Over the last decade, the number of African American (and Caribbean) patients seeking rhinoplasty surgery has significantly increased, statistics showing a tripling in demand. It was once uncommon for ethnic patients to seek out the services of a cosmetic surgeon, but the stereotype of plastic surgery being for “white” people is no longer relevant, giving more patients- Latin, Arab, Asian, and African- the incentive to seek out a solution for their cosmetic concerns. In particular, African American patients have started to realize that rhinoplasty, when performed properly, can help them achieve an aesthetically appealing nose that complements the other facial features without compromising ethnic appearances.
Dr. Jeffrey Epstein, with his offices in Miami and NYC, has extensive experience- and can be considered a leader- in the field of African American rhinoplasty, adapting specific techniques to the unique needs of this diverse population. While many of the components of rhinoplasty are similar across all patients, there are a number of key steps that are essential to providing successful results in patients of African and Caribbean ethnicity. Dr. Epstein finds it, above all, of upmost importance to tailor the African American rhinoplasty surgery to a patient’s facial features, any expressed desire to maintain ethnic characteristics, and most importantly the individual patient’s goals.
Dr. Epstein’s Keys to a Successful African American Rhinoplasty:
- Retaining Ethnic Features:
Besides holding excellent surgical skill, the surgeon performing an African American rhinoplasty must have an artistic eye for subtle ethnic qualities. Dr. Epstein is able to enhance the nose so that the final outcome is a nose that still retains its original ethnic features.
- Ethnic Compatibility
Ethnic compatibility goes along with retaining a patient’s original ethnic features. For a rhinoplasty to be a success, the new nose must be compatible with the prevailing ethnicity; this may mean changing certain nasal features to better fit the cultural norm. Dr. Epstein has extensive experience in these cases, so he is extremely adept at assessing the facial feature needs that must be met for overall patient satisfaction.
- Understanding – and Enhancing- Facial Harmony
A upturned tip may look fabulous on one face, but on another, it may be unattractive. The reason for this is facial harmony – the way the nose visually balances the other facial features. Facial harmony is dictated by a patient’s gender, ethnicity, bone structure, facial dimensions, and the aesthetic contours of the face; the nose must be congruent with these features. Dr. Epstein possesses both extensive technical and surgical skill, as well as the artistry and understanding of facial harmony needed to create a nose that visually appealing with the existing architecture of the face.
- Maintaining Nasal Function
While a lot of attention is paid to the intended aesthetic look of the nose, maintaining nasal function is equally important. Here, Dr. Epstein, given his board certification not only in facial plastic surgery but also in Otolaryngology (ear, nose, and throat) is well qualified to address this area by achieving long-lasting strength of the nasal structure,is necessary for healthy breathing. If the supporting structures (cartilage and bone) of the nose are weak, not only can there be changes in the appearance of the nose with healing that are undesired, but also breathing issues can develop. By utilizing an external approach (see below for more on this), Dr. Epstein utilizes a structural approach, establishing support from which appearances will follow.
- Patient Satisfaction
Some patients who seek out rhinoplasty may have a goal in mind, while others are not as sure as to what kind of nose will complement their facial features. While obtaining the ideal nose is not always possible, Dr. Epstein is committed to satisfying his patients’ overall desires for aesthetic results. To accomplish this, the first step is at the consultation, where he will listen attentively to each patient’s concerns and goals, and assess what is realistic. The next step will be to explain to the patient what he recommends and what is possible, showing the patient multiple Before/After photos of his patients. Lastly, the patient will be sent several computer imaging photos that illustrate for the patient what is possible, and here is where the communication is so valuable, as the patient will be able to provide feedback to Dr. Epstein after seeing these photos, with this communication resulting in not only the patient having realistic expectations, but more importantly Dr. Epstein being able to understand what exactly it is the patient seeks and to take those goals into the OR with them as he is doing surgery.
