In the NY Times Magazine last week we came across these stunning pictures of Yasmine Warsame, a beautiful East African model from Somalia who grew up in Canada.

We looked her up since we had never seen her before and we came across her myspace site where she’s quoted as saying:

“I believe that ’Black beauty’ is understated and isn’t appreciated, so that’s what I want to represent in this modeling industry. I want to inspire young girls and women all around the world to follow their dreams, especially women of color.”

When Jennifer Hudson was featured on the cover of Vogue last year, a controversy arose because she was one of a small handful of black women ever to appear along on the cover.  It got us thinking about all of our ethnic patients who ask if we have expertise in ethnic rhinoplasty and facial plastic surgery. It’s a fair question, but one that requires a nuanced response. Yes, we do have expertise in working with a variety of ethnic patients…but truthfully, that’s less important than an understanding of aesthetics and anatomy in each individual.

No ethnic group can be pigeonholed into one group, though broad generalizations can be made (see our online book). You, your face and your nose are unique and individual to you, regardless of race or ethnicity.

So, getting back to black beauty - here are just a few of the beautiful black women who grace the landscape of our media world. You’ll note they’re all very different and yet stunning in their own way…

Sure, we can. Your situation is something that happens often after rhinoplasty and is one of the more common reasons that patients come to us for a revision. That’s because taking down a bony hump on your bridge is fairly straightforward. Techniques to make the nasal tip smaller are more advanced and many plastic surgeons are simply not comfortable with them. So, we frequently see people with persistent tip concerns after surgery elsewhere.

What you are asking for is referred to as a tip-plasty because the intended changes are only to the tip. That doesn’t necessarily mean that the procedure is less challenging but it will usually take a little less time than a rhinoplasty that also addresses additional concerns.

Your tip can be manipulated without affecting the rest of your nose. It sounds like you are looking for some deprojection of your tip to make it more refined and to bring it closer in to your face. We can do that in several ways, but the workhorse techniques for making these changes are called vertical dome division and lateral crural overlay.

The photos shown here demonstrate what a vertical dome division can do. The photo on the left is the Before view. The photo on the right shows a vertical dome division and overlap done on just the left tip cartilage. The right side was left untouched in this photo. If you compare the left to the right, you can see that the tip cartilage is shorter but retains its shape and contour. The overlapped edges are sewn together to maintain the strength of the tip. This is a powerful technique that can be used to reliably address a big or wide tip, a boxy tip, a droopy tip, a hanging tip, and any tip asymmetries or irregularities.

We won’t bore you with all the technical details. But, in both these techniques, the tip cartilages are made smaller by carefully cutting the cartilage, overlapping the edges, and suturing them together again. By doing that, the cartilage is made just as strong, if not stronger, so that the desired change will last for a lifetime without putting you at risk for collapse down the road. We choose which technique to use based on whether you also want your tip to be rotated up or down or other changes to be made. You can view the photos above to see how these techniques can decrease the size of your tip. Check out our Modern Rhinoplasty online textbook on our main site for more details.

If you see an experienced rhinoplasty surgeon, you should feel confident that your concern can be addressed in a very predictable and satisfying way.

The complaint of a nostril that is “too wide” is a problem which we more frequently encounter among certain ethnic groups: African Americans, Asians, and some Hispanics. Alar base (“nostril narrowing”) surgery poses a unique set of difficulties, which should not be understated.

All too often many surgeons make it sound like, “No problem, we’ll just take a little wedge of tissue out from both nostrils.”

Unfortunately, external incisions can be noticeable, even when designed correctly. Most commonly, evidence of alar resection is noted as a teardrop or “Q” deformity in the base of the nostril. In others, the nasal base appears abnormal, as the smooth contour of the nostril has been interrupted (see Michael Jackson) or because resection has resulted in more marked asymmetry. Moreover, overresection can result in a narrow dysfunctional nostril opening that is difficult, if not impossible, to correct.

 Michael before surgery had relatively wide nostrils.

  When Michael first had rhinoplasty you see transition after alar base reduction to a smaller nostril size, but it still looked relatively normal.

 Michael Jackson after numerous revision rhinoplasties has ended up having very irregular nostrils, which are dead give away for having been “done”

In general, we employ alar base modifications in the context of an overall surgical plan and normally defer this portion of the case to the end of the surgery. No surgeon can determine preoperatively the exact location, shape, and amount of alar base alteration which is required because nostril size and shape as well as alar base width and flare (see our online textbook for more information regarding these definitions) are all affected by other modifications made during rhinoplasty. Specifically, increased tip projection (making the tip bigger), will often sharply reduce the alar flare and alar base width. On the other hand, retrodisplacement of the nasal tip (making the tip smaller) has, at least classically, been noted to create alar flaring as well as a rounded nostril.

So if you have wide nostrils, we recommend you view alar base surgery as a useful adjunctive measure that can be used to provide an additional measure of refinement. With this in mind, and in the right hands, alard base reduction can maximize the chances for a smooth, natural nostril contour with no discernible scar. When its overdone, or done incorrectly the results can be difficult to fix.

In the last couple of weeks, we have seen several patients seeking revision augmentation rhinoplasty who have had silicone or medpor implants previously placed in the nose. These have become warped and displaced and are in need of revision.

Here at Profiles, we are fans of silicone rubber (silastic) implants for chin, cheek, and jaw augmentation. But, for the nose, we much prefer to use your own cartilage for augmentation, if available. Why is that?

