the unique needs of Asian ethnic groups.
As with all of the surgeries we perform at our facility, the goal of Asian rhinoplasty surgery 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
Asian rhinoplasty using all natural tissue (without silicone, Gortex, or other foreign implants)
No need for rib grafts (in most cases) or skull bone grafts! Recent advances in Asian nasal surgery have developed that allow all natural tissue to be used consistently to build up the tip and bridge of the Asian nose without resorting to the use of foreign body implants such as Gortex or silicone.
Prior to the development of this new technique, an all natural Asian rhinoplasty required obtaining a large piece of cartilage from the rib or a piece of rigid bone from the skull. These were the places with material large enough to build up the bridge.
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.
Asian Vs. 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:
- 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.
- 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 labeled as "Westernization", rather than an ethnically consistent beautification.
- 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.
- 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.
- 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.
Rhinoplasty surgery is generally performed in our state certified operating room with our board certified physician anesthesiologist who has worked over ten years with us and understands the anesthesia needs of our patients. We prefer general anesthesia in order to maximize patient comfort. If you strongly prefer IV sedation, we can usually accommodate your needs. In any case, you will be treated with the highest level of safety and care.
Contact us for more information.