Tuesday, October 28, 2008

African Americans Rhinoplasty (Nose Job, Nose Refinement)

Rhinoplasty helps to refine the nose and brings it into harmony with the rest of the face. I will emphasize at this early stage that there are no structural defects in the black nose. The difference between an African and a Caucasian nose may be due to adaptation to their unique environments.

There is great reluctance amongst African Americans about doing any type of cosmetic surgery, however it has become increasingly popular in the last 10-15 years as a result of well publicized successful surgeries in prominent African American entertainers.

Good results in Black rhinoplasty are greatly increased with a better understanding of the cultural diversity of the Black nose. Following the works of prominent Black plastic surgeons, the Black nose has been classified into three main groups:

Afro-American Afro-Caucasian Afro-Indian

A typical Afro-American nose has a nasal bridge that is wide, short, flat or saddle shaped. The tip of the nose is bulbous with no significant projection. Nostrils are wide, height is short and the skin envelope is thick and oily.

Low or concave dorsum is corrected by dorsal augmentation. Augmentation can be accomplished by cranial, rib or iliac bone graft, cartilage graft or silastic implant. The silastic implants are employed only in primary rhinoplasty, when the skin is thick, and preferably when a cartilage tip graft is in place. The cartilage tip graft ensures that the caudal end of the implant does not press directly into the skin and therefore reduces the possibility of skin erosion and implant extrusion.

Dorsal augmentation can be accomplished without breaking and putting together (osteotomy and infracture) the nasal bones. The dorsal graft not only raises the dorsum, but also creates the illusion of narrowness.

The main concern of patients with African type noses is the bulbosity of the nasal tip. This bulbosity arises from the thick oily skin and the extensive fibro-fatty tissue covering the alar cartilage and attached to the overlying skin. Correction of bulbosity therefore involves defatting of the alar cartilages, the space between the domes, and sometimes the surrounding skin. The alar cartilages are smaller and thinner, excision of the upper portion of the cartilage is limited in order to avoid alar collapse. Poor tip projection is corrected usually by tip grafts using septal or conchal (ear) cartilage.

Another major concern with African type noses is the width of the nostrils. These are narrowed by excision of the alar rims and reduction of the nostril floor. Sometimes in patients with very wide nostrils, there is a limit to which this can be reduced in order to avoid a pinched look.

Afro-Caucasian Nose

The Afro-Caucasian nose is longer and the bridge is narrower with a hump. The tip is thinner and projects. The nose is higher and nostrils are narrower.

In the Afro-Caucasian nose, dorsum can be narrowed by separating the nasal bones from each other, as well as their attachments, and compressing these bones together in order to narrow the dorsum of the nose. Dorsal augmentation may not be necessary to narrow the nasal bridge, but if required it is usually thin.

Management of the tip in the Afro-Caucasian includes generous excision of the alar cartilages because they are usually big and thick. The domes of the alar cartilages can be sutured together with non-absorbable sutures to further narrow the tip.

The width of the nose is usually smaller than the Afro-American nose, therefore nasal floor reduction is not usually necessary.

Afro-Indian Nose

Afro-Indian noses are long and straight. The bridge is wide with a big hump, with a bulbous tip and wide nostrils.

The management of the dorsum in the Afro-Indian type of nose is very similar to the Afro-Caucasian. The nasal bones are usually broken from their attachments and pushed together to narrow the nasal bridge. In addition, the Afro-Indian nose usually has a hump that needs to be shaved down. There is less frequent need for an augmentation.

The management of the nasal tip involves more generous resection of the alar cartilages, like in the Afro-Caucasian nose, as well as an extensive defatting, as in the Afro-American nose. Better tip projection is also achieved by suturing the alar cartilages together until the desired result is achieved. The nostril are usually wide in the Afro-Indian nose and nostril floor reduction is usually indicated.

What patients should know

Other important information to let patients know, prior to surgery, includes the need for nasal packings for a couple of days and drainage from the nostrils for about the same length of time after surgery.

The nose is swollen for up to six months following surgery, and patients will need to wait for the swelling to go down to fully appreciate their new features.

As pointed out earlier, there is nothing wrong with the Black nose, provided it is well proportioned to the face. Corrections are needed in parts of the nose where there may be excesses or inadequacies. The ultimate correction depends on what the individual patient wants, within the capability of the surgeon to make the changes.

Middle-aged affluent Blacks want refinement with maintenance of their ethnicity. These patients generally have good results. Problems generally occur with patients who desire Caucasianization of their noses, but do not request it at the time of their initial surgery. Overall, rhinoplasty can be dramatically positive with a proper pre-surgical evaluation and appropriate surgery.

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