How Much Cartilage is Needed for a Taller Nose?

Q: I am of Asian and European descent, however I have a short Asian nose. I don’t want to use implants or my ribs, would my ear cartilage be enough to make difference?

A: First of all, wise decision to say no to synthetic implants.
The amount of cartilage required for your rhinoplasty will depend solely on the degree of change you hope to achieve.  Will cartilage harvested from your septum and ear be sufficient to give you a significant change?  Most definitely.  Will it give you the maximal change?  No.  If you are completely against rib cartilage being harvested, and this is your first rhinoplasty, then a combination of your septal cartilage and one or both ears will give you a significant result.
Rib cartilage is great for patients who have undergone prior surgeries (where cartilage has already been used) and for patients seeking the absolute maximum difference.  There is simply much for cartilage available to graft when rib is harvested, allowing for greater augmentation and a nose that is taller.

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I think my silicone implant is displaced?

Q: I am a Korean woman who got a nose job 3 years ago to make my bridge higher. My surgeon used a silicone implant. Not sure what “displacement” means, but my implant has shifted upwards. 1) Do I need reconstructive surgery if I still like the way my nose looks? If I don’t, is this dangerous for my health? 2) I think the part of my nose bridge towards my forehead flattened when I applied heavy downwards pressure to the top. I bumped my nose & wanted to make sure it was still in place. Is this possible?

A: Silicone implants can become “displaced” or “migrate”, meaning they can move.  The possible danger to your health would be from the risk of extrusion (of the implant thinning your skin to the point of ulcerating through) and the risk of infection.  Signs that this is occurring include redness and tenderness along the nose where the implant is.  Unless either of these is happening, your health is not at imminent risk.

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Should Asian Nose-concerns (Ie:fractures, Broken Nose, Sinusitis) Be Approached & Diagnosed Like Other Ethnicities?

Q: I am an Asian female, and I was recently head-butted directly onto the bridge of my nose. My nose physically feels different (indented) and my breathing feels different ever since the injury. It has been 2 weeks now. Bruising and swelling have gone down. I did research & many Asian-rhinoplasty specialists state there’s an anatomical difference between Asian noses and other ethnicities. Will a regular Otolaryngologist [without much experience with Asian noses] be able to diagnose/evaluate me effectively?

A: Anatomically there certainly are differences, but a well-trained otolaryngologist will be able to account for these.  When it comes to a closed reduction of a fracture, sinus surgery, or septoplasty, you can expect excellent treatment from an otolaryngologist.

The need for an Asian rhinoplasty specialist comes into play more during rhinoplasty – or reshaping of the nose.  This is because the aesthetics of the Asian nose certainly are different from other ethnicities, and it’s important to seek out a surgeon familiar with the subtleties and nuances of your nose – and knows which techniques will achieve the best results during surgery.

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Can Ear Cartilage Grow Back After Being Harvested?

Q: Would it be possible for cartilage to grow back? How does an ear look after the harvest?

A: When properly performed, ear cartilage harvest results in little to no change in appearance to the ear.  The incision can be hidden in a crease behind the ear, and cartilage only from the center – which does not alter size, shape or appearance – is harvested.

This video is a little graphic, but shows the procedure in detail.

 

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I Would Like to Have my Septal Extension Grafts Removed. What Are the Risks?

Q: I am an Asian who had a tip rhinoplasty 3 months ago and strongly dislike the stiffness brought by the caudal septal extension grafts. However, the changes are not noticeable. I have discussed with my surgeon about a revision rhinoplasty to remove it. He told me it is possible to take it out and return to the previous nose. Perhaps he would leave some cartilage as columellar strut to support the tip. Would columellar strut grafts be good instead of caudal septal extension grafts? Is it really risky?

A: I wouldn’t advise touching your nose this early after surgery.  It’s normal for the nose to feel stiff and almost artificially fake after having a septal extension graft placed.  This will soften over the course of the year as your nose heals.  Unlike other grafts (such as rim grafts) that are not sutured to other structures and can be easily removed, a septal extension graft is secured to your tip cartilages so your tip will need to be put back together once removed.

