Q: What is best way to build up an African-American nose that is short and small?
A: The overall shape of the African-American nose is often that of being broader and less projecting than that of a more Roman or aquiline nose shape. As a result, one of the key considerations in the rhinoplasty management of this nasal shape is to build up the bridge or dorsal line of the nose and improve tip projection and definition. Such an approach is most likely what is meant by having a nose that is ‘short and small’.
An type of augmentative rhinoplasty requires the addition of some form of graft or internal support structure to lift up the roof (skin) and reshape it. How much graft volume is needed determines the best way to do it. Each patient will be different in this regard. But this discussion always comes down to whether one wants to use a synthetic implant vs. cartilage.
The historic debate between allograft vs. autograft in rhinoplasty is an old one. Each has their own advantages and disadvantages with surgeon advocates on both sides. But the differences between the two are always the same. An implant is a lot easier to do (off-the-shelf) for both patient and surgeon and comes in a variety of ready-made shapes to create small or big ghraft needs. The price that is paid for this ease is the increased risks of infection and long-term implant extrusion and problems. Cartilage grafting is much harder to do, necessitates a donor site and require more surgical skill and experience to do well. But the risk of infection is much lower and there is no risk of any long-term extrusion or rejection problems.
Which is best must be determined with the patient through a thorough consultation and educational session. Both methods can be successful but the patient with the plastic surgeon must weigh the benefits and risks of each approach. When possible and acceptable, I prefer cartilage grafting because of its long-term benefits.
Dr. Barry Eppley