Asian Rhinoplasty
Globally Renowned Anti-Aging Experts
Asian Rhinoplasty in Los Angeles, Orange County and San Francisco
Asian Rhinoplasty is a technically challenging and delicate procedure that requires a skillful plastic surgeon who is both meticulous and has a keen eye for detail. However, the most important aspect of performing a Rhinoplasty is not the procedure itself, but to have a clear idea of the realistic expectations of the patient. A beautiful shape of the nose is important to a person because it stands at the center of the face, giving harmony to the overall facial appearance.
Rhinoplasty of the Asian nose can be quite challenging to surgeons unfamiliar with the difficulties in working with this population. The anatomy of the nasal bones and cartilage structures differs from other ethnicities. For example, the nasal bones are broad and flat, while the tip cartilages tend to be thin and amorphous. The nasal skin is thicker and more sebaceous, creating less definition in the tip of the nose.
Because of these differences, techniques that are standard in non-Asian rhinoplasty are not applicable. Most rhinoplasties involve dorsal hump reduction and tip cartilage reshaping. In contrast, the vast majority of Asian patients present with a nose deficient in dorsal height and length, as well as poor tip projection and definition. As a result, rhinoplasty in Asians typically involves methods to augment the volume in both the dorsum and tip regions.
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Asian Rhinoplasty
When you come in for your consultation, we will listen carefully to your expectations in order to gauge how much augmentation is needed, as well as the type of treatment each area of your nose will need. We know how critical it is that you and your surgeon are on the same page, so please do not be afraid to ask questions or bring up any concerns.
Don’t waste time speaking with plastic surgeons who are unfamiliar with the anatomy of your type of nose. At Wave Plastic Surgery, we specialize in providing natural looking results for the growing Asian American community in Southern California. Give us a call today to speak with one of our trained plastic surgeons.
Asian Nose Surgery Offers Facial Enhancement Benefits
The majority of our East Asian patients in Los Angeles seeks nasal augmentation in contrast to Occidental or European patients who generally request a reduction. On average, the East Asian nose appears more triangular, the nasal bridge is typically flatter, the spine is often shorter and less defined, and the tip of the nose tends to be wider and less angular.
Southeast Asians typically benefit the most from augmentation of the bridge and length, while East Asians often request less, or even none at all. The desire for nostril reduction is also more frequent in Southeast Asians than those from the Northeast. Asian nose surgery can be more challenging because the cartilage is often more fragile and the overlying skin is thicker.
Real Wave Patient. See more on our Before & After gallery!
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DCF Rhinoplasty
The goal of an Asian rhinoplasty is no longer just to increase the size of the nose as it was 20 years ago. With a greater understanding of the anatomy, we now augment the dorsum (bridge) separately, carefully defining and augmenting the tip of the nose using a separate, anatomical unit. The nasal tip can be sculpted by manipulating the cartilages of the nose as well as augmenting it with cartilage from the septum and ear.
The dorsum, which refers to the bony area of the nose that runs from between the eyes through the tip of the nose, can be augmented with either a synthetic implant made of silicone or EPTFE (Gore-Tex) or a graft made from the patient’s own tissue, referred to as diced cartilage fascia (DCF).
Unlike an implant which comes in pre-defined sizes and shapes, the DCF graft can be molded to the surgeon’s desire, much like a sculptor molding clay. Once the DCF graft incorporates into the nose, it becomes a part of the patient and feels like part of the native nose and gives the nose a very natural look.
Although the risk of an infection of a synthetic implant is low, the risk remains present throughout the lifetime of the implant. If the implant becomes infected, the body may not be able to clear the infection, even with antibiotics, requiring the removal of the implant. One of the other advantages of the DCF graft is that it behaves like any other part of the patient’s own body. Although exceedingly rare, a nasal infection with DCF can be treated with antibiotics like an infection to any other part of the body.
Augmentation of the Dorsum
There are a wide variety of methods to augment a low or deficient dorsum. Traditionally, a silicone implant has been used. Silicone has the advantage of being well tolerated by the human body and has long history of safety in medical settings. It is highly consistent and can be molded into a variety of shapes and sizes to suit an individual patient.
Silicone Implants
- Pro: Inert and very stable. If secondary surgery is required, very easy to remove.
- Con: Sometimes, they do not stick and they move around. They can also form capsular contracture, being able to see the boundaries of the implant distinctly, therefore more unnatural
Microporous materials such as Gore-Tex have become more popular recently for dorsal augmentation and are well tolerated in this application. Gore-Tex can be carved to suit the individual patient, its porous nature can allow tissue ingrowth to stabilize the implant to the surrounding tissues. All alloplastic implants have the disadvantage of potential infection and extrusion. Care must therefore be taken to handle tissues gently in surgery to avoid devascularization, and topical antiseptic agents must be used liberally intraoperatively.
Surgiform Implants
- Pro: Because there is tissue ingrowth, the implant is stable and does not move around. Also, there is no capsule that develops. Because of these reasons, we mostly use the Surgiform ePtfe.
- Con: Typically, Gor-Tex is a great implant material. However, the microscopical pores/tissue will grow together with the first generation of Gore Tex implant. The upgraded Gore-Tex EPTFE is great because it is the same technology as the Gore-Tex, but microscopically, it is “cone shaped” for easy removal if needed.