To fully understand Dr. Epstein’s Keys to African American rhinoplasty, it is first necessary to have a grasp of the entire surgical experience. The ethnic nose presents a unique physical structure and often a surgical process, as well as the fact that the African American patient also may hold a different set of desires and goals than a typical Caucasian patient. The discussion below outlines some of the unique features that must be taken into account for a successful result. Once understood, and the specific keys to a successful rhinoplasty are met, it is possible for Dr. Epstein to meet and even exceed the goals of his every ethnic patient, whether African American or Latin or any other ethnicity.
While there is no “one” African American nose, the typical one has several anatomical features that set it apart from that of many Caucasian patients. Please realize that there are certain typical Latin noses that have similar features to the typical African ethnic nose. To perform a successful rhinoplasty, the surgeon must be aware of these differences, have a deep understanding of facial anatomy, and be able to create a surgical plan unique to each patient.
Three main structural differences generally arise between an African American nose and a Caucasian nose, each one creating specific needs:
- African Americans generally have a small, lower nasal bridge (the upper, bony portion of the nose).
Dr. Epstein can, when appropriate, address this concern with some type of augmentation of the nasal bridge to bring it into proportion with the rest of the nose and face- in particular, with the nasal tip which is the first area that Dr. Epstein addresses. Once the desired tip position and shape is achieved, the rest of the nose is sculpted to fit in with the tip. There are a variety of techniques for building up a bridge when indicated- most commonly Dr. Epstein relies on the use of either GoreTex® (a wonderful implant that feels like cartilage and is typically accepted by the body readily and has a very very low rate of extrusion) most commonly, and less commonly cartilage from the patient’s either nose and/or ear.
- The African American nose is typically wider at the base and nostrils.
As the wide base and protruding nose tip can give the nose an oversized appearance, Dr. Epstein will, after first establishing an aesthetic tip (it always starts from the tip), when indicated, perform one or more of several different types of nostril narrowing and/or thinning out to balance the nose with the rest of the face. By bringing in this wide tissue, a more aesthetically pleasing nose can be created.
- A bulbous nasal tip that lacks support.
The thick tissue present in the African American nose can occasionally be thinned to improve the nasal tip, and removing excess cartilage can further help- however, this is not the key step. Rather, the key step is in establishing good tip support- by the strengthening of the nasal columella (the bottom of the nose that divides the two nostrils) most commonly using cartilage from the septum and/or ear. This is called a “columellar strut” and is usually the most powerful way not only to increase the projection of the tip but also provides the means by which the tip can assume a more refined and defined appearance. This strut strengthens what is very common in African and many Latin noses- weak cartilages of the tip. Once the tip position and shape is established, the rest of the nose can be addressed to it fit in with the tip.
Unique Rhinoplasty Goals and Desires:
The decision to undergo a Rhinoplasty is very personal decision. The shape and form of the nose is more than functional, it is a plays a key factor in an individual’s overall aesthetic look and can have an impact on one’s self-esteem. The nose must lend balance to the facial structures, as well as ‘fit in’ with a patient’s place in the social environment. A nose that is too small or too defined may look out of character for an African American patient. The ideal African American nose does not necessarily fit into the traditional shape and sculpted appearance that is desired in a Caucasian nose.
Generally, ethnic patients are looking for a narrowing of the nose, added tip definition, and a raised and sculpted nasal bridge. All realistic rhinoplasty patients are ultimately seeking a nose that is proportionate and natural looking on their face. Rather than just making the nose smaller, the key is usually to make it more sculpted and defined. Dr. Epstein understands the complexities faced by these specific patients; he will create a cooperative effort between the patient’s desires and what is surgically possible.
Rhinoplasty, the Procedure:
Rhinoplasty is typically considered the most challenging, delicate plastic surgery procedure, for in order to achieve consistent results, the surgeon must be adept at working on the relatively small, important underlying structural elements of the nose. There are multiple steps that can be undertaken that can be performed alone or in tandem to create the look the patient is seeking.
African American rhinoplasty can include one or more of the following correctional procedures:
- Decreasing the wideness of the nostrils.
- Reshaping of the nostrils, making them flare less.
- Refining the nasal tip, not only by removing some cartilage but more importantly by strengthening it.
