Rhinoplasty Options for Wide Nose Bridge?

A wide nasal bridge may be from just that, wide nasal bones. The nasal bones make up the upper third of the nose. However if the nasal bones are very small, as is common in African American noses, narrowing them often has little effect. Sometimes actually raising the profile of the nose by adding what is called a dorsal graft can make the bridge appear narrower. The rest of the nose can be made more slender as well yet not sacrifice ethnicity.

Dear Kendra, thank you for your inquiry and photos you attached. You are a good candidate for close rhinoplasty without no columellar incision.Regarding your photos you have wide nasal bridge and bulbous nasal tip .You may benefit from alar base reduction and tip definition also nasal bridge reduction can be performed.
I wish the best for you.

An open rhinoplasty can be used to narrow the bridge of your nose.  If you narrow the bridge, it might be a good idea to mildly reduce the tip and bring in the nostrils so that your nose stays proportional.  Making the bridge smaller than the rest may not look good.  If you're curious about how it would look, see a african american rhinoplasty specialist in your area that has the Vectra 3D imaging system that allows you to see what your nose can look like after surgery with or without any changes to the tip and nostrils.  Hope that helps!

The bridge, or dorsum, of the nose is made of a combination of bone and cartilage. The ratio of bone to cartilage varies from person to person and will be identified by the surgeon. In order to narrow the nose the sides are cut and moved closer towards the center. In patients who have a large hump, the hump is lowered before the sides are cut. In patients where the bridge is still too low after cutting the sides, additional cartilage is used as grafts to be added on top of of the bridge in order to raise it up. The skin is the final tissue that will contribute to the final effect. Thin skin will show more definition, thicker skin will make it more difficult to see detail. Thick skin over the dorsum will always make it look a bit wider. 

African American frequently desire rhinoplasty to create a thinner nose, especially along the nasal bridge.  There are a variety of techniques to thin a nose including:
1. Osteotomies- narrowing nasal bones.  This is typically the case where the bones are wider along the nasal cheeks and require further narrowing.
2. Augmenting the bridge- using cartilage to make the nose appear thinner.  Placing a thinner piece of cartilage along the bridge can make it appear thinner can improve the dorsal aesthetic line.  Some surgeons will use nasal implants which are artificial, however there is still controversy with the use of artificial nasal implants such as silicone or gore-tex.  I prefer the use of autologous cartilage from either the inside of the nose or ear or rib.

There are basically two tools a rhinoplasty surgeon can use to narrow a  bridge. The first option is to reposition the nasal bones. The bones are very thin, however most patients cringe at the thought of breaking the bones. This is not that uncomfortable. The uncomfortable part of rhinoplasty used to be the six feet of packing the doctors used on the inside. I do not use packing, instead, I use dissolveable sutures to hold the structures together. The second option to narrow a bridge is to build the bridge up with an implant. Implants can be silastic, or they can be created from your cartilage from the nose, ear, or rib. To see which option is best for you, one would need a side view. 

There are several options for reducing the size of an ethnic nose. Because the thickness of the skin and profile views are important in making any recommendations, it is best to be seen in person by a plastic surgeon well versed in this area.

It appears that you are concerned with the width of the bony vault of your nose. This is the upper third of the nose and includes both dorsum (bridge) and nasal sidewall (between the bridge and the transition point of the nose-cheek junction). A flat dorsum  along with a wide bony vault is common in black patients seeking rhinoplasty. Some other common concerns that prompt black patients to seek rhinoplasty include the width of the lower nose including flaring of the nostrils, and a flat, large, ill-defined tip. Increasing the height of the dorsum will help to balance the profile but also improve definition of the bridge from the front view. In the case of a wide bony vault, osteotomies (controlled fractures of the bones) can be performed to narrow the bony vault of the nose and narrow the point of inflection where the cheek appears to transition into the nasal sidewall of the nose. This change in the bony vault along with improving tip definition and projection can help to make the nose appear less flat and wide giving the nose more definition. Typically, alar base surgery is also required to decrease the flaring or an excessively rounded appearance of the nostrils as well as their size. Although it is possible to make the nose look significantly better with rhinoplasty, it is important that the resulting changes still appear in balance with the other facial features and remain ethnically congruent to avoid an unnatural result and stigmatizing result. The goal of rhinoplasty surgery should be to create a nose that is best suited to your face both in proportion and shape so that you achieve the most natural looking result. If done well, it is possible to achieve a result after rhinoplasty that looks significantly better to you while making it not obvious that surgery was ever performed. You would benefit from a consultation with a board certified plastic surgery that has significant experience with rhinoplasty in black patients.

Rhinoplasty options truly depend on approriate analysis of your nose. Your rhinoplasty surgeon will have to determine the best surgical option for a natural outcome, which may or may not include osteotomy (repositioning of the bones) to narrow the bridge.

Various methods are available to narrow the nasal bones.  Many can be done without external scarring.  Your main concern is to see a nasal surgeon with a broad experience in rhinoplasty. Many  aesthetic  plastic  surgeons  feel  rhinoplasty  is  the  most  artistic and difficult cosmetic surgical procedure. I agree. Every change the surgeon makes has three-dimensional aspects that instantly alter other areas of the nose, like the ripple effect from a single stone cast into a quiet pond. As if that wasn’t enough, the nose swells during the procedure, obscuring landmarks, and some- times heals unpredictably. A limited number of experts specialize in rhinoplasty, so do your homework. With rhinoplasty, the touch-up rate is a solid 15 percent nationally.

 

 
I would really need to see photos to give you the best advice. For a wide nose bridge, osteotomies may be performed (narrowing of the nasal bones). Thank you and best of luck.
Dr. Nassif