The surgical management of platyrrhine nasal morphology is based on structural augmentation and functional optimization techniques that strengthen a weak skeletal framework, rather than relying on classic reduction procedures. Challenges typical of Afro-descendant nasal anatomy—such as thick skin and low dorsal projection—are addressed by elevating the nasal dorsum and supporting the nasal tip with autologous cartilage grafts harvested from the patient’s own body. This ethnic rhinoplasty approach, which may also include narrowing of a wide alar base, aims to preserve airway patency while achieving a natural, proportional, and character-defining appearance that harmonizes with the patient’s facial features.
İçindekiler
What Is Ethnic Rhinoplasty, and How Should the Approach Be for the African Nose?
Ethnic rhinoplasty is one of the most sophisticated areas of modern plastic surgery. A common mistake in the past was attempting to create the same standardized, small “European-style” nose for everyone. On an Afro-descendant face, that approach often looks artificial and can disrupt the person’s characteristic facial expression. Today, our vision is clear: enhance aesthetic appeal without compromising ethnic harmony.
In African nose surgery, the core philosophy is not “to reduce,” but “to reconstruct.” While in many standard noses we remove excess bone and cartilage, in this nasal type we often restore what is lacking. This is called “augmentation,” meaning structural reinforcement. The key issue is usually not size, but rather limited definition and a flatter profile. By elevating the dorsum and refining the tip, we aim to create a stronger, aesthetic focal point in the midface.
The primary goals of this surgical approach include:
- Natural appearance
- Ethnic harmony
- Facial proportionality
- A stronger profile
- Healthy breathing
What Is the African Nose Type and What Are Its Features?
To understand this nasal type, it helps to describe what we feel as surgeons when we examine it. Anatomically, the African nose differs from many other morphologies in several distinct ways. We often refer to a “triple challenge.” What are these challenges?
First—and most importantly—is the skin. In many Afro-descendant patients, nasal skin is quite thick. Not only the skin, but also the underlying fatty and fibrous layers can be more substantial. This makes it harder for the fine cartilage work performed internally to become visible externally. It’s like placing a small object under a thick blanket—its shape is not easily seen.
Second is the surprising weakness of the cartilages. One might assume that thick skin is supported by strong cartilage, but in this nasal type the opposite is often true. The tip cartilages are thin, soft, and flexible. As a result, the desired sharpness and definition at the tip does not naturally occur without structural support.
Third is the bony framework. The nasal bones are often shorter, and the dorsum is lower. In profile, the transition between the forehead and the nose can appear deeper, and the nose may not project sufficiently from the facial plane. In addition, the nostrils tend to be wider along the horizontal axis.
The main anatomical components of this nose type include:
- Thick skin
- Oily skin texture
- Weak cartilages
- Low/flat nasal dorsum
- Wide nasal alae
- Short columella
How Is a Low Nasal Dorsum (Flat Bridge) Treated?
One of the most common aesthetic concerns in the African nose is insufficient dorsal height. This also affects overall facial expression: when the dorsum is low, the eyes may appear farther apart and the face can look wider and flatter.
The key procedure here is “dorsal augmentation,” meaning raising the nasal bridge. The material used for this is critical. Although synthetic implants (such as silicone) were used in the past, they are less favored today due to infection risk and potentially unnatural long-term appearance. The best material is often the patient’s own tissue.
At this point, the most reliable source is rib cartilage. Why rib cartilage? Because septal cartilage inside the nose is usually insufficient for a meaningful augmentation. Rib cartilage provides a large amount of straight, strong graft material. We harvest it from the patient and carve it—like a sculptor—into a form that best fits the patient’s facial proportions. Sometimes it is used as a solid graft; other times we use a “diced cartilage” technique, where cartilage is finely cut and placed inside a sleeve. The goal is to create a smooth, elegant dorsal line from the forehead to the nasal tip.
Material options used in this procedure include:
- Rib cartilage
- Ear cartilage
- Septal cartilage
- Cadaveric cartilage
- Fascial tissue
How Is the Nasal Tip Shaped in Thick-Skinned Patients?
