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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Asian female rhinoplasty. What do you think I should be aware of before removing my implant?

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

Q: Will 2 mm of silicone implant make a huge difference for Asian females (considering typical Asians have flat nose)? I am thinking to remove my nasal implant because the bridge looks “fake” and too high, and I am not going to replace it with another implant. What do you think I should be aware of before removing my implant?

A: Some of the things to consider when undergoing removal of a silicone implant is the type of implant that was placed, the duration of placement, and the performance of any adjunctive rhinoplasty maneuvers during the surgery.

What this means in plain English is that if only a dorsal implant was placed, without resecting the bridge and without tip work, then your nose will return to your pre-operative state when this is removed.  In any other scenario, simply removing the implant will unfortunately not restore your pre-op nose.

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I’m Asian, 56 years old. My nostrils are uneven. Do you think there is any hope for me to correct them?

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

Q: I’m Asian, 56 years old. My nostrils are uneven. Do you think there is any hope for me to correct them?

A: While nostril asymmetry is the most difficult area of asymmetry to correct, in most cases it can be improved during rhinoplasty.  While perfect symmetry is not attainable, improved symmetry usually is.

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Raising area between eyebrows in Asian rhinoplasty. What is this procedure called?

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

Q: I notice in a lot of Asian rhinoplasty photos that the nose appears to start between the eyes, giving a short appearance as if cut off at the top. The area between the eyebrows is raised to give a more aesthetic appearance of the nose starting at the browbone. What is this procedure called and what materials (would fat be possible?) would be involved for the augmentation?

A: You make a very astute observation in differentiating between dorsal augmentation and what you are observing: radix augmentation and raising of the nasal starting point.

The area of the bridge between the eyebrows (radix) can be augmented and built up during Asian rhinoplasty.  I prefer to use the DCF technique for radix augmentation as it creates smooth, natural-appearing contours using your own tissue.

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How can a surgeon narrow a wide droopy nasal tip without adding projection that becomes bulky?

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

Q: I am an Asian patient that previously had a medpor graft removed because it was infected, but it was holding a very wide droopy tip closed while narrowing it. My surgeon replaced this with a shield graft & I feel it only bulkily augments the tip, without narrowing it. How do I narrow the sides of my nose & my nasal tip again without adding too much projection? What sutures or techniques can I ask my surgeon about?

A: Just as not all sculptures made of marble are masterpieces, surgeons will achieve different results even when using the same techniques.  More important than what to ask your surgeon, is to ask yourself if you have done your due diligence and research in finding a surgeon capable of delivering the results you seek.

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How safe is rhinoplasty with implants?

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

Q: I’m a 22 year old Asian planning to get rhinoplasty for a taller nose and bridge. However, I am still not convinced about the safety of implant whether it be silicone/goretex/etc. The nose has very thin skin and inserting foreign material is bound to have inflammation, resulting in expulsion through nose tip or granuloma formation. I believe it’s pretty well known that breast implants fail due to capsular fibrosis and I’m worried for nose implants. What material is safest even after several years? Thanks!

A: The absolute safest material for your nose from a lifelong, permanent perspective is tissue from your own body (autologous grafts).  Autologous graft techniques do require specialized expertise, and you will achieve the best results with a rhinoplasty specialist experienced in rib cartilage and ear cartilage grafting techniques.

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