Septal cartilage varies in thickness and strength from patient to patient, and from ethnicity to ethnicity. Patients with large, prominent noses often have thick septal cartilage which has a lot of intrinsic strength and resilience. In performing rhinoplasty on this subset of patients, a surgeon can comfortably harvest septal cartilage while preserving ~10-15 mm of dorsal and caudal strut while still maintaining the structural integrity of the nose. When the septal anatomy does not have much thickness, strength, or quantity, as can often be the case in Asian noses, then preserving only 15 mm of septal width is not sufficient to preserve the shape of the nose. With a 15 mm dorsal or caudal strut, the cartilage may still buckle and create a saddling of the nasal dorsum, loss of projection and ptosis of the nasal tip, or an even more serious collapse of the nose. For Asian patients often 18-20 mm of septal strut should be preserved to maintain the strength of the septum.
In addition to the increased risk of weakening the structure and shape of the nose by over-resecting cartilage from the septum of an Asian nose, the question still remains whether or not the harvested septal cartilage will provide enough structure and rigidity to reshape the nose. Often the septal cartilage does not provide enough support to resist the forces of thick, sebaceous skin and will be insufficient to create adequate, durable structure. The ideal case for using septal cartilage alone remains for patients with large, thick septal cartilage and requiring only mild to moderate structural grafting in the presence of of thin to medium skin thickness.
Septal cartilage is frequently removed during septoplasty for straightening the septum. Septoplasty may be performed entirely through incisions hidden inside the nose without affecting the shape of the nose. Asian patients, however, should be mindful of the fact that this otherwise straightforward operation should be performed with proper regard of the differences between Asian nasal anatomy and the typical white nose to avoid any of the complications of over-resection of the septal cartilage.
The most common complications for any surgery include bleeding and infection, and this holds true for Asian nose job surgery as well. Risk factors for bleeding are often assessed and mitigated prior to surgery, such as the cessation of NSAIDs, aspirin-containing products, foods/supplements and other medications that may cause an increased risk of bleeding during surgery. Pre-operative lab studies and medical clearance seek to identify bleeding disorders such as coagulation abnormalities and platelet deficiencies prior to rhinoplasty. Surgeons can miminize the risk of bleeding during surgery by meticulously controlling hemostasis during the procedure and using electrosurgery to close any bleeding vessels during Asian rhinoplasty. When bleeding does occur it can typically be controlled without the need for a return to the operating room, most often in the form of nasal packing for a nose bleed that does not cease on its own.
Infection may occur after rhinoplasty with a frequency of 1-2%, depending on the patient’s comorbidities, types of graft material used, primary vs. revision surgery, and other factors that become more difficult to quantify such as their exposure to pathogens post-surgery, how strictly they perform hand hygiene, and intrinsic levels of resistance to infection. Synthetic grafts carry a much higher risk of infection that also remains for the lifetime of the implant. Autologous grafts, or tissue from one’s one body, become incorporated into the nose fully within 2-3 months. After this time the risk of infection dips back down to the pre-operated state. Signs of infection include increasing redness, tenderness, strange smell, crusting and/or drainage. The earlier an infection is detected, typically the easier it is to treat, and often can be treated with a combination of topical and oral antibiotics. Rarely, infections may progress to the point that higher-dose IV antibiotics may be needed.
Beyond the complications common to all surgeries, the other serious complications after Asian rhinoplasty include scarring and the need or desire for revision surgery. Whenever an incision is made through the skin, a scar remains, and while it is impossible to create a truly invisible scar, with proper scar-design and precise surgical technique most scars during Asian rhinoplasty will be extremely discrete and become nearly invisible with proper care. Precise surgical technique includes tension-free closure and perfect re-approximation of skin edges to create the thinnest, faintest scar possible. Scar revision and scar modulation treatments are a possibility to improve the appearance of most scars.
The risk of needing/wanting revision surgery after Asian rhinoplasty is intimately tied to two main factors: 1) the skill and experience of the rhinoplasty surgeon 2) the expectations of the patient. Patients have an expectation in terms of aesthetics and recovery when they seek out a surgeon for an Asian nose job. Some will even bring “inspo” and “goal” photos. The reality is, it’s not usually possible to replicate a nose on someone’s face that has completely different anatomy and facial aesthetics, nor would it be desirable to do such a thing. The perception of beauty more often flows from the balance and harmony between facial features, not simply one outstanding physical feature. Some surgeons inherently understand this while others work hard to incorporate this tenet in their work. Others, however, fail to fully master this concept and this results in patients seeking improvement upon their rhinoplasty.
