Although a generalization, most Asians patients seeking rhinoplasty desire some degree of augmentation or projection, while most white, Middle Eastern, or Jewish patients will seek out a more reductive rhinoplasty procedure. During traditional reductive rhinoplasty, the existing width, volume and size of the nose can effectively be reduced by removing and excising the pre-existing cartilage and bone. Commonly a white, Middle Eastern or Jewish patient will seek out reduction of a dorsal hump, or bump on the bridge of the nose, which can be accomplished by removing excess bone and cartilage, followed by fracturing and narrowing the nasal bones. These surgical maneuvers require no additional tissue or support to supplement the nasal anatomy.
In contrast, many Asian patients have a smooth and straight dorsum (nasal bridge) naturally, and the shape of the intrinsic anatomy may be preserved. The nasal pyramid often has a wide appearance from frontal view not due to wide nasal bones, but due to the small overall size and projection of the nasal bones. In other words, the base of the nasal pyramid frequently has an optimal width naturally, and thus does not require frequent fracturing. Rather, Asian patients more commonly benefit from augmenting the projection of the nasal pyramid and dorsum, creating a taller profile but also generating a slimmer appearance from the frontal view by establishing the contours of a well-defined dorsal aesthetic line. In order to augment the nasal bridge or dorsum, more volume is needed.
This volume for dorsal augmentation can potentially come from a variety of sources, including synthetic (alloplastic), natural (autologous) or even from a deceased person (cadaveric). Of all the potential options, tissue from your own body (autologous) has the lowest risk of side effects and complications, and produces the most permanent, natural results when used correctly. In white rhinoplasty, Middle Eastern Rhinoplasty or Jewish rhinoplasty, there typically exists an abundance of cartilage within the nasal septum. This cartilage divides the left and right sides of the nasal cavity, and a portion of this cartilage can be removed to support or reinforce other parts of the nose during rhinoplasty. Surgeons will commonly remove a portion of the septum if it deviated in order to straighten it. For a white, Middle Eastern or Jewish patient’s nose this septal cartilage may be sufficient to reshape the nose. However for most Asian patients the available septal cartilage will be insufficient in both quantity and strength to add appropriate volume or reinforcement to the nose to create the desired aesthetic outcome.
Since we know that tissue from your own body produces the best outcomes in rhinoplasty and nose job surgery, the next question that arises is that of possible sources for this tissue. The nose consists of primarily cartilage, bone and fibrofatty soft tissue underneath the skin envelope, so the best source will emulate the existing anatomy of tissue. Bone could be used, but it would also produce sharp contours, an extremely rigid nose, and come with significant donor site morbidity relative to available sources for cartilage. Cartilage can be harvested from very discrete incisions, most commonly from behind the ear or through a tiny (~1 centimeter) incision hidden in the crease below the right chest. Both these sources provide optimal tissue for grafting inside the nose while leaving no changes to the function or form of the harvest sites.
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