Mark Anthony Knight, MD

As a fellow Jamaican, I am delighted to learn of your interest in Rhinoplasty.  I agree with you that the end result must still be compatible with the ethnic context of your features.  A surgeon who understands your preferences and has the proper training and artistic skills should be able to perform this procedure to your satisfaction.

The bulbous tip results from excessive sebaceous gland and fibrofatty tissue in the nasal tip.  This can be debulked with direct surgical excision.  This should leave a thinner skin envelope for coverage.  The alar cartilage that constitutes the tip can be trimmed, and interdomal sutures can be placed to define the tip.  For increased projection, a columella strut can be placed.  You may want to place a tip graft if you prefer a more boxy tip.

MANY asian rhinoplasty cases can be performed with one of TWO modern, MINIMALLY INVASIVE modalities.

A silastic (silicone) implant can be placed as a columella strut, and the dorsum can be augmented with a filler such as Radiesse. Alternatively, a combined columella and dorsal (L shaped) implant can be placed eliminating the need for filler. The first procedure is less invasive than the second, and BOTH can be done under local anesthesia. As with any surgical procedure, sterility is paramount, but particularly so in this region given the very thin overlying skin. In addition, the dorsal strut should be placed in a SUBPERIOSTEAL pocket, to reduce the pressure on the overlying skin, to maintain control of the implant position and minimize movement, and to reduce the risk of infection.

While these procedures are conceptually very simple, they should ONLY be performed by experienced surgeons who understand YOUR goals, YOUR anatomy, and the technical aspects of your procedure.

Contrary to some of the comments here, all surgical procedures increase your risk of having a DVT.  However, the extent to which this risk is increased over your baseline risk is determined by several factors.  First, your INTRINSIC risk of developing a DVT is based upon your individual propensity for coagulation.  This itself is modulated by genetic, physiologic, metabolic and anatomic factors.  Genetic...some individuals have abnormal expression of their clotting components based on their genes.  Affected products include the factor X, fibrin, thrombin, and the von Willibrand spectrum of hypo coagulable disorders and on the other end of the spectrum are people who are HYPER coagulable.  Physiologic factors include oncotic and osmotic influences that change the viscosity of the blood, making it thicker or thinner and changing the propensity for thrombosis.  Metabolic factors are the micronutrient and metalloproteins that are involved in the clotting cascade, such as vitamin K, magnesium, selenium and calcium, in addition to the oxygen carrier hemoglobin.  The anatomic influences vascular pathology (venous valvular dysfunction leading to venous stasis, areas of impeded or constricted vascular flow,  and the presence of certain tumors).  Anatomic influences will also include cardiac dysfunction (pump failure).
Age, gender, medical conditions, body habits (obesity) also influence your baseline risk for developing DVT.
External influences  include exposure to exogenous estrogen, compression or restriction of vascular flow for example.  In addition, there are lifestyle issues (sedentary lifestyle) and poor physical condition. The muscles are actually designed to serve both in moving the skeletal frame, and by their contraction-release they simultaneously function as a pump to push vascular flow and reduce the stress on the heart.

NOW we come to surgical influences.  
I always insist on placing the sequential compression devices and using Heparin 5000 units SQ on every patient BEFORE starting the IV infusion.  The logic is this.  There are two pathways leading to clot formation.  The intrinsic and the extrinsic.  The extrinsic pathway is dominant, and can be triggered by simple things such as micro tears in the endothelium of the blood vessels.  These micro tears expose the underlying collagen to the circulating platelets, which then bind to the collagen to "plug the leak".  A cascade of chemical signaling events involving FactorVII, tissue Factor, thrombin, factor XIa, factor XII, and factor FXa.  Prothrombin is activated to thrombin, which starts the cycle over again.  I have left out a few technical details, but you get the idea.  

This is critical to understand, because the acute infusion of what is essentially a volume of fluid equal to 20 to 40% of your circulating blood volume will cause a rapid expansion in the diameter of the veins.  This can induce micro tears, triggering the aforementioned cascade.  IF the anticoagulation devices are in place before this process begins, then it is much less likely that the CYCLE of coagulation will propagate into an extensive clot (thrombus).  

Specific surgical influences on the risk of DVT are the type of procedure, the length of the procedure, and the use of anticoagulation measures.  The reason that liposuction increases the risk is that, in addition to the volume if IV fluids given during the procedure, the Tumescent solution infiltrated into the tissue is absorbed into the vascular tree via the lymphatic and venous systems, essentially counting toward the increased intravascular volume.  This increases the risk of micro tears as explained above.  

In your particular situation, the cumulative time for the combined procedures with ABSOLUTELY increase your risk of DVT above baseline.  However, with a simple understanding of the process and careful planning with strategic precautions implemented, it is quite safe to perform the procedures.  

IT is quite true that the prolonged duration of your flight is a more significant concern.  Again, an understanding o the situation and a few practical precaution such as getting up every 2-3 hours and walking about the aircraft should minimize your risk. To further edge the odds in your favor, I would recommend that you take aspirin or ask your surgeon to prescribe Xarelto or lovenox prior to your flight.  A short course of several days should cover your pre and post flight risk.

I have completed two Surgical residencies, one in General Surgery, and the other in Plastic and Reconstructive surgery.  I am half Asian, and my wife is Asian.  Furthermore, I have performed both cosmetic Rhinoplasty and reconstructive Rhinoplasty (nose surgeries) as well as cosmetic Otoplasty and reconstructive Otoplasty.  This gives me a very good perspective from which to respond to your question.  While traditional surgical approaches to asian rhinoplasty often used cartilage to support the tip via a columella strut, and to raise the dorsum via a dorsal graft, the logical choice for options would look to the septum first.  It is a good source for cartilage grafts, is loco regional to the anatomic surgical area, and very often improves the airway for the patient (especially if there is pre-existing septal deviation.  Conchal grafts harvested from the ear are another option for autologous cartilage grafts, however they tend to be curved by require careful selection and carving to create a structurally appropriate graft.  

Rib cartilage is almost universally reserved for TRUE NASAL RECONSTRUCTION, and even then in younger patients with more pliable cartilage.  As we age, the cartilage ossifies and becomes harder and more brittle, rendering it less receptive to the passage of needles and the placement of sutures.  

That being said, MANY asian rhinoplasty cases can be performed with one of TWO modern, MINIMALLY INVASIVE modalities.  

A silastic (silicone) implant can be placed as a columella strut, and the dorsum can be augmented with a filler such as Radiesse.  Alternatively, a combined columella and dorsal (L shaped) implant can be placed eliminating the need for filler.  The first procedure is less invasive than the second, and BOTH can be done under local anesthesia.  As with any surgical procedure, sterility is paramount, but particularly so in this region given the very thin overlying skin.  In addition, the dorsal strut should be placed in a SUBPERIOSTEAL pocket, to reduce the pressure on the overlying skin, to maintain control of the implant position and minimize movement, and to reduce the risk of infection.

While these procedures are conceptually very simple, they should ONLY be performed by experienced surgeons who understand YOUR goals, YOUR anatomy, and the technical aspects of your procedure.