The most technical and challenging part of surgery is the nasal tip. As noted above, the skin is thick and heavy, while the cartilage meant to support it is weak. If we try to shape the tip only with sutures—without reinforcing the framework—the tip can lose to gravity and the pressure of the thick skin within months, leading to drooping and a return of the broad appearance.
For that reason, African rhinoplasty often requires strong structural support to the tip. We place robust cartilage supports (grafts) that function like a tent pole. These “strut grafts” help prevent tip droop. In addition, we may place “shield” or “cap” grafts at the most prominent point of the tip to push the skin outward from within and improve definition.
Imagine placing your hand under thin silk—your fingers show clearly. Place your hand under thick velvet, and the shape disappears unless you press more strongly. Similarly, we use cartilage grafts to create enough internal projection for definition to become visible through thick skin.
Technical elements commonly used in tip surgery include:
- Columellar strut
- Septal extension
- Tip graft
- Shield graft
- Rim graft
Is Alar Base Surgery Necessary for Wide Nostrils?
One of the most recognizable characteristics of the African nose is alar width. The nostrils are often broad and the alae may flare outward (alar flaring). To achieve better facial proportionality, this width may need to be refined.
For this purpose, we perform “alar base reduction,” removing a small amount of tissue from the natural crease where the alar base meets the cheek to narrow the base. However, the balance is delicate. Over-resection can create a “pinched” look and can compromise breathing. The goal is not to make the nostrils tiny, but to bring them into harmony with the face and align them appropriately relative to landmarks such as the inner corners of the eyes.
Because incisions are hidden in natural creases, scars are often minimally noticeable after healing. That said, because scar behavior can vary—especially in darker skin types—we use meticulous suturing and gentle tissue handling.
How Is Breathing Function Affected by These Aesthetic Procedures?
As an ENT and facial plastic surgeon, one principle is non-negotiable: a nose that cannot breathe—no matter how beautiful it looks—is a failed result. In African-type noses, because alar narrowing may be part of the plan, protecting the airway is even more critical.
While refining the external shape, we must avoid narrowing the internal air passages. During surgery, we also evaluate turbinate size and septal deviations, and address them in the same session when needed.
Even more importantly, we apply the principles of “valve surgery.” If the sidewalls are weak, they can collapse inward during inspiration. To prevent this, we use cartilage grafts not only for aesthetics but also to support the lateral walls and maintain the nasal valve region. In other words, we are not just beautifying the nose—we are strengthening the structural roof of the airway. The patient gains both an improved appearance and better airflow quality.
Functional issues that may require intervention include:
- Septal deviation
- Turbinate hypertrophy
- Nasal valve narrowing
- Synechiae (adhesions)
- Mucosal problems
How Should the Healing Process and Scar Management Be Handled?
In Afro-descendant patients or individuals with thick, oily skin, the recovery timeline can differ from that of thin-skinned patients. The biggest difference is the duration of edema (swelling). Thick skin tends to retain fluid, so it can take longer for swelling to resolve and for the final contours to emerge. We consistently emphasize one word: patience. The final result typically settles around 1 year, and in some cases can take up to 1.5 years.
Another key topic is scar behavior. In darker skin types, hypertrophic scars or keloids (raised scars) can occur more frequently due to genetic predisposition. Knowing this risk, we handle tissues gently during surgery and remain proactive postoperatively.
Post-op care doesn’t end when the procedure is done. If we observe excessive firmness or thickening at the tip or incision lines, we intervene early. Local steroid (cortisone) injections can help reduce edema and fibrosis (scar tissue thickening), allowing thick skin to settle more smoothly over the framework.
Key recommendations during recovery include:
- Regular massage (as directed)
- Sun protection
- Salt restriction
- Sleeping with the head elevated
- Patience
Is Non-Surgical Rhinoplasty (Filler) an Option for This Nose Type?
