Ultra soft silicone advantage against other implants? Need to replaced after a few years? Asian Rhinoplasty - Malaysian (photos)

Question

I dont want a pointy tip I just want my alar base narrowed and some but not a lot of projection. I have thick skin. what I want is only an alarplasty since I can somewhat play with angles and make my nose look like it has a bridge in photos but the wide alar gives it away. Will the surgeon need to shave some bridge for the placement of an implant? that wouldn't be ok for me if I reject the implant and needs to be removed leaving an even lower bridge.

Donald B. Yoo, MD, FACS · Answer

First, I would caution you on the use of synthetic implants in your nose.  While they can provide good results for years - sometimes 20, 30 years - they are never a permanent solution and never become a viable part of your nose.  They also carry a higher risk of infection, migration and extrusion than using grafts made from tissue in your own body (autologous grafts). Based on your photos, it would be a mistake to simply perform alar base modification.  There is an important relationship between the proportion of the width of the nostrils relative to the width of the tip, and if the nostril width is reduced without addressing the width of the tip - it will appear even more bulbous in comparison.  Given the thickness of your skin, you will need some degree of tip projection to achieve a refined or "pointy" tip.  Without projection it will be difficult to see the changes made underneath the skin.

Charles S. Lee, MD, FACS · Answer

is not always possible to do without involving the tip area. Your nose is similar to many othe Aisan noses in that the tip is somewhat short - from a front view, the nostrils are slighlty overly visible. An alarplasty to narrow the nostrils will worsen this situation. To prevent what is called "over-rotation" countermeasures need to be taken at the nasal tip. Essentially a sort of backstop to prevent the nose from becoming too upturned. This may be more involved than you want to hear, but I would recommend not doing the procedure otherwise.PS I also notice that the nose widens upon smiling - you need reinforcement of the tip cartilages to reduce this effect. It's not that wide when you are not smiling.

Toby Mayer, MD · Answer

Silicone implants like all foreign materials can become infected and have to be removed. Therefore for more than 35 years of Asian rhinoplasty I have use the patient's own cartilage to raise the bridge and or tip along with a alar base reduction. The alar base reduction can be done by itself without anything else if you desire. See a very experienced searching for the best results.

Lily Lee, MD · Answer

My personal preference is not for permanent foreign body implants in the nose. That said, if you are looking for something modest and non-surgical, fillers work very well and can last over 1-2 years. I agree with you that alarplasty reduction would be the only way to reduce the flare in your nostrils and narrow the base. The good news is that alarplasty is easily done in an outpatient setting without a long recovery time. Good luck!

Michael Elam, MD (retired) · Answer

Dear Heart88, Different surgeons use different techniques for Asian rhinoplasty procedures. Some surgeons will use implants and others will use the patients cartilage. This will also vary from patient to patient depending on the patients needs and desired results. You may have alarplasty in combination with the bridge projection or you may have alarplasty alone. An in office consultation and examination will help answer your questions. Best regards, Michael V. Elam, M.D.

Ultra soft silicone advantage against other implants? Need to replaced after a few years? Asian Rhinoplasty - Malaysian (photos)

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