- Building up the nasal bridge using either a GoreTex® implant or the patient’s own cartilage or an implant.
- Narrowing a broad nasal bridge by resetting the nasal bones and removing excess fatty tissue along the walls of the nose.
- Improving breathing while reshaping the nose; surgically addressing the nasal septum or removing tissues that block nasal passages.
External or “Open” Rhinoplasty:
External rhinoplasty allows for full visualization of all the nasal structures, permitting the cartilage and bone to be sculpted all in its original position so that it not only looks more natural but also keeps its strength. It is performed through a tiny incision across the middle of the columella (the bottom of the nose that divides the two nostrils)that connects with additional incisions inside of the nose, and that typically heals within 10 days to be essentially undetectable. External rhinoplasty is the most common surgical technique used by most experienced rhinoplasty surgeons, and is Dr. Epstein’s technique of choice in virtually every nose her performs, allowing for the most visualization of nasal structures and extensive restructuring and sculpting of the complex nasal anatomy.
Endonasal or “Closed” Rhinoplasty;
Endonasal rhinoplasty is typically reserved for patients needing only minor nasal repair (such as sometimes needed for a revision rhinoplasty); when extensively modifying position, structure, and shape of the nasal cartilages, this type of surgery is less likely to be utilized. The incisions for the endonasal rhinoplasty are made inside each nostril, but as they are not connected, visibility during surgery is markedly reduced, and sculpting of the cartilages can only be done with them separated from the other nasal tissues which can weaken them significantly. In general, for Dr. Epstein the endonasal procedure is not the procedure he utilizes.
Rhinoplasty procedures have been performed by plastic and cosmetic surgeons for years, with minimal complications. Unfortunately, problems such as bleeding, infection, and loss of sensation can still occur – especially by an inexperienced surgeon. Always choose a Board Certified, experienced cosmetic surgeon; this will be your best defense against surgical risks. African American patients present unique conditions though, that require extra attention from their Rhinoplasty surgeon, in order to assure satisfactory results. These include:
- Scarring and Keloid Formation
Every patient must be assessed for their scarring potential before proceeding for a Rhinoplasty. In general, African American patients have a low incidence of scar formation, so the risks from a Rhinoplasty are extremely low. Dr. Epstein takes all preventative measure to avoid scarring, such as using tension free and fine permanent sutures.
- Prolonged Swelling
After a Rhinoplasty, swelling and edema may last from 12-18 months. As a result, Rhinoplasty results may be hard to gauge during this time, the nose may be abnormally shaped, and breathing difficulties may occur. Steroids, nasal-splinting, and meticulous post-op care can improve some swelling. Patients must be extremely aware of this possibility; especially since before a Revision Rhinoplasty or other surgical procedure of the nose can be considered, patients need to wait until the nose has completely healed and edema subsided.
While African American Rhinoplasty surgical results are almost always positive, there is some risk of disproportion after surgery. If one nostril is larger/smaller than its partner, or the bridge of the nose is tighter/higher on one side, a noticeable asymmetry may be seen. This can diminish on its own over time, but may require surgical intervention or a Revision Rhinoplasty to correct.
- Tip Necrosis
The tip of the African American nose is comprised of thick, fibrous tissue, which contributes to its shape and form. This tissue should be carefully addressed; too much reduction of skin may cause a decrease blood flow to the area, developing into necrosis (dying tissue). An experienced Rhinoplasty surgeon understands and explains the limitations of surgery, for each individual patient. Dr. Epstein performs between four and five Rhinoplasty procedures each week; he is proficient in the evaluation and safe execution of African American nasal surgery options.
- Racial Incongruity
It needs to be pointed out that not every nose is meant for everyone.
Patients may find their ideal nose on a model or television star but that does not mean it will be do-able or even appropriate for them. Think of a haircut, you cannot make a thick, wavy hairstyle on a person with thin, stick-straight hair; the nose is similar. A Rhinoplasty has the potential for resulting in a nose that does not fit with their personality, or their ethnic presentation. Dr. Epstein takes an added amount of time at the consultation appointment with each potential Rhinoplasty patient, at which time he will assist the best aesthetic surgery choice.
