Dr. Sam Lam Plastic Surgery Forum

Dr Lam, I am a light-skinned African-American woman. I originally had a very large, masculine-looking nose with a droopy tip. I had naturally sufficient height in the bridge of my nose. In my first rhinoplasty, I had the size of my nostrils reduced and the tip reshaped, but soon I developed scar tissue and the tip began to droop. Also when the doctor removed the splint, a patch of skin came off the bridge of my nose and it took over ten years for the skin to regain its normal pigmentation. About a year after the first surgery, the same doctor did a revision, in which he removed the scar tissue, but it returned again and the tip drooped again. Several years later, an African-American doctor told me he knew how to handle my sort of problem. He removed a piece of cartilage from my rib and used it to prop up the tip, but again I have developed scar tissue in the tip, and it has given the tip of my nose a blobby look. The size of my nostrils is fine, the width of my nose is fine, but I would like to have a defined tip that has a feminine tilt to it. Is there any hope for this, or will I alway develop scar tissue that will continue to make the tip of my nose look undefined?

Unfortunately, the more you cut, the more scar tissue can develop. In thicker skin patients like African-Americans, Asians, Hispanics, and even many whites, I recommend taping the nose for the first 3 months following rhinoplasty to minimize scar tissue. In the event that scar tissue does develop and needs to be managed, I prefer to use an injectable known as 5-fluorouracil (5-FU) to dissolve down the scar tissue that in my opinion is significantly safer in colored skin (and even white skin) because the risk of color loss and atrophy of tissues is negligible compared with kenalog/steroid injections. Unfortunately, I would say 99% of docs out there still use kenalog because they still don't know about this safer alternative to reduce scar tissue. It is an easy office procedure but obviously there are no promises that I can make. It oftentimes requires 2 to 3 times to get it where you want it to be.
best,
sml