L-Shaped implant causing too much pressure on nose tip. Should I wait or try to do revision ASAP?

Posted on May 2, 2017 by Donald B. Yoo, M.D.

Q: Almost 5 months ago I had Asian rhinoplasty done with L silicon implant and ear cartilage at the tip. There has been lots of pressure at the tip ever since the operation. Aside from the pressure, the nose tip points dramatically to the right since the day of the operation. The bridge is straight. I’m sure I will seek another, more experienced surgeon for revision, but when should I do revision? I’ve read that it is recommended to wait 6 months, but I’m worried about the pressure on the tip.

A:  Signs of impending implant extrusion include increasing redness and tenderness.  Extrusion is a gradual process, as the skin is slowly thinned by the implant to the point of ulcerating.  In this case, when the skin is being thinned by a synthetic implant, the risks of waiting too long may be greater than operating sooner than the “recommended” time.  Using tissue from your own body (autologous grafts) will greatly reduce the risk of this possible complication.

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1 year post op Rhinoplasty, is this a Zit or Silicone implant infection?

Posted on May 2, 2017 by Donald B. Yoo, M.D.

Q: I had a nose job using a I-shaped silicone implant a year ago. Keep in mind, I am very acne-prone and have similar bumps all over the rest of my face. About 1-2 months ago, this bump started forming on my nose (not directly on top of the implant, but rather the side of my nose).Is this a silicone implant infection, or just another zit? It’s been over a month, so I’m getting worried. Also, this appeared about three days after I bumped my nose when the showerhead fell on me.

A: Implants will typically begin to show signs of ulceration and extrusion closer to the midline of the nose, because this is where they are exerting the greatest amount of pressure on the skin.

It would be advisable to see your surgeon in person to better evaluate your nose as to prevent progression of this “pimple” into a larger complication.

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5 months post op Asian Revision Rhinoplasty, could it be possible that the columella bone got trimmed?

Posted on May 2, 2017 by Donald B. Yoo, M.D.

Q: I have Asian nose. It’s been 5 months post-op but the collumella feels so soft, it can be pushed to right/left easily. Isn’t it supposed to be cartilage kind of feel /a little bit hard when touched? My nose does looked upturned then previous. Could it be possible that the collumella bone got trimmed? What could this mean? Thank you.

A: The columella is made of cartilage, and note bone, and is naturally a soft area of the nose.  When extensive cartilage grafts are placed in this area, the area may become more rigid and take time to soften.

The fact that your columella is soft is not likely to have an effect on your final result, but bring up your concerns with your surgeon as he/she is in the best position to reassure you with the details of your surgery.  Tip rotation will decrease and will look less upturned as you continue to heal.

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Thick Asian Nose. Is surgery a good option? Should I exclusively look at doctors who have worked on Asian clients?

Posted on May 1, 2017 by Donald B. Yoo, M.D.

Q: I am half Filipino and half Hispanic. My nose is from my Filipino side. And I’ve been reading online how Asian noses compared to Caucasian noses are fundamentally different, and how some doctors specialize in just the Asian rhinoplasty. Knowing this, I have become apprehensive going to a doctor who hasn’t done a lot of ethnic or Asian noses. So when looking for my doctor, should I exclusively look at doctors who have worked on Asian clients or does it matter?

A: Asian noses have not only anatomical differences from noses of other ethnicities, but different aesthetics.  This makes it important to find a surgeon who appreciates Asian beauty and is able to create a nose, which enhances and complements your other features.

As a patient, looking at a surgeon’s before and after photos will give you a good sense of whether he/she has the expertise and the aesthetic sense to help you achieve the nose you have in mind for yourself.

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How soon can I get an Asian Revision Rhinoplasty?

Posted on May 1, 2017 by Donald B. Yoo, M.D.

Q: 1 month ago I got a rhinoplasty and I am unhappy about the size of my bulbous / tip area. It is really big (I wanted definition, narrower elongated tip. I believe that my nose is attainable for this definition but my surgeon did not build it that way. I also got a cartilage augment. How early can I get revision? And how much can I expect to pay more? I paid 8k in Los Angeles and may go anywhere in US to fulfill a revision. I know it’s early but my nose is NOT what I want.