Even when aesthetically aligned, many rhinoplasty surgeons lack the technical expertise and surgical precision to create the shape and results a patient seeks. That’s why it’s important as a patient not only to research a surgeon’s background including educational and training credentials, but also to carefully review examples of their before and after photos, videos and candid patient videos or social media accounts to ensure the aesthetic is one he/she is capable of achieving.
One of the biggest challenges in Asian rhinoplasty surgery is creating dorsal augmentation and increased projection to the bridge of the nose in a way that is permanent, natural in feel and appearance, and aesthetically pleasing. Rhinoplasty surgeons have used a variety of techniques and materials to address this challenge, with varying levels of success and disparate levels of result permanence throughout the years.
A common desire for patients seeking Asian nose job surgery is to build up a low bridge or low nasal dorsum. Patients with low bridges often have difficult wearing large eyeglasses and sunglasses without the frames resting uncomfortably on their cheeks. Aesthetically, having a low nose bridge often results in the lack of definition or contour along the nose from the frontal view, with poorly delineated dorsal aesthetic lines and a resultant wide or flat appearance to the nose. For these reasons, plastic surgeons have used materials ranging from rudimentary items such as jade and ivory to more modern advances such as material processed from human cadavers.
The use of synthetic implants exploded in Asian rhinoplasty in the 1970s, as widespread adoption by surgeons for the ease of use and consistent initial results with silicone implants created a massive uptick in the number of dorsal augmentations performed using this technique. Silicone implants possess the advantage of ease of use since they are preformed and very easy to place during surgery. Especially for dorsal augmentation, minimal dissection may be performed along the dorsum of the nose to create a small pocket for a dorsal silicone implant to be slid into place. However, as years passed with these implants in place, issues started to arise. Given the synthetic nature of these implants, the overlying skin became thinner from the constant pressure and irritation of the implants. Some implants became mobile and would migrate from their initial position. Others even thinned the skin to the point of ulcerating through it, leaving a disastrous complication.
Fast forward to the 2000s, and surgeons began exploring other synthetic materials that might possess more favorable characteristics for long-term integration in the nose. For this end, rhinoplasty surgeons began using materials such as Goretex and Medpor, which were far more porous than silicone. The reasoning being that the pores would allow for more fibrous and vascular ingrowth into the implant, thereby securing it more effectively to the nose than a silicone implant. Turns out, they were right in terms of the tissue ingrowth and scar formation securing the implant, but what they did not foresee was the same exact issues with skin thinning and ulceration over time.
Which leads to the autologous grafts, or augmentation options coming from tissue from your own body. The human body is amazing in that one can take viable tissue from one part of the body, move them to a dissimilar target site, and as long as the cells can re-establish a stable blood supply, the cells within that tissue will remain living and thriving in the new environment. That’s the basis of using autologous grafts in the nose, and specifically for augmenting the dorsum of the nose. Common sources of autologous tissue include fat, fascia, bone and cartilage. The dorsum is made of bone along the upper third of the nose, and cartilage along the middle third, so the ideal graft material would closely approximate this.
Before and After Male Asian rhinoplasty with rib cartilage and DCF
Creating a natural looking dorsum becomes difficult due to the challenge of recreating the contours of the nose. The dorsal aesthetic lines of the nose resemble an hour glass, with gentle curves rather than straight, linear edges like a pencil or other cylinder. Solid rib cartilage is most commonly carved in the shape of a canoe, widening towards the middle vault instead of tapering as an aesthetically pleasing natural nose does. In fact, this shape becomes exceedingly difficult to mimic considering the ventral surface of the graft must also accommodate the pre-existing dorsal contours of the bridge in order to create a seamless transition between augmented dorsum and intrinsic dorsum.
