Asian Rhinoplasty (Nose Surgery) at our Practice in California

As with all of the surgeries we perform at our facility, the goal of Asian rhinoplasty is not to create a Caucasian nose, but to create a nose that is compatible with the Asian face. While the goal of Caucasian nose surgery is usually to make the nose smaller, Asian rhinoplasty typically involves making the nose larger.

The Nose Bridge

When performing Asian nose surgery, the material we typically use for the bridge is silicone, although other materials such as Porex or Gore-Tex® can be used. Silicone plastic bridges have been used for over fifty years and have proven to be very safe for Asian nose surgery. While some surgeons advocate Gore-Tex™, we find the prefabricated shape to be too limited. The original use of this tissue was for use in Caucasian rhinoplasty. A thin 1millimeter sheet is laid on top of the nasal bone to smoothen out any small bumps after shaving the bone. The manufacturer subsequently made thicker sheets measuring 3-4mm in thickness for use in non-Caucasian patients. Although appropriate in some patients, we have found that the broad wide sheets do not conform well in the myriad of Asian nasal shapes.

Some surgeons have advocated using autogenous tissue (tissue from a patient's rib, skull, or ear) to build a nose bridge. However, most Asians do not have enough ear or septal tissue for this method to work. In addition, harvesting material from the rib or skull bone at our California facility involves a larger procedure than many Asian rhinoplasty patients are willing to undergo.

The Nose Tip

Compared to other ethnic groups, the tip of the Asian nose tolerates slightly less definition and projection. However, it can still be altered slightly through nose surgery to better blend with a patient's face. When treating the tip of the nose, Dr. Lee prefers to use natural tissues to reduce the risk of implant rejection. He typically uses tissue from the septum inside the patient's nose to better define the tip. If necessary, he may use ear tissue. Generally, the ear returns to its normal shape after a few days.

How Asian Rhinoplasty techniques differ from Caucasian rhinoplasty

With our large volume of Asian rhinoplasty patients, we have had the opportunity to observe what works and doesn’t work when Caucasian rhinoplasty techniques are used on Asian noses:

1. Inadequate tip projection. Most commonly, surgeons not familiar with Asian rhinoplasty techniques attempt to perform a Caucasian rhinoplasty on an Asian nose. Typically, tissue is removed from the tip area in an attempt to narrow and sharpen it. Sometimes suture techniques are used to fold the cartilage into the right shape. Our experience is that these techniques are inadequate for giving the right shape. Because Asians typically have weaker cartilage in the tip area, attempts to manipulate the shape of the cartilage fail. We advocate buttressing the tip structure with additional cartilage either from the inside of the nose – the septum, which separated the left and right air passage – or from the ear, through a hidden crease behind the ear. This cartilage is used to reinforce and project the tip upward, somewhat akin to a pole propping up the tent. The cartilage should have adequate length and strength to properly fulfill this function. The correct way of placing the cartilage is to make it into a buttressing pillar. We do not advocate laying cartilage on top of the native weak tip cartilage, because the foundation is too weak to support an “onlay” graft at the tip.

2. Overly large bridge. This problem relates to an inadequate understanding of Asian nasal aesthetics. The Asian nasal bridge should start approximately at the level of the eyelashes or lower. The important thing is that a slight break should exist between the forehead and the starting point of the bridge. Otherwise, a Greek nose results, which is not ethnically compatible on an Asian face. This is an easy trap for a surgeon to fall into if the procedure is labelled as “Westernization”, rather than an ethnically consistent beautification.

3. Inappropriate material for the bridge. In Caucasian rhinoplasty, it is almost sacrosanct that natural tissue from one’s own body be used in the nose. Typically rib, skull or other bone is used. Our experience with patients who have undergone such procedures elsewhere is that these materials tend to be too bulky and difficult to shape. The edges are frequently visible or can be felt, and the top of the bridge does not blend well with the nose, resulting in an overly large bridge. We have frequently been asked to remove these materials due to patient dissatisfaction with the aesthetic results. Many surgeons experienced in Asian rhinoplasty have found silicone plastic (SIlastic) to be well tolerated in the thicker skin of the Asian nose. Other materials such as Gortex ™ or Alloderm™ have been used without any clear consensus on their superiority. We generally prefer Silastic implants due to their proven effectiveness.

4. Inappropriate nostril narrowing. The need for nostril narrowing varies depending on the country of origin. Contrary to popular opinion, nostril narrowing is not generally required for patients whose ancestry traces to Northern Asia – perhaps 15% need narrowing. The need for narrowing is more common in Southern Asians. Narrowing should only be performed when necessary in order to avoid unnecessary scars. Some narrowing effect is seen with tip projection alone. When narrowing is performed, the outside curvature of the nostrils must be maintained in order to avoid a “pasted-on” appearance.

5. Implant extrusion. This becomes problematic if a silicone or other foreign body implant is placed into the tip area. This technique is more commonly performed in Asia. Our experience is that the preferred location of the implant is along the bridge only. Because the nose tip is mobile, any firm material in this area will begin to erode the overlying skin and the implant will become visible. The preferred material for the tip area is cartilage, which is soft and pliable.

6. Breaking the nasal bones. This procedure is frequently performed in Caucasian rhinoplasty as part reducing the nose size. In Asians, this is not frequently necessary. The perhaps 10% of Asian patients undergo this step. Adding an implant to the bridge has a narrowing effect so that additional narrowing of the bones is rarely needed. Performing this step on an Asian nose can lead to airway blockage, as well as uneven bone position.

Anesthesia for Asian rhinoplasty.

Because the bones are not usually fractured as part of an Asian rhinoplasty, we do not find the need to have patients undergo general anesthesia with intubation (breathing tube). Our personal preference is intravenous sedation (“twilight anesthesia”). Our large experience with Asian rhinoplasties has allowed us to become very time efficient, with most cases taking less than one hour, with minimal bleeding. Most people are able to return to work in 7 days.