What’s an estimate for Asian rhinoplasty using diced cartilage wrap in fascia? How long is the procedure, recovery etc?

Q: I’ve always hated my nose growing up. Families would point out how flat/big my nose is compared to my sisters. These hurtful comments isn’t the reason why I want the surgery. I’m doing it for me. My nose doesn’t look too bad when I have on makeup. Although I feel like my face is 2D rather than 3D. I want to start saving up as I plan on having this surgery soon. What’s an estimate for diced cartilage wrap fascia? How many hrs will take? Is it open or close rhinoplasty? How long is the recovery?

A: Diced cartilage fascia (DCF) is a great technique to create augmentation along the bridge of the nose.  However, not every surgeon is equally skilled at creating an attractive, natural-appearing result with this technique.

The most important factor in achieving a beautiful result is finding the right surgeon.  Finding rhinoplasty specialists experienced in Asian rhinoplasty is the first step.  After this, consult with 2-3 of these surgeons in person and determine your comfort level with their approach, demeanor, and before and after results.

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I’m considering Asian rhinoplasty. Are my thoughts realistic?

Q: I would like to have a nose job as I feel like it is obscuring my features. Right now, I feel that my nose is perfect in width. I would like nose holes (not triangles), a less fatty piggy nose and maybe a higher nose bridge. I also feel like the base of my nose is not pointing down enough but rather slightly forward. What are your thoughts and suggestions? and estimated price?

A: Your cosmetic concerns are something that can be addressed and improved with Asian rhinoplasty.  While there are a variety of approaches and techniques employed by various surgeons, it is up to you to do your due diligence to find a rhinoplasty specialist experienced with Asian rhinoplasty in order to achieve the best results possible.  Using autologous grafts (tissue and cartilage from your own body) will provide the safest and most permanent results.  Achieving an attractive result, however, will demand a surgeon with great expertise in Asian rhinoplasty.

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Asian Revision rhinoplasty. When is the soonest I can get this redone and what would you recommend be done?

Q: I had a revision rhinoplasty done 4/2015 and I feel that it is too long and pointy. It totally changed the way I look. It was done with diced cartilage and fascia. I now have a humped nose. When is the soonest I can get this redone and what would you recommend be done?

A: Your nose will continue to change in appearance as it heals.  Especially since you are healing from a revision surgery, it will be prudent to allow your nose to heal fully before considering planning another revision.  After such an extensive revision (with rib cartilage and fascia) I would wait at least 9 months before considering a revision.

The positive is that given the amount of augmentation and counter-rotation your nose was given during the revision surgery, you may not need additional grafts taken during this future revision.

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What kind of nose surgery do I need to make my nostrils (or sides of my nose) much thinner?

Q: I don’t have a HUGE problem with my entire nose (such as the bridge etc.), but it really bothers me whenever I smile and my nose suddenly looks so much wider. I realize that it’s natural for that to happen, especially for an ethnic nose but I don’t want it to be so WIDE. I just want the sides of my nose to be a lot thinner and compliment my entire face. And I’m not really liking the idea of an open rhinoplasty, would it be possible if it were closed?

A: Alar base modification is an effective way to reduce the flare and/or width of the nostrils.  Showing us a base view (photo from bottom up looking up into your nostrils) is the best view to evaluate your nostrils.  Excess width can be reduced with sill incisions, excess flare with Weir incisions, and excess flare + width addressed with a combined Weir+sill incision.

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Will my rib cartilage become weaker after rib-harvesting rhinoplasty?

Q: Hi, I am a 19-year-old Asian with very thick skin. I have had multiple consultations, and almost all the doctors said that rib cartilage is the only option to augment my nose bridge. But I am really concerned with the donor site. Will rib-harvesting procedure affect the function of my rib? Will my rib be more likely to break? The procedure sounds a bit scary. Please explain it to me. Thanks a lot!

