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!
Silicone Implant to Get Sharp Tip in Asian Rhinoplasty?
Doctor Answers 23
Tip refinement in Asian rhinoplasty
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.
Asian Rhinoplasty - Implan
The reason for the lack of permanence is that synthetic implants never become fully incorporated into your body. Using tissue from your own body will give you the safest, longest lasting results and a beautiful nose.
Silicone Implant to Get Sharp Tip in Asian Rhinoplasty?
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Very refined tip in Asian Rhinoplasty
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
Silastic implants work very well to augment the nasal bridge and tip if they 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.
For Asian rhinoplasty, cartilage grafts are the best way to shape the tip
Silicone is commonly used in Asia to raise the nasal profile, sometimes with nasal tips included, called an L-Strut. The problem with silicone is that it can become infected and even erode through the skin or into the nose decades after it is place, especially if the tip is made of silicone as well.
I prefer shaping and strengthening the tip with your own cartilage, usually septal cartilage and then using Gortex for the bridge. Silicone is acceptable fro the bridge as well.
Nasal implants for Asian rhinoplasty
We do not prefer a sharp tip for Asian noses since anything that will create a sharp tip is likely to put excess pressure on the skin causing necrosis and break down the overlying skin. The most common nasal implant we use for Asian rhinoplasty is the Flowers nasal dorsal implant, not the L-strut. There have been numerous complications from L-struts over the years and we have taken many of these out. We prefer a very natural and balanced Asian rhinoplasty that does not look like it has been operated upon, so we avoid any sharp angles and tips. There is an alternative to the silastic implant, we can use the patient’s own cartilage, which works quite well.
Ways to enhance tip definition in Asian rhinoplasty
Tip projection, narrowing, and definition in Asian rhinoplasty often require significant sculpting in the nasal tip area. Here are some of the ways to achieve the goals more safely and effectively:
- cartilage sculpting of the existing nasal tip cartilages
- cartilage grafting, from the septum, ear, or at times from rib cartilage
- silicone implant with layered AlloDerm, fascia to minimize chance of extrusion
Suture techniques and cartilage grafts allow nasal shaping
Usually the desired nasal shape can be accomplished with suture techniques and cartilage grafts. The cartilages of the nasal tip can be narrowed, increasing tip definition and projection, and also setting the proper angle of the tip. Cartilage grafts can further increase tip definition, projection,and support, and also build up the bridge if necessary.
The septum is the best source for cartilage grafts, and if this is not sufficient, then ear cartilage or rib cartilage can be used. Your plastic surgeon can describe the grafts that might be appropriate, but these might include dorsal onlay graft, columellar strut graft, tip shield graft, and others. An open rhinoplasty will allow most accurate placement of the sutures and grafts and the scar is usually not noticeable, even in men.
With your rhinoplasty, you may find that the indentation at the juncture of your nose and upper lip may be blunted. If not, filler, such as Juvederm, would probably be the best correction. I would suggest avoiding a silicone implant due to risk of infection or extrusion.
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.