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Thousands of rhinoplasties are performed in the East on Asian patients by inserting a piece of silicone molding to augment the nasal bridge and define, project and elevate the nasal tip. Those typically do very well, but the implant can cause some problems with infection and extrusion. Another option is using ear or septal cartilage, or even rib cartilage.
The best materials are from your own body, usually your ear cartilage and or septum from inside your nose. These materials are used to reinforce your native cartilage. I would not recommend using any other material - too many risks when your own tissues are readily available.
For more than 30 years I have used the patient's own cartilage for grafting. That way you have nothing foreign in your nose.
In the nose, I prefer to use cartilage from your own body to build up the tip or dorsum. I have seen many complications from patients who have had foreign body placed in the nose by others that have required revision rhinoplasty. My recommendation is to have the rhinoplasty done right the first time so you don't have to have a revision.
Options for nasal augmentation in Asian rhinoplasty include synthetic materials like silicone and Gortex or natural materials from the patient's own body like septal cartilage, auricular cartilage or costal cartilage (from the nose, ear or rib). An L-shaped silicone implant may change the tip but with the risk or excessive pressure to the skin envelope or a late stage infection. Gortex is used typically for dorsal augmentation. Cartilage grafts are more "natural" and can be carved from cartilage harvested from different sites. There is a lower risk of infection. My personal preference for the tip is a double stacked graft constructed from auricular cartilage.
The best donor tissue to increase tip projection in an Asian nose is the patient's own cartilage. Many times narrowing of the nasal base will improve the final result.
IMHO after performing Rhinoplasty for over 20 years, conchal ear cartilage (from the back of your own ear) works the best to strengthen and shape the nasal tip, hands down.
Injectables for augmenting the bridge does not yield attractive results. The materials that are safe to use in the nose do not "stack" very well and have a propensity to slide down the sides, like trying to build a mountain using sand. This results in a wide and blobby appearance,...
Personally I feel the safest and most-natural appearing results come from using your own tissue as grafts. Silicone and Gore-tex implants are rarely a permanent solution because they carry risks with them regardless of how long they are in place.
Absolutely, yes it can be done. It is a direct excision that removes the central portion of the alar wall. This results in a thinner ala. The scar heals quite well as long as the incision has been made cleanly and not at an angle.
There is really no question that your own cartilage (septal, auricular, or rib) is by far the safest and most preferable material for use in augmenting the nasal structure in Rhinoplasty. Non-native materials are generally utilized only when there is a lack of autogenous cartilage...
In Vancouver, where we have a large Asian population, changes of the nature you describe are quite commonly requested. Your requests are very reasonable and this if often what patients achieve with augmentation rhinoplasty (see the link below for more information). In your case, you will require...
In general taping helps to efface the nasal skin envelope back down on the underlying nasal framework. Start at the top of the bridge and work your way down with overlapping pieces of tape until you reach the tip. Your surgeon may instruct you otherwise if there is a specific issue...
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