Asian Rhinoplasty

The nose takes center stage on your face, and is often the first facial feature other people notice. Rhinoplasty and Asian rhinoplasty have continued to grow in popularity, as technical refinements have allowed ever improving cosmetic and functional results.

Rhinoplasty is one of the oldest procedures in facial plastic surgery, dating back thousands of years. Today, it is the most popular cosmetic procedure for men, and the second most popular procedure for women. Rhinoplasty requires both specialized surgical skills and a finely-tuned artistic eye to achieve a result that is attractive, natural, and balanced with each individual’s unique facial features. In addition, maintaining and improving the nasal function is a critically important part of successful Asian rhinoplasty.

Some rhinoplasty surgeons try to generalize Asian rhinoplasty to mean reshaping noses that are bulbous, short, wide and flat. However, in many ways this perspective is too simplistic and limited. As an Asian rhinoplasty specialist, Dr. Donald Yoo prefers to take a more personalized approach to Asian rhinoplasty, customizing each procedure for the individual patient.

Asian Rhinoplasty Anatomy

Asian rhinoplasty is unique, and requires not only special expertise but also a keen eye for Asian beauty. A beautiful nose is not just tall and projected, but should look natural and balanced when viewed from every angle. Some of the distinct characteristics of Asian noses are plain to see from the outside, while others extend far beyond the skin surface. The anatomy of the nasal framework and nasal bones often differ from other ethnicities, as well as the skin itself. Asians tend to have nasal skin that is thicker and more sebaceous, creating less definition in the tip of the nose.

The lower lateral cartilage, or tip cartilage, tends to be softer and less rigid than other ethnicities, and often is shorter in overall length. Tip shape, size and projection is determined by the intrinsic characteristics of the tip cartilage, and these characteristics many times result in a tip that may be bulbous, wide and under-projected. The nostrils may also appear to “flare” due to the convexity of these cartilages.

Dorsal height, or the height of the “bridge” of the nose is determined by the size, shape and orientation of the nasal bones, as well as the cartilage in the middle vault of the nose. In some Asians, the nasal bones have an oblique (more horizontal than vertical) orientation, and simply fracturing the nasal bones will not allow them to be narrowed sufficiently. In these cases, the dorsum must be augmented to allow better definition of the bridge, and create a more attractive profile and a more refined frontal view.

Implants in Asian Rhinoplasty:
Silicone / Gore-tex vs. Autologous grafts

One of the advancements in Asian rhinoplasty is the choice of material used to construct a beautiful nose. In the past, artificial implants made of Silicone or Gore-tex were the most popular choice due to their ease of use, and the quick learning-curve for surgeons to become comfortable with them. Surgeries using Silicone or Gore-tex implants can be performed quickly, since there is no need to harvest or tailor grafts to the individual patient. However, synthetic implants do come with several distinct disadvantages compared to grafts made from your own tissue (autologous grafts). These include:

1) Infection
2) Migration (movement)
3) Extrusion (coming through the skin)

With a synthetic implant, such as Silicone or Gore-tex, the nose may look great initially – sometimes even 15-20 years. However, in the vast majority of patients the implant will need to be removed or revised at some point. Some have attempted to improve the safety of this old-fashioned technique by employing a synthetic implant in the bridge while using septal or ear cartilage grafts in the tip of the nose. A foreign body still remains in the nose, and the result continues to have a higher rate of complications than autologous grafts. With autologous grafts, the result lasts a lifetime.

Besides synthetic implants, some surgeons have also used homologous implants (donated tissue from a cadaver). Cadaveric cartilage has a lower risk of complications than synthetic grafts, but generally have less predictable long term results than autologous grafts from your own body. Unlike autologous tissue, which is still viable and has living cells which become incorporated into your nose, homologous implants have been irradiated and do not have any living cells. This causes these implants to be more prone to resorption and loss of volume than autologous grafts which provide lifelong results.

Dr. Yoo exclusively uses autologous grafts as they provide the most permanent, natural, and beautiful results in the safest manner. Using the most cutting-edge techniques, he is able to harvest these grafts with hidden, minimal scars.

Autologous Grafts

Dr. Yoo chooses the best material for your nose, and each type has a specific purpose and application.
The autologous graft materials Dr. Yoo may use include:

1) nasal septal cartilage
2) ear cartilage (auricular conchal cartilage)
3) rib cartilage (costal cartilage)
4) fascia (deep temporalis fascia)

During your consultation, Dr. Yoo will perform a comprehensive external and intranasal examination of your nose. He will then sit down with you and create personalized computer imaging of your nose based on your aesthetic goals and determine which combination of surgical techniques and grafts will be necessary to achieve your ideal profile line and the most attractive nose for your face.

Not all surgeons are equally comfortable harvesting each of these grafts, and this is another reason pre-made Silicone and Gore-tex implants are so popular. Nasal septal cartilage is the cartilage between the nostrils, and a small portion can easily be removed without visible incisions to provide material for grafts. Ear cartilage is harvested through an incision hidden in the crease behind the ear, and does not change the size, shape or appearance of the ear.

Rib Cartilage Graft

Specialized training and expertise is especially necessary to safely and efficiently harvest rib cartilage, and Dr. Yoo is amongst a small group of surgeons who routinely perform this procedure. Dr. Yoo harvests rib cartilage (~4 cm) from the 5th or 6th rib through a minimal incision (~2.5 cm) hidden in the infra-mammary crease (under the right breast/chest). Once healed, the appearance, contour and feel of the chest is just as it was before surgery, with the addition of a small scar.

Dr. Yoo will determine the most suitable autologous tissue for grafting based on your unique anatomy, and your aesthetic as well as functional goals. The septum provides relatively straight, strong, cartilage and is a good source of creating grafts to project, support and refine the tip of the nose. When dorsal augmentation is desired (building the bridge of the nose), and often during revision rhinoplasty, additional cartilage is usually required. Ear cartilage is soft, and provides a great source of tip refining grafts and for mild to moderate dorsal augmentation. When more dramatic tip refinement, tip projection or dorsal augmentation is desired, rib cartilage is the preferred choice as it provides the greatest strength and the most volume of cartilage for maximal change.

Fascia is harvested through a small incision hidden in the hair above the ear, without shaving or cutting any hair. The incision is closed with surgical clips for 1 week, and once these clips are removed a week after surgery most patients forget anything was done in this area as it is hidden in the hairline.

A great benefit of autologous grafts is that within a few weeks after surgery, the grafts become fully incorporated into the nose – with its own blood supply and lymphatic drainage. It is as if you were born with it, because it is your very own tissue.

Alar Base Modification / Nostril Reduction

Alar base modification, also known as nostril reduction surgery, is a technique used in rhinoplasty to alter the width, and/or the flare of the nostrils. When excess flare is present, a Weir incision is designed which removes a wedge of the nostril tissue. When excess width is present, a sill incision is designed to reduce the width of the nostrils.

As a general guideline, the width of the base of the nose should approximate the distance between the inside corners of the eyes. Alar base modification may be considered when this relationship is distorted and the base of the nose is wider than the distance between the inside corners of the eyes. When performed correctly, alar base modification can improve the balance and harmony of the facial features while preserving a natural appearance.

Dr. Yoo looks forward to helping achieve a more beautiful you.

Call now for your consultation: 310-275-2467