Asian/ethnic rhinoplasty: Cost and Methods?

Posted on April 19, 2016 by Donald B. Yoo, M.D.

Q: I have always been self-conscious about my nose I want ethnic rhinoplasty to make my nose more defined specifically my tip, bridge and septum. Can you explain to me about the cost and the method?

A: There are a variety of techniques and philosophies when it comes to reshaping the nose during Asian rhinoplasty.  One of the most important technical differences between surgeons is the use of artificial implants versus using your own tissue.  I feel very strongly that the best way to achieve safe, permanent results is with tissue from your own body.
Achieving the most attractive result will be possible by finding an experienced Asian rhinoplasty specialist who also shares your aesthetic goals.

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Asian rhinoplasty. Should I use ear or rib cartilage?

Posted on April 19, 2016 by Donald B. Yoo, M.D.

Q: I have this Asian nose bridge that is flat and the alar is wide instead of high and straight. I think I’m going to need augmentation to make the nose bridge and the overall nose look higher. What should I use for the augmentation? I’m thinking my own ear or rib cartilage, but I’m afraid of the risks. BUT I don’t want to use silicone implant or something “unnatural”.

A: Ear cartilage is sufficient for mild to moderate augmentation and change, however for more significant amounts of augmentation and change additional cartilage (and often stronger cartilage) is necessary in the form of rib cartilage.  Rib cartilage harvest, when performed by a specialist, can be performed through a minimal incision (< 2 cm) and will leave a small, well-hidden scar and does not prolong the recovery from your rhinoplasty surgery at all.

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Can the nose bridge be enhanced through closed Asian rhinoplasty?

Posted on April 13, 2016 by Donald B. Yoo, M.D.

Q: Can the nose bridge be enhanced through closed Asian rhinoplasty? I would like to know if I can make my nose bridge higher through closed rhinoplasty and if ear cartilage is a good choice for this procedure as I am just looking for a subtle change.

A: The endonasal approach in Asian rhinoplasty is suboptimal to address most cosmetic concerns, but if your only goal is to achieve subtle dorsal augmentation, then this can be achieved through an endonasal or closed rhinoplasty approach.

Any significant changes to the tip and significant dorsal augmentation are best achieved through an open approach.  Ear cartilage is sufficient for a mild dorsal augmentation.  In addition to ear cartilage, temporalis fascia may be necessary to create a diced cartilage fascia graft for augmentation.

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Can skin from the back be used to make an implant to augment the nose for rhinoplasty?

Posted on April 9, 2016 by Donald B. Yoo, M.D.

Q: Can skin from the back be used to make an implant to augment the nose for rhinoplasty?If so, how is this performed? Is it better than using cartilage?

A: The method you may be referring to is using dermal fat to augment the dorsum.  A common site for harvesting this fat is the buttocks.  Unfortunately, dermal fat does not give you a dorsum, which feels like your own natural nose and will resorb with time.
Using your own cartilage has the advantage of a bridge, which will not resorb, and also feels like your natural nasal dorsum.  Sometimes the surgeon is more important to an excellent outcome than the technique, but this technique is inferior to autologous cartilage techniques.

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How much ear cartilage will absorb when used for Asian rhinoplasty?

Posted on April 4, 2016 by Donald B. Yoo, M.D.

Q: I had a rhinoplasty 2 weeks ago. My bridge is still very straight between the eyes. I’m hoping it will curve in more as time progresses (ear cartilage was used). I don’t have a clear understanding of cartilage absorption, but will my nose have a more dramatic curve as over time? What will my nose look like if it does absorb? I’m considering having the bridge btw my eyes shaved down with a needle if it doesn’t curve over time. What is the complication if I do have it shave down?

A: At 2 weeks, you are very early in your recovery and there is still quite a bit of swelling that will resolve along your bridge, and especially between your eyes. The ear cartilage itself will not resorb, but the final height of your radix will be lower when fully healed.

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I had a rhinoplasty in 2003, and the tip of my nose was turned up too much. It looks like a pig nose! How can it be turned back down?

Posted on February 27, 2016 by Donald B. Yoo, M.D.

The amount that the tip of the nose is turned up or down is referred to as “rotation”. One important angle to look at is the nasolabial angle, or the angle the nose makes with the upper lip. For a female, an attractive angle is obtuse, from 105-115 degrees. For a male, the ideal is closer to a right angle, from 95-105 degrees. When the angle of rotation becomes much more than 120 degrees, the result is usually unattractive with too much of the nostrils visible from the frontal view. During surgery, when we turn the tip of the nose up we call it rotating the nose, and when we turn it down we call it counter-rotating the nose. Counter-rotating the tip in rhinoplasty typically presents a much greater surgical challenge.

Counter-rotating the tip has the effect of lengthening a shortened nose. In order to push the tip downward and outward, additional structure and support is needed. Cartilage is used to fashion grafts for this purpose. Common cartilage grafts used to counter-rotate the tip in rhinoplasty are extended spreader grafts, septal extension and caudal septal extension grafts, and a variety of onlay grafts. Previous scar tissue contracture and the skin envelope often limit the amount of counter-rotation that is possible. The maximum amount of lengthening and counter-rotation may be achieved using these grafts made from rib cartilage.