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How much swelling with minor closed rhinoplasty, only 1 piece of cartilage removed?

Q: I’m a 25-year-old Asian female. I had rhinoplasty 5 years ago; unfortunately a piece of cartilage seems to have shifted down to the tip of my nose. It feels so strange and sharp that it’s very distressing. I’m considering minor closed rhinoplasty with only that piece of cartilage removed. My concern is how much swelling and how long it’ll last. I can’t afford to hide away for months; my nose is already not small and when it’s swollen it looks awful.

A: Obtaining your previous operative note and consulting with a rhinoplasty specialist would be helpful in determining if your diagnosis is indeed correct. If it is in fact a piece of cartilage or cartilage graft that has shifted over time, then a removing it through a closed approach would not result in a significant amount of downtime.

Sometimes sharp contour irregularities can result from twisted or deviated cartilage, and if that is the case you may require a more extensive revision to achieve a nice result.

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What type of nose implant is best for Asian nose?

Q: I would like to know what types of implant that can last a lifetime as I do not wish to go for a rhinoplasty revision later on. What type of implant would give me the best harmony on my face and enhance my feature without looking fake?

A: There are many options when choosing Asian rhinoplasty, but the safest, most permanent and predictable way to achieve excellent results is with tissue from your own body (autologous grafts). They have a much lower risk of infection, extrusion, or migration than synthetic implants because they become fully incorporated into your nose unlike synthetic implants, which remain as a foreign body in your nose. Diced cartilage wrapped in Fascia will provides customizable, precise augmentation to give you a natural, attractive contour. The choice of cartilage grafts will depend on the degree of augmentation and refinement you desire.

Computer morphing of your nose during an in-person consultation with a rhinoplasty specialist would more definitively determine the best grafts for your nose. 

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Open Revision Rhinoplasty | Before and After

This patient had an open revision rhinoplasty with Dr. Donald Yoo exactly 1 month ago. Dr. Yoo used her own tissue to correct and enhance her nose. It looks like her recovery is going pretty smoothly so far!

The swelling is 70% resolved after the first three months, and the remainder goes down over time. The final result will be evident 18-24 months following surgery.

Revision Rhinoplasty Frontal View

Revision Rhinoplasty Frontal View

Primary Rhinoplasty Left 3qt View - 1 month post op

Primary Rhinoplasty Left 3qt View – 1 month post op

Primary Rhinoplasty Left Profile View

Primary Rhinoplasty Left Profile View

Revision Rhinoplasty Base View - 1 month post op

Revision Rhinoplasty Base View – 1 month post op

Revision Rhinoplasty Right 3qt View

Revision Rhinoplasty Right 3qt View

Revision Rhinoplasty Right Profile View

Revision Rhinoplasty Right Profile View

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Root of nose too high (looks like it starts from forehead)?

Q: I had a rhinoplasty 15 days ago. When the gyps was removed the root of nose was too high like it started from my forehead and looks horrible. Doctor had stitches there also that he removed (I don’t know why stitches were there). When I touch there I feel mostly bone with small breaks. Is this temporary swelling or a bad job?

A: 2 weeks after rhinoplasty your entire nose will still be swollen, including the bridge of your nose.  It is too early to judge what the final appearance of your bridge will be.  When dorsal augmentation is performed sometimes sutures are placed percutaneously (through the skin) to hold the dorsal graft in place.

You will have a better idea of the true height of your bridge in 3-6 months, though full healing may take up to 1-2 years.

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Would septal cartilage be enough for bridge augmentation and tip projection?

Q: Would septal cartilage be enough for bridge augmentation and tip projection?

A: Septal cartilage alone is not enough to create dorsal augmentation and tip projection.  Tip projection in Asian rhinoplasty often requires several grafts:  extended columellar strut, lateral crural struts, and tip grafts.  Once those are fashioned from septal cartilage, there is typically very little remaining cartilage.

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