Who is the best doctor in the US for Asian revision rhinoplasty?

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

Q: I want to lower my nose (ie bring it back closer to my face) and make the nose less “tight” in appearance. I had a columellar strut, shield graft, and cap graft, and interdomal sutures. My nose used to flex with my skin when smiling, now it just stays in one place and looks rigid, in comparison to my soft and flabby alars (which doesn’t have any cartilage support anymore). I was told that I have thick skin and weak cartilage, which can complicate the surgery. How high is the risk of a revision for myself?

A: Giving any surgeon the title of “best” Asian rhinoplasty surgeon is subjective at best.  As a patient, the best thing to do is to seek out experienced Asian rhinoplasty specialists, go on ~3 in-person consultations, and choose the “best” surgeon for your nose.

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I have a bulbous nose and I’m an Asian. Which rhinoplasty procedure would make my nose appear smaller?

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

Q: I don’t have high bridge and I don’t mind about it. All I want is to get a smaller nose and a sharper tip. May I known what rhinoplasty procedure should I take as I know rhinoplasty can be consist of many types. Should I do an alarplasty? Thanks for reading

A: Especially for Asian rhinoplasty the relationship between the profile and frontal appearance of the nose is very important.  Due to the thickness of our skin, there is a limitation to how small a nose can be made without increasing projection (or the height) of the nose.
Alar base modification would be effective in reducing some of the flare and width of your nostrils.

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I’m having an asian rhinoplasty with small/medium implant only. Can I achieve this result?

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

Q: I like my nose only when I do makeup contouring. I didn’t want to do anything permanent so I had a nonsurgical rhinoplasty and I like the result. Now I’m ready for permanent rhinoplasty. I want the surgery to heighten my bridge. I’m not planning to have anything done to the tip. I had a consult with a Dr. and he agrees with me. He suggested a sm/md silicon implant without tip work. He quoted $2500-$3500$ Depending if I get mommy-makeover and rhinoplasty together.

A: There are a number of techniques available to reshape and build up the bridge of the nose during Asian rhinoplasty.  Synthetic implants such as silicone implants carry a higher risk of complications (including infection, migration, and extrusion) than grafts made from your own tissue (autologous grafts).  In general they produce aesthetic results which appear less natural than an expertly placed autologous graft, and do not produce a permanent result.

Be sure to understand the advantages and disadvantages of the available techniques in order to make an informed decision.

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I have wide nostrils that look like a big nose and a space between the bridge and its tip.

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

Q: What nose job will suit me? Is it possible without breaking my nasal bone?

A: While it’s difficult to make an accurate assessment without an in-person exam, you would likely benefit from osteotomies (fracturing the bones).  This will allow for the bridge to be narrowed slightly, creating more definition for it.

Depending on the degree of refinement and augmentation you are looking for, the appropriate grafts would be determined.  Either a combination of ear and septal cartilage or rib cartilage would provide a very nice change.

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Would I get good results from Rhinoplasty – with Asian nose, wide/thick, skin is rather thick?

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

Q: I’m unhappy with my nose – I have an Asian back ground (I’m 1/2 American, 1/4 English, 1/4 Filipino), so I believe my nose has some Asian features (flat bridge, wide). I have also noticed that my skin there is rather thick (also oily, lots of pores/blackheads/congestion) and have heard that thick skin makes rhinoplasty more difficult to produce good results. I just want to know what my options are, and if I would have a likely success if I went ahead with rhinoplasty.

A: As you have noted, the thickness of your skin will limit the amount of refinement that is possible with the tip of your nose during rhinoplasty.  However, even with thick skin quite a significant can be achieved with the appropriate techniques.

Success or failure in rhinoplasty depends chiefly on 2 things:

1) realistic expectations
2) choosing the right surgeon for your nose

If you do your due diligence in researching and consulting with rhinoplasty specialists experienced in Asian rhinoplasty, then you will have a very good opportunity to achieve an attractive nose.

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Are my desired rhinoplasty results obtainable without a premaxillary implant?

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

Q: More specifically I am wondering if my midface concavity can be corrected with rhinoplasty alone to stretch the skin and create a more proportionate nasolabial angle, and is the degree of my desired tip projection and rotation realistic?Thanks.

A: A septal extension graft in conjunction with extended spreader grafts would help to lengthen and counter-rotate your nose to create a more balanced nasolabial angle and greater tip projection.  The degree of counter-rotation and projection your photos you seek will likely require rib cartilage as it is a fairly dramatic change.

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I’m Asian. My nose is small with a wide base. How much will a nostril reduction cost, and how long is healing time?

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

Q: I’m Asian. My nose is small with a wide base. How much will a nostril reduction cost, and how long is healing time?

A: After alar base reduction surgery you will have sutures along the incision lines that remain in place for a week.  After the sutures are removed, typically the incision lines will need another week or so to be fully approximated and not appear “raw”.  Make-up may also be worn 2 weeks after surgery – so most patient will take 10-14 days off of work or school to recover.

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Crooked nasal implant, 3 weeks following Asian rhinoplasty.

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

Q: I underwent Asian rhinoplasty a few weeks ago, which involved tip sculpting and a custom-sculpted medpor implant (just for the bridge, not the tip). Since cast removal, I noticed the implant seemed very slanted more to one side where it starts between the eyes. The nose tip and end of nose, however, seems very central. As the swelling subsided, the position of the top of the implant hasn’t changed. In fact, it’s become more defined and consequently more prominent… I am seeking advice on this.

A: The textbook answer is that you should allow your nose to heal a full 6-12 months before considering revision.  However, voice your concerns with your surgeon.  If he/she feels there is a grossly misplaced implant he/she may decide to re-operate in a more expedient manner.

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How to change my flat bulbous nose to a smaller feminine nose? (Procedures and type of implants)

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

Q: I do want it to look natural. The bridge needs a lot of work, but I’m not sure how high. I would like to narrow the tip and the width of the nose base. My nose wing and nostrils also look large, can that be shaped? The tip and the nose wing bother me the most. I also think my nose tip skin is thick. Do I need to lengthen to not have an upturn nose? I do not want silicone implant & a high Caucasian nose bridge.

A: In order to create definition for the bridge and tip of your nose, you do require a fair bit of augmentation.  Given the amount of volume needed, and the need for strong grafts to project and counter-rotate the tip of your nose, I would recommend using grafts fashioned from your rib cartilage.

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When is the best time to consult and advice on finding a doctor?

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

Q: When should I consult? Is 6 months too far ahead? Will the doctor go over details again before surgery? Is peak season December because of holidays? This is a question for the states, specifically Houston. I live 10hrs away but will visit cause of family. I decided on December because of the holidays but I do have a date. I’m choosing facial plastic surgeons only. I feel conflicted when I find before and after pictures from younger doctor better than a very experience 20+ years doctor.

A: The right time to start going to consultations is when you are mentally and emotionally ready to go through rhinoplasty.  As you mentioned, for most facial plastic surgeons the surgery schedule fills up quickly for summer and winter as these are the most popular times.

6 months is not too early as most surgeons will schedule another “pre-operative” appointment (which is the practice in my office) to go over all of the things you’ve discussed during consultation once more.  The pre-operative appointment an be made closer to the surgery date, so that you have an opportunity to discuss any changes before your surgery date.

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