African American Rhinoplasty with Miami Plastic Surgeon, Dr. Bared
Keys to African American Rhinoplasty
In the recent past the number of African American patients seeking rhinoplasty has greatly increased. More patients of African ethnicity are seeking the potential refinements of a rhinoplasty procedure while wanting to maintain their ethnic features. Dr. Bared’s main objective in rhinoplasty is to attain natural appearing results while providing the refinements patients are seeking for their nose. After spending years working with patients of different ethnicities, he appreciates how refinements can be made to the nose while preserving the patient’s ethnic features. Regardless, of the patient’s ethnicity, Dr. Bared tailors each rhinoplasty to be in harmony with the patient’s overall facial features.
During your consultation with Dr. Bared, you can expect that he will listen to your concerns and your specific goals regarding your procedure. The consultation is an integral part of the process, one where mutual goals and trust need to be established between the patient and the surgeon. Dr. Bared will perform a thorough physical examination of your nose. After listening to your concerns and performing a detailed physical examination, Dr. Bared will communicate what can be realistically accomplished with your procedure. Dr. Bared uses his aesthetic background to convey what is realistic and what will be in harmony with the rest of your facial features. Dr. Bared takes into consideration, amongst other details, the distance between the eyes, the shape of the face, and the existing anatomy of the nose. He will assess the amount of tip cartilage support, the width of the tip cartilages, the size of the nostrils, the width of the base, and the width of the bridge.
On the profile view, he will analyze the height of the bridge, the ‘droopiness’ of the tip, the angle between the tip and the upper lip, and the amount visibility of the columella. Of course, there is not “one” African American nose; however, there exists some anatomic features which are more commonly seen in the African American nose. Some of these features may include: a lower nasal bridge, bulbous tip with lack of tip support, wide nasal base and nostrils, and a columella which is ‘hidden’ on the profile view.
Dr. Bared’s main objective in African American rhinoplasty is to provide for natural appearing refinements to the nose while preserving the patient’s ethnic traits. While each case is specific to the patient, there are key maneuvers which need to be employed in all cases. The most important of these is tip support. The tip needs adequate support in rhinoplasty. If the tip cartilages remain weakened after surgery, the tip will droop in time. Dr. Bared utilizes grafts from the patient’s own body to provide for this tip support. In primary cases, grafts are commonly fashioned from the septum. The septum is the cartilage that divides both sides of the nose.
In the African American patient the septal cartilage may be small; therefore, at times, additional cartilage is taken from the ear. If needed, the cartilage from the ear is taken from an incision hidden behind the ear. Grafts, in general, are used to provide shape to the nose while, at the same time, support the nose. Grafts ensure that the refinements you see are present for a very long time as the nose structure will be adequately supported. Since they are from one’s own body, studies have shown that they decrease the risk of complications from infections more prevalently seen when implants are used in the nose. While tip support is uniform in all rhinoplasty cases there are further maneuvers employed which may be used in each specific case. These maneuvers include refinements made to the bridge and the width of the base of the nose. The refinements to the tip are balanced with refinements to the width of the bridge. The width of the bridge is usually narrowed by means of osteotomies where the nasal bones are reset into a more narrow width. Osteotomies themselves need to be performed a bit differently in the African American rhinoplasty versus a Caucasian nose.
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The osteotomies need to be performed at a lower level given that the African American nose typically has shorter nasal bones. Finally, to balance the refinements made to the tip and bridge on the frontal view, at times the width of the base requires narrowing. In order to accomplish simultaneous narrowing of the nasal base and the size of the nostrils, alar base reductions are performed. Alar base reduction can be a complex maneuver that if not performed properly by a specialist can be fraught with risks. Dr. Bared acknowledges how careful one needs to be when performing alar base reductions to prevent obvious scarring as well as an overly narrowed and unnatural appearance. If the alar base reduction is performed too aggressively the nostrils lose their natural rounded appearance and start to take on more of a triangular shape. The loss of the more the circular appearance of the nostrils is a telltale sign of a rhinoplasty and makes the nose appear artificial.
Dr. Bared uses a small measuring device called a caliper when performing alar base reductions which measures the changes made to the size of the nostrils to the millimeter, carefully measuring how much to remove. The placements of the incisions for an alar base reduction are also of utmost importance. Dr. Bared carefully places these incisions in areas of the nostrils where they would be best camouflaged. Another technique employed in African American rhinoplasty which helps to create tip refinements is the careful de-fatting of the nasal tip skin. Often the skin of the tip in the African American patient is thickened secondary to a layer of fat found between the skin and the nasal tip cartilages. This layer of fat can be carefully removed to allow for the skin to re-drape over the cartilages and allow for the refinements made to the cartilages to become more evident. The de-fatting of the nasal tip skin needs to be done in a very careful and meticulous matter to risk injuring the skin.
Narrowing the nasal bridge in African American Rhinoplasty
The nasal bridge may appear wide as a result of either widened nasal bones or a low bridge. A widened nasal bridge can be narrowed via two approaches. If the nasal bones are found to be wide, osteotomies are used to reset the bones into a more narrow position. The second component of narrowing a bridge may be due to the flatness of the bridge. A lower bridge will also give the appearance of a widened bridge. Dr. Bared does not place synthetic implants in the nose such as Medpore® or Gortex®. Dr. Bared’s approach to rhinoplasty is to, whenever possible, only use the patient’s own cartilage during the procedure. Implants are often used by surgeons during African American Rhinoplasty to augment the dorsum (the bridge) of the nose. Augmentation of the dorsum is utilized to narrow the bridge and create height for a lower bridge. It is Dr. Bared’s practice to not use synthetic material to augment the dorsum as these can be prone to infections and even extrusion. Infections and extrusions have been reported to occur even years after a surgery. Dr. Bared will often use ear cartilage and temporalis fascia (removed fomr a small incision hidden within the hairline). Although this procedure for dorsal augmentation requires more technical skill and surgical time, Dr. Bared feels that it is in the best, long term interest of his patients in order to avoid the use of artificial implants.
The goals of rhinoplasty are common across all ethnicities. Patients desire to have a natural-appearing nose that takes attention away from the nose and towards the eyes. If a nose appears overly narrowed, artificial, and manipulated, then the goals have not been met. The results of any rhinoplasty are long term. Patients often misunderstand that the results will be “immediate.” Rhinoplasty results take time to manifest as the skin needs time to heal and the swelling to subside. Patients may not even begin to see refinements for up to three months after the surgery. Particularly patients with thicker skin are expected to have longer periods of swelling after surgery. The follow up with Dr. Bared is very important to the ultimate outcome after surgery. Oftentimes, Dr. Bared may place small amounts of anti-inflammatory steroid injections into the nose to help with the swelling after surgery. If used, these are usually started one month after surgery. Swelling in the tip area is the most persistent whereby refinements to the tip are often not seen for up to one year. With time patients will see the natural refinements made to their nose.