Rhinoplasty:

Rhinoplasty in everyone is different, but the most important aspect of rhinoplasty is to have a clear idea of the realistic shape that is expected. Beautiful nose is so important because it stands at the center of the face and gives the face the harmony.

Rhinoplasty is also important in aging face. As we age, the tip of the nose becomes more droopier and the nose becomes longer. Elevating the tip and shortening the nose in aging face makes the overall face more youthful.

Consultation:

What patients consider beautiful can vary dramatically so the I like to have as much idea about the want of the patient as possible. So I ask them to bring me 5 different photographs of a nose shape that the patient likes. I ask them not to think about whether it will match their face or not, because the goal of the photographs is to determine what the patient thinks is a pretty nose shape.

After reviewing the photographs, we can go over the the realistic shape of the nose that is possible and appropriate for the patient. I like to use the computer photographs, but not the warping features because real surgeries cannot make the shape exactly like the altered images.

Dorsum and Bridge:

This refers to the area of the nose from the bridge to the tip. In Asians, most patients usually requires augmentation of the this area. The important features of all dorsum is the smoothness in transition. The transition from the forehead to the nose should be smooth and curved. The transition from the dorsum to the tip should also be smooth. Some people may wish for slightly curved profile from the dorsum to the tip, and others may wish for straighter profile. The other important t feature of the dorsum is that although definition is wanted, the implant should not be evident. With very few exceptions, most patients desire a smoother, more natural, and not very high bridge and dorsum.

There are many different material that can be used to augment the dorsum. My preference is combination of alloderm and goretex. Gortex gives definition to the dorsum, but is pliable and soft that it adheres to the underlying contour. Because the skin in the dorsum is very thin, however, even gortex can cause an unnatural appearance. Alloderm over the goretex gives the goretex more coverage with a very soft tissue, that enhances the smoothness and natural appearance.

Tip:

For most Asians, the tip is usually bulbous and lacking in both definition and projection. the goal of surgery is to define the tip points without making the tip unnatural.

I like to use the patient's own cartilage to enhance this area. My first choice for the material is the septum which is the cartilage between the two nostrils. Sometimes, if that has been previously used or is too small, then I will use the ear (auricular) cartilage. I think it is critical to first give the tip a strong and sturdy foundation by inserting a cartilage in the mid columella. Then, using a cartilage, tip graft can be inserted to enhance the shape. At times, if the tip appears too pointy, alloderm or patient's own tissue can be used to soften the tip. It is important to make sure that the tip is not too rotated upward or downward.

Columella:

Columella is the portion of the nose from the tip to the upper lip. The angle created between the columella and the upper lip determines the rotation of the tip. Most people now do not wish for too much of upper rotation which can cause more visibility of the nostrils.

Some people have either too much of a hanging of the columella, or too much retraction of the columella. Correcting the amount of columella that hangs is subtle, but an important point in the overall aesthetics of the nose.

Some people have deep groove of the columella/upper lip junction, especially if the upper lip is projecting. This area can be filled with diced cartilages.

Alar rim:

Some people have alar rim which acutely goes up. This can create an appearance of increased nostil show. Lowering the alar rim so that the nostril is not as visible is another subtle, but an important point.

Alar width:

After refining the tip and increasing the tip projection, the alar width will become narrower. For some, if this is not enough, the width can be narrowed using various method of excising the alar sides.

Skin:

Sometimes, the overlying skin of the nose is overlooked. Many asian noses have thick and sebaceous skin at the tip and alar areas. To reduce the pores and smooth out the skin will make the overall nose much finer. I personally recommend all patients to undergo various laser refinement at a later time after surgery to refine the nose.