Unusual Asian nose; high bridge but wide nasal base and tip. What procedure would be best? (Photo)

Hi bbylinx,

It's a very astute question, as you are happy with the projection of your dorsum and tip. One of the nuances of Asian rhinoplasty that distinguishes it from other primary rhinoplasties of a reductive nature is the combination of weaker natural tip support relative to skin thickness. The techniques used differ in that during Asian rhinoplasty it's often necessary to add more support to the framework of the nose to create the definition that will show through the thicker skin. Typical rhinoplasty techniques may actually result in a paradoxically more bulbous nose, and removing cartilage and soft tissue can weaken the tip support. During Asian rhinoplasty it would be possible create a smoother, smaller nose.

The concept of an 'ethnic' or 'asian' rhinoplasty specialist is pure marketing. When there is a thorough understanding of the anatomy and its impact on nasal shape and function, then anyone's nose can have a successful outcome to a rhinoplasty surgery. There is nothing unusual about your nose. The part of the bridge closest to your face, the radix, is actually low, common among those with asian genetics, and it represents the bony portion of your bridge. The cartilaginous part is arguably slightly high and definitely wide. The tip is slightly blunted, but most importantly it doesn't transition smoothly along the sides towards the ala. A structural rhinoplasty should be designed to address each of these issues. The cartilaginous septum should be marginally lowered with adjustment to the lateral cartilages that are bonded to it. This will narrow and lower the bridge where it is needed. An onlay cartilage graft place on the radix will complete the 'straightening' of the bridge. The tip complex should be supported with a rigid septal extension graft to secure it's desired position (to be determined during an in person evaluation), and reshaped with suture technique. Alar rim grafts should be placed to smooth the transition from side tip to ala. Finally, small excisions of alar base skin will take some of the flare out.

Based on your photos, your bridge may be a bit over projected, relative to your nasal tip. And the height of your upper bridge from your lower eyelid to your upper eyelid maybe a drop too low. Please consider meeting with several reputable rhinoplasty specialists so you can discuss your concerns and see what might be best for you moving forward. Thank you for your question. Sincerely, Dr Joseph

Your bridge couid be lowered slightly and the bones narrowed. Also consider alar wedge excisions to narrow your nostrils

Really not that unusual. You mostly need tip support so that the bottom of the nose is more defined and does not flare with with smiling. You also need radix augmentation and some lengthening of the bottom of the nose to correct columellar retraction. All in all these are common features of Asian noses.

You have a lower set Radix, which is very common in asian patients, however you also have a dorsal hump that is predominantly cartilaginous in nature. The best strategy to address this, in addition to the other concerns you mentioned (bulbous tip, wide nasal base), would be to reduce the dorsal hump, and possibly mildly augment the radix with cartilage graft. For the tip, a combination of cartilage resection and suturing methods could be used to refine and narrow the tip as well as adjust tip rotation and projection if you desire it. Finally, alar base resection would allow for narrowing of the alar bases. These are common techniques employed in many rhinoplasties, not just "asian rhinoplasty". A well trained surgeon who has specific training in rhinoplasty should be able to accomplish this or you.
Sean Fisher Aesthetic Plastic Surgeon

A closed rhinoplasty approach can accomplish shaving down the dorsal hump, narrowing the bridge line, and refining the nasal tip with all the incisions placed on the inside of the nose.