- Applying Western techniques to an Asian nose, you’re gonna have problems
- Caucasian nose the tent poles (the cartilage of bone structure) are very thick, whereas the tent fabric (the skin that sits on top of the nose) is very thin
- In an Asian nose, you have to augment the tent poles and push through that thick fabric, otherwise you won’t see a result
When it comes to traditional rhinoplasty, less is typically more. Rhinoplasty, as we have come to know it, is generally reductive in nature—where the goal is to soften a prominent profile, minimize a noticeable hump or shorten a bulbous tip. However, this is not always the intention. For patients who seek Asian rhinoplasty surgery, the aim is usually to add or lengthen the nose rather than to reduce it.
“If you try and apply Western techniques to an Asian nose, you’re gonna have problems,” said Dr. Samuel Lam, a facial plastic and hair restoration surgeon at Lam Facial Plastics in Plano, Texas.
Noting that Asian rhinoplasty is completely different from Western rhinoplasty, Dr. Lam mentioned that the cartilage of bone in a Caucasian person’s nose is very thick and the skin is very thin. So when you shave down all that cartilage of bone, it shows through very nicely underneath the skin.
“With an Asian, if you try to create that same degree of refinement doing the same technique, you’ll have a problem, continued Dr. Lam. “One thing is, you’ll make the nose smaller, because the cartilage of bone is very flimsy and the skin is very thick. So if you shrink down the framework, the cartilage of bone, you’ll actually create scar tissue between the thick skin and the cartilage of bone, and thick skin won’t sit down.”
To describe the difference between Western and Asian rhinoplasty, Dr. Lam used the analogy of a tent pole and fabric. He noted that in a Caucasian nose the tent poles (the cartilage of bone structure) are very thick, whereas the tent fabric (the skin that sits on top of the nose) is very thin.
“You can refine the poles, and the fabric will sit down and hug the new poles,” added Dr. Lam.
But with Asian rhinoplasty, the reverse is true.
“In an Asian nose, you have to augment the tent poles and push through that thick fabric, otherwise you won’t see a result. In many ways, it’s actually the exact opposite anatomically, and the goals are the exact opposite. And the technique is the exact opposite,” expanded Dr. Lam.
The goal with Asian rhinoplasty is to make the nose look a little bit more augmented and defined, while at the same time making it look absolutely natural, emphasized Dr. Lam.
Dr. Lam said that there are a number of ways to perform Asian rhinoplasty, but with each technique applied, the intention remains to raise the infrastructure.
Traditionally in Asia, the most classic way of conducting the surgery is to do it with a silicone implant, elaborated Dr. Lam. The benefit of silicone is that it is easily removable and it only takes around ten minutes to conduct this procedure in the office with little anesthesia.
However, he noted that he hasn’t used silicone for about a decade, because the material has a lot of problems associated with it, such as migration and encapsulation, where you can see the entire outline of the implant through the nose.
“Now, what is more en vogue is what’s called a two-piece augmentation, using gore-tex for the bridge and cartilage for the tip,” recounted Dr. Lam. “You can also do all-cartilage grafting for the nose.”
All-cartilage grafting can prove tricky though, since there is very little cartilage in an Asian nose. With this method, Dr. Lam cautioned that you have to use rib grafts, and there are issues with taking rib out of the nose, as it is very firm and doing so could potentially cause scarring.
In the quest to achieve a beautifully proportioned nose though, a two-piece augmentation would be a better option.
“I typically like to use gore-tex for the bridge and cartilage for the tip,” stated Dr. Lam. “Then you can also refine the nasal nostrils by making them narrower, but you have to be careful making sure the whole nose maintains a good balance.”
The benefits of this technique is that it is more natural-looking than the other methods and has a lower risk of infection and migration problems. The downside is that it is harder to remove if you don’t like it.
After the rhinoplasty surgery is complete, the surgeon will put a splint on your nose to hold everything in place. The recovery period for this surgery is very quick, stated Dr. Lam. You would need to stay at home and rest for approximately a week post-procedure, during which the swelling would go down.
Regardless of the method used, Asian rhinoplasty surgery works best when a surgeon works with and remains true to a patient’s natural facial anatomy.
“Some of the hallmarks to prevent one from looking like a popsicle stick nose, so to speak, is not to overly define the tip and not to raise the top of the bridge beyond the pupils,” Dr. Lam clarified. “If you look at the side view of the pupils, they’re the highest placed part, whereas with a [Caucasian] nose, it can go all the way up to the crease of the eyelid. So you have a different esthetic value. You don’t just raise it up, but you raise it more subtly.”
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