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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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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