Suite 201
Huntington Beach, CA 92647
Tel: 714.230.2430
6310 San Vicente Blvd.
Suite 285
Los Angeles, CA 90048
Tel: 714-293-8030
PLASTIC SURGERY ARTICLES
Complex Asian Rhinoplasty
A frequent request that I get in my practice is, “I would like to make my bridge higher”. This reflects a popular notion that the main problem with Asian noses is the relatively low height of the nasal bridge. In the past decade, this misperception has lead to the pervasive practice of rhinoplasty utilizing nasal implants only. The problem with this surgical approach is that it fails to identify and correct some of the other deficits that may be present in the patient’s nose.
The ability to deliver an attractive result is dependent on the detailed analysis of the patient’s nose and identifying the areas that need corrections or improvements. We have all seen Asian celebrities, friends, colleagues, family members who have very attractive noses without a high bridge. These individuals usually have a nasal profile that is internally harmonious and accentuates that individual’s face. The nasal height is only one component of 4 main components in the attractive nose. The components are:
1. The nasal bridge height
2. The nasal bridge width
3. The nasal tip contour
4. The alar base
It is possible to have patients whose only deficit is the height of the nasal bridge. But in my experience of performing more than a thousand rhinoplasties, patients who have only a nasal bridge deficit represent a small portion of the Asian rhinoplasty patients. They represent the cases in which a patient would say “my friend had only a nasal implant and looks great”. The majority of Asian patients with low nasal bridge also have other features that need improvement such as large nasal tip, wide nasal bridge, or wide alars. This also reflects the differences that exist in the various ethnicities within the broad Asian identification.
The correction of the low nasal bridge represents the easiest deficit to correct (if a nasal implant is used) but entail the highest risk of future problems. Placing a nasal implant is a very simple maneuver, but because the implant is an artificial material, it can lead to higher incidence of nasal implant infection that may require subsequent implant removal. The implant can also move slightly and lead to the perception of the nose pointing to the left or right. When a nasal implant is used without any other additional restructuring to protect the nasal tip, the nasal tip skin can atrophy (thin out), leading to the appearance of skin-over- nasal-implant tip (unnaturally pointy tip), seen in a significant number of these patients.
The nasal implant also has to be placed right on top of the nasal bone and below the periosteum (bone lining) to minimize the movement of the nasal implant after the surgery. In cases in which the implant is not placed at the right level, touching the nasal tip area can lead to movement of the upper part of the nasal bridge giving rise to the unattractive appearance that some have described as “chopstick-on-the-nose” movement.
In Asian patients who have adequate bridge height; avoiding the use of nasal implant can lower the risk of complications and produce a very satisfactory outcome. However, there are cases in which the nasal bridge is significantly low and the placement of a nasal implant is necessary to produce an attractive result. I would not hesitate using a nasal implant as long as the patient understands the inherent risks involved.
Placement of a nasal implant alone rarely results in a satisfactory appearance in most Asian patients. Most will have other aspects of the nose that also requires improvement. Many will require either narrowing of the nasal bridge, refinement of the tip, and/or alar narrowing. Without paying attention to these areas, the nose will rarely have an attractive and elegant appearance that most patients desire.
Narrowing the nasal bridge is also a very important component of Asian rhinoplasty. In general, most patients presenting for rhinoplasty will have a moderate to significantly wide nasal bridge. This has to be narrowed to ensure the appropriate proportion between the nasal bridge and the refined nasal tip. Placing a nasal implant on a wide bridge will make the nose bigger both physically and appearance wise. The vast majority of Asian patients who desire rhinoplasty do not want a bigger nose. They may want a higher nasal bridge, but with an appearance of a refined and appropriately sized nose for the usually smaller Asian face. By combining the nasal implant placement with narrowing of the nasal bridge, the nose can appear higher, yet smaller. In some cases, the narrowing of the nasal bridge alone without an implant placement can create the illusion of a higher nasal bridge.
In addressing the nasal tip, it is wise to pay attention to the thickness of the nasal skin. In patients with a heavy and thick nasal skin, firm structural support of the nasal tip has to be ensured to prevent the collapse of the nasal tip structure when the heavy thick skin is replaced back over the contoured nasal tip. Not addressing the nasal tip support can lead to the drooping nasal tip after the surgery. The thick nasal skin also requires a longer period of remodeling after the surgery to attain the final contour. In most patients this can take from 6 months to up to 2 years.
The nasal alars (nostrils) in Asian patients significantly differ from the Caucasian patients. Many plastic surgeons, especially if they were trained mostly on Caucasian patient population, will narrow the nasal base in a way that would not create an aesthetic result in Asian patients. The anatomic structure of the nasal base is different between these 2 groups. The reduction has to be done in the area that is widest which is the horizontal portion of the nasal base. Reduction in other dimension can result in a triangular lower third of the nose much derided as “bad nose job nose” appearance.
Asian nasal rhinoplasty can be very difficult even in the most experienced surgeons. It can be treacherous if the surgeon does not have expertise in it. I have heard a colleague complain that “no one needs another Asian rhinoplasty in their practice.” I believe that Asian rhinoplasty can be challenging, but if appropriately performed can result in a very gratifying result.
| Special1 | Special2 | Special3 | Special4 | Special5 |
