Can the removed hump be used to build the bridge?

Q: In asian rhinoplasty using all natural cartilage, where I am looking to reduce my hump while slightly augmenting the bridge, can the hump be slid up and used as a graft to build the bridge? Wouldn’t this be better than ear cartilage since it is made of the same material as the nose bridge itself? Thanks!

A: One consideration your surgeon must be careful to assess is the height of your radix (bridge between your eyes) in relation to your “hump” or pseudohump.  Often in Asian rhinoplasty surgeons will attempt to reduce the hump in a misguided attempt to straighten the profile instead of augmenting and building up the radix.

If a significant amount of cartilage needs to be removed, then it may be possible to use it to augment your bridge using that cartilage, but it is rarely the best graft option.  The width, height and length of the graft needs to be precisely tailored to provide a natural, smooth contour – and the amount of cartilage removed from the hump rarely provides this in Asian rhinoplasty.

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Would an alarplasty or tip plasty be enough to make my Asian nose slimmer and more defined?

Q: I’m not so concerned about a high nose bridge. It’s just that the tip of my nose is so large, it swallows up my face, especially when I smile. It’s also pretty wide and flat; in some photos it’s like I have no nose and the whole thing is flat until my nostrils. I’d like it to be a bit more defined and feminine. I’d like a minimally invasive procedure, so is alarplasty or tip plasty enough to improve my nose? What procedures can be done to make my nose fit better with my face?

A: Since your concern is primarily your tip, it is possible to reduce the width and bulbosity of the tip of your nose without altering the appearance of  your bridge.  The width and flare of your nostrils can be addressed as well with alar base modifcation.

The proportion of the width of the tip and the width of the nostrils is very important.  If the nostril width is reduced without reducing the width of the tip, the tip will look even more bulbous and wide in comparison.

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What is the best revision of rhinoplasty in Asian nose?

Q: I’m Asian and I had nose job last 3 months ago, and it’s a perfectly done but I’m scared for possibility bad effects of it. This is a hard L shaped silicone implant. I’m planning to remove it and change to silicon soft implant and ear cartilage for my tip. Do you think this is a good option? How long that the ear cartilage last?

A: While there is no urgent need to replace the silicone implant, it will likely need to be removed in the next 10-20 years, if not sooner.  Since it is a foreign body, the silicone will not become incorporated into your nose and it will gradually thin out the skin of your nose.

Cartilage from your own body (septum, ear, or rib cartilage) will last permanently.  However if you like the look of the silicone implant, ear cartilage may not be sufficient and rib cartilage may be necessary to achieve the same degree of augmentation and refinement.

Consultation with an Asian rhinoplasty specialist experienced with autologous grafts will help you to carefully weigh the available options.

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My bridge is significantly off-center after osteotomy. How long do I have to wait before getting a revision rhinoplasty?

Q: Had asian closed rhinoplasty (primary) 3 months ago. I had a small hump shaved down and osteotomy performed to bring the nasal bones together. My bridge before surgery was perfectly centered, but now my bridge is very off center (5 mm closer to one eye than the other) and everyone (even my ENT doctor, who I went to see for an unrelated issue) notices it immediately. It’s bad. How long do I have to wait before I can get a revision rhinoplasty with osteotomy to move my bridge back to the center?

A: After an endonasal (closed) rhinoplasty, if your main concern is reshaping the dorsum (bridge) of your nose during a revision, this may safely be addressed as soon as 6 months after the initial surgery.

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Who is the best doctor in the US for Asian revision rhinoplasty?

Q: I want to lower my nose (ie bring it back closer to my face) and make the nose less “tight” in appearance. I had a columellar strut, shield graft, and cap graft, and interdomal sutures. My nose used to flex with my skin when smiling, now it just stays in one place and looks rigid, in comparison to my soft and flabby alars (which doesn’t have any cartilage support anymore). I was told that I have thick skin and weak cartilage, which can complicate the surgery. How high is the risk of a revision for myself?

