeping your round tip. Your other options could include not narrowing the base to the usual 3.2cm. If your current intercanthal distance is 3.2cm then your alar base width would be 5.6cm which gives you plenty of room to work with. There is no reason why you could not narrow it to 4cm if you wanted it. The best way for you to decide what you want is have your surgeon do imaging with various parameters. You would, of course, have to realize that this is not an exact science and the imaging cannot be an actual guaranteed result. I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

 To narrow a wide nose requires osteotomies placed in the nasal bones, a tip rhinoplasty, and an alar plasty to narrow wide nostrils. It's also helpful to use the patient's own cartilage for grafting purposes along the bridge line to build up the height of the nasal bridge line.