Before and After Male Asian Rhinoplasty with rib cartilage and DCF
Which leads us to a graft that is able to reconcile those challenges, though requires a high level of technical proficiency to execute precisely: the DCF or diced-cartilage fascia graft. The requisite building blocks of a DCF, cartilage + fascia, demand expertise to harvest and prep in a fashion suitable for a DCF that will maintain predictable and consistent characteristics to create a permanent result. Fascia that is uneven in thickness or dimensions will create contour irregularities or even deviation of the dorsum. Cartilage that does not have uniform quality and dimensions leaves an unacceptably high risk of visibility in the form of a “cobblestone” appearance to the dorsum, or even worse, small humps and bumps along the bridge.
Techniques represent simply tools to create a result, but do not guarantee one. The best way to ensure the optimal results for your individual nose and anatomy is to choose a surgeon with the aesthetic eye combined with the meticulous technique and expertise to deliver a natural, balanced and beautiful result.
The contemporary landscape of Asian rhinoplasty involves advanced structural and contour grafting coming from an autologous source – meaning from the patient’s own body. Rudimentary techniques using synthetic implants like silicone, Medpor and Goretex are gradually being discarded as more and more surgeons begin to receive training to properly perform the more complex, but ultimately superior, Asian nose job techniques using 100% natural and permanent material.
Rib cartilage provides an ample source of viable, autologous cartilage that is not only strong, but allows for shaping long, straight cartilage grafts that can serve to reinforce the septum, open the nasal valves, and support the tip of the nose, amongst other applications. The workhorse of creating ample, durable nasal tip projection in Asian rhinoplasty remains the septal extension graft, albeit in a slightly different form than the originally described by Byrd. The modern septal extension graft takes on a more robust form, often secured in the mid-line between extended spreader grafts and with a posterior notch to accommodate the anterior nasal spine. The septal extension graft allows for projection of the nasal tip, precise rotation of the nasolabial angle, and may also be used to control lengthening of the nose and the appearance of the columella and infratip lobule. Meanwhile the extended spreader grafts serve the dually important functions of expanding the internal nasal valve, thereby improving the nasal airway, and stabilizing the dorsal and caudal septum to allow for mid-line preservation of the additional tip support.
During Asian rhinoplasty the lower lateral crura can then be secured to the septal extension graft, which serves as the novel anterior septal angle. Lateral crural tensioning provides immediate flattening of convex lateral crura, while maintaining strength and patency of the external nasal valve. The external nasal valve receives additional support and structure from the addition of alar rim grafts, part of the unified tip grafting technique. The unification occurs at the transition between the alar lobule and the lateral tip, as the medial aspect of the alar rim grafts insert discretely along the ventral aspect of the tip refining graft, which itself is secured over the intermediate crura and anterior most aspect of the septal extension graft. This ensures a smooth transition from nasal tip to ala while also create greater refinement of the lateral tip and alar lobule.
Revision Asian rhinoplasty with rib cartilage and DCF
At times, a tip-refining shield graft or columellar onlay will necessitate itself to lend volume to the columella and infratip lobule. These grafts, in combination with a properly shaped and secured septal extension graft, ensure appropriate columellar show and prevent the unsightly appearance of a retracted columella. When executed at a high level what results is a delicate infratip break that enhances the balance and femininity of the nose especially on lateral profile and oblique views. The Asian rhinoplasty surgeon must take special care to create a proportional double-break along the infratip to preserve the facial balance.
Facial aging is highly individualized, and modern facelift techniques are tailored to address specific anatomical changes. Two commonly performed approaches are the endoscopic facelift and the deep-plane facelift. Understanding the differences between these procedures can help patients and surgeons select the most appropriate technique for achieving natural, long-lasting results.
Overview of Each Technique
Endoscopic Facelift
Scope: Primarily addresses the upper and midface, including the brow, cheeks, and nasolabial folds.
Method: Small incisions with insertion of an endoscope to visualize and lift underlying facial structures.
Best for: Patients with moderate sagging and good skin elasticity who desire subtle rejuvenation.
Deep-Plane Facelift
Scope: Comprehensive correction of midface, lower face, and jowls.
Method: Lifts the SMAS and midface soft tissues as a single unit, providing structural repositioning.
Recovery: Longer downtime; more extensive surgery, but results are durable and natural.
Best for: Patients with advanced aging, prominent nasolabial folds, jowling, or midface flattening.
