Primary, or initial, Ethnic Revision Rhinoplasty is one of the most challenging and difficult procedures for a Facial Plastic Surgeon to perform in Cosmetic Surgery. Ethic noses typically have excessive fatty tissue in the tip of the nose, poor supporting cartilages and thick skin. All of these attributes make it much harder to get good results as opposed to Caucasian noses. Revision Ethnic Rhinoplasty is even more challenging and can result often in just marginal improvements. The average national complication rate for an Ethnic Rhinoplasty Surgeon is about 1% to 2%. That means that a Surgeon must revise 1% to 2 % of his/her Rhinoplasty cases, whether it is a minor or major revision. Complications, which lead to a revision surgery, include:
1) Poor implant placement and/or selection.
2) Improper reduction of nostril width.
3) Poor surgical planning and approach to the African American nose.
How do you, the patient, ensure having to undergo Ethnic Rhinoplasty (Revision Rhinoplasty) Surgery a second, and sometimes even a third time?
The first most important step is securing a Facial Plastic Surgeon with training specific to the face and nose, versus a General Surgeon whose training encompasses the entire body. Second and just as important, the Ethnic Rhinoplasty Surgeon must have experience and proven results performing not only Primary, but also Revision Rhinoplasty on African American and Ethnic noses. Third, the surgeon must be able to work with you towards your desired result. Make sure your first consultation includes the following:
1) Computer imaging of the nose is absolutely essential to pre-operative planning and will show you an excellent and realistic approximation of your desired results. This process reinforces the doctor/patient understanding of expected results.
2) See actual before and after photos of the surgeon's patients who have undergone Rhinoplasty and if possible, have results that you like and are similar.
3) Getting references from patients who have undergone the same procedure. Speak to three and at the very least two.
4) Discuss and be very specific about what the expected results will be post-operatively.
There are 4 major reasons that African American and Ethnic patients seek Revision Nose Surgery.
1) To further improve and refine the tip.
2) To further narrow and/or elevate the nasal bridge.
3) To correct a poorly placed or crooked dorsal (bridge implant).
4) For nostril correction and/or further reduction or narrowing of the nostrils.
Ethnic Nasal Tip Refinement
The nasal tip in the African American patient has a thick layer of fibro-fatty tissue. Typically if the tip is still too bulbous, there is left over fibro-fatty tissue in the tip. To remove this fibro-fatty tissue correctly, an "Open" Rhinoplasty has to be performed for the surgeon to directly visualize the fibro, fatty tissue and excise it. Otherwise, this excision is hardly precise in a "Closed" Rhinoplasty. Another reason for a bulbous tip result is not enough grafting material having been inserted or poor tip support was created using cartilage grafts. In these cases, cartilage may have to be harvested from the ear to further tip support. Post-operatively the tip may also need to be injected with Kenalog (steroid) to help with the swelling.
Correction of Ethnic Dorsal/Bridge Deformities
Ethnic Dorsal or Bridge deformities are usually attributed to poorly placed implants or poorly performed osteotomies. A nasal implant for African Americans should be not be a factory made "one size fits all" implant. The implant should be custom carved, specific to your desired outcome, such as my SLUPimplant™. Second, the implant must be placed in a precise pocket, and in the right surgical plane. This ensures the implant will not move and will rest just above the nasal bone. An implant should also be placed in the nose through an "Open" approach Rhinoplasty to ensure the correct placement. I perform many revision implant surgeries on patients who had their primary surgery with another surgeon and this usually requires removal of their one size fits all implant and replacing it with a custom carved implant.
Ethnic Nostril Narrowing and Alar Base Reduction
Ethnic Nostril corrections are definitely the most difficult for an Ethnic Rhinoplasty Revision Surgeon to perform. Some nostril reductions are so poorly performed that a revision may not even be possible due to aggressive cartilage removal. Please keep in mind that most nostrils are asymmetric to start and after a nostril reduction, the asymmetry may become more apparent! The surgeon, prior to surgery, must point out this possible result.
Correcting an asymmetric nostril will depend on the extent of the asymmetry. Typically a larger nostril can be reduced to a smaller nostril, but not the other way around.