Plastic Surgery 101

Concerns about keloids may be overblown for cosmetic surgery

Q. I am a 28-year-old African-American woman. I am not happy with my nose and I’m also concerned that I look tired from bags under my eyes. I'm concerned that I will get keloids, or scars, from surgery. What can you tell me about this?

A. While keloids are associated with patients of color, I personally have not seen a greater propensity for keloid scarring. I did my training at Tulane University in New Orleans, where 50 percent of my patients were African American. I cannot remember an instance where cosmetic surgery was associated with bad scarring and/or keloids.

Nasal surgery is more complex in African Americans because of the nature of their skin and cartilage. Because there is such a variety in the thickness and in the sturdiness of the cartilage, very often two types of techniques need to be done. The open rhinoplasty technique allows for thinning and fashioning of the cartilages to make the tip smaller. Many times, Weir excisions ( narrowing of the nostrils) are done to add symmetry to the nose. Not all patients require this and not all patients require the open technique. The closed technique of rhinoplasty is when all the incisions are made inside the nose.

With respect to your eyes, since you are young enough, you will probably need to have surgery with a trans-conjunctival approach. This approach allows for an incision to be made inside the eye so there's little to no chance of keloid. This incision allows for the removal of the excess fat so you no longer look tired.

If, however, you do not have enough fat but just a small indentation that makes your fat more prominent, you can fill this area with fillers. Fillers include hyaluronic acids marketed as Restylane, Perlane and Juvéderm.

While caution should be entertained when considering surgery, the reality is that there is low risk in developing keloids as it pertains to cosmetic surgery.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at