Thick, Tight Skin with Short Columella-Is L-shaped Implant the Only Choice for my Nose?

I am an Asian male. My doctor said that besides the thickness, my skin is also very tight. Therefore, he discouraged using septal cartilage for the tip, saying that cartilage is not strong enough to hold my nose tip and may collapse in long term, causing deformities. Moreover, because I had a short columella, the height of my nose bridge can only raised limitedly if I choose septal cartilage for the tip. He suggested L-shaped, which I am really skeptical about. What do you suggest?

Doctor Answers 5

Options during Asian rhinoplasty

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Augmentation with rib cartilage can give you significant results.  A combination of a septal extension graft to lengthen and project your nose, and a DCF (diced cartilage fascia) to build your bridge, will give you a very nice change.  

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Asian nose

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In Asian noses where the skin is tight and the columella short it takes a strong structure to add projection and definition. Even then the result may be limited by the inability to stretch the skin.  Synthetic implants are seductive and tempting because they have perfect shape, are strong and come out of the box ready to use without having to harvest anything. Unfortunately they put you at high risk of infection, rejection or skin erosion which can be a disaster for you. Septal cartilage is great but you may not have enough to achieve the desired result. Your own rib, or irradiated donor rib cartilage will be a safer option for you. Think long term. a little more recovery time and discomfort now for a lifetime of safety or quicker and cheaper but lifetime risk of problems. Ultimately it's your choice.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Do not use an L shaped nasal implant

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I have performed Rhinoplasty for over 20 years and have written numerous blog and internet posts urging people not to use the L shaped silastic nasal implants to build up the nose.  I know this is a common practice in some Asian countries and communities but read the available information, on the internet about L-shaped nasal implants, extruding through the skin.  This is not new information but has been around for years.  I recall reading a scientific paper, as a resident at USC in the 80's, that stated100% of these L-shaped nasal implants eroded through the skin within 15 years of placement.

 I remove the L shaped section of these implants whenever I have patients who had them placed elsewhere.  The L section also widens and distorts the nasal tip as it is placed through the middle of the nasal tip cartilages requiring later tip repair upon removal.  The L-shaped nasal implant is easy and quick to place and this is the main reason, IMHO, that it continues to be used....despite much better long term options.

 IMHO, a much better option would be a conchal cartilage ear graft to the nasal tip for strength and refinement coupled with a straight silastic (no L section) to raise the nasal bridge.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

No L strut

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Tight skin that needs augmentation is a tough combination.  But an L-strut is always a problem.  The problem is that the greatest tension in the nose after surgery is at the point of the L--right at your tip.  Eventually the silicone will erode through and need to be removed.  You cannot push a tip out under stress.

Tip grafts are a better idea, and can almost always be made to work.  They allow the tip to move normally and do not put excessive tension on the skin if done well.

Your instincts are right on.  Be careful. 

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Rhinoplasty in the Asian male.

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What you describe is something that would require photos for a good opinion. Skin envelope often limits results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.