The goal of Asian rhinoplasty is to create a harmonious, natural and refined nose that is compatible with Asian patient's facial features. The goal of Asian Rhinoplasty is not to create a Caucasian nose. In general Caucasian rhinoplasty requires reshaping and frequently reduction in the nasal size. In Asian rhinoplasty patients frequently require augmentation and building of their nose. In most cases the bridge needs to be elevated the tip needs to be narrowed, projected, and lengthened. There are a number of surgical and in some cases non surgical options to achieve these simple goals.
The Nose Bridge
When performing Asian rhinoplasty a decision has to be made weather to use synthetic medical grade implants i.e. Gore-Tex to build the bridge or to use cartilage from the nasal septum, ear and in many cases the patient's rib. Silicone is a synthetic implant used in by many surgeons in Asian and North America. Dr. Parag does not use silicone implants for rhinoplasty as it has a tendency to extrude and get infected over time. Most Asian's do not have enough ear or septal tissue for significant nasal bridge augmentation. Therefore in Dr. Parag's practice the two most common methods of building and reconstructing Asian patients nasal bridge is either layered gortex sheets which can provide up to 8-10 mm of augmentation and can be shaped and customized, or to use Rib cartilage grafting. Rib grafts can be composed of cartilage and in some cases bone and cartilage. Dr. Parag will review your surgical options and discuss the pros and cons of each. Together you will decide on the option that is best for your case.
The Nose Tip
Asian nasal tips often lack definition and projection. The goal of Asian nasal tip Rhinoplasty is to enhance definition, improve projection and often narrow the nasal base. When treating an Asian patients nasal tip, Dr. Parag prefers to use a patients own tissue and to reduce the risk of synthetic implant infection or extrusion. Dr. Parag typically uses tissue from the septum inside the patient's nose to create grafts that better define the tip. If necessary, he may use ear tissue or rib cartilage. In certain situations where a patient does not have adequate septal cartilage and doesn't want to use rib cartilage a "combination tip reconstruction" can be performed. This procedure refers to the combination of medpore struts " a firm synthetic medical grade implant" combined with cartilage tip grafts. When medpore is used to support the nasal tip, Dr Solomon uses cartilage from the septum and ear to cover the graft to protect the implant from extrusion through the patient's skin. This method often creates excellent, natural and long lasting results.
Asian Rhinoplasty techniques differ from Caucasian rhinoplasty techniques
Having performed Asian Rhinoplasty for many years Dr. Parag has seen patients who have undergone a multitude of different Asian rhinoplasty techniques. He has observed a number of common errors in Asian Rhinoplasty surgery which often leads to less than ideal outcomes.
Surgeons not familiar with Asian rhinoplasty techniques attempt to utilize conventional Caucasian rhinoplasty on an Asian nose. This involves reduction of nasal tip cartilages and suture techniques to shape the nasal tip. This procedure alone does not produce ideal results in Asian rhinoplasty. In Asian rhinoplasty unlike Caucasian rhinoplasty most cases require cartilage grafting to the nasal tip. In Caucasian rhinoplasty nasal tip cartilage grafting is required in a minority of primary rhinoplasty procedures. In Asian rhinoplasty cartilage nasal tip grafting is required in the majority of cases. In Caucasian rhinoplasty tip cartilage grafting can appear unnatural through thin nasal tip skin whereas in Asian patient's nasal tip grafts are required to provide ideal nasal tip definition and projection. Asian patients' nasal skin generally is thicker and nicely accommodates tip grafts.
While most Asian rhinoplasty patients desire a higher and more defined nasal bridge it is an error to overly enhance the height nasal bridge. The Asian nasal bridge should start just above the upper eyelashes. A natural break should be maintained between the forehead and the nasal bridge. A high bridge commonly referred to as a "Roman or Greek nose" is not ethnically compatible on an Asian face. In some cases lowering of the patient's bridge is required to accommodate the graft or implant and provide a natural flow from the forehead to the nose.
Other Asian Rhinoplasty Considerations
Rib cartilage can provide an excellent option for nasal bridge grafting. It provides a significant strong piece of cartilage to create an ideal nasal bridge. While using this material can provide good results it is a major procedure with its own potential risks. The potential downside of rib grafts in Asian Rhinoplasty is that up to 10-15 percent of the time the graft shrinks or warps over years. Rib grafts must be tapered carefully to ensure that they appear natural and blend in with the other components of the nose.
Gortex is a synthetic implant which can be tailored to the perfect size and can be ideal for Asian rhinoplasty. It has a 1-3 percent infection rate. It can be performed in our private surgical center and can be performed with local anesthetic with sedation. Results of Gortex Asian rhinoplasty are often extremely natural and last a lifetime. Gortex should only be placed on the nasal bridge and not be used in the nasal tip.
Breaking the nasal bones known as osteotomies in Asian Rhinoplasty Surgery
This procedure is frequently performed in Caucasian rhinoplasty as part reducing the nose size. In Asians, this is not frequently necessary. The perhaps 10% of Asian patients undergo this procedure in rhinoplasty. Adding an implant to the bridge has a narrowing effect so that additional narrowing of the bones is not always needed.
Nostril Narrowing in Asian patients
It is commonly felt that Asian noses require nostril narrowing with rhinoplasty surgery. In Dr. Parag's opinion this is not universally required. If the nasal tip is reconstructed and raised, nostril narrowing may not be necessary. Where nostrils have significant excess width "alar narrowing will be performed" Dr. Parag reduces the nostrils from small incisions on the floor of the nostril and only in specific cases carries the incision along the side of the nostril.
Anesthesia for Asian rhinoplasty
Depending on your surgical procedure and personal preferences you can undergo this procedure under local anesthesia with sedation or general anesthesia. In cases where gortex bridge work is desired alone local anesthetic generally is fine. In cases where a rib graft reconstruction is performed General anesthetic at a hospital is required.