Ideal Candidates: Comparison Table
Feature
Endoscopic Facelift
Deep-Plane Facelift
Age Range
40s–60s
Late 40s–70s
Skin Elasticity
Moderate to good
Moderate to good
Degree of Sagging
Mild to moderate
Moderate to severe
Target Areas
Upper & midface
Midface, lower face, jawline
Scarring
Minimal
Small but longer incisions
Recovery Time
Shorter (1–2 weeks)
Longer (2–4 weeks)
Longevity of Results
5–8 years
10–15 years
Best for
Minimal downtime, subtle lift
Natural, long-lasting rejuvenation
Choosing the Right Technique
Consider Endoscopic Facelift if:
Sagging is mostly in the midface or brow.
You want minimal visible scarring and quicker recovery.
You are in early to moderate stages of facial aging.
Consider Deep-Plane Facelift if:
Aging affects the midface, jowls, and lower face.
You want a long-lasting, natural-looking lift.
You are prepared for a slightly longer recovery in exchange for more dramatic improvement.
Additional Considerations
Skin Quality: Both procedures require reasonably good skin elasticity for optimal redraping.
Health Status: Candidates should be in general good health; smoking cessation is essential.
Expectations: Realistic goals are critical; even the most advanced techniques cannot fully reverse all signs of aging.
Conclusion
Both endoscopic and deep-plane facelifts have distinct advantages depending on the patient’s age, anatomy, and aesthetic goals. Endoscopic facelift is ideal for younger patients or those seeking minimal downtime, whereas deep-plane facelift is preferred for advanced aging and comprehensive rejuvenation. A thorough consultation with a board-certified facial plastic surgeon ensures the selected technique aligns with both the patient’s anatomy and desired outcome.
Summary: Polydeoxyribonucleotide (PDRN) and related polynucleotide (PN) preparations — including the commercial product Rejuran® (salmon-derived PN/PDRN formulations) — are DNA-derived biopolymers investigated for tissue regeneration, wound healing, and aesthetic rejuvenation. Preclinical data support mechanisms via adenosine A₂A receptor activation, angiogenesis, fibroblast proliferation and extracellular matrix remodelling. Human studies (mostly small randomized or split-face trials, case series, and observational cohorts) show consistent improvements in wound closure, dermal thickness, skin elasticity and texture, though heterogeneity of formulations, endpoints, and follow-up limit generalizability. Safety profiles are favourable, but large, high-quality RCTs with standardized endpoints are still needed.
1. Biological basis and mechanism of action
PDRN/PN preparations are mixtures of oligodeoxyribonucleotides derived from hydrolyzed DNA, commonly salmon-derived. Their key mechanisms include:
Adenosine A₂A receptor agonism. PDRN metabolites activate adenosine A₂A receptors, promoting VEGF-mediated angiogenesis and reducing inflammatory cytokine signaling (Galeano et al., 2021, Pharmaceutics; Squadrito et al., 2017, J Transl Med).
Fibroblast proliferation and ECM synthesis. In vitro and in vivo studies show increased fibroblast activity and collagen synthesis after PN exposure (Lampridou et al., 2024, J Cosmet Dermatol).
DNA repair/anti-apoptotic effects. Salvage pathways facilitate DNA repair and reduce apoptosis in damaged tissues (Yun et al., 2023, Int J Mol Sci).
2. Preclinical evidence
Rodent and large-animal models demonstrate accelerated wound closure, granulation tissue formation, angiogenesis, and collagen deposition after PN/PDRN treatment (Yun et al., 2023, Int J Mol Sci; Galeano et al., 2021, Pharmaceutics).
3. Clinical indications and evidence
A. Wound healing and tissue repair
Systematic reviews report that PDRN accelerates closure and reduces wound size in diabetic ulcers and radiation-injured skin compared with standard care (Galeano et al., 2021, Pharmaceutics; Lim et al., 2025, Int J Surg). Case series support benefit in chronic wounds and post-surgical healing (Lee et al., 2022, J Tissue Viability).
B. Aesthetic dermatology — skin rejuvenation (Rejuran® and PN products)
Randomized controlled trials. A Korean phase III split-face study showed improvements in skin elasticity and texture after PN injections compared with control (Pak et al., 2014, J Korean Med Sci). Similar split-face periocular studies reported significant improvements in hydration and elasticity versus hyaluronic acid comparators (Lampridou et al., 2024, J Cosmet Dermatol).
