Nose implant alternatives in Asian Rhinoplasty?

Surgery with silicone implants is quicker, since they are pre-fabricated and easier to place than autologous grafts (tissue from your own body), and the recovery may be a bit easier. The results may also look good for several years, however they are not a permanent solution. As long as the implant is in place there will be an associated risk of infection, migration, and extrusion (coming through the skin) which is higher than that of autologous grafts. 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. Your own tissue has a much lower risk of infection or extrusion. Cartilage can be harvested from within your nose (septum) or from your ear, through an incision hidden in the crease behind your ear. Even in Asian patients these areas heal impeccably.

One can use fillers to augment the dorsum of the nose and I do so to get an instant rhinoplasty but that is not a permanent procedure.  If you do use fillers, make sure to use a hyaluronic acid filler.  Silicone implants are certainly not my preference-I use either autologous rib or fresh frozen rib to give the look you desire for a dorsal augmentation.  However, to augment the tip one should use the patient’s own autologous cartilage.It is very important to seek a board certified plastic surgeon or ENT surgeon who is a true expert in ethnic rhinoplasty. 

Use your own tissue to build up the bridge. Cartilage from your septum and your ear will be sufficient to build your bridge without having to resort to rib. There's no more a natural look than using your own tissues.

Besides silicone implants other options include using your own cartilage (septum, ear, or rib). Other materials that implants can be made of include gortex and portex. Depending on your goals there are several options. I tend to prefer using patient's own tissue for these types of cases, but with bridge augmentation a synthetic implant can have its place, if you understand the risks.

An in person exam woul allow for a better evaluation of your options and a more detailed discussion of the pros and cons of the various approaches.

Hi ttcl,

Thank you for sharing a photograph. Based on the single photograph and your personal goals, a conserviative skin excision to narrow the nostrils might be more appropriate than a nasal implant.

Nasal augmentation of the bridge is a common part of rhinoplasty in Asian patients. Augmentation material is typically "plastic" material such as goretex or silicone. While one's own cartilage is generally preferred to augment the bridge, there may be insufficient nasal cartilage to provide adequate augmentation. Ear cartilage is another option. As a result, many plastic surgeons will use either of these materials. Both materials have advantages and disadvantages. There is a possibility with either implant that it may problems such as movement/shifting or infection, which may require removal.

Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

You are right. Augmenting the bridge gives a more narrow appearance on the front view. A conservative augmentation will minimize this. Consult a rhinoplasty expert who performs computer imaging to get a sense for how this would look on you.

Alternatives to silicone include Gore-tex or your own cartilage. Cartilage can be taken from your septum or external ear.  Both are excellent alternatives.

In terms of recovery, swelling and bruising is at its worst on day three following surgery, and usually subsides two weeks following surgery. Follow the link before to find out detailed information about Asian Augmentation Rhinoplasty and what to expect from the recovery period, including when you can go back to work and regular activities.

 

Thanks for the question about alternatives to silicone implants for building up the bridge in Asian rhinoplasty. My preference in these cases is to use your own cartilage, usually taken from the septum, or in some cases, the ears. I prefer to use cartilage from the septum as it avoids having to take cartilage from another area, so the decision would be based on the amount of cartilage needed to reach your aesthetic goals. In either case, cartilage can be safely taken without any unfavorable implications for the donor site and the changes achieved are permanent. 

I utilize computer imaging during the rhinoplasty consultation to give you a sneak preview of the appearance of your nose after surgery. I find that it is a really great opportunity for patients to tell me if they want their bridge higher or lower, narrower or wider, tip up or down etc. In your case, this would help guide us as to the degree to which you would want your bridge built up and your nose narrowed. 

Another issue which many Asian patients bring up is the roundness or bulbousness of the tip. This can be corrected by using suture techniques to narrow the tip cartilages and cartilage grafts to increase projection (the distance at which the nose projects forward from the face). Others are also bothered by the width or flaring of the nostrils, particularly while smiling. The nostrils are brought in with Weir or sill excisions at the time of your rhinoplasty surgery. 

As for recovery after rhinoplasty, most patients look quite presentable by day 10 after surgery to return to work or social situations although this can vary by 1-2 days depending on the individual's bruising and swelling tendencies. Most people are able to work from home and do most activities by day 3 after surgery. Pain is usually mild and prescription medication is typically required for 3-4 days. I usually advise waiting 2 weeks before resuming vigorous exercise. 

Best Regards,

Dr. Mehta

Implant options for Asian rhinoplasty include silicone and Gore-Tex, which are the most commonly used materials: SiliconeThe most popular implant material in Asia, silicone is inexpensive, easy to use, and produces good aesthetic results. Silicone implants come in various shapes and can be placed on the dorsum of the nose. Gore-TexA porous implant that's becoming more popular in Asian rhinoplasty. Gore-Tex implants are stable, have a lower risk of extrusion than silicone, and are less likely to cause capsule formation. However, they decrease in volume after insertion and are more difficult to remove than silicone implants. Cadaver tissueA third option for Asian rhinoplasty is tissue from a cadaver, which can be irradiated to remove bacteria and viruses. The tissue can be cartilage or dermis (skin). In Asian rhinoplasty, dorsal augmentation is often necessary for patients with a low nasal dorsum. The amount of augmentation needed is usually more extensive for Asian patients than for Caucasians

As in many asian rhinoplasty cases, we discuss improving tip support, narrowing the nostrils (alar base reduction) and also dorsal augmentation. As mentioned, your options are augmentation using your own ear or rib cartilage, or a synthetic implant such as Goretex or Silicone. Implants can shift or extrude over time, and so for this reason I prefer a conservative dorsal augmentation with ear cartilage - if this is something you seek.
Discuss this with your surgeon carefully and good luck!!

I agree with Dr. Lee, there is no better alternatives than your own tissue.  However, her options include your own cartilage or donor cartilage or a silicone implant.  The silicone implant as you pointed out should be the last choice because it's really only practical and patients who want moderate changes to the bridge and have thicker skin.  The patient who has thicker skin can have that silicone implant for a very long time and it want show through.  If your skin is a little bit on the thinner side for an Asian the implant tends to show.Chase Lay, MD