I'm 20 years old and an African-American male. I have a depressed nasofrontal angle that I want to get fixed, I've posted on here before and I'm having trouble deciding on the cartilage graft or the silastic implant, which is better as well as safer? Also, I want to have a slimmer face and am considering buccal fat extraction. Would this be the right procedure? How could I achieve a slimmer look? Thank you!
Nasofrontal Angle and Cheeks? (photo)
Doctor Answers 8
Nasofrontal angle and cheeks
Small dorsal augmentations are best performed with the patient’s own cartilage. If a large dorsal augmentation is required, the options to be considered are rib graft or silastic implants. Both medial and lateral osteotomies of the nasal bones will narrow the bridge and give slight added height in that area as well. We do not recommend buccal fat pad removal as it accelerates the aging process.
Augmenting Nasofrontal Angle
Augmenting the nasofrontal angle with cartilage is better and safer because you are using your own tissue which will integrate with the surrounding tissue and will not move or extrude later in life. Rather than removing cheek fat consider cheek augmentation and a chin-jowl implant to bring the cheeks and chin into proportion with the fullness you don't like. This approach will improve facial definition.
In my opinion it is always safer to use cartilage. The reason being that with an implant there is always the chance of rejection. Cartilage always looks more natural if places correctly. You will benefit from narrowing as well. You would also benefit from a buccal lipectomy. You need to understand that this procedure will only give you some narrowing at the lower face by the outer corners of your lips. You may want to consider some liposculpting of your face.
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How to improve nasofrontal angle
You are right, your nasofrontal angle is deep, which is mainly due to a very prominent frontal bone. This is usually corrected with an onlay graft. The most commonly used material is cartilage (likely from your septum) which can be either stacked together in several layers or minced and wrapped into a special material. Silicone implant is another possibility, although less popular nowadays given the potential problems related to implants. The tip of your nose may also benefit from refinement and narrowing the nostrils. Personally, I don't think you need buccal fat extraction. Your lips are very prominent, and there are ways to make them slightly smaller -- I think this would benefit you more than buccal fat extraction which will accentuate your lips even more.
Nasofrontal Angle and Cheeks?
From the photo, aesthetically The cheeks are flat and the chin is weak. Cheek implants, chin implant and a straight silastic dorsal nasal implant along with thinning the nose and nasal tip with Rhinoplasty would be recommended.
African American Rhinoplasty and Nasal Augmentation
African American rhinoplasty is a specialty in itself. I have dedicated a website to African American rhinoplasty below. In my experience the best material to augment the naso-frontal angle or nasal bridge is custom carved silicone implant. Using this implant requires alot of skill and experience. Cartillage grafting will not give you same shape and elevation needed to achieve the result you are looking for. Raising your bride and your nasofrontal angle will make your face slimmer. Buccal fat extraction will give you very little added slimness to your face. See link below for many before afters. As well as the video link.
Nasofrontal Angle and Cheeks
The depressed nasofrontal angle is best corrected with a cartilage graft, the complication rate of cylastic (rubber) implants in this location is too high. As far as the buccal fat extraction, that is a good procedure for achieve a thinner face.
Solid Silastic or cartilage can be used in the nasofrontal region. The buccal fat pads can be reduced, but later in life you may wish you had them back as you age.