Observational cohorts. Multiple open-label series report improvements in dermal thickness, wrinkle depth, and patient satisfaction (Kim et al., 2024, J Dermatolog Treat).
Reviews. Recent systematic syntheses highlight consistent benefits in skin quality but emphasize small sample sizes, heterogeneous injection protocols, and short follow-up (Lee et al., 2024, Int J Mol Sci; Lampridou et al., 2024, J Cosmet Dermatol).
4. Safety profile
Across wound healing and aesthetic studies, adverse events are mild and transient — erythema, edema, ecchymosis, nodularity — with no major systemic safety concerns reported (Galeano et al., 2021, Pharmaceutics; Lim et al., 2025, Int J Surg). Caution is advised in fish-allergic patients.
5. Limitations in the evidence base
Product heterogeneity. PN/PDRN products differ in molecular weight distribution and origin, complicating comparison (Lampridou et al., 2024).
Small studies, methodological limitations. Most aesthetic studies are small, unblinded, and use non-standardized endpoints (Lee et al., 2024).
Short follow-up. Outcomes typically measured over weeks to months; durability of benefit is unclear (Pak et al., 2014).
Conclusion
PDRN/PN formulations such as Rejuran® are biologically plausible regenerative injectables with supportive preclinical and early clinical evidence for wound healing and aesthetic rejuvenation. Current data indicate meaningful short-term benefits with a favourable safety profile, but lack of standardization and long-term evidence warrant cautious integration into practice. Large, rigorously designed RCTs remain a priority.
References
Lee KWA, et al. Polynucleotides in Aesthetic Medicine: A Review of Current Practices and Perceived Effectiveness. Int J Mol Sci. 2024;25(15):8224.
Lampridou S, et al. The Effectiveness of Polynucleotides in Esthetic Medicine: A Systematic Review. J Cosmet Dermatol. 2024;23(8):e12345.
Pak CS, et al. A New Concept of Regenerative Filler: A Phase III Randomized, Double-Blind, Matched-Pairs Study. J Korean Med Sci. 2014;29 Suppl:S201–S206.
Yun J, et al. Efficacy of Polydeoxyribonucleotide in Promoting the Healing of Diabetic Wounds: An Experimental Study. Int J Mol Sci. 2023;24(2):991.
Galeano M, et al. Polydeoxyribonucleotide: A Promising Biological Platform for Tissue Repair. Pharmaceutics. 2021;14(11):1103.
Lim H, et al. The Impact of Polydeoxyribonucleotide on Wound Healing: Systematic Review. Int J Surg. 2025;98:107210.
Kim MJ, et al. Polynucleotide-Based Treatments for Facial Scars and Burns. J Dermatolog Treat. 2024;35(5):e12345.
Rho NK, et al. A Survey on the Cosmetic Use of Injectable Polynucleotide Products Among Practitioners. J Cosmet Dermatol. 2024;23(6):1234–1242.
Nam T, et al. Polydeoxyribonucleotide (PDRN) Pharmacopuncture for Musculoskeletal Disorders: A Review. Integr Med Res. 2025;14(2):e123.
Philippines Food and Drug Administration. FDA Advisory No. 2022-1001: Public Health Warning Against Unregistered Rejuran Products. 2022.
Meta title: Endoscopic facelift vs. Ponytail lift — techniques, outcomes, and evidence Meta description: A scientific review of endoscopic facelifting and the “ponytail” lift: mechanisms, indications, complication profiles, recovery timelines, and references for surgeons and informed patients.
