African American rhinoplasty

What repeats

Five findings that hold across the literature.

The group contains several distinct nasal patterns, and they were counted

An anthropometric study of 201 black American noses sorted them into three groups. The African group held 44% of the noses, the Afro-Caucasian group 37% and the Afro-Indian group 19%. A concave dorsum was present in 53% of the African group, 10% of the Afro-Caucasian group and 8% of the Afro-Indian group. A dorsal hump ran the other way: 18% in the African group, 36% in the Afro-Caucasian group and 63% in the Afro-Indian group.

Rests on: Ofodile et al., the black American nose.

The measurements exist, taken directly rather than assumed

Fourteen standard anthropometric measurements of the face and nasal region were taken from 107 African American women aged 18 to 30, including nose length, nose width, nasal bridge inclination, nasal tip protrusion, ala thickness, nasal root width and columella length. The study set out to test whether subjective subcategorisation could replace anthropometry.

Rests on: Porter and Olson, analysis of the African American female nose.

Neoclassical proportions are treated as the wrong yardstick

Reviews state that early rhinoplasty attempted strict adherence to neoclassical aesthetic ideals and that the anatomy and the patients' aims are more varied than those ideals allow. Preoperative assessment of a non-Caucasian nose is described as something that cannot be based on the neoclassical canons. A comparison of those canons against the measured proportions of beauty pageant winners from seven regionally defined ethnic groups, nominated between 2005 and 2015, was run to test the same point.

Rests on: Patel and Kridel, African-American rhinoplasty · Patel and Most, concepts of facial aesthetics · Saad et al., the neoclassical canons revisited.

The stated goal in the recent literature is preservation

A 2020 review describes the change in approach from cultural and ethnic transformation to ethnic preservation, with the nose harmonised to the rest of the face and the patient's self-defined ethnicity taken as the reference. A second 2020 review reports a particularly strong wish among patients of African descent to keep nasal features that are ethnically and culturally congruent.

Rests on: O'Connor and Brissett, the changing face of America · Boahene, the nasal tip, base and soft tissue envelope.

Patients report keeping their features after structural surgery

An anonymous questionnaire went to 75 African American patients, 21 men and 54 women, aged 14 to 58 with a mean age of 33.8, all operated by open structure rhinoplasty using a three-tiered approach. On a scale where 1 was no change and 5 complete change, the mean rating for change in ethnic characteristics was 2.3. Mean satisfaction was 4.6, mean self-esteem 4.3 and mean nasofacial harmony 4.3, each at P < .001.

Rests on: Slupchynskyj and Gieniusz, 75 cases.

By what part of the nose is being changed

The reviews divide the operation the same way each time.

The tip

Building tip definition through thick skin is named as one of the three main technical problems. The reviews for this group treat the tip as a structural problem, addressed with grafts and sutures that add support, rather than by removing cartilage.

Rests on: Patel and Kridel · Chike-Obi et al., tip nuances · Rohrich and Muzaffar, rhinoplasty in the African-American patient · and the pinched tip.

The bridge

Building dorsal height is the second named problem, which puts this operation in the augmentation family rather than the reduction family. Where the dorsum is concave, as it was in 53% of the African group in the 1993 series, the material has to come from somewhere.

Rests on: Patel and Kridel · Ofodile et al. · and rib cartilage grafts.

The nasal base

Producing a different alar base is the third named problem. A systematic review of nostril surgery covering 22 studies and 1599 patients found excision techniques used in 728 patients, cinching sutures in 642, and excision combined with flap advancement in 189. A randomised comparison of two alar reduction methods in 40 patients, 22 with cutaneous and vestibular excision and 18 with cutaneous excision only, tested the effect on the appearance of the nasal sill at one year.

Rests on: Patel and Kridel · Gandolfi et al., nostril surgery · Gilbert, alar reductions.

The skin

Soft tissue envelope thickness was measured at six nasal subsites on computed tomography in 200 adults without nasal deformity, comparing across races and subsites. Management of the envelope is listed alongside the tip and the base as a separate part of the operation, not a passive covering.

Rests on: Eggerstedt et al., soft tissue thickness · Boahene.

The graft supply

Harvestable septal cartilage was measured on computed tomography in 200 patients across four self-described racial and ethnic groups, preserving a 1 cm L-strut. African American self-described race was one of the factors independently associated with smaller harvestable area and shorter length, at p < 0.05.

Rests on: Urban et al., donor cartilage availability · and rib cartilage grafts.

What to ask about this operation

Questions the evidence supports asking.

