Asian rhinoplasty: post-implant removal?

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

Q: Hello~ About 1 1/2 years ago in Seoul, I had a silicone implant and cartilage graft put in my nose, and I had the base pulled down for more nostril show. I’ve had no problems with the implant, and I think it looks nice (at most angles), but I have regrets about my decision– I had done *zero* research and I was just too young to be making this choice. My nose feels unnatural and I’m uncomfortable worrying about protecting it all the time. What would my nose be like if I had the implant removed?

A: First of all, don’t overly stress yourself out about having a silicone implant if it has not yet caused you issues.  At some point it will need to be removed (years down the line) but you have time to consider your options and make an informed decision.  Simply removing the implant will sometimes not restore your original nose because of the changes it has undergone from the initial surgery.  Consultation with an Asian rhinoplasty specialist will give you a better idea of what options are available to you.

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Will an Autologous Rib Cartilage Graft Help Achieve Desired Results?

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

Q: I’m in the last few months of researching before I schedule a date for my rhinoplasty. I am most interested in the autologous rib cartilage graft instead of using synthetic materials for height. I was wondering, for the rhinoplasty procedure, is this achievable? A doctor told me he will be using my 7th rib cartilage to achieve the height.

A: Depending on the extensibility of your skin, it may or may not be possible.  Without question, using rib cartilage will be the best option to achieve maximal projection and refinement of your nose.

Especially when building up the nose a significant amount, using synthetic implants will put excess tension and stress on the skin, ultimately thinning it and causing issues down the road.

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What procedure do I need to get the desired result?

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

Q: I have been thinking about getting a Rhinoplasty for a bit now so I would just like to know what maybe the procedures needed for my desired nose? What I desire is to narrow/thin my wide Asian nose and thin the tip and its sides a little bit to make it look slimmer. I am actually fine with my side view so pointing the tip and having a pronounced dorsal hump for me is not a big deal, I don’t really want it.

A: During Asian rhinoplasty, the relationship between frontal and profile view is important because sometimes the nose needs to be made taller to appear more narrow from the front.
Due to the thickness of Asian skin, at times simply removing cartilage will not make the nose smaller because it will have the unwanted effect of reducing support.  To achieve your aesthetic goals, I would recommend some degree of augmentation and increased projection.

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Would medial crura be an ideal implant/strut for projection and definition for the Asian nose?

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

Q: Would this be an ideal implant/strut for projection and definition for the Asian nose? There isn’t much literature on it. Also, could it be combined with a nasal spine implant, collumella strut? Or would it give the same results?

A: The medial crural attachment to the caudal septum is one of the 3 major tip support mechanisms.  The medial crura are often advanced on a columellar strut/septal extension graft in cases where additional projection is desired (i.e. Asian rhinoplasty).

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Will a lateral osteotomy narrow the nasal aperture? I have Asian nose.

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

Q: Do low bridged, wide Asian noses benefit from lateral osteotomy? Will it help with nasal base narrowing and overall making the nose less wide?

A: For wide nasal bones that are obliquely oriented, lateral osteotomies will be successful in narrowing and improving the shape of the dorsum.  In some Asian patients, the dorsum is so low, and the bones so horizontally oriented, that osteotomies will not be a great choice and recreating dorsal aesthetic lines with a dorsal graft (such as a diced cartilage fascia – DCF) is the best option.

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I have wide tip, bulbous nose. I feel my nose is too wide for my face. Should I have an alar base reduction?

Posted on March 30, 2017 by Donald B. Yoo, M.D.

Q: I feel my nose is shapeless but want a natural result and not a harsh “pinched” look. Should I have an alar base reduction, or will cartilage trimming be enough? Also, would a lateral cartilage reduction be a good idea?

A: You would achieve a nice result with tip refinement without alar base reduction.
Lateral cartilage reduction will be necessary to refine your tip, but in conjunction with additional support in the form of lateral crural strut grafts.  Simply removing excess cartilage in the presence of thick skin will result in loss of structural support and increased and not decreased definition.  Removing cartilage without providing additional support is what leads to pinching and collapse over time.

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Asian rhinoplasty removal. Will people notice the difference?

Posted on March 25, 2017 by Donald B. Yoo, M.D.

Q: I want to remove my silicone implant badly because it looks fake and not considering any replacement. Will people notice the difference of 2-3mm silicone removal in Asian nose?

A: When it comes to the nose, most people will notice 2-3 mm of difference.  However, the important question to ask yourself is – were you happy with the height of the nose before surgery?  If yes, then remove the implant and don’t look back.  You will avoid the issues of skin thinning and ulceration that will inevitably come down the road if you keep the implant in place.

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Dorsal silicone implant with/without tip work or dice cartilage wrap fascia? How much/which procedure will get me these result?

Posted on March 25, 2017 by Donald B. Yoo, M.D.

Q: Overall I like my nose but I want it to look more narrow, higher bridge & less bulbous tip. I want it to look natural and like myself still. Which procedure should I do? How much will it cost? I’m not scared of going through the pain. No pain no gain $$ is the only issue for me. I don’t know if I can afford rhinoplasty in this lifetime, if I do I’ll be in debt. I know in my heart it’ll be worth it!

A: For the short term, silicone implants can deliver fantastic results.  Thick skin and swelling helps to hide the unnaturally sharp contours and edges of the silicone implant and deliver narrowing, height, and refinement.  However, the downside is that silicone is not permanent, and at some point will begin to be visible through the skin as an unnatural appearing implant.
Using tissue from your own body can also deliver fantastic results, when performed by an experienced rhinoplasty specialist.  Whereas a silicone implant is premade and can be inserted by just about any rhinoplasty surgeon, autologous grafts (tissue from your own body) must be harvested and tailored specifically for you – and thus greater variability exists in the results.  With the right surgeon it is the best option to achieve a permanent, naturally beautiful result.

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What are the operations I have to go through for this kind of nose?

Posted on March 25, 2017 by Donald B. Yoo, M.D.

Q: Hi I am ASIAN. I want to get my nose done, but I don’t know that should I go through, like alarplasty, rhinoplasty, etc. I am okay with my bridge, but adding little height will be excellent. It is just the tip of my nose. Help me please so that I would know the options that I should go through.

A: A nice degree of refinement and projection of the bridge and tip of your nose would be possible using cartilage from inside your nose (septum) as well as from your ears (through an incision behind your ears without altering their appearance).  Fascia could also be used in addition to the cartilage to build up the bridge of your nose to create a more attractive nose.

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Can I still have a pointy nose?

Posted on March 25, 2017 by Donald B. Yoo, M.D.

Q: Hi. I’m 17 years old, turning 18 in 3 months. I’m an Asian female. I’m wondering how to have a pointy nose because I have a small nose and my nose bridge is not high. Can I do something about it? I want the normal way if possible. Hope you can help me. Thanks a lot! 🙂 God bless.

A: The bridge of your nose can be augmented and the tip of your nose refined in a way that is balanced with your facial features and provides a natural, beautiful result using tissue from your own body.  Results depend on the skill and experience of the surgeon, so it’s important to find a rhinoplasty specialist with expertise in Asian rhinoplasty.

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