For Revision Asian Rhinoplasty, could my columella be carved/customized?

Posted on April 24, 2017 by Donald B. Yoo, M.D.

Q: For my 4th Revision Asian Rhinoplasty, I want to add columellar strut to support the tip using irradiated rib cartilage. Could it be shaped as if there’s a ‘half bone cut’ look? Could columellar strut be added using ear cartilage by the way? Thank you!

A: A common maneuver to support the tip or push out a retracted columella to improve its appearance is the use of a columellar strut or septal extension graft.  It’s not quite clear to me what you mean by “half bone cut” look, but several aspects of the shape, width, projection, rotation of the tip and infratip lobule can be manipulated with a columellar strut/septal extension graft.

Ear cartilage is typically not the best option for use as a columellar strut as the cartilage and softer and more curved than other options (septum or rib).  Especially since this is your 4th revision, be sure to complete your due diligence finding a revision rhinoplasty specialist experienced in Asian rhinoplasty.

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Can my nose be improved? Asian nose here.

Posted on April 23, 2017 by Donald B. Yoo, M.D.

Q: I am an Asian with a typical Asian nose. The bridge seems distinct but the tip is another story. It has fallen a bit short in terms of length and form, its looks is similar to when I look up at the ceiling and you can see my nostrils, it is like it is pressed up, the opening is a bit obvious even though I’m am looks horizontally straight.

A: As you noticed, the tip of your nose is a bit over-rotated (turned up) and the overall length of your nose is slightly short for your face.  The tip of your nose can be counter-rotated (turned down) and lengthened by adding grafts made from your own cartilage.

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How long does an Asian rhinoplasty last that requires autologous cartilage graft?

Posted on April 13, 2017 by Donald B. Yoo, M.D.

Q: Hi I am thinking about getting a higher nose bridge and improved nose tip. From my research I prefer getting an autologous cartilage graft because gortex would normally slide down my nose due to gravity over time which means corrective surgery will be required. I am hoping that my own cartilage would fuse with my nose avoid that problem. Just wondering would my own body absorb my own cartilage instead? Thanks.

A: The biggest advantage of using autologous grafts (tissue from your own body) is that after a few weeks, it becomes incorporated and becomes a living part of your nose.  Thus autologous grafts have a much lower rate of complications than synthetic grafts.  Cartilage from your own body, when handled properly during surgery, does not resorb and remains a permanent part of your nose.

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Can Costal Rib cartilage/Silicone/Goretex be carved so it creates little hump in Nose Bridge? Revision Rhinoplasty case.

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: Look forward to 4th Revision Asian rhinoplasty. Long story short, my nose’s bridge now looks too tall with Silicone inside and too straight.  I want to have nose with a little hump that makes my nose look natural & unique in some way IMO. Is it possible to carve Rib cartilage or silicone so it has small hump?

A: It is possible to intentionally create a little hump during dorsal augmentation (building the bridge) in Asian rhinoplasty.  While a number of techniques exist to build the bridge, using autologous grafts (tissue from your own body) is the safest and most permanent method.

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Asian rhinoplasty: post-implant removal?

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: Hello~ About 1 1/2 years ago in Seoul, I had a silicone implant and cartilage graft put in my nose, and I had the base pulled down for more nostril show. I’ve had no problems with the implant, and I think it looks nice (at most angles), but I have regrets about my decision– I had done *zero* research and I was just too young to be making this choice. My nose feels unnatural and I’m uncomfortable worrying about protecting it all the time. What would my nose be like if I had the implant removed?

A: First of all, don’t overly stress yourself out about having a silicone implant if it has not yet caused you issues.  At some point it will need to be removed (years down the line) but you have time to consider your options and make an informed decision.  Simply removing the implant will sometimes not restore your original nose because of the changes it has undergone from the initial surgery.  Consultation with an Asian rhinoplasty specialist will give you a better idea of what options are available to you.

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Will an Autologous Rib Cartilage Graft Help Achieve Desired Results?

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: I’m in the last few months of researching before I schedule a date for my rhinoplasty. I am most interested in the autologous rib cartilage graft instead of using synthetic materials for height. I was wondering, for the rhinoplasty procedure, is this achievable? A doctor told me he will be using my 7th rib cartilage to achieve the height.

A: Depending on the extensibility of your skin, it may or may not be possible.  Without question, using rib cartilage will be the best option to achieve maximal projection and refinement of your nose.

Especially when building up the nose a significant amount, using synthetic implants will put excess tension and stress on the skin, ultimately thinning it and causing issues down the road.

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What procedure do I need to get the desired result?

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: I have been thinking about getting a Rhinoplasty for a bit now so I would just like to know what maybe the procedures needed for my desired nose? What I desire is to narrow/thin my wide Asian nose and thin the tip and its sides a little bit to make it look slimmer. I am actually fine with my side view so pointing the tip and having a pronounced dorsal hump for me is not a big deal, I don’t really want it.

A: During Asian rhinoplasty, the relationship between frontal and profile view is important because sometimes the nose needs to be made taller to appear more narrow from the front.
Due to the thickness of Asian skin, at times simply removing cartilage will not make the nose smaller because it will have the unwanted effect of reducing support.  To achieve your aesthetic goals, I would recommend some degree of augmentation and increased projection.

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Would medial crura be an ideal implant/strut for projection and definition for the Asian nose?

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: Would this be an ideal implant/strut for projection and definition for the Asian nose? There isn’t much literature on it. Also, could it be combined with a nasal spine implant, collumella strut? Or would it give the same results?

A: The medial crural attachment to the caudal septum is one of the 3 major tip support mechanisms.  The medial crura are often advanced on a columellar strut/septal extension graft in cases where additional projection is desired (i.e. Asian rhinoplasty).

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Will a lateral osteotomy narrow the nasal aperture? I have Asian nose.

Posted on April 4, 2017 by Donald B. Yoo, M.D.

Q: Do low bridged, wide Asian noses benefit from lateral osteotomy? Will it help with nasal base narrowing and overall making the nose less wide?

A: For wide nasal bones that are obliquely oriented, lateral osteotomies will be successful in narrowing and improving the shape of the dorsum.  In some Asian patients, the dorsum is so low, and the bones so horizontally oriented, that osteotomies will not be a great choice and recreating dorsal aesthetic lines with a dorsal graft (such as a diced cartilage fascia – DCF) is the best option.

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I have wide tip, bulbous nose. I feel my nose is too wide for my face. Should I have an alar base reduction?

Posted on March 30, 2017 by Donald B. Yoo, M.D.

Q: I feel my nose is shapeless but want a natural result and not a harsh “pinched” look. Should I have an alar base reduction, or will cartilage trimming be enough? Also, would a lateral cartilage reduction be a good idea?

A: You would achieve a nice result with tip refinement without alar base reduction.
Lateral cartilage reduction will be necessary to refine your tip, but in conjunction with additional support in the form of lateral crural strut grafts.  Simply removing excess cartilage in the presence of thick skin will result in loss of structural support and increased and not decreased definition.  Removing cartilage without providing additional support is what leads to pinching and collapse over time.

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