Do I have to have a implant for my rhinoplasty to be successful?

Question

I have consult in a couple weeks and I been researching a lot about ethnic rhinoplasty. I see a lot of surgeons use implants for their rhinoplasty. I really don't want a implant but I do want a successful procedure. My nose is large and wide and I just really want a smaller nose without taking away all my ethnic features!

Scott Trimas, MD · Answer

Judging from your photographs and having performed many rhinoplasties on both African American noses and Asian noses, I seldom if ever recommend implants in a primary rhinoplasty. For augmentation of the nose, I recommend septal cartilage, ear cartilage and rib cartilage as a better option for both the short term and long term. Implants can be used but they carry a higher infection risk. Also, narrowing can be done by reducing the base of the nose and augmenting the tip region. Good luck in your area.

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for the questions.The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.In this regard, After having analyzed all the info. and photos provided to us, i recommend you perform an Open Full Rhinoplasty, includding narrowing of the nasal base and nostrils, with nasal bones treatment (controled fracture) and alar + triangular nasal cartilages re-shaping.With this procedure you get a delicate nose, better harmonize with your other facial features.Respectfully, Dr. Emmanuel Mallol.-

Kenneth Hughes, MD · Answer

You do not need an implant.  You may have a nice result with tip refinement, alar base reduction, and bridge narrowing.Kenneth Hughes, MDBeverly Hills, CA

Thomas Trevisani, MD · Answer

Ethnic rhinoplasty- presents unique set of challenges. Some areas of the nose need to be augmented and some reduced. The augmentation can be an implant, or your own tissue- for example rib cartilage graft, or a bone graft. Therefore, you can have your improvements without an implant- although, the implant may be the most direct method.

Barry L. Eppley, MD, DMD · Answer

Part of achieving the perception of smaller nose is to add some height to your low and wide nasal bone. While an implant is the simplest method to achieve this effect, it is not the only method. Rib cartilage is the other choice which is why implants are more appealing to most patients.

Aaron Stone, MD · Answer

Any answer is limited by your submission of only a frontal view. By a smaller nose I assume you mean a narrower bridge and tip. The broadness of the bridge is due to flatteniing and deficiency of the nasal bones. The standard approach to narrowing it is moving the bones toward the midline and augmenting the bridge with bone, cartilage or synthetic material. I doubt you would have enough ear cartilage or septal cartilage to give you sufficient graft material so you will need rib cartilage or cadaver cartilage. If you go with bone the options are olecranon (used more in the far east), iliac crest or outer table of skull (more common in the US). If you go with synthetic material your options are goretex, medpor or silicone. Each of these options has its own pros and cons and you should take an active part in choosing the augmentation material with as much care as choosing your surgeon. You also need to take into account that different surgeons are more comfortable and more skilled with specific augmentation materials so choosing a surgeon and choosing the material go hand in hand. Afro-americans can also have problems with scarring such as keloids at donor sites so you need to take that into account if you choose to use your own tissues.With respect to the tip the usual alar base reduction consisting of removal of skin at the outer base of the nostrils may be insufficient in Afro-americans if the nostril rim is wider than 3 to 4mm. Your surgeon should be able to easily address that.I can understand your wanting to maintain your ethnic features which would likely mean keeping your round tip. Your other options could include not narrowing the base to the usual 3.2cm. If your current intercanthal distance is 3.2cm then your alar base width would be 5.6cm which gives you plenty of room to work with. There is no reason why you could not narrow it to 4cm if you wanted it. The best way for you to decide what you want is have your surgeon do imaging with various parameters. You would, of course, have to realize that this is not an exact science and the imaging cannot be an actual guaranteed result. I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

William Portuese, MD · Answer

To narrow a wide nose requires osteotomies placed in the nasal bones, a tip rhinoplasty, and an alar plasty to narrow wide nostrils. It's also helpful to use the patient's own cartilage for grafting purposes along the bridge line to build up the height of the nasal bridge line.

Jeffrey Marvel, MD · Answer

I would offer you tip refinement and alarplasty otherwise known as alar base reduction procedure.  You have a very wide nose, but it could be narrowed significantly.   The tip needs more projection and definition.  This will be difficult because I imagine that you have thick skin.  This is done by suturing your cartilages in a more projected position.  You would get more pronounced tip projection with an implant, but longterm there is more risk of infection and extrusion.

Sean Freeman, MD · Answer

dillionMom, no implant in my office. You would need added cartilage if that's what you mean by an implant but I would not recommend anything but your cartilage or perhaps a cadaver rib graft. Do your alar rims after your rhinoplasty for a better scar and more predictable results. See an experienced facial plastic expert. Good luck!

Jeffrey Zwiren, MD · Answer

Need a lateral or side view to assess the dorsum of your nose to understand if you need a nasal dorsal implant.  It is best to avoid a silicone  implant if you can due to high risk of infection

Do I have to have a implant for my rhinoplasty to be successful?

Answers (12)

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