I'm a black girl with a really big nose, and would like to know what options are available to me for rhinoplasty. (photos)

Question

The skin is pretty thick, and my nose can only be referred to as bulbous. I'd like to scale it way down, without resembling Janet Jackson (although she's gorgeous and makes it work for her). I don't want to get rid of my African features (I also have large lips, and a tiny, European nose would probably ruin my face), but I kind of want to go from Jay-Z to Beyoncé - how likely is that to happen?

Carlos L. Wolf, MD · Answer

Nasal surgery in a African American patient should be done with an experienced surgeon. When choosing a surgeon you should ask them about their experience. Undergoing surgery should be a very positive experience for you. Make sure you see before and after pictures so that you can judge the doctors aesthetic sense,. Your doctor should have experience in both the open and closed nasal surgery technique.

Sean R. Weiss, MD, FACS · Answer

The improvements you are looking for can be achieved with rhinoplasty surgery.  You appear to need some tip refinement and to have the bridge built up. Consult with a facial plastic surgeon or general plastic surgeon who specializes in nose surgery for best results.

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for the questions.The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.In this regard, After having analyzed all the info. and photos provided to us, i recommend you perform an Open Full Rhinoplasty, includding narrowing of the nasal base and nostrils, with nasal bones treatment (controled fracture) and alar + triangular nasal cartilages re-shaping.With this procedure you get a delicate nose, better harmonize with your other facial features.Kind regards, Dr .Emmanuel Mallol.-

David Whiteman, MD · Answer

At my office, I am able to perform ethnic rhinoplasty procedures for African American patients who have specific needs and aesthetic goals. In many cases, African American patients have noses that contain weaker cartilage and shorter nasal bones that must be treated with extra precision. Additionally, African American skin is thicker and darker, meaning that a plastic surgeon must understand that these patients may be more vulnerable to visible post-surgery scarring. It takes a skilled cosmetic surgeon with experience performing ethnic rhinoplasty to recognize the structural differences between different ethnicities and employ the techniques required to provide satisfying, natural-looking results.

Luis Pedroza, MD · Answer

The BEST option for an ethnic rhinoplasty is the "Banner technique" because you have a very thick skin and the only way to define the nasal tip is to put a small septal cartilage graft that gives the tip and the skin a little preassure so it decreases its thickness. Most of my patients are latin and they have the same problem and Ive had excelent results with this technique. You can find pictures on the link provided. Have a good day.

Richard Clark, MD · Answer

Your concern is very real
and your level of sophistication will serve you well in assessing who should do
your rhinoplasty. To assuage some of your anxiety, it is your thick skin and
wide features that protect you somewhat from having an "overly-operated"
look. Please read after my personal note to you the list of the issues that I
often encounter with an African American Ethnic Rhinoplasty. A tiny nose is not
likely to happen and the truth is that in order to give you tip definition
[catch light in a manner that looks defined and narrow] on the front and
oblique views, you need to have a sophisticated restructuring of the tip
cartilage to give it strength to take up the slack of the thick skin. Try this
experiment: Take your finger nail and put it under your shirt or coat sleeve
and stretch it out till you see the nail defining itself through the fabric.
Your skin is a fabric as well. The thicker the fabric...the more tension you
must put on your finger to get the nail to thin and define the fabric. A European
thin skinned tip can have cartilage reduced and the skin will redrape and
follow the new contour. The thicker skinned African, Asian, Mediterranean,
Hispanic, etc. tips will just become more amorphous with the same approach.
Therefore, you need to discuss with your surgeon the need for perhaps increased
projection and support of your tip as well as perhaps augmentation of your
bridge which will narrow the gestalt of your nose. By the way, you don’t need
to have the scar of an open rhinoplasty. A common denominator
in many of my patients of African heritage has been the following:

1] thick skin (which is not
a bad thing since this skin ages better than thin skin).
Thick
skin does not redrape around any reshaped cartilage well and not only requires
the surgeon to be savvy to maintain proper tension of the tip area to take up
the slack of the skin to keep it from looking amorphous, but also requires
perhaps aggressive post op taping which is preferable to steroid injections. I
do use steroids judiciously but let’s not forget Michael Jackson who had his
skin thinned out to a skeletal state by over use of steroids.

2] Low bridge. Often the bridge
looks too wide and flat and the best treatment is a more narrow cartilage graft
to give a linear and narrow and elevated light reflex along the dorsum
[bridge]. The patient’s own rib or bone can be used as well yet there is some
morbidity [pain form the donor site] and I therefore choose irradiated freeze
dried bone which comes from a bone bank and can give a dramatic clean bridge to
narrow the nose.

3] Wide Nostrils. The
nostrils look OK if they are close to the distance between the eyes but may
still be wide in comparison to the mouth or a face in general. There is an exquisite
technique to reduce the nostril width that must involve a scar yet with a
proper zig-zag across the nostril sill and hiding most of the scar in the
nostril crease...it is very acceptable and a remarkably good trade-off. {By the
way, though I am well trained in open rhinoplasty, I choose to perform all
rhinoplasties without a scar on the columella [middle skin between the
nostrils]}. If a patient has a particularly wide nostril area, it is rarely
best to consider a second minor procedure to further reduce the width 6-12
months later after the skin has become used to its first reduction.

4] Acute Nasolabial Angle. Often African
American patient [as well as many Asian] have the nose crowding the upper lip
and the angle between the two is less than 90 degrees and it is a very nice
aesthetic improvement to augment the area with cartilage or bone or an implant
and, if I use drawing or computer imaging to show them, my patients are
routinely in agreement upon visualizing the importance of this often overlooked
element of the beauty of their face.

Carlos Burnett, MD, FACS · Answer

Hello and thanks for the analogy. Thick oily skin can limit your results with rhinoplasty. Accordingly, you will need cartilage grafts (possibly from your ribs) to design an appealing nasal shape. Your tip can be reshaped and your nasal bones need to be narrowed to provide ethnic balance for your new nose. See an experienced BCPS in consultation to discuss your options and expectations.

Theodore Nyame, MD · Answer

Thank you for your question. The key to addressing your nose is to look at your total facial structures and determine what aspects of your nose can be modified while keeping you face balanced. Most of the maneuvers have been address below. The key is to find a qualified surgeon with extensive experience in this area.  best wishesTheodore T. Nyame MD

Michael Eisemann, MD · Answer

Reducing the bulbosity  of the nasal tip would require narrowing the flared lower lateral cartilages bringing the domes together, a lateral crural steal by recruiting  portions of the lateral crura to enhance the length of the medial crura.  columellar strut grafts, and  defatting the undersurface of the skin which is often quite thick .Experienced rhinoplasty surgeons are  familiar with these techniques  but each must be done carefully to avoid a overdone  appearance.An alar base excision is often necessary to narrow the alar base which may be too wide.Mixhael Eisemann M.D.Plastic Surgeon and otolaryngologistHouston, Texas

Jon F. Harrell, DO, FACS · Answer

Your goals you have seem reasonable based upon the photo you submitted. You are probably looking at a conservative Rhinoplasty to narrow the bony vault and to refine/narrow the tip of the nose somewhat. A skilled nasal surgeon should be able to present all options to you and formulate a plan that will satisfy your goals.  Best of Luck    Dr Harrell

I'm a black girl with a really big nose, and would like to know what options are available to me for rhinoplasty. (photos)

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