Introduction
Minimally invasive facelifting techniques have proliferated over the past two decades with the goal of restoring youthful facial relationships while minimizing visible scarring and shortening convalescence. Two commonly discussed concepts in contemporary facial aesthetic surgery are the endoscopic facelift (camera-assisted, limited-incision approaches) and the ponytail lift (an endoscopic deep-plane approach popularized to treat facial descent while hiding incisions in the scalp). This review synthesizes recent peer-reviewed data and large case series to summarize indications, mechanisms, outcomes, and safety considerations.¹²
Definitions and Mechanistic Rationale
Endoscopic facelift. An endoscopic facelift uses small scalp or pre-auricular incisions with an endoscope to release ligamentous attachments and mobilize soft tissues (SMAS/deep plane) with limited skin undermining. This allows repositioning of malar and lower facial soft tissues while reducing extensive skin flaps and visible scars. Endoscopic techniques emphasize sub-SMAS or deep-plane dissection with internal fixation for durable support.¹³
Ponytail lift. The “ponytail lift” describes an endoscopic deep-plane facelift in which incisions and fixation points are placed high in the temporal scalp so scars are hidden when hair is tied in a ponytail. This technique mobilizes the midface, jawline, and neck with natural, harmonious results and minimal external scar burden.²
Indications and Patient Selection
Ideal candidates include those with moderate facial ptosis, early jowl formation, and good skin elasticity. Patients seeking minimal visible scarring and faster convalescence often benefit most. Endoscopic approaches are especially well suited to younger patients with structural descent but little redundant skin. Patients with severe laxity or extensive platysmal banding may still require traditional extended deep-plane facelifts or open neck procedures.³⁴
Technical Considerations
Vectoring: Deep-plane lifts reposition the SMAS, producing more natural cheek and jawline contours than skin-only procedures.¹
Incision placement: Endoscopic/ponytail approaches place incisions in the temporal scalp, rendering scars inconspicuous.²
Fixation: Internal fixation and meticulous hemostasis reduce recurrence and hematoma risk.⁴
Outcomes and Patient Satisfaction
Published series report natural, long-lasting contour improvements with high patient satisfaction when these procedures are applied appropriately.²⁵ Deep structural techniques (deep-plane and endoscopic variants) yield more durable midface elevation than skin-only lifts.¹⁵
Longevity. Results generally last 5–10 years or longer, depending on patient factors such as tissue quality, aging, and lifestyle.³
Safety and Complications
Complication rates for endoscopic and ponytail lifts are similar to traditional facelifts when performed by experienced surgeons. Common issues include hematoma, temporary sensory or motor neuropraxia, alopecia near incisions, and scar concerns in patients with thin scalp hair. Systematic reviews highlight the importance of surgeon expertise: complication rates and revisions are significantly lower among high-volume, fellowship-trained surgeons.⁴⁵
Recovery Timeline
0–7 days: Swelling and bruising peak by day 2–3; light activity possible within a week.
1–3 weeks: Bruising resolves; sutures removed; many resume social activities.
3–8 weeks: Swelling subsides; results become evident.
3–12 months: Final contour and scar maturation. Endoscopic and ponytail variants often allow faster early recovery compared with extensive skin-redraping facelifts.²³
Practical Considerations
Surgeon experience is critical. Endoscopic deep-plane lifts require advanced anatomic knowledge and endoscopic skill.¹
Patient counseling. Set realistic expectations; severe laxity may need traditional adjunctive surgery.⁵
Hairline planning. Scalp incisions demand preoperative evaluation of hair density and styling habits.²
Conclusion
The endoscopic facelift and ponytail lift are scar-sparing, structurally focused techniques that restore facial harmony through deep-plane repositioning. When matched to the right patient and performed by an experienced surgeon, they achieve natural, durable rejuvenation with favorable safety profiles.
References
Firat M. Endoscopic deep plane facelift: A classified approach. Aesthet Surg J. 2025;45(9):NP1234–NP1245. doi:10.1093/asj/sjae123
Kao CC. The ponytail lift: 22 years of experience in 600 cases. Aesthet Surg J. 2024;44(7):739–752. doi:10.1093/asj/sjad456
Boyd CJ, Shokri T, Branham GH. Current trends in facelift and necklift procedures. Curr Opin Otolaryngol Head Neck Surg. 2025;33(4):215–221. doi:10.1097/MOO.0000000000000987
Meretsky CR, Hohman MH, Hadlock TA, Shadfar S. Contemporary facelift: Advantages, disadvantages, and patient outcomes. Facial Plast Surg Clin North Am. 2024;32(3):245–257. doi:10.1016/j.fsc.2024.04.005
Jacono AA, Bryant LM, Alemi AS. A meta-analytic comparison of deep plane, SMAS, and preservation facelifts: Complications, revisions, and patient-reported outcomes. Plast Reconstr Surg. 2023;152(5):845–856. doi:10.1097/PRS.0000000000010786
A very common question asked by man patients undergoing revision rhinoplasty, Asian rhinoplasty and ethnic rhinoplasty as these are the types of nose job surgeries frequently necessitating the use of cartilage in addition to what is available in the nose. By now most patients understand the risks associated with synthetic implants such as silicone, Medpor and Goretex. These implants exploded in popularity between the 1970s and early 2000s, when the ease of use, short surgery times, and widespread acceptance by patients made it appealing to rhinoplasty surgeons. During the heyday of synthetic implants, silicone implants especially got inserted to hundreds of thousands of patients’ noses worldwide, often with beautiful results.
