Can only tip plasty and alarplasty be done without bridge augmentation for Asian nose?

Question

My biggest concern is flat & wide nasal tip with flaring of alar (piggy nose). PS suggested rib graft rhinoplasty and alar resection. I’m unsure if he’s doing DCF/the entire piece/diced cartilage without fascia for dorsal. I want to avoid “invasive” surgery like harvesting rib graft. He suggested tip plasty with ear cartilage & alar resection. Will I be able to see good result with just tip plasty & alarplasty alone? And Is the risk of warping high for diced rib cartilage without fascia? Thanks.

Edwin Kwon, MD, FACS · Answer

You can certainly do only a tip and alarplasty, but you may be limiting yourself in what you can achieve for your nose. If your bridge is also low and you do not augment the bridge, you are limited in terms of how much projection you can achieve in your nasal tip due to the resulting differential in height between the tip and the bridge being too great. One of the main techniques to refine the tip is to increase the projection, however, if you increase your projection too much without altering your bridge, you will have a "Pinocchio" tip. This can be mitigated somewhat with a graft on the supratip break but will give you a curved profile (which some people prefer).

If you are concerned about the rib harvest, you can utilize a cadaver rib with comparable results to using your native rib without the extra surgery. Using an en-bloc rib poses a higher risk of warping as there is some memory in the rib. Dicing the rib cartilage removes the memory in the cartilage.

If you are concerned about the rib harvest, you can utilize a cadaver rib with comparable results to using your native rib without the extra surgery.  Using an en-bloc rib poses a higher risk of warping as there is some memory in the rib.  Dicing the rib cartilage removes the memory in the cartilage.

Seckin Ulusoy, MD · Answer

Greetings;
In Asian rhinoplasty surgeries, it is usually necessary to use a cartilage outside the nose, because usually there is insufficient cartilage in the front of the septum. At this point, the only solution is not to use your own ribs or silicone implants. However, as an alternative to this, we can also use cadaveric irradiate rib cartilages. Of these, Tutoplast uses the trademarked product very intensively on our revision patients. Alternatively, this may also be considered, and there are also fascia products of the same company. Bending problems in the use of all rib cartilages do not occur when cutting with the "oblique split" method. In addition, we successfully use the cadaver fascia product of the same company to many of our patients.
Thanks for your interest

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos and I would go on some complimentary consultations with experts that use digital photography to show you what can be accomplished with your nose and how it might be done and then look at photos of similar patients and become fully informed about the desired procedure. That said you appear to be a good candidate for a tipplasty and ala reduction

Dr Corbin

Dr Corbin

Can only tip plasty and alarplasty be done without bridge augmentation for Asian nose?

Answers (3)

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