Asian Rhinoplasty by Seattle, Bellevue's Dr. Philip Young
Asian Rhinoplasty can almost be a speciality itself. The approach to the Asian person's nose is much different than the approach to a caucasian person's nose. The caucasian nose is typified many times by the need to reduce the nose, to make it smaller. Usually when a rhinoplasty is requested for a caucasian nose, the complaints are usually regarding a prominent nasal bridge, or a large tip. The answer to this is a reduction of the height of the bridge and a refinement of the nasal tip. The structures are their. They just need to be taken down and parts need to be removed. You usually don't need extra cartilage because it is there and when you do there usually is enough in the septal area. This is in contrast to the Asian nose. The asian nose is characterized anatomically by a lack of projection of the nose and bridge. The dorsum or bridge of the nose is usually short and low, lacking definition. The aesthetically pleasing progression from the eyes to the bridge to the tip is usually broken up in the asian nose. There is a resulting lack of continuity.
The Asian Rhinoplasty Procedure entails augmentation. The bridge can be raised with medpor, silicone or through grafting. You can graft with a solid piece of cartilage like your own ribs. Or you can use a rib from a cadaver. The other option is to augment the dorsum / bridge by taking both ear cartilages and mincing the cartilage into small 1mm pieces that are then wrapped around with a flat piece of tissue that can be taken from the temporal area. This is the area above your ear within the hair. This requires an incision usually shaped as a triangle. This flat piece of cartilage is wrapped around a thin syringe and sewn for construction. The small pieces are then placed inside and the flat piece not a cylinder is closed. This is then placed in the bridge to create height in the bridge | dorsum.
Below is a Revision Asian Rhinoplasty that had this ear cartilage graft minced to create a bridge. She had a dorsal implant extrude or come out of her nose at the tip area and we reconstructed it. You can read more about this case by clicking here as well: Asian Revision Rhinoplasty. The tip was reconstructed by using a tip graft and replacing the lateral crural cartilages. Also a caudal extension graft was used for tip reconstruction. We have a section on our website that defines these terms. You can learn more about these terms here: Rhinoplasty Terms | Definitions. You can also read more below to learn more about how we do Asian Rhinoplasty:
Below is another Asian Rhinoplasty Before and After showing tip refinement, projection, and refinements and contouring for the nasal bridge. We have a particular approach for the tip with Asian Noses and we'll explain more after these pictures:
Asian Tip Rhinoplasty: Asian noses typically can have a wide variation in their anatomy. Some have structure just like a western caucasian nose. In this case the answer is simpler and you approach is like a western caucasian nose. Some have noses that are quite different. In the extreme, the lower lateral cartilages are weak, malformed and have no effect on the tip structure. The tips structure is mainly created by the soft tissue in the tip. It is in this situation that the skills of a rhinoplasty surgeon is tested. Below is a picture of the lower lateral cartilages that are outlined in blue. In this particular case the lower lateral cartilages are strong and can be manipulated much like a caucasian's nose.
Below is another view and following that picture is the same picture but with color coding showing the different parts of the lower lateral cartilages. The blue outlines the medial crus or portion of the lower lateral cartilages. The yellow outlines the intermediate or middle crus or portion of the lower lateral cartilages. The green outlines the lateral crus of the lower lateral cartilages.
When they are weak we have to build structure. The key to this is using a caudal extension graft. This graft is connected to the septum and allows us to really project the tip lower lateral cartilages. This is done by puting them back together over or at the most projecting part of the caudal septal graft. A picture below shows where the caudal extension graft is placed. The blue is an example where the caudal extension graft is placed and the green shows the outline for the edges of the septum and together where a possible overlap and connection area is located. You can click here to see more Before and After Rhinoplasty Images:
|Before Asian Rhinoplasty Revision with Natural Ear Cartilage Diced and Wrapped with Fascia for the Nasal Bridge and Ear Cartilage Grafting for Tip Refinement to replace the Silicone Implant and to lower the Tip and cover the Nostrils More as Desired by the Patient||After Asian Rhinoplasty Revision with Natural Ear Cartilage Diced and Wrapped with Fascia for the Nasal Bridge and Ear Cartilage Grafting for Tip Refinement to replace the Silicone Implant and to lower the Tip and cover the Nostrils More as Desired by the Patient|
|Before Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft | Implant and Tip Refinement Replacing Silicone Nasal Dorsal Graft and Goretex Tip Implant||After Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft | Implant and Tip Refinement Replacing Silicone Nasal Dorsal Graft and Goretex Tip Implant|