African American Rhinoplasty Consultation:
The consultation - whether done face-to-face in the office, or by email/photo review, is a key part of the entire rhinoplasty experience. The consult gives the patient a platform in which to discuss her/his surgical goals and concerns, while the surgeon can go over what he recommends and what results are achievable. Dr. Epstein utilizes the consultation to establish a mutual trust with his patient, listen to his/her desires, and help educate the patient. There are extremely diverse facial features across the African and Caribbean ethnic patient population; Dr. Epstein uses this one-on-one time to individualize each procedure.
At the in-person consultation, Dr. Epstein will review the patient’s medical history and examine the nose inside and out. Whether done in the office or by email, he will discuss the various rhinoplasty options in terms of outcome that are possible, go over the techniques in as much detail as the patient desires, describe likely results, review any possible complications, and explain how the anesthesia and entire surgical process works. Dr. Epstein has thousands of before and after photos of his previous patients- his style and skill is evident in the pictures, giving the patient a clear idea of what they can expect from their own procedure. Whether the consultation is done in person or online, this step in the ethnic rhinoplasty course is an invaluable necessity.
Surgical Course and Recovery:
Dr. Epstein performs virtually all of his rhinoplasty surgeries in his accredited office operating room on an outpatient basis. He is assisted by his team of nurses and assistants who work with him every day, while twilight sedation anesthesia is administered by the same CRNA with whom Dr. Epstein has worked since 1996. Usually no packing is placed inside the nose, permitting most patients to breathe the very same day as the surgery. For the first several days, there is typically some swelling and bruising around the eyes- the swelling is usually gone by the third day while the bruising can take 7 to 10 days to resolve. There is surprisingly little pain, rather some discomfort for the first few days, that is treated with appropriate pain medications. A splint goes over the nose which supports the healing of the nasal bones, which is removed usually on the sixth to seventh day, with all sutures removed by the eighth to ninth day. Most patients are fully presentable without any obvious signs of having had surgery, and may resume light activity by the eighth day. Full exercise is permitted within 2 weeks, with the exception of activities that risk hitting the nose which must be avoided for the first 6 weeks.
All rhinoplasty patients should understand that the complete healing process can take up to a full year. Most swelling of the tip in particular can take 6 months to fully resolve, with subtle changes occurring with the nose for as long as a year or longer. The occasional patient is a candidate for a refinement procedure- such as further narrowing of a nostril or a bit more elevating of a nasal tip. While these revisions are not common, they are occasionally indicated, and in most cases are performed under just an oral sedative and local anesthesia.
Through careful consideration when choosing the most appropriate rhinoplasty surgeon, African American patients can expect excellent, long-lasting results. Independent of ethnicity, rhinoplasty patients typically share a common goal of wanting to eliminate unwanted attention from their nose. After rhinoplasty, the nose can be made to properly enhance the face, while allowing for more focus on other features such as the eyes and skin. As long as the key components of African American Rhinoplasty are kept in mind, the final product will look natural and organic, not artificial or manipulated. Patients will be happy to continue looking like themselves – only better.
More About Dr. Epstein:
Jeffrey Epstein, MD, FACS has been specializing in rhinoplasty since 1990 starting with his training in Otolaryngology (Ear, Nose, and Throat) at the University of Miami, followed by his completing a one-year fellowship in facial plastic and reconstructive surgery in San Francisco. A Fellow of the prestigious American College of Surgeons, he earned the highest score in the nation on his facial plastic surgery board exams. A leader in the most advanced, result-driven procedures, in addition to his busy private practice, Dr. Epstein is an Associate Clinical Professor at the University of Miami, and has been featured in such magazines as Elle, Vogue, and Ebony.
Consultations with Dr. Epstein are available in his Miami and NYC offices, as well as rotating dates in London. Online consultations are also provided. All surgeries are performed in the Miami office. Call Dr. Epstein’s office at 212.759.3484 (NYC) or 305.666.1774 (Miami) to speak to a patient advisor and receive more information.