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Asian rhinoplasty can be complex, and the approach usually differs from that in Non-Asian rhinoplasty. I have significant interest and experience in this area.
Depending on specific Asian cultural background, some or all of the below considerations may be relevant. A balanced, natural look is desired that must be in harmony with other Asian facial features. As in all rhinoplasty, some look for subtle changes while others want a big difference. Pre-operatively defining what would look best and what is possible through discussion and image morphing is essential.
The nasal bridge is often lower and flatter in Asians and is the most common reason this patient group seeks rhinoplasty. Augmenting the dorsal height is usually necessary; in some instances, this may need to be quite a significant increase. Augmenting can be done via several different techniques.
Except for the mildest of augments, I usually use costal (rib) cartilage to build up the nasal bridge. This would usually be as a single-shaped graft fixed in place and heavily camouflaged with soft tissue to achieve a natural, smooth look. This technique also dramatically enhances the brow-tip lines, an important nasal aesthetic goal but generally lacking when the nasal bridge is low and flat.
For lesser augments, I may use diced cartilage in fascia or perichondrium. The skin on the bridge is often thinner in Asians, and an augment needs to achieve a very smooth result. Many surgeons use synthetics (Silicone, Goretex, Medpore) to augment the nasal bridge. The use of synthetics is very commonly performed but does carry a higher risk of inflammation (leading to thickened or pigmented skin), infection and extrusion.
I prefer to use a graft that will be incorporated into the patients nasal structure and, once healed, will be a stable part of their living nasal framework. Costal (Rib) cartilage may be from the patient (Autologous) or Donor Cadaveric Rib Cartilage (Allograft).
Autologous grafts have been a mainstay for many years and usually provide good quality cartilage, although it can vary. I have used hundreds of autologous costal cartilage grafts as it is commonly needed in complex or revision rhinoplasty, which is a significant component of my work. The main downside is that removing a segment of one’s rib will be somewhat sore for 1-2 weeks following the surgery (sorer than the nose).
Allograft is now available in Australia and is an excellent alternative to autologous cartilage in graft quality and quantity. Allograft is important in Asian Rhinoplasty as often quite a lot of cartilage is needed for the reconstruction (Not just for the Augment graft), and often the amount available from the patient’s chest wall can be limited.
The Asian nasal tip may be broad, under-projected, lack definition, and covered in thicker skin. Strong structural techniques to increase projection and hold tip position are essential.
Increasing nasal bridge height and tip projection will tighten the skin envelope, and in many cases, this is the limiting factor in how much size the Asian nose can achieve with rhinoplasty. If strong tip techniques are not employed, the skin envelope will ultimately pull the tip in and down or twist it.
Refining/trimming tips can predispose to alar (nostril) rim retraction if not supported by rim grafts of some sort. Sometimes Asian tips require the creation of prominent structural tip-defining points to achieve better external tip definition through thicker skin.
Narrower nostrils are a common concern in Asian rhinoplasty patients.
The width can actually be normal but look wider as the nose is flatter or it can be truly wide and need addressing. Sometimes increasing tip projection with strong grafts will be enough to make the base look proportionately narrower (unaltered base looks narrower if the tip sticks out more) and sometimes the base still needs to be narrowed.
This is something that would be discussed during morphing, but the decision is only fully made during surgery as many factors need to be considered (such as skin tightness and nostril shape).
Asian skin can vary considerably in thickness and elasticity, as in every population. If a nose is relatively small and the skin tight, the amount of augmentation (how big we can make the nose) is limited.
Once all the grafts are placed to make the nose bigger the skin needs to come together and be closed without excessive tension. Frequently, the skin is the limiting factor in how large I can make a nose.
This can especially be so in revision cases that are more heavily scarred. Your skin features will be assessed and discussed before your surgery.
I encourage some patients to regularly lift and stretch the skin out over their nose in the weeks before surgery to maximise the augment possible. In some cases (especially revisions) this can be quite helpful.
In all rhinoplasty, it is essential to maintain or improve the nasal airway.
Techniques that weaken the nose or compromise the airways risk later revision surgery and a compromised aesthetic result may occur. Asian rhinoplasty is no different in this regard. Structural techniques are a mainstay in this group to achieve long-lasting results with good airways. Closed and preservation techniques have limited to no role.
Revision Asian rhinoplasty
This can be for all the same indications as non-Asian rhinoplasty, but there are a few more common problems.
The movement, infection or extrusion of synthetic grafts is not uncommon and, in this setting, generally needs replacement with cartilage grafts.
In small noses with tight skin, refining the tip by conventional means (Cephalic trim) without structural support can lead to very highly arched, flared, contracted nostrils that can be particularly complex to correct.
The tip can be challenging in Asian rhinoplasty with thicker skin and poor underlying natural cartilage support. Often a flatter, broader, poorly defined tip can result. Strong structural techniques are required to add projection and achieve the best definition the skin will allow.
Some or all of these issues may be relevant to your rhinoplasty.
No two noses are the same, and Dr Jumeau will tailor his surgical approach specifically to you.