Asian Rhinoplasty Virginia
Asian Rhinoplasty is a very popular and yet controversial topic amongst Plastic Surgeons. The term “Asian Rhinoplasty” usually refers to an augmentative Rhinoplasty where the height of the bridge is built up and more definition and structure is provided to the nose.
However, to assume that all Asians have similar noses is a mistake. It is equally wrong to assume that all Asian patients desire a similar outcome for their noses. Therefore I urge my Plastic Surgery colleagues to not think of an “Asian Rhinoplasty” as a certain “cookie cutter” surgery and I would urge them to stop thinking that “one size fits all.”
In fact, after seeing and closely examining and operating on Asian patients for years, I have come up with the following pearls of wisdom for my fellow Plastic Surgeons.
- Many Plastic Surgeons in Asia and the United States do use silicone, Medpor, Gortex, or other “plastic” implants in the nose as a quick fix. These cases are usually very quick, inexpensive, with immediate results and minimal swelling and down time, often performed under local anesthesia in the office setting. While some patients do achieve great aesthetic results using these techniques, many end up with noses that simply look fake and imbalanced. Others end up with implants that clearly show their edges. Some end up with implants that are mobile and shift. And a portion end up with horrific infections of their implants, resulting in extrusion or significant permanent scarring. Even the patients, who achieve the nice immediate results, are essentially sitting on “ticking time bombs” that could at any time in the future become dislodged, extruded or infected.
- Many Asian patients share these common features:
- Small short nasal bones
- Low “nasal starting point”
- Short nose
- Washed out bridge
- Poorly defined nasal tip
- Very weak tip cartilages
- Very thin and small Septal cartilage
- Medium thickness skin susceptible to hyperpigmentation
- Not all Asian patient’s noses fit the above criteria. I have seen and operated on many Asian noses with what many would equate to a “middle eastern patient’s nose”: a prominent nasal hump rather than a low bridge. What has always surprised me is the failure of many Plastic Surgeons to step back and diagnose the problem at hand before offering an “Asian Rhinoplasty” solution. I have seen many Asian patients who do not need any bridge or dorsal augmentation whatsoever. However, many of these same patients have been told by other Plastic Surgeons that they need implants or rib cartilage for their Rhinoplasty. Use of an implant or rib in such patients would be a disastrous complication ending up with a certain need for a Revision Rhinoplasty. The take home message here is that all patients regardless of their ethnicity need to undergo a thorough examination and facial analysis. Diagnosis is the most important step in the initial consultation process. No surgeon should ever simply categorize an ethnic patient and devise a plan for nose job purely based on the category. However, with experience, each Rhinoplasty Surgeon will learn and devise his/her own set of knowledge base to draw from.
- For example, while it would be wrong for a surgeon to automatically assume that an Asian patient needs or even wants a higher bridge, it would be equally foolish for the Plastic Surgeon to ignore the fact that many Asian patients do have weak tip cartilages, making the use of additional tip grafts for support often necessary.
1) Asian rhinoplasty patient of Dr. Naderi. This patient came to Dr. Naderi with a silicone implant already in her nose (picture on left) from a previous surgeon’s Asian rhinoplasty but there was still inadequate tip projection and there was lack of tip definition and dorsal height. Dr. Naderi did an open revision Asian rhinoplasty and removed the implant, and replaced it with natural frozen rib cartilage.
- Proper pre-op planning in Asian patients does often involve the discussion for possible additional sources of cartilage. Since many have weak tip cartilages, additional cartilage grafts at the tip are often necessary to achieve aesthetic tip definition. Since the Septal Quadrangular cartilage of many Asian patients is often too thin and too small to be useful as a structural graft, discussions and planning for use of ear, rib, or frozen rib cartilage must be thoroughly carried out with each patient pre-op to avoid any intra-op surprises or shortcomings.
- Not all Asian patients require an Open Rhinoplasty and not all can be successfully carried out with a Closed Rhinoplasty technique. Each patient’s nasal reshaping surgery must be individualized and planned out properly.
2) Asian male patient underwent closed Asian rhinoplasty with frozen rib (costal) cartilage by Dr. Naderi to build up his nasal bridge and lengthen his nose successfully
Use of Computer Imaging is crucial in the pre-op consultation dialogue to ensure that what the Plastic Surgeon plans and what the Asian patient desires are achievable and one and the same.