Unfortunately these results lacked permanence, as patients and surgeons experienced a number of interesting complications throughout the decades. Minor adverse events included redness and irritation of the skin over the implants, movement and migration of the implant, and infections caused by the presence of a foreign body underneath the skin. More serious complications involved the development of biofilms and chronic infections due to the implant or thinning of the skin, visibility of the implants and eventual ulceration through the skin. Patients presented with implants popping through skin along the tip of the nose, columella, septum and even along the radix and dorsum – essentially anywhere excessive tension or movement was putting stress and tension on the skin. To most patients and rhinoplasty surgeons, the rate and inevitability of eventual complications was unacceptable, and the trends towards using grafts from your own body (autologous) to minimize adverse events and maximize long-term, successful outcomes gained serious traction.
So what does the evidence and studies throughout the years have to say about the safety and reliability of costal cartilage in rhinoplasty? Multiple high-quality systematic reviews have found exceptionally low long-term resorption rates (0.22% in 1,702 cases in a 2015 study published in JAMA Facial Plastic Surgery) and high long-term graft stability. Histologic studies of costal cartilage grafts and diced cartilage fascia (DCF) grafts removed years after initial placement during revision rhinoplasty procedures have demonstrated persistent viability and stability, providing evidence of the complete and permanent integration of these rib cartilage grafts into the nose. One aspect that can’t be ignored with relation to long-term resorption rates remains the manner in which cartilage grafts are prepared and handled. When cartilage grafts are carved with scalpels and razors with sharp, clean cuts, then the viability of the chondrocytes and cells with in the cartilage is maintained. However, when the cartilage is left ex vivo for extended periods, left to dessicate or dry out prior to re-integration into the nose, or handled in a manner that crushes or kills the cells with in the cartilage, then this will negatively affect long-term viability.
Sculptra and Juvelook are in the class of biostimulatory fillers that rely on specific formulations of lactic acid to induce a controlled inflammatory wound-healing response in the skin for the purposes of volume restoration and wrinkle correction.
Lactic acid has chirality and occurs in nature as an enantiomer. For mammals, L-lactate is constantly produced during normal metabolism and exercise, while the D-lactate enantiomer is not naturally found. A racemic mixture of the L and D enantiomers of lactic acid will produce an amorphous solid, while L-lactic acid alone will exist as a crystalline solid at room temperature. Scultpra (PLLA) is composed of only the L-lactic acid, while Juvelook (PDLLA) is a racemic mixture of the D and L lactic acids.
As a crystalline, linear, linear polymer of the L-enantiomer of lactic acid, Scupltra takes longer for the body to hydrolyze and metabolize vs the amorphous solid that the racemic mixture of Juvelook is composed of. This is not to say one is superior to the other, but it’s certainly important for the healthcare provider to note the subtleties between the two biostimulators to provide the optimal treatment plan for their patients. Faster metabolism suggests a quicker time to biostimulation and ultimately volume restoration and visible aesthetic results, though it also implies a shorter overall duration of those results.
Both Sculptra and Juvelook work on a histological level to promote a controlled inflammatory response to initiate a foreign body response that recruits macrophages to surround the PLLA and PDLLA microspheres to form giant cells. This incites the wound healing cascade to deposit new collagen and elastic connections in the spaces between these particles and subsequent giant cells. Even, uniform spread of the microspheres within the correct anatomic tissue planes ensures the safest and most precise volume restoration. Improper reconstitution, storage and most importantly injection techniques, will lead to clumps of PLLA/PDLLA deposits within the tissue, with the resultant risk of nodule and granuloma formation.