What will change and what will stay

The recent reviews frame the operation as preservation of the patient's own features. Ask the surgeon to name, on a photograph, which features are being changed and which are being left, before any measurement is discussed.

Rests on: O'Connor and Brissett · Boahene.

Are you narrowing the base, and by which method

Excision, cinching sutures and combined techniques are all in use, in the proportions the systematic review counted. The methods differ in where the scar sits and in what happens to the nostril rim, and one randomised comparison exists on that question.

Rests on: Gandolfi et al. · Gilbert.

Where is the cartilage coming from

Septal supply is measurable in advance and was smaller in this group in the radiographic study. If the plan involves dorsal augmentation and tip support at the same time, ask whether the septum alone will cover it.

Rests on: Urban et al. · and rib cartilage grafts.

How long before the tip settles

Thick skin over the tip is named in every review as the reason definition takes time to appear. Ask the surgeon for their own photographs at one year rather than at three months.

Rests on: Patel and Kridel · Boyette and Stucker · Stucker et al., topographic and surgical anatomy · and recovery.

Do you use an open or a closed approach here

The 75-patient satisfaction series used open structure rhinoplasty throughout. The reviews for this group describe the same preference, on the grounds that the grafting is structural.

Rests on: Slupchynskyj and Gieniusz · and open versus closed rhinoplasty.

The terms, defined

The words used about this operation.

• Alar base: the width of the nose where the nostrils meet the cheek. [20446207]
• Alar flaring: outward bowing of the nostril rims beyond the alar base. [32812083]
• Nasal sill: the floor of the nostril, between the base of the columella and the alar rim. [8663954]
• Columella: the strip of skin and cartilage between the nostrils. [12560683]
• Soft tissue envelope: the skin and the fat and muscle beneath it, covering the nasal framework. [32212978]
• Tip projection: how far the tip stands out from the face. [12560683]
• Dorsal augmentation: raising the bridge with a graft or implant. [20446207]
• Neoclassical canons: a set of classical facial proportions used as an aesthetic reference, which the reviews state does not apply here. [32008729]
• Anthropometry: direct measurement of the face with calipers or from standardised photographs. [12560683]
• Structure rhinoplasty: an approach that adds cartilage support rather than removing tissue. [18645089]

Where else this is documented

Sources outside the journals, each one free to read.

The national guideline

The American Academy of Otolaryngology publishes a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what the surgeon should assess and record before operating, and it applies whatever technique is chosen.

Rests on: the clinical practice guideline · the plain language summary.

The surgeons' own textbook chapters

Rhinoplasty Archive, the free online rhinoplasty textbook edited by Daniel G. Becker, runs an ethnic rhinoplasty category. Three of its chapters cover this operation, the alar base and the augmentation it usually needs. They are written for surgeons and go further into technique than a patient page should.

• African American Rhinoplasty
• Alar Base Modification
• Bilaminar augmentation for paranasal and premaxillary deficits

The reference summary

StatPearls, on the National Library of Medicine's Bookshelf, carries two chapters in full text at no charge.

• Rhinoplasty, the anatomy, the approaches and the complication list.
• Rhinoplasty Tip-Shaping Surgery, the suture and graft techniques used on the tip.

The societies

• American Society of Plastic Surgeons, patient information.
• American Academy of Facial Plastic and Reconstructive Surgery, patient information.
• The Rhinoplasty Society, the surgeons' body, with its member directory. See associations.
• International Society of Aesthetic Plastic Surgery, which surveys its members every year and reports procedure counts by country.

The trials in progress

Alar base surgery is under test in a registered trial.

• Aesthetic and Functional Results of Alar Base Modifications in Rhinoplasty, status unknown, 50 participants.

What is not settled

• The three-group classification rests on one 1993 series of 201 noses and has not been repeated. [8239410]
• The anthropometric baseline for this group comes from 107 women aged 18 to 30 at one centre. Men and older patients are not covered by it. [12560683]
• A systematic review of regional variation states that disparate groups have been clustered by geography, and that variation within those groups has had little attention. [35725958]
• The satisfaction data are a single-surgeon, single-technique questionnaire series of 75 patients, answered anonymously and retrospectively. [18645089]
• A 2026 meta-analysis of ethnicity-conscious rhinoplasty drew on 17 comparative clinical studies published between 2003 and 2023, which is the size of the comparative evidence base for every group in it. [40906288]
• Alar base technique choice is described by counts of what was published, not by trials. One randomised comparison of 40 patients exists on the sill. [32812083] [8663954]