There are several good reasons for this philosophy:

1. Chin, cheek, and jaw implants are ‘contour’ implants; that is, they are placed only to improve the overall contour of the cheek or jawline. Whereas, nasal implants must improve contour while also providing structure, definition, and support to the nasal bridge and tip. And, cartilage does a better job of that.

2. The skin, muscle, and fat covering the chin and cheek areas are quite thick whereas these same soft tissues overlying the nose are quite thin by comparison. One risk of a foreign implant is the possibility that it may place pressure on the nasal skin and further thin it over time, especially in the tip area, risking exposure of the implant. Also, in areas of thinner skin, implants can sometimes appear more visibly obvious. Again, cartilage is not a risk here.

3. Moreover, the chin and cheek skeleton is made up of a large continuous bony surface, areas that lend themselves well to coverage by a large solid implant. The nasal skeleton, on the other hand, is made up of an intricate group of cartilage structures that give the nose its unique surface appearance. For this reason, a single lump of silicone can look unnatural in the nose. Cartilage grafts can be tailored to more naturally reconstruct this elaborate topography.

4. Cartilage is desirable for other reasons, including a lower risk of infection and tissue rejection, since it is your own tissue. We also suture cartilage grafts in place so the risk of migration or displacement is minimized.

The end result? You have the best chance of getting a great rhinoplasty result that lasts for a lifetime. Read more about this and other rhinoplasty topics in our online Modern Rhinoplasty text.

Your concerns are valid and it is important to discuss your history of poor scarring whenever you undergo any type of surgery. You should note however that different parts of the body will heal differently. The simple answer is that keloids rarely develop in the central face and we here at Profiles have never seen a keloid develop after we have done rhinoplasty.

A more in depth explanation begins with an explanation of scarring. First, we need to help you in understanding the difference between a hypertrophic scar and a keloid. Clinically, hypertrophic scars are enlarged scars that stabilize or shrink with time. Keloids, however, initially develop as hypertrophic scars but later extend beyond the original injury area. They rarely regress on their own and have a propensity for recurrence after excision.

Keloids may affect virtually any surface on the body with the central chest, deltoid/shoulder region, and back having the highest frequency. And this has led some doctors to speculate that motion and tension play a large role in causing keloids to develop. While this may be true to some extent, the earlobes, which are one of the most frequent sites affected, are obviously subject to minimal motion or tension forces.

This African American patient demonstrates a typical example of a large keloid scar of the earlobe that was removed in one session with flap reconstruction of the back of the ear. The After photo to the right shows her postoperative result over 6 months after the procedure.

All this being said, while you should explore this issue with your doctor before surgery, you should feel some comfort in knowing that the nose is rarely a site for keloid development after rhinoplasty or nasal surgery. In fact, we did a literature review to check on your answer and were unable to find any papers which could point to a case of a keloid after rhinoplasty.

As would be expected with any ethnic population, we have found that there is a continuum of nasal features in our Hispanic population, rather than distinct types. Rather than trying to categorize various subgroups, here at Profiles we focus on your individual characteristics and your goals.

In general, we have found that our Hispanic patients’ facial and nasal characteristics can be differentiated from our Caucasian patients in the following ways:

(1) Broader faces, commonly with prominent cheek bones and a relatively small nose

(2) A slightly small chin(3) A nasal hump(5) Wider nostrils (6) Wider and lower nasal bridge

(7) Moderately thick, sebaceous skin

So what does this mean to you?

It means that it is important for you to work with surgeons who will take the time to understand what you are trying to achieve and who are comfortable in dealing with different ethnic populations. We take these differences in anatomic and structural components into consideration in planning your surgery and in explaining to you, what can be accomplished with your surgery. During your consultation we will work together to define what your goals are using computer imaging. Based on your desires and your individual anatomy, we will then devise a surgical plan which is best suited to achieve your individual goals.

For further info we recommend you go to our Modern Rhinoplasty online book and read further on Hispanic Rhinoplasty.

Skin quality and thickness is one of the most important factors in determining your final Rhinoplasty result. And it can also be one of the hardest to predict. When we perform Rhinoplasty, most of what we do involves altering the cartilage and bone that makes up the nasal skeleton. We shape the cartilage and bone in many ways to take on the new desired contour. During the healing period for many months after surgery, the skin and soft tissue that lays over this skeleton must contract inwards and ’shrink wrap’ onto this altered framework for the desired changes to become noticeable. That’s why you don’t see real definition for weeks to months after surgery while the skin and soft tissue is swollen.

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We see many patients of Asian or other backgrounds with the very same concerns you describe. There are a number of ways to build up your bridge and give your tip more projection.

The easiest way for a surgeon to do this is by using a prosthesis, usually made of silicone, to lay over the entire bridge in order to make the nose more prominent. This is a very common procedure, especially in East Asian countries. Sometimes, it works with success, but other times there are problems with these prostheses, such as infection, exposure, or movement as time passes.

For this reason, here at Profiles, we use prostheses as a last resort. Our material of choice is your very own cartilage. We usually take this cartilage from your septum (the midline wall deep within your nose) or sometimes from one or both ears. In either case, you won’t notice it’s gone and your ear anatomy will look the same.

By using your own cartilage, we are able to achieve a significant and natural-appearing nasal augmentation with almost no risk of rejection, infection, or other graft problems, even long-term. So, you can be reassured of a better chance at a great result.

We encourage you to contact us to discuss this and other approaches related to Ethnic Rhinoplasty. You can also read more about it in our online text on Modern Rhinoplasty.