I'm of mixed Asian-Caucasian heritage, and I want my nose to look more Caucasian rather than Asian. I really dislike how bulbous it is and how wide it is, especially when I smile. I just want my nose to be slightly smaller and not as round. I can tell that the skin is very thick, so I know it is much more difficult to make my nose pointier. I would rather my nose be fixed by performing a closed rhinoplasty. Is it possible, and what should be done to make my nose look as natural as possible?
Can my Bulbous Nose Be Fixed by Using a Closed Rhinoplasty? (photo)
Doctor Answers 7
Can My Hapa Haole Nose Be Improved Using Closed Rhinoplasty Techniques?
I personally use the closed rhinoplasty for all my Asian and hapa haole noses. Since you have a slight flair of your nostrils, removing wedges first before the main part of the rhinoplasty allows the surgeon lots of room to do a closed rhinoplasty. The lower lateral cartilages that are the main portion of the tip of your nose need to be resected slightly more than in a pure Caucasian nose. Cartilage from your ear can be brought up through your upper lip to the tip of your nose. This will give both a tip projection and bring down the little piece of skin between your nostrils (columeller show). Since your skin is relatively thick, some additional cartilage from your ear could be added on top the cartilage in your columella to give a tip graft (the two together are referred to by George Peck, M.D. as an umbrella graft).
On lateral view, your maxilla (the bone under your nose) appears to be slightly retrusive, and here I would put a peripyriform implant (first described by Bob Brink, M.D.).
As you can see, this is a technically challenging surgery, so I recommend you pick a Board Certified plastic surgeon experienced in both the Asian and hapa haole rhinoplasty.
Radix augmentation to improve profile and frontal views
In order to create a more narrow appearing and slightly more white appearing nose, raising the bridge of your nose above the hump, will be a crucial step. This will give you a more feminine appearing profile from the side, while making your nose appear more narrow from the front. Your tip refinement can be increased through a closed approached, and alar base modification will help balance your nostrils with the middle and upper third of your nose.
Closed rhinoplasty can be as effective as open rhinoplasty.
Based on your pictures, you may benefit from removing a dorsal hump, tipplasty to increase the tip projection, improve the tip asymmetry, refine the bulbous tip, and alarplasty to reduce the alar flaring and correct the asymmetry of the nostrils.
Although it may be technically more challenging, closed approach rhinoplasty can achieve all of the procedures mentioned above.
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Asian rhinoplasty, tip rhinoplasty.
You've clearly done your research. As you mentioned, the amount of tip refinement that can be achieved is limited to a large extent by the thickness of your skin. That being said, you can achieve increased tip refinement with either a closed or open approach. A greater amount of refinement is probably possible with the open approach vs. the closed. Both approaches can give you a natural appearing, attractive nose. The best way to achieve that is to find a surgeon experienced with Asian rhinoplasty and spend the time to make sure your vision is in line with your surgeon's.
Can my Bulbous Nose Be Fixed by Using a Closed Rhinoplasty?
Either an endonasal (closed) or external (open) approach could be used. I would recommend the open approach as the results tend to be more predictable, in my experience. The incision does heal very, very nicely. If you were interested your profile could also be straightened as well as your nasal bones to make your nose more straight from the front view. I hope this information is helpful.
Stephen Weber MD, FACS
Weber Facial Plastic Surgery
You could certainly use either a closed or open approach, but Asian nasal skin tends to be thick and require a lot of tip support to get the desired definition...I would add a tip graft to optimize the tip appearance. The approach, closed or open depends on the surgeons comfort level.
Bulbous Nose and Alar Base Reduction
Your request is quite common in my practice. Many asian patients experience the flaring of the nostrils when smiling and wish that have that reduced along with enhanced definition of the nasal tip. The most important thing is that your results still look natural and balanced with the rest of your face and to preserve the functionality of your nose.
Generally speaking, to get the tip defined and symmetric the way you envision, an open approach is recommended. If you are concerned about scarring, the scar heals well and is virtually unnoticeable when completely healed. We use a special regimen to minimize the scar postoperatively. Please consult with a board certified specialist who can assist you in achieving the results you seek.