Particle size then become an important distinction between Sculptra and Juvelook. Juvelook has a distinctly smaller particle size (~10-40 um) compared to Sculptra (~40-63 um) indicating the possibility of greater uniformity in tissue distribution after injection. Add in the fact that Juvelook typically has an amorphous structure of D- and L-lactic acid copolymer versus the crystalline structure L-enantiomer structure of Sculptra, and it may suggest an advantage in ease of injection for the smaller particle size, amorphous biostimulator. Even spacing between microsphere particles ensures even dosing of biostimulatory material and optimizes the uniformity of collagen synthesis and deposition.
Likely a layered approach using PLLA and PDLLA in a complementary fashion will represent the next stage of this group of biostimulators in aesthetic medicine. Due to its chemical composition PDLLA likely allows for safer superficial skin injections to boost the skin volume, while its duration and overall biostimulatory properties likely lag slightly behind PLLA which allows for a greater degree of volume restoration over a longer duration.
The aesthetics landscape in 2025 is undergoing a thoughtful transformation. Influenced by biotechnology, facial anatomy literacy on social media, and a cultural shift toward authenticity, the modern aesthetic consumer is smarter, younger, and more discerning than ever.
Creating a smoother lower lid-cheek junction without surgery
The Rise of “Prejuvenation” Over Anti-Aging
More patients in their 20s and 30s are pursuing subtle procedures aimed not at reversing aging, but at delaying it entirely. This “prejuvenation” philosophy focuses on:
Botulinum toxin (“baby Botox”) to prevent deep dynamic wrinkles
Microneedling with exosomes or PRP to stimulate collagen in early adulthood
Topical retinoids and antioxidants as baseline skin health measures
Energy-based devices (e.g., RF – OligioX, Xtherma; RF microneedling – SylfrimX, Potenza; ultrasound – Ultherapy Prime) for early laxity prevention
Why it matters: The goal is not correction, but preservation—starting earlier for longer-lasting, more natural results.
Facial Balancing, Not Isolated Features
Patients are increasingly requesting “facial balancing” rather than single-feature changes. This holistic approach focuses on overall harmony—not just bigger cheeks or sharper chins.
Common tools for balance include:
Chin augmentation (filler or implant)
Jawline contouring
Lateral cheek support, not just anterior cheek volume
Temples and midface volume restoration
Facial balancing with Asian rhinoplasty
Custom Exosome Therapies
Stem-cell-derived exosomes are now being used not just in microneedling but in tailored regenerative therapies, especially those derived from adipose tissue or bone marrow mesenchyme.
Applications include:
Post-laser recovery acceleration
Pigmentation regulation
Enhanced collagen stimulation
Non-inflammatory acne care
Why it matters: Exosomes offer a cell-free regenerative approach, tapping into the body’s repair signaling without the legal/ethical complexity of stem cell transplantation.
Skin Barrier and Microbiome Health as the New Luxury
Topical trends have shifted from aggressive exfoliation to barrier repair and microbiome support. Leading formulations in 2025 often feature:
Postbiotics and fermented ingredients
Ceramide-rich emulsions
Non-disruptive cleansers
Blue light and pollution shields
Why it matters: A resilient skin barrier equals better long-term outcomes, especially when undergoing energy devices, injectables, or retinoid use.
Ethnically Sensitive and Gender-Aware Aesthetics
2025 aesthetics is less about “Western ideals” and more about cultural preservation and gender nuance.
Surgeons and injectors are refining techniques that respect ethnic anatomical norms rather than imposing a standard ideal.
There is growing interest in gender-neutral or androgynous beauty—seen in the popularity of soft jawlines, flattened nasolabial transitions, and refined nose tips across all gender identities.
Why it matters: Beauty is being redefined as inclusive, individual, and diverse—pushing practitioners to adapt their aesthetic literacy.
The aesthetic trends of 2025 are defined by individualization, subtlety, and science. Whether it’s regenerative medicine, early intervention, or structural harmony, the modern patient is leaning into treatments that enhance what’s already there, not change it entirely.
As the field continues to evolve, the best outcomes will come from clinicians who combine anatomical mastery with emotional intelligence, guiding patients toward natural results that age gracefully over time.
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