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African American Rhinoplasty

African American rhinoplasty is a highly specialized form of ethnic cosmetic nose reshaping. Anyone considering this type of cosmetic procedure should consult with a very experienced rhinoplasty specialist who has not only expertise in the technical aspects of the surgery, but also a thorough appreciation of the esthetic beauty of the African American nose.

Analysis of the African American Nose

There are a number of specific features that have been classically associated with the typical African American nose. However, given the wide variation of ancestries and diverse genetic makeups in the African American population, it is sometimes difficult to categorize this subset of patients based on just a limited number of nasal features. That being said, there are some features of the African American nose that are more commonly seen than others.

One of the more common features of the African American nose is the relatively thicker skin and soft tissue covering. This is particularly true in the nasal tip region where the soft tissue is described as being more fibrofatty, or spongy, which inherently lacks definition. In addition, the underlying cartilage in the African American nose is frequently found to be thinner and weaker than in other ethnic noses. This type of attenuated cartilage support does not allow for adequate projection of the nasal tip – meaning it does not provide adequate support for the tip to project out from the face. This combination of thicker skin and thinner, weaker cartilage translates into a less defined nasal tip that often times appears flatter than desired.

Another frequent issue in the African American nose is an excessively wide nasal bridge when compared with other ethnic noses. This primarily has to do with African American noses tending to have a relatively lower bridge height. The lower the bridge height, the wider the nose will appear when seen from the front.

One other feature of the African American nose that is commonly reshaped during rhinoplasty is the nostril base. This is done in certain African American rhinoplasty patients who have an excessively wide and/or flared nostril shape. A wide nostril base is commonly a result of an excessively wide nostril sill on one or both sides. This is represented visually in the adjacent diagram by the yellow line that spans the distance of the sill. This typically corresponds to the lower border of the nostril as seen from the base, or bottom, view. You can imagine if this particular measurement was significantly larger than normal how the entire nasal base may appear too wide. A separate but related issue is a flared outer nostril rim. This refers to the exaggerated curvature some nostrils have as indicated by the red and white shaded area in the diagram. Now all nostrils have some degree of curvature that is simply natural. In the African American population, as in other ethnic groups, this nostril curvature can be excessive and contribute to the nose looking too wide. In some African American nose job patients, both issues exist – a wide sill and flared base – while in others one or the other is the main factor in the nose looking too wide.

African American Rhinoplasty

African American Bridge Augmentation

In many cases of African American rhinoplasty, the bridge is reshaped to provide a more refinement as seen from the front. But just because the nose is wide does not necessarily mean that the goal of African American rhinoplasty surgery is to create a narrow nose. Most African American rhinoplasty patients do request some degree of narrowing and refinement, but this has to be done so that ethnic consistency is maintained with the remaining facial features. For example, creating an overly narrow bridge or excessively defined nasal tip in the African American patient would be ill advised since the end result would likely appear unnatural for that particular face. Instead, the aim in African American rhinoplasty is to achieve refinement and definition while creating a nose that looks as if the patient could have been born with it. This is most commonly done by adding to the nasal bridge height. Ideally, one would use the patient’s own cartilage to accomplish this goal – termed autogenous cartilage grafting. This involves taking cartilage from one area of the body and using it to elevate the bridge height. Unfortunately, many African American rhinoplasty patients simply do not have a sufficient amount of cartilage in their septum to facilitate creation of an adequate sized graft. And auricular, or ear, cartilage grafting is usually not a viable option given the type and amount of bridge augmentation that is needed in the African American nose. That leaves rib grafting as the best option for an autologous source of cartilage in the African American rhinoplasty patient. Rib provides one with a plentiful supply of resilient cartilage that can be used very effectively to raise the bridge height in the African American nose.

An alternative to using the patient’s own cartilage is use of a nasal implant, which implies placement of a biological material as a substitute for the cartilage. In the African American nose, polytetrafluoroethylene (PTFE), also known simply as Goretex, is a reasonable option for a nasal implant. This biocompatible material can be customized to elevate the nasal bridge to the desired level in a very predictable manner. Unlike cartilage grafting, there is no worry about resorption of the Goretex material. However, there is a higher chance of infection with use of the Goretex when compared with grafting one’s own cartilage. Fortunately, African American patients tend to have thicker than average nasal skin, which greatly minimizes this potential complication. And history has shown that rhinoplasty experts have been using Goretex nasal implants in select ethnic rhinoplasty patients for years now with excellent long-term cosmetic outcomes.

African American Tip Rhinoplasty

With regard to the African American nasal tip, rhinoplasty to refine this area invariably involves use of cartilage grafting. This is typically done with septal cartilage taken from inside of the nose, which is added to the native tip cartilage for added definition. Unlike cartilage grafting to raise the nasal bridge, African American noses typically have a sufficient amount of septal cartilage to reshape the tip of the nose. One of the more commonly used grafts for this purpose is the shield-shaped graft that can be placed to project the nose and create a more refined nasal tip. Trying to use only suture technique to reshape the lower lateral cartilage that comprises the tip is often times unsuccessful in the African American nose since the cartilage is simply too weak by nature. Keep in mind the ultimate goal in tip reshaping in the African American nose is improved tip definition – not a narrowed nasal tip that is more fitting in the Caucasian rhinoplasty patient. The African American nasal tip should maintain an overall rounded shape but with adequate definition that is in harmony with face.

African American Nostril Narrowing

The goal in managing the African American nasal base is to narrow the nostrils sufficiently without creating a surgically altered appearance. If there is an excessively wide nasal sill, this is addressed by removing a segment of skin along the lower border of the nostril. If there is an excessively flared outer nostril rim, a wedge incision is made to remove a segment of this outside border. This is frequently referred to as a Weir incision by rhinoplasty specialists. By removing this outer margin of the nostril rim and sewing the remaining edges together, the nasal base width is reduced. As noted above, in some African American rhinoplasty patients, it is necessary to combine a sill incision with a Weir incision to adequately narrow the nasal base.

San Diego African American Rhinoplasty Expert

If you are an African American patient considering cosmetic nose reshaping surgery to provide a more refined, yet ethnically consistent, appearance, contact one of San Diego’s best rhinoplasty experts today, Dr. John Hilinski.

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