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Why is smoking such an issue in cosmetic surgery and plastic surgery?

Posted on February 10, 2016 by Donald B. Yoo, M.D.

Besides the links to many cancers and health problems, smoking is problematic for patients undergoing cosmetic, dermatologic or plastic surgery because it impairs proper wound healing. Skin has an intricate blood supply that is provided mainly by something called the subdermal plexus. This maze of tiny vessels makes up a “micro-circulation” and is especially susceptible to injury by agents such as nicotine, which cause the vessels to close off (vasoconstriction).

When the blood supply to the skin is compromised, healing is also detrimentally affected. Not only can the skin take longer to recover from surgery, but it can also necrose (die) from a lack of adequate blood supply. During surgery like rhinoplasty or facelift surgery, a healthy, robust blood supply is necessary for proper healing. For this reason, Dr. Yoo strongly recommends a minimum of 6 weeks of no-smoking before and after surgery, to allow time for your micro-circulation to recover.

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I had a rhinoplasty 10 years ago, and now I’m told I have an inverted-V deformity. What is it?

Posted on January 20, 2016 by Donald B. Yoo, M.D.

An inverted-V deformity usually occurs after rhinoplasty when the upper lateral cartilages (middle-third of the nose) separate from the dorsal septum (bridge) and collapse. This collapse in the middle third of the nose manifests as a visible step-off in the transition between the nasal bones of the upper third of the nose and the upper lateral cartilages in the middle third of the nose. The shape of the visible nasal bones is an upside-down, or “inverted” V.

The reason the inverted-V deformity after rhinoplasty is so problematic is that not only does it result in an obvious cosmetic deformity, the upper lateral cartilages are an important part of the nasal valve. Collapse of the nasal valve results in significant functional issues with nasal obstruction. It’s an area that commonly needs to be addressed in revision rhinoplasty.

How is the inverted-V deformity avoided during rhinoplasty? During rhinoplasty, when a dorsal hump is removed, care must be taken to reconstruct the nasal valve by reattaching the upper lateral cartilages to the septum +/- spreader grafts (pieces of cartilage used to widen the nasal valve).

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Rhinoplasty Recovery – What To Expect

Posted on January 13, 2016 by Donald B. Yoo, M.D.

Rhinoplasty, or a “nose job” as it is more commonly known, is one of the most frequently performed cosmetic surgery procedures today. If you are considering undergoing rhinoplasty it is important to consider all aspects of the procedure, including what you can expect during your immediate recovery period so you can make an informed decision.

In general, after rhinoplasty you can expect to experience some throbbing pain and headaches. Most patients who have undergone rhinoplasty only require a couple of days of a narcotic for pain relief. After that, most report that over-the-counter pain relievers such as Tylenol are more than sufficient to relieve their discomfort. The majority of patients are pleasantly surprised how the level of discomfort is less than expected. Most bruising and swelling will resolve within 7-10 days after surgery, and the majority of patients will take 10-14 days off from work or school.

The most uncomfortable aspect of the recovery is probably not being able to breathe through your nose during the first week after surgery. This is due to swelling from the surgery itself, and sometimes from small silicone splints that Dr. Yoo places inside the nose to aid the healing process. Nose blowing should be avoided for the first two weeks, and instead nasal saline irrigation and sprays should be used to help keep the inside of the nose moist and clean. As the swelling resolves, your breathing will be dramatically improved compared to before surgery.

Dr. Yoo sees patients the day after surgery, then one week after surgery. At the one week post-op visit, the cast and sutures are removed and a light, nude colored tape is applied. Light cardio exercise may resume 2 weeks after surgery, and full workouts may resume 4 weeks after surgery.
About 3-6 months after your surgery the vast majority of the swelling (60-80%) will have resolved, though your nose may still feel a bit numb. Healing will continue for a full year after surgery, and up to two years after revision surgery. Many patients enjoy seeing the subtle changes and progressions their noses undergo during the healing process as they reach their final aesthetic result.

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When are the bones broken in rhinoplasty? How is this done?

Posted on January 6, 2016 by Donald B. Yoo, M.D.

Osteotomies (fracturing the nasal bones) are performed for a number of reasons in rhinoplasty. These controlled fractures of the nasal bones allow for moving and reshaping the nasal bones. It is performed by using a sharp osteotome (similar in design to a chisel) driven through the nasal bones with controlled taps with a mallet.

During rhinoplasty, the most common reason to perform osteotomies is to medialize (narrow) the nasal bones. This is necessary when the nasal bones are too wide, when there is an “open roof” deformity, or the bones are obliquely oriented. An open roof deformity is sometimes created during dorsal hump removal (removing a bump on the bridge) as the bone and cartilage is removed to lower the dorsum. In order to close this opening, osteotomies are used to bring the bones together.

Another reason that fracturing the nasal bones may be necessary is to improve the symmetry between the nasal bones. Especially after nasal trauma or a previous nasal fracture, the bones will often acquire asymmetric deformity. Controlled fractures of the bones are used to reshape the bones.

In general, osteotomies will be responsible for the majority of bruising during nose job surgery. Surgical technique does play a role in the degree of bruising after surgery, as precise, controlled osteotomies will often result in less bruising. Bruising from osteotomies can result in “black eyes” that last an average of 7-10 days.

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