A: At 1 month, you are extremely early in your recovery period and the nose is expected to be quite swollen at this point.  The majority of the swelling will resolve in 3-6 months, and will continue to resolve as your nose heals for up to 1-2 years.

Revision surgery generally is more complex and challenging than primary surgery, and thus is typically costlier.  In some cases, depending on the area being addressed, revision surgery may be considered as early as 6 months post-op, but in general waiting a full year is prudent.

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1 year post op Asian revision rhinoplasty, I have an extrusion, crooked results. Any suggestions?

Posted on April 24, 2017 by Donald B. Yoo, M.D.

Q: I got my nose done a year ago using I-silicone & ear cartilage. Kindly need your advice on my questions below: 1. The nose is crooked. The nostril is contorted. Is this normal/acceptable? Are there potential complications? 2. I noticed a faint red bump on the tip of my nose. I don’t feel any pain/sensation. Is it an extrusion case? Will the bump get more pronounced with time? 3. I want to take the silicone out. Do I still need to insert cartilage to ensure the tip doesn’t sag? Thank you!

A: The silicone implant may be misaligned and is causing a deviation to the bridge of your nose.  Removing the silicone implant and replacing it with tissue from your own nose (autologous grafts) will allow it to be reconstructed in a safe, permanent way.

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For Revision Asian Rhinoplasty, could my columella be carved/customized?

Posted on April 24, 2017 by Donald B. Yoo, M.D.

Q: For my 4th Revision Asian Rhinoplasty, I want to add columellar strut to support the tip using irradiated rib cartilage. Could it be shaped as if there’s a ‘half bone cut’ look? Could columellar strut be added using ear cartilage by the way? Thank you!

A: A common maneuver to support the tip or push out a retracted columella to improve its appearance is the use of a columellar strut or septal extension graft.  It’s not quite clear to me what you mean by “half bone cut” look, but several aspects of the shape, width, projection, rotation of the tip and infratip lobule can be manipulated with a columellar strut/septal extension graft.

Ear cartilage is typically not the best option for use as a columellar strut as the cartilage and softer and more curved than other options (septum or rib).  Especially since this is your 4th revision, be sure to complete your due diligence finding a revision rhinoplasty specialist experienced in Asian rhinoplasty.

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Can my nose be improved? Asian nose here.

Posted on April 23, 2017 by Donald B. Yoo, M.D.

Q: I am an Asian with a typical Asian nose. The bridge seems distinct but the tip is another story. It has fallen a bit short in terms of length and form, its looks is similar to when I look up at the ceiling and you can see my nostrils, it is like it is pressed up, the opening is a bit obvious even though I’m am looks horizontally straight.

A: As you noticed, the tip of your nose is a bit over-rotated (turned up) and the overall length of your nose is slightly short for your face.  The tip of your nose can be counter-rotated (turned down) and lengthened by adding grafts made from your own cartilage.

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How long does an Asian rhinoplasty last that requires autologous cartilage graft?

Posted on April 13, 2017 by Donald B. Yoo, M.D.

Q: Hi I am thinking about getting a higher nose bridge and improved nose tip. From my research I prefer getting an autologous cartilage graft because gortex would normally slide down my nose due to gravity over time which means corrective surgery will be required. I am hoping that my own cartilage would fuse with my nose avoid that problem. Just wondering would my own body absorb my own cartilage instead? Thanks.

A: The biggest advantage of using autologous grafts (tissue from your own body) is that after a few weeks, it becomes incorporated and becomes a living part of your nose.  Thus autologous grafts have a much lower rate of complications than synthetic grafts.  Cartilage from your own body, when handled properly during surgery, does not resorb and remains a permanent part of your nose.

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Can Costal Rib cartilage/Silicone/Goretex be carved so it creates little hump in Nose Bridge? Revision Rhinoplasty case.

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: Look forward to 4th Revision Asian rhinoplasty. Long story short, my nose’s bridge now looks too tall with Silicone inside and too straight.  I want to have nose with a little hump that makes my nose look natural & unique in some way IMO. Is it possible to carve Rib cartilage or silicone so it has small hump?

A: It is possible to intentionally create a little hump during dorsal augmentation (building the bridge) in Asian rhinoplasty.  While a number of techniques exist to build the bridge, using autologous grafts (tissue from your own body) is the safest and most permanent method.

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