African American (Black) Rhinoplasty
Dr. Rizk has specific techniques which create harmony in black noses so they appear as belonging naturally on the rest of the face. African Americans should seek rhinoplasty only if they are really self-conscious or bothered by their noses. Sometimes he will not recommend rhinoplasty to patients who are African Americans and this might sound unusual on a rhinoplasty website. Dr. Rizk would not recommend rhinoplasty to patients if he doesn’t feel like a rhinoplasty would fit well with their faces in a natural subtle way.
Also, Dr. Rizk does not like to categorize a nose as African American or black without explaining that there is significant variability in each black nose. Ethiopian blacks who grew up in the colder mountain climate of Africa have more of a bridge and more tip definition, whereas, blacks from warmer climates with flatter lands in Africa have flatter noses with larger nostrils.
Anatomy of a Black Nose
The anatomy of a black nose tends to have a flatter (lower) bridge, flaring wider nostrils, a soft flat tip with lack of definition, thick fatty skin and a deeper angle between nose and forehead. Their nasal cartilages tend to be weak and flat. Their nasal bones tend to be short and flat. That being said, Dr. Rizk wants to emphasize that there is significant variability.
African American Nostril Reduction
It is very important when bringing the nostrils in and making them smaller to do it from small hidden incisions inside the nostrils and to bring them in while maintaining the natural curvature of the nostril. If the nostrils are brought in too much, this straightens the sides or natural curvature of the nostril and creates an unnatural result. To avoid this tell-tale sign of a "nose job" often seen in bad rhinoplasties performed on celebrities and creating a "stigma" of the bad "african american nose job", it is essential to preserve some of these natural curves of the nose and avoiding pointy, sharp angles in the nostrils.
Dr. Rizk's Surgical Innovations for Black Noses
Dr. Rizk’s goals are to:
- Give definition and refinement to the nose within the realm of Ethnic Preservation which may or may not include grafting using patient's own cartilages or synthetic and defatting the skin. Dr. Rizk does not use silicone or believe it is good for the nose as it never integrates into the body. The nose forms a capsule or layer of tissue to isolate silicone which can make it move with time. He customizes each implant (either cartilage or medpor) and has a patented method and instrumentation which he uses to sculpt each graft and smooth the edges of all grafts. Medpor is an excellent synthetic material which can be sculpted and customized like cartilage and integrates with the rest of the nose and doesn't usually move like silicone. This is done with specialized micro-sanding instruments. Dr. Rizk may not increase the height of the bridge as some blacks have adequate height. He achieves tip definition by either modulating the existing cartilages with stitches or by adding various tip cartilages with soft edges so patients have a natural (not a pointy tip).
- High definition Rhinoplasty- Dr. Rizk has pioneered 3D live high definition rhinoplasty where he inserts a micro 3D high definition telescope to view the structures of the nose more precisely and this results in a more rapid recovery with a much more precise operation since every structure being changed in the nose is also seen live on a 3D high definition fiber optic screen in addition to direct viewing of each structure. This technique allows significant advances in precision and allows surgery to be done through smaller incisions and less scarring.
- The nostrils: The nostrils may not need to be changed in every black nose since the height of tip is increased with grafts. This brings in the nostril without an extra scar. Furthermore, when Dr. Rizk performs a nostril reduction, he does it from inside the nostril, not from the curved region or from the nostril connection to the cheek (on the outside).
- Harmony - The nose Dr. Rizk creates has to be in harmony with the eyes, cheeks, forehead, lips, mouth and chin. If he feels the rhinoplasty will disrupt his vision of harmony, he WILL NOT DO YOUR NOSE. Realize that each surgeon has their own vision of beauty and you must examine pictures and videos of the doctor to understand his vision of beauty. A picture is worth much more than words or descriptions.
Patients typically look socially presentable and return to work in a week. The splint (cast) is removed in a week. The procedure is typically painless afterwards and most patients do not require prescription pain medicine. Very little bruising if any will occur because of the precision surgery with the 3D technology. There is some swelling which may not be apparent to the patient or other people that will take 1 year to resolve and Dr. Rizk will continue to take pictures every 3 months and follow you carefully. Taping the nose in first few weeks at night helps decrease the swelling more rapidly. Glasses are not recommended to be worn in first month or two after the surgery because they can create some temporary dents if they are heavy. We recommend either patient gets contacts or tapes glasses to forehead and away from bridge of nose. Dr. Rizk provides a rapid recovery kit with various herbal medications which will expedite your recovery. Dr. Rizk will not pack your nose after the surgery.
Patient is a 25 yo patient interested in creating a bridge to nose and more tip definition and reducing nostrils and also lifting the hanging columella. Patient underwent rhinoplasty and a customized medpor implant in nose which is sculpted during the rhinoplasty. Patient also underwent nostril reduction from incisions inside nostrils,rather than from external part near cheek. Patient is shown one year after rhinoplasty. This is considered an ethnic rhinoplasty procedure as patient has thick tip skin and weak tip cartilages as well as a flat bridge.