A: Giving any surgeon the title of “best” Asian rhinoplasty surgeon is subjective at best.  As a patient, the best thing to do is to seek out experienced Asian rhinoplasty specialists, go on ~3 in-person consultations, and choose the “best” surgeon for your nose.

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I have a bulbous nose and I’m an Asian. Which rhinoplasty procedure would make my nose appear smaller?

Q: I don’t have high bridge and I don’t mind about it. All I want is to get a smaller nose and a sharper tip. May I known what rhinoplasty procedure should I take as I know rhinoplasty can be consist of many types. Should I do an alarplasty? Thanks for reading

A: Especially for Asian rhinoplasty the relationship between the profile and frontal appearance of the nose is very important.  Due to the thickness of our skin, there is a limitation to how small a nose can be made without increasing projection (or the height) of the nose.
Alar base modification would be effective in reducing some of the flare and width of your nostrils.

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I’m having an asian rhinoplasty with small/medium implant only. Can I achieve this result?

Q: I like my nose only when I do makeup contouring. I didn’t want to do anything permanent so I had a nonsurgical rhinoplasty and I like the result. Now I’m ready for permanent rhinoplasty. I want the surgery to heighten my bridge. I’m not planning to have anything done to the tip. I had a consult with a Dr. and he agrees with me. He suggested a sm/md silicon implant without tip work. He quoted $2500-$3500$ Depending if I get mommy-makeover and rhinoplasty together.

A: There are a number of techniques available to reshape and build up the bridge of the nose during Asian rhinoplasty.  Synthetic implants such as silicone implants carry a higher risk of complications (including infection, migration, and extrusion) than grafts made from your own tissue (autologous grafts).  In general they produce aesthetic results which appear less natural than an expertly placed autologous graft, and do not produce a permanent result.

Be sure to understand the advantages and disadvantages of the available techniques in order to make an informed decision.

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I have wide nostrils that look like a big nose and a space between the bridge and its tip.

Q: What nose job will suit me? Is it possible without breaking my nasal bone?

A: While it’s difficult to make an accurate assessment without an in-person exam, you would likely benefit from osteotomies (fracturing the bones).  This will allow for the bridge to be narrowed slightly, creating more definition for it.

Depending on the degree of refinement and augmentation you are looking for, the appropriate grafts would be determined.  Either a combination of ear and septal cartilage or rib cartilage would provide a very nice change.

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Would I get good results from Rhinoplasty – with Asian nose, wide/thick, skin is rather thick?

Q: I’m unhappy with my nose – I have an Asian back ground (I’m 1/2 American, 1/4 English, 1/4 Filipino), so I believe my nose has some Asian features (flat bridge, wide). I have also noticed that my skin there is rather thick (also oily, lots of pores/blackheads/congestion) and have heard that thick skin makes rhinoplasty more difficult to produce good results. I just want to know what my options are, and if I would have a likely success if I went ahead with rhinoplasty.

A: As you have noted, the thickness of your skin will limit the amount of refinement that is possible with the tip of your nose during rhinoplasty.  However, even with thick skin quite a significant can be achieved with the appropriate techniques.

Success or failure in rhinoplasty depends chiefly on 2 things:

1) realistic expectations
2) choosing the right surgeon for your nose

If you do your due diligence in researching and consulting with rhinoplasty specialists experienced in Asian rhinoplasty, then you will have a very good opportunity to achieve an attractive nose.

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Are my desired rhinoplasty results obtainable without a premaxillary implant?

Q: More specifically I am wondering if my midface concavity can be corrected with rhinoplasty alone to stretch the skin and create a more proportionate nasolabial angle, and is the degree of my desired tip projection and rotation realistic?Thanks.

A: A septal extension graft in conjunction with extended spreader grafts would help to lengthen and counter-rotate your nose to create a more balanced nasolabial angle and greater tip projection.  The degree of counter-rotation and projection your photos you seek will likely require rib cartilage as it is a fairly dramatic change.

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