I narrowed down my choices down to the the diced cartilage wrapped in fascia or a medium implantech implant for my bridge and need a little work on my bulbous tip. Can you please tell me which would be a better option for me? I feel like my nose is too large and flat from the front. I also have to hardest time wearing glasses with my low bridge. Attached is a picture of a girl nose that I would like to aim for in term of shape and height. Is this reasonable expectation? Thank you in advance.
"Diced Cartilage" Wrapped in Fascia or Implantech Implant for an Asian Bridge?
Doctor Answers 17
Long-Term Perspective On Dorsal Implant Options For Asian Rhinoplasty
Both diced cartilage and a synthetic implant can be used to augment the dorsum in an Asian rhinoplasty. There are advocates for each technique and good results can be achieved with both. What you want to really look at though is the long-term of the rhinoplasty result. That is where differences can be seen, assuming that the desired initial results are obtained. Cartilage is never going to give you any problems with infection, tissue thinning, or implant exposure for the rest of your life. The same can not be said for a synthetic dorsal implant where such problems can occur anytime in your long remaining lifetime. It is better in my opinion to invest the effort up front of harvesting and shaping a cartilage graft to enjoy a lifetime free of any long-term implant complications.
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Nasal Augmentation -- Implants are Cheaper and Faster, and are a poor choice
In my opinion, implants are a poor compromise for the nose
Sure, implants are easier to use and take less time in the operating room to prepare and place than using your own tissue. This can certainly save money for your surgeon and perhaps for you, but many surgeons that have seen problems with implants feel that they are a poor choice (even if major problems with implants are infrequent).
Diced cartilage wrapped in fascia seems to offer the least amount of compromise:
- Minimal to no resorption (there is good data to support the longevity of diced cartilage when we use your own cartilage and wrap it in your own fascia -- and in my own experience with this technique I have not seen any detectable resorption at up to 6 year after surgery)
- No bending or warping of the cartilage (when diced into small pieces)
- Does not move independent of your normal nose tissues like silicone implants tend to
- Infection risk is minimal and decreases to almost zero after healing (unlike implants that will always have a risk of infection, which can be a catastrophic problem -- think Michael Jackson)
- Minimal tendency for "visibility" over time as there are no "edges" of the graft to show through the skin
I'd guess from your photos that fascia-wrapped diced cartilage is a good option for augmenting your nose, although when a very large augmentation is needed, diced cartilage may not suffice (and you'd need to consider something like a block of carved rib cartilage).
Hope this helps.
Nick Slenkovich, MD FACS
Natural cartilage is always best
I take out warped and shifted implants that were placed by previous plastic surgeons as a "quick fix" all the time! Yes cartilage wont looks at "perfect" as an implant initially and it can have some asymmetries but so do most natural noses. Placing an implant in the nose is dangerous and even surgeons who have done thousands of this procedure in Asia report high complication rates. Asian rhinoplasty is a complex surgery that should be left to very experienced surgeons who specialize in rhinoplasty. Diced cartilage is one option but rib cartilage is another option. Septal cartilage is often too small and weak in Asians to be useful. Ear cartilage is not a good choice for the bridge although again many surgeons use it because its easily harvested. Do your homework. Then do even more homework. Implants do not belong in the nose!
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Diced cartilage wrapped in fascia vs Implantech implant for asian rhinoplasty
Either diced cartilage wrapped in fascia or a nasal implant (Inplantech) could be used to enhance or enlarge a nasal bridge for Asian rhinoplasty. Each has its advantages and disadvantages. If there is a shortage of cartilage, it may be difficult to get enough of the graft to achieve the amount of bridge elevation that you are looking for. Cartilage grafts also can warp or resorb to some extent. Further there can be donor defects associated with cartilage graft donor sites. Although, implants can result in an excellent shape and are usually easier to perform and are less costly than cartilage graft rhinoplasty, they may carry a higher risk of infection or extrusion. Given you individual nose, your plastic surgeon may suggest one or the other procedure.
Diced cartilage or silicone implant for bridge
Based on your photo it appears that you don't need a tremendous amount of bridge augmentation. In that case, I would strongly recommend cartilage, diced or not, along the bridge. By using your own tissue, the risk of having problems goes down. Silicone is fine if it works out (I've done plenty of them without problems), but your own tissue works even better.
Diced cartilage graft
Both techniques are used commonly to elevate nasal bridge. Diced cartilage graft, however, is my preferred technique. It gives a natural look, can be moulded even a week after surgery and there is no risk of infection, displacement or extortion. Even if you minimal cartilage in you nasal septum, ear cartilage can be used and the fascia is taken from the temporal area with a small incision. Good luck
Asian Bridge augmentation
There are several approaches to improving the height of the bridge in noses like yours. You mentioned an implant or diced cartilage wrapped in fascia. Another option is a solid cartilage graft that is carved for your nose. Depending on your supply of septal cartilage rib cartilage may be required. Asian noses often don't have adequate cartilage to create the augmentation desired.
As other surgeons have mentioned here, silicone implants are commonly used. It is a faster fix for the problem however, there can be delayed issues with such implants. I've have seen patients who have done well for many years/decades before developing issues with their implant.
In experienced hands using your own tissue (cartilage) can give very good results that have a lower risk of these issues. I also find that structural cartilage grafting techniques allow for a more natural improvement to the nasal tip issues that you mention.
Benefit of autologous grafts for dorsal augmentation during Asian rhinoplasty
Asian Rhinoplasty - Dorsal Augementation
Because I've seen many problems from patients having a quick fix Asian Rhinoplasty using silicone implants (including infection, extrusion, and an unnatural appearance), I prefer to augment the nasal dorsum using material from within yourself, such as diced cartilage wrapped in fascia or rib. I prefer results that give a natural appearance. Asian rhinoplasty is a complex surgery that needs to be addressed by a specialist that will ensure that your nose not only looks great but is also functional as well. Good luck!
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