A: A small portion of the cartilaginous portion of the rib is taken (for my patients usually 4 cm from the right 6th rib).  You will not have any untoward effects in terms of health or function, and this is well tolerated even in my patients who are professional boxers and mixed-martial artists.  The biggest downside to have rib cartilage harvested is a thin 2 cm scar, which will be present in the crease under your right breast.

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Will my nose bridge grow taller as I grow?

Q: I’m 14 years old and I’m Asian. I understand Asians have pretty flat noses. I was wondering if our nose bridges grow taller or if they stays the same.

A: Your nose may change in appearance if you have not yet reached your full height.  However, if you have already had your major growth spurt than it is unlikely to change significantly moving forward.

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Revision rhinoplasty – is more definition achievable between the tip and nasal wings?

Q: I had a rhinoplasty (narrowed tip, increased projection with ear cartilage), but am still a bit unhappy about the bulkiness of my nose. I have super thick skin, so I was wondering if it was even possible to be able to achieve definition between the nasal tip and the wings of my nose? I’m not sure if it makes sense, but my nose looks quite defined in the dark, but otherwise can look extremely thick and wide in normal light.

A: Especially when seeking maximal tip refinement during Asian rhinoplasty in patients with thick skin, sometimes additional structural support is needed to achieve the projection and definition necessary to get the most refinement.

It would be possible to achieve further refinement with rib cartilage as opposed to the septal cartilage and ear cartilage, which was used for your primary surgery.  Your nose will continue to change as it heals, so it is important to allow full healing before considering revision surgery.

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If my nose is lifted up – will the nostrils get smaller or it is separate procedures. My priority is fixing the nostrils.

Q: My nostrils are big and the annoying thing is they get bigger when I talk or laugh. If this is my biggest issue – can I fix it without putting a filler to my nose – It is great to have a taller nose, but it is not my priority. Also, if I can get my nostrils smaller – later on, If I want to lift up my nose, will it still be possible?Thanks.

A: Projecting the tip of your nose (making your tip taller) will reduce the flare of your nostrils but not significantly reduce the width.  Alar base reduction using incisions around your nostrils will be necessary to significantly reduce both the width and the flare of your nostrils.

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I’m Desperately Wanting to Have Two Operations for Rhinoplasty and Buccal Fat Pad Removal on Both Sides?

Q: I had a stroke last year in Jan (I’m 40 now) & have been on Plavix ever since. I know it’s very risky for people to have any operation whilst on Plavix. Then 2 months ago, I had my gall bladder removed & only the snr surgeon would operate (another wouldn’t touch the operation due to me being on Plavix). During my surgery I needed a blood transfusion and I also needed to be in hosp. for a week and half rather than just overnight due to the excessive bleeding. So can you please give me advice on this?

A: It’s difficult to recommend elective cosmetic surgery when you are on long-term anticoagulation that probably should not be discontinued.  While the risk of bleeding for rhinoplasty and buccal fat removal is not likely to put your health in jeopardy, the increased bleeding is likely to adversely affect your results.

You may consider looking into other options with a much lower chance of bleeding complications to improve your appearance (i.e. Botox/fillers/lasers).

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Is it alright if I have one cigarette each day after having rhinoplasty done two weeks ago?

Q: I’m seventeen years old & had rhinoplasty done two weeks ago. My doctor took a bump off my nose since my nose was broken for eleven years & I had breathing problems. I have dissolvable stitches on the inside of my nose & on the right side of my head just above my right ear. My doctor said I’m healthy but I’ve been craving to have a cigarette for a long time now. So is it alright for me to have a cigarette a day or once every now & then since it’s been two weeks after having my rhinoplasty done?

A: After rhinoplasty, the blood supply and lymphatics of your nose is very sensitive and can easily be compromised. Smoking and nicotine will hurt the blood supply and circulation of your nose, which can result in poor healing. Touch base with your surgeon about when is a safe time to resume smoking. I typically instruct my patients to wait 6 weeks after surgery.

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