Female patient from London who came specifically to New York seeking Dr. Rizk’s signature 3-Dimensional High Definition Rhinoplasty technique. She had a Rhinoplasty with nostril reduction and is shown here 1 month post-operatively.
27 year old actress who had a rhinoplasty as well as nostril reduction. Postoperative pictures shown are 1 year post-surgery.
26 yr old female of African-American/Caribbean Descent underwent Rhinoplasty with multiple sculpted cartilage grafts and medpor implant and alar base reduction. Base view shows hidden scars, patient is 6 weeks post surgery and is still swollen. Final result takes one year.
Patient is a 24 yo african american female who underwent an open rhinoplasty with alar base reduction. Patient is shown 6 months after her rhinoplasty. This patient had a bump (rather than being flat on the bridge like most african american noses) and a bulbous tip. Her tip cartilages were weak and soft and she had thick skin. Dr. Rizk used her own cartilage obtained from the nasal septum to graft her tip and make her nose more refined, as well as removing her bump. Her nostrils were reduced conservatively.
18 yo African American patient who underwent rhinoplasty with medpor implant and nostril reduction. Patient is shown 6 months post-surgery and although there is still some tip swelling, the general structure of tip and dorsum is much more refined. Additionally the incisions of the nostrils are on inside of nostril rather than on outside where it joins the face.
29 year old female who is both African American and Asian who wanted a revision rhinoplasty to improve her bridge and nostril symmetry as well as give her more tip definition. Patient had an open rhinoplasty with medpor implant custom sculpted onto her bridge as well as ear (auricular) cartilage graft into her nasal tip. Patient also had revision nostril reduction. Patient is shown 1 year after revision rhinoplasty.
50 yo female who has had a congenital nose deformity of the tip who has had multiple previous rhinoplasty surgeries to build her underprojected tip with cartilage but her cartilage grafts dissolved. she presented to Dr Rizk for revision rhinoplasty. Patient underwent revision rhinoplasty to increase her tip projection (distance nose tip projects forward) to make it more balanced with her lips/chin. Dr Rizk used a medpor implant as it is more permanent and since she has failed cartilage grafts in tip.
NOTE: ALL THE IMAGES USED ON THIS PAGE ARE ACTUAL PATIENTS THAT DR. RIZK PERFORMED RHINOPLASTY ON WITH APPROVED CONSENT.
What are specific characteristics of the african/black nose?
African/black noses are characterized generally by a flat, depressed dorsum or bridge, bulbous tip, flared nostrils or alae, short columella, and thick, oily skin. According to Dr Sam Rizk, there is a great deal of variability amongst african noses. Some actually have a bump rather than a flat bridge and skin thicknesses is also variable. Also because of the mixing over the centuries with other ethnicities, Dr Rizk sometimes sees black patients with Asian or Indian features in their noses. Dr Rizk believes that understanding these variations and customizing the rhinoplasty leads to a more natural and attractive outcome with a unique nose rather than a stamped procedure. This individualized approach is one of the cornerstones of Dr Rizk's philosophy in dealing with the ethnic nose.
Can the differences in the african/black nose be categorized?
Dr. Rizk sees at least 3 broad general variabilities in the African/Black nose. 1. African. 2. African/Caucasian. 3. African-Indian.
The African nose has those features typical of our understanding of the classic black nose. The nose is short and bridge is low, nostrils are wide and flared and tip is bulbous. Its origins are in West Africa, central and South Africa.
The African/Caucasian nose is found more often in light-skinned American blacks. This nose is longer and the bridge is higher and narrower. It may even have a bump. The nostrils are not as wide as in the classic African nose. The tip is less bulbous and columella is longer.
The African-Indian nose shows Indian features and is usually long and large, with a drooping nasal tip, the bridge is wide and high with a bump, and the nostrils are flared and wide. The tip is bulbous but the tip also projects more than in the classic black nose. The above division of the types of black noses seen is no intended to be a substitute for an individualized analysis and surgical planning. It is designed to help bring some order to a wide variation of anatomy seen in the black nose.
What techniques lead to a successful result in rhinoplasty in the black patient?
According to Dr. Rizk, a successful rhinopasty requires careful preoperative analysis and planning followed by successful execution of this plan to create a natural nose which fits the person's face. The rhinoplasty should be done using the latest cartilage conserving techniques and grafting. Dr. Rizk developed the 3d rhinoplasty techniques which allow a painless, rapid recovery and also pioneered the use of new cartilage sculpting techniques to achieve a smooth and natural result, rather than a pointy, unnatural result of past rhinoplasty techniques. Understanding the above mentioned variabilities in the classic black nose is important to tailoring a customized rhinoplasty.
What do most African/Black patients request?
Most black patients in Dr. Rizk's practice requesting rhinoplasty are simply seeking refinements of their noses to achieve better facial harmony. Some patients in Dr. Rizk's practice are specifically requesting caucasinization of their noses. The ones requesting their noses to be more Caucasian are usually young blacks in their teens and 20s and blacks in the entertainment or modeling industry. Dr. Rizk emphasizes that it is important to listen to the individual patient's desires but also just as important to guide them to what kind of result will look natural and be in harmony with their particular facial features.