The “non-surgical rhinoplasty” trend seen on social media—using fillers—is often not a suitable option for the African nose type. The reason is simple: filler adds volume. In a nasal morphology where the core concerns are already width, broadness, and weak structural support, adding volume can make the nose appear larger and heavier. Fillers cannot narrow alar bases, permanently refine the tip, or overcome the masking effect of thick skin in a structural way.
In addition, fillers carry serious risks. In inexperienced hands, vascular compromise can occur, leading to tissue loss (necrosis). In cases that require meaningful structural change—support, narrowing, elevation—filler may offer only temporary camouflage and can lead to disappointment over time. For durable, healthy, and aesthetic outcomes, surgery remains the most realistic path.
Disadvantages of filler treatments include:
- Temporary results
- Added volume
- Tissue expansion
- Vascular risks
- Recurring cost
Why Do Revision Risk and Surgeon Experience Matter?
As with any surgical procedure, revision (secondary) rhinoplasty is always a possibility. In ethnic rhinoplasty, minimizing that risk depends heavily on the surgeon’s specialized experience.
There are major technical differences between standard rhinoplasty and African rhinoplasty. A surgeon who excels at reducing a prominent, hump-backed nose does not automatically have the skillset for augmentation-focused African rhinoplasty—because the philosophies are essentially opposite: one is reduction, the other is reconstruction.
These surgeries may take longer (often around 3–4 hours) and can include additional steps such as rib cartilage harvest. The surgeon must evaluate not only the nose, but also the patient’s ethnic background, cultural expectations, and facial anatomy as a unified whole. A poorly planned operation can cause both aesthetic dissatisfaction and significant breathing problems.
For example, while removing a hump and lifting the tip may be adequate in some Middle Eastern noses, an Afro-descendant nasal morphology often requires dorsal augmentation and alar base refinement. Choosing a specialist who understands these distinctions, can assess tissue quality, and can manage potential complications is one of the most critical factors for success.
The most important takeaway for patients is this: there is no such thing as the “perfect” nose—there is the nose that best suits your face, breathes well, and feels like it truly belongs to you. With modern techniques, it is absolutely possible to refine ethnic features without erasing them, and to achieve natural, confident results.
Prof. Dr. Murat Songu – Burun Estetiği (Rinoplasti) Uzmanı
Prof. Dr. Murat Songu, 1976 yılında İzmir’de doğmuş, tıp eğitimini Ege Üniversitesi Tıp Fakültesi’nde tamamladıktan sonra Celal Bayar Üniversitesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2005–2006 yıllarında Fransa’nın Bordeaux kentinde Prof. Vincent Darrouzet ve Dr. Guy Lacher gibi rinoloji alanının önde gelen cerrahlarıyla çalışarak rinoplasti, fonksiyonel burun cerrahisi ve kafa tabanı cerrahisi üzerine ileri eğitim almıştır.
Burun estetiğinde doğal görünüm, nefes fonksiyonunun korunması ve yüz estetiği dengesini ön planda tutan Prof. Dr. Songu, açık teknik rinoplasti, piezo (ultrasonik) rinoplasti, revizyon rinoplasti, burun ucu estetiği ve fonksiyonel septorinoplasti operasyonlarında ulusal ve uluslararası düzeyde tanınan bir cerrahtır. Yurt içi ve yurt dışında çok sayıda rinoplasti kongresinde eğitici ve konuşmacı olarak yer almış; yüz estetiği ve burun cerrahisinde modern tekniklerin yaygınlaşmasına öncülük etmiştir.
100’den fazla bilimsel yayını, kitap bölümü yazarlıkları ve 1700’ü aşkın uluslararası atfıyla rinoplasti alanında Türkiye’nin en saygın akademisyenlerinden biri olan Prof. Dr. Murat Songu, doğal, yüzle uyumlu ve fonksiyonel sonuçlar hedefleyen cerrahi yaklaşımıyla hem bilimsel hem estetik başarıları bir araya getirmektedir.
