What Changes Can Realistically Be Done In An African-American Rhinoplasty?

Q: Dr. Eppley, Would like to have a more defined nose tip and thinner nostrils. My nose spreads and flairs. I have a bridge and a nice profile, would life the nostrils thinned and not rounded. Not interested in keeping a so called afrocentric ethnic nose.

A: As you know, you have many nasal features that are consistent with your ethnicity that you want to change. The typical African-American nose at its tip is reflective of the underlying cartilaginous structure.  It is due to broad and widely-spaced lower alar cartilages that are inherently weak, a blunted and shorter caudal end of the septum, vertically-deficient columellar skin and a horizontally-ovoid wide nostril bases. The overlying tip skin is also very thick which blunts tip cartilage definition. Therefore, to make the change of more narrow nostrils and a better defined nasal tip, changes must be done to these structures. Through an open rhinoplasty, the lower alar cartilages need to be brought together and supported by both a septal extension and columellar strut cartilage grafts harvested from the septum. This is much like a tentpole effect raising up the tip and allowing it to push upward against the thick nasal skin for a more narrow and defined tip. The nostril width  needs to be reduced by removing skin at the sides of the nostrils bringing them inward. Depending upon how much the nostrils need to be narrowed and the location of the scar determines what nostril reduction technique is used.

While seeing your pictures is helpful, only a non-smiling front view is useful for imaging. I have cropped the one such picture that you have sent but the image quality on magnfication is not great. But this rudimentary altered image helps illustrate the rhinoplasty objectives.

Dr. Barry Eppley

Indianapolis, Indiana