If we're doing a major reconstruction, especially if we're building up the dorsum or an ethnic rhinoplasty, then we like to use the patient's own material. And what I like to do is do something if I'm building up the dorsum, for example, I'll take some tissue from the scalp called fascia. I'll take cartilage whether it's from the rib, ear or inside the nose, the nasal septum. We'll dice it up. We'll make it into almost what we call a burrito or a D.C.F., diced cartilage fascia implant, and we'll put it right here. So, some of the doctors will use silicone implants in the nose. I'm against anything that's foreign in the nose. I feel that with time that will reject and stick out. I've had patients have implants stick out here, here, inside the nose. I don't like anything artificial. I'm looking at some notes I wrote about this and by the way, with using synthetic implants, called an allograft, there's a heavy risk of extrusion, infection, deviation of the implant. And one of the things too that I really try to do is I focus on the actual patient's, ethnicity, the facial features. I listen to the patient to really hear what they want. Sometimes I can't give them what they want or I disagree with what they want. So, it's really, really important to make sure you know what you're doing and to make sure the patient understands exactly and have great realistic expectations, it's important. Other doctors probably do that, but I'm just giving you some of my thoughts.

This is actually something that I do want to say. It's probably different since I'm a revision rhinoplasty specialist. So, a patient goes in to have a rhinoplasty. In general it's a deconstructive rhinoplasty where you're taking stuff out of the nose. You're bringing down cartilage, you're removing cartilage, you're bringing down humps, bones, you're narrowing it. The problem with doing that, if you don't make the smaller structures of the nose stronger, it will collapse. Whether it collapses here, whether it collapses in the middle, whether it just collapses this way, loses support. All these will cause nasal obstruction and a poor aesthetic result which looks like you've had a rhinoplasty, like a pinched nose or over-rotated nose. So I take this into account when I'm performing the first rhinoplasty so that hopefully these issues won't occur.

Rhinoplasty Approach to Implants, Ethnic Patients, and Revision Work

Dr. Paul Nassif explains some of his considerations when completing a rhinoplasty procedure in order to produce a nose that is healthy, strong, and aesthetically pleasing.