To lessen the risk of infection, natural tissues can be used to add volume to the dorsum. A nasal implant can be fashioned from cartilage. This can either be autologous, from one of the ribs, or from processed donated cartilage. These are highly customizable and have proven extremely resistant to infection. An elegant alternative to carved rib is the diced cartilage/fascia implant. Cartilage is harvested and diced. This is then wrapped with a sheet of connective tissue harvested from the temple region and fashioned into an implant. These have also proven to be resistant to infection, and customizable as far as size and shape. With both carved rib and DCF implants, there is a slight risk of absorption and deformity, but they can generally be expected to last for many years.
In either case, the open rhinoplasty incision is made and the skin flap elevated off of the underlying cartilages. A pocket is then created for the implant on top of the underlying bone and cartilage. This allows the implant to be inserted and secured with sutures.
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Ala / Collumela
Procedures to reduce the alar base are common in Asian rhinoplasty. Generally, the width of the base of the nose should approximate the distance between the eyes. Although this is very subjective, many Asian patients fall outside of this guideline. If necessary, reduction of the alar base width can be performed by strategically excising a wedge of skin from the base of the nostrils. This maneuver can also provide subtle shaping of the nasal alar, and results in a rounder nostril. The procedure is known as Weir excision, and it can performed as a stand alone surgery under local anesthesia if desired.
Another common complaint is a low hanging collumela the structure between the nostrils) which can give the appearance of overly prominent, snarly nostrils. This is caused by an inferiorly positoned medial portion of the lower lateral cartilages, also known as the medial crura. These can be positioned higher during rhinoplasty with sutures. Another contributing factor is excess tissue along the membranous septum, and excision may be necessary to achieve proper positioning.
Tiplasty
In the past, many dorsal nasal implants were L shaped, providing both dorsal augmentation and structure for the tip. While stable and consistent in shape, these implants were prone to erosion through the skin at the tip due to excessive tension. The trend has therefore been towards addressing the dorsum and tip separately.
Augmentation of the tip involves the use of autologous and occasionally donor cartilage. This is harvested from both the nasal septum as well as the ear. The nasal septum provides sturdy, flat sections of cartilage suitable for lengthening and projecting the tip, while the concha of the ear is a plentiful source of cartilage for onlay grafts to further enhance tip projection. Once harvested, the septal cartilage is shaped and sewn between the paired lower lateral nasal cartilages in the form of a septal extension graft or columellar strut. Depending on how the strut is positioned, it can provide projection and optimal rotation of the tip, as well as stability. Onlay grafts are then prepared and sewn into position allowing precision and adjustment of tip projection. Stacking of multiple onlay grafts is often necessary due to the lack of tip projection in most Asian noses.
To lessen the risk of infection, natural tissues can be used to add volume to the dorsum. A nasal implant can be fashioned from cartilage. This can either be autologous, from one of the ribs, or from processed donated cartilage. These are highly customizable and have proven extremely resistant to infection. An elegant alternative to carved rib is the diced cartilage/fascia implant. Cartilage is harvested and diced. This is then wrapped with a sheet of connective tissue harvested from the temple region and fashioned into an implant. These have also proven to be resistant to infection, and customizable as far as size and shape. With both carved rib and DCF implants, there is a slight risk of absorption and deformity, but they can generally be expected to last for many years.
In either case, the open rhinoplasty incision is made and the skin flap elevated off of the underlying cartilages. A pocket is then created for the implant on top of the underlying bone and cartilage. This allows the implant to be inserted and secured with sutures.
The Procedure
Rhinoplasty is usually performed as an outpatient procedure under general anesthesia. Local anesthesia with sedation can be considered for minor tip alterations. In either case, a patient should have very little awareness during the procedure.
Although rhinoplasty techniques are divided into open and closed techniques, Asian rhinoplasty almost always utilizes an open approach. This allows exposure of the tip structure and placement of extensive cartilage grafts. In an open rhinoplasty, a hidden incision is made underneath the base of the nose, and a skin flap is carefully dissected off of the underlying structures.
The Recovery
Recovery is similar to a non-Asian rhinoplasty in that patients usually wear a nasal splint for the first week. Swelling and some bruising around the eyes can be expected. This will begin to improve after the third day and last up to two weeks or more. You will be significantly recovered by 4-6 weeks. The final shape of your nose will be apparent will be apparent at 6 months.
Strenuous activity should be avoided for three to six weeks after surgery, but you may return to social activities as soon as two to three weeks.
Our Asian Rhinoplasty Specialist
Peter Lee
M.D., F.A.C.S.
Dr. Peter is CEO and Chief Surgeon of WAVE Plastic Surgery Center with over 20 years of plastic surgery experience, overlooking 30K+ successful plastic surgery cases. He has mentored master surgeons around the world in state-of-the-art techniques, and has been inducted into the RealSelf 100 & 500 Hall of Fame.
His many accolades and shining results are evidence of Peter’s expertise.
Frequently Asked Questions About Asian Rhinoplasty
Rhinoplasty is commonly referred to as a nose job. This type of nose surgery can be performed for cosmetic reasons to change the shape or look of a nose. Or for medical reasons to improve its function due to birth defects or trauma, like a broken nose.
1 week after the Rhinoplasty procedure, the bruising and swelling will go down. About a month after the procedure, you should be able to see the full benefits. You will continue to see improvements for the next six months.
Usually, an Asian Rhinoplasty procedure takes about 2 to 4 hours, depending on how much work needs to be done.
Give us a call today to schedule your Asian Rhinoplasty consultation with one of our plastic surgeons at Wave Plastic Surgery.
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Proudly using his creativity to help patients regain a sense of wholeness and confidence, Dr. Ben Lee takes a very patient-centered approach to care.
