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This category of ethnic rhinoplasty is not simple since northern Egyptian-type noses may have a much higher bridge than people of a more equatorial African origin and many people who classify themselves as African American are of mixed race and perhaps inherited some Asian or Caucasian or Hispanic or whatever qualities in their nose in addition to traits from their Black parent. A common denominator in many of my Black patients 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.