Silicone Implant to Get Sharp Tip in Asian Rhinoplasty?

I was wondering if the only real method to achieve a super sharp tip in Asian noses is with the use of a big silicone implant since septal/ear cartilage is insufficient/weak. A respected rhinoplasty surgeon said so, but he doesn't do this. So I figured I'd ask doctors who have more experience with producing sharp tips in Asians. In the photo,note the features,specifically the sharp/projected tip and the supratip break. What kind of cartilage/implant/strut is needed to achieve that profile? The subnasale advancement is separate and would be done prior to having the rhinoplasty. Please chime in with feedback,thanks!


Doctor Answers (19)

Surgical judgement necessary for Asian augment rhinoplasty

+2

Silicone implants for Asian augmentation Rhinoplasty are extremely common world wide. In North America however we tend to be more cautions with the use of Silicone in the nose because of the possibility of infection and extrusion.

I think excellent refinement of the nasal tip can be achieved with the use of a autogenous grafts (patient's own cartilage). I personally use gortex for the nasal bridge and autogenous cartilage for the tip.

Regardless of whether a full silicone implant is used or not, the most important factor is good surgical judgment. Be sure to seek out a rhinoplasty expert for this surgery. Over augmenting a nose that will not tolerate a big implant is a recipe for extrusion no matter what implant material is used.


Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 57 reviews

I would use rib cartilage, not a silicone implant

+2

While I have never personally placed a silicone nasal implant in a nose, I have seen several patients that were having problems with them. There is a real risk of infection and a gradual thinning of the skin overlying the implant to the point of it actually becoming exposed.

Having seen these examples it is clear to me the risks are not worth the benefits of using a silicone implant. For an Asian patient seeking a more defined and projected tip I would use a rib cartilage graft. The major downside to using rib cartilage is small chest incision used to harvest the rib. Rib cartilage is a great material as it is natural and flexible with a low risk of infection and extrusion.

Hope this information helps you.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Silicone Implants

+1
The size of the Silicone implant need not necessarily be big to have the sharp tip effect. These factors need to be considered:
1. Thickness of the skin/subcutaneous layers over the nose tip area
      - Thicker skin needs more push while a thinner skin will show the shape of an implant placed below it.
2. How the surgeon carves and places/inserts the implant
      - Making a big or long implant can result to implant extrusion.
      - An implant with adequate length but with the right shape and angle (with the strut) will equally produce a sharper tip. 
Good luck with your choice..

Al Farabi L. Jaafar, MD
Manila Plastic Surgeon

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Silicone Implant to Get Sharp Tip in Asian Rhinoplasty?

+1
I recommend using your own cartilage as best.  Furthermore with the tip you describe and show on the picture, the silicone may be more problematic for you and cause the skin to die over the tip.

For more information, please go to my website at:
WirthPlasticSurgery.com

Garrett A. Wirth, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 5 reviews

Very refined tip in Asian Rhinoplasty

+1

Thanks for the question,

The reality is that it depends.  As an Asian Facial Plastics specialist I would say that it's still best to avoid full-sized "L-shaped" implants when possible.  in some cases implants of this type are a good choice. Most Asian patients have relatively thick skin with a sometimes soft consistency which makes sharp definition of the tip with cartilage grafting or implants difficult. In general you can augment the nasal dorsal and do very aggressive and sharp cartilage work on the nasal tip to give the Asian nasal tip a very refined look in Asian rhinoplasty. There really are few shortcuts and Asian rhinoplasty.

I'll attach a little information regarding this procedure.

Chase Lay, MD
double board certified facial plastic surgeon

Asian facial plastics specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 39 reviews

Tip refinement in Asian rhinoplasty

+1

Part of the reason that silicone implants can create a "super sharp" tip is that they exert a tremendous amount of pressure on the skin, and ultimately thin skin.  A great deal of refinement can be achieved with a septal extension graft and shield graft, but the level of "sharpness" will be limited by the thickness of your skin.  

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Don't recommend silicone at the tip

+1

Thank you for your question. You do bring up some important points when discussing the tip of an Asian nose. The typical Asian nasal tip has thicker skin and weaker underlying cartilages.  So to improve tip definition I typically recommend building out on the tip only with cartilage.  Septal cartilage grafts and rib cartilage grafts can have the "rigidity" required to improve tip definition.  I do not recommend silicone at the tip because of potential extrusion and infection.

Edward S. Kwak, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Nasal Implants - Asian Rhinoplasty

+1
Thousands of rhinoplasties are performed in the East on Asian patients by inserting a piece of silicone molding to augment the nasal bridge and define, project and elevate the nasal tip. Those typically do very well, but the implant can cause some problems with infection and extrusion.
Another option is using ear or septal cartilage, or even rib cartilage.

Philip Miller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 39 reviews

Do not use silicone in the tip of the nose

+1

To get a sharp tip, foreign materials at the tip are not safe. The likelihood of damage to the skin and underlying cartilage is high - probably the rule rather than the exception.

In order to get a sharp tip using cartilage, there is enough tissue in the ear and septum to build the tip by reinforcing the cartilage securely to prevent bending and softening of the tip.

Charles S. Lee, MD, FACS
Los Angeles Plastic Surgeon
4.5 out of 5 stars 40 reviews

Silastic Implants

+1

Hi,

Silastic implants work very well to augment the nasal bridge and tip if the are custom carved. DO NOT get a preformed "one size fits all implant". Along with the silastic implant you should have a 1) srtut graft 2) shield graft and if needed 3) tip defatting. All these maneuvers will enhance your chances for a defined tip. Be careful with only using a silastic implant, if not placed properly they can necrose through the skin.

Best,

Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 212 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.