I’ve been researching about the pros and cons of ear cartilage, rib, silicone, and goretex. My goal is to figure out what is best for my situation OVERALL. For some background knowledge to help you assess I’m Asian with a slightly flat nose. I just had a consultation and he said my nose just needs a little lift. Doc suggested using ear cartilage to raise the tip of my nose and goretex for the bridge. Based on your expertise do you agree with the doc & what do you think is the best?
Asian Rhinoplasty for Slightly Flat Nose
Doctor Answers (11)
Best Implant in Asian Rhinoplasty
While cartilage and bone may be a tempting grafting selection, both can shift and resorb or diminish with time. While slightly more technically difficult to place, implants made of hydroxyapatite are my preference. The advantages of hydroxyapatite implants are that 1. they can be custom sculpted; 2. they provide great structural support; 3. they provide adequate volume for even the smallest and flattest of noses; 4. they do not resorb or shrink, typically; 5. their 3-D "micro" mesh structure allows your own bone and cartilage, (as well as your own blood vessels) to grow into it not only to anchor it so it is unlikely to shift, but also to reduce the possibility of infection or extrusion following trauma.
Dr. Michelle Yagoda, NYC Female Facial Plastic Surgeon
The most common goals of asian rhinoplasty surgery are:
1. raise the bridge
2. narrow/refine the tip
3. add tip projection
4. narrow the alar base (bottom of the nose) if needed
In general, the skin is thicker on an asian nose than a caucasian nose and the cartilage is weak. Looking at your photographs, I would agree with your doctors recommendations of a dorsal implant to raise the bridge and a cartilage graft to define and project the tip. On my monitor, the alar base in the photo on the left looks narrower than in the middle photo. If this reflects a change that you were hoping for, neither of the grafts mentioned will achieve this and it would require an alar base narrowing procedure. There are many different opinions on the best material for the bridge graft. I have used custom carved Goretex grafts for many years with excellent success.
Nasal Elevation with implants
I have used custom carved silicone nasal implants for 15 years with very few problems. If silicone is carved right and placed correctly it works great. You can see many patients that had this implant on my website below. Gortex is also a good implant material as it cartilage grafting. It all depends on the surgeons experience and preference. Make sure you see some before and afters of bridge augmentation before you decide on a surgeon. No matter what implant you use, if its not placed properly, you'll have problems.
Web reference: http://www.africanamericanrhinoplasty.com
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Asian rhinoplasty with autologous cartilage
If you desire a subtle change, then septal cartilage with cartilage harvested from both of your ears should yield enough graft material to raise your bridge and refine the tip of your nose.
Asian rhinoplasty for slight flat nose
We do not recommend Gortex in the nose since we have seen many disasters from other offices that have used them. We use a smaller silicone implant which when placed along the bridge gives an excellent cosmetic and long-term functional result. Large implants tend to create migration, shifting, and necrosis of the skin if the skin is stretched too tightly. A small implant such as a Flower’s nasal dorsal implant manufactured by Implantech give excellent results for this type of a problem.
To do photo imaging with your own photo, download our iPhone app free of charge. Just enter "Seattle Plastic Surgery with Dr. Portuese" as search terms. Once downloaded, you can simulate rhinoplasty by changing the shape of your nose to be smaller, larger, etc...
Web reference: http://seattlefacial.com
Augmenting Asian Nose
I know excellent nasal surgeons who would do exactly what your surgeon suggested. However, after 35 years of rhinoplasty surgery, I continue to use the patient's own cartilage.
Best implants for the nose
As most surgeons will agree your own cartilage is the best grafting material. Rib is often the best for Asian noses do to their characteristics, although it does require a second incision on the chest (below the breast) and some additional discomfort. Rib grafts, when done well rarely need revision and have the lowest rate of infection while providing the best structural support. Synthetic materials may provide for good outcomes much of the time, but do have a much higher rate of infection, extrusion (works it's way out of the body), chronic erythema (redness) in the nasal skin, and malpositioning. The advantage of an implant is that they can be placed quickly with less recovery and can often be easily removed if any of the above complications occur - in which case rib cartilage can place secondarily.
Nasal projection is a common concern among Asian patients. Most American surgeons favor natural materials such as your own cartilage, however implants such as silicone are popular in Eastern countries. Foreign materials may lead to infection or extrusion while most patients do well when using their own cartilage. Non-surgical rhinoplasties involve the use of fillers and some patients find that they can achieve the results they desire with this alone.
Asian rhinoplasty, best overall is natural tissue
No one will dispute the fact that natural tissues, septal or ear cartilage, or rib cartilage gives the 'best' tissue for raising the bridge. The permanence and infection resistance is second to none, and the tissue is truly a 'real' nose. There are technical challenges with all though, be it availability, donor site issues, carving and shaping. The list of substitutes is long, now also includes allografts here in the US. In Taiwan Gortex may be common and work very well, not a situation of right or wrong. You might suggest a stacked allograft such as Alloderm which might be incorporated as a more natural material for a slight lift. If your surgeon is a good one whom you trust, his suggestions may work well in his experience, and work well for you.
Best of luck,
Web reference: http://www.peterejohnsonmd.com/rhinoplasty
For a subtle but natural and effective change to your nose, an injectible filler like Restylane or Radiesse may be used for a temporary lift or an implant for a permanent solution. For many years, I have used silicone dorsal implants which have been very effective and safe. They are an excellent, long-lasting choice particularly when performed by a caring and experienced physician. The key for you is to find a surgeon with whom you feel comfortable. Good luck!
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.
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