Rhinoplasty or nose surgery performed on most Caucasian usually involves some sort of reduction in the size of the nose. In particular, the nasal hump, or the large nasal tip is reduced.
On the contrary, rhinoplasty for most Asians and African-Americans involves enlargement or augmentation of the nose! In these cases the flat nasal bridge is heightened or the projection of the nasal tip is increased. This requires a different type of rhinoplasty, one that involves use of nasal implants.
Nasal implants are generally used to augment the nasal dorsum or bridge. Many Asians and those of African descent don’t have prominent noses and at times are deficient in the height of the nasal bridge. In addition to wanting to enhance and balance their facial features, they often complain that their glasses slip off their nose because they don’t have a strong nasal bridge!
Esthetically speaking, lack of nasal dorsal or bridge height tends to make the nose look short and fat. It also makes the eyes appear too far apart. Finally, lack of forward nose projection also tends to make the face look too flat and round. Augmentation of the nasal bridge will help elongate the nose and gives the face a more refined and balanced appearance.
Most plastic surgeons prefer to used natural material for nasal augmentation, especially that from the patient themselves. This material is called an autologus graft, and is often harvested from the nasal septal cartilage, ear cartilage, ribs, or bone. While autologus grafts have the advantage of better acceptance by the patient’s body and less chance of infection; they do partially re-absorb or shrink. Besides requiring added surgery to harvest these grafts from a patient’s body, often the amount of tissue available for harvest might be limited and not enough to achieve the desired augmentation. On the other hand, synthetic grafts or implants are abundant and come in a variety of shapes and sizes. They don’t require added surgery to harvest a graft, and don’t re-absorb or shrink after implantation. Unlike autologus grafts, synthetic nasal implants carry a higher chance of infection or extrusion. These implants are typically made from Silicone, Gortex or PTFE.
For many years, a “one size fits all” approach was taken to nose reshaping, and this also applied to the type of implants that were used. “Caucasian” implants were used on all patients.
Today, however, cosmetic surgeons tailor implants according to specific facial characteristics of various ethnic groups, including African-Americans, Hispanic, and Asian patients. For example, an implant used for an Asian is usually slimmer and smaller than one used for a typical African-American.
A skilled cosmetic surgeon will choose the appropriate implant size and shape, and might even carve and modify them to customize it for the patient’s ethnic traits and specific facial features.
This is a procedure that should be performed only by a highly skilled plastic surgeon, with experience in ethnic nasal surgery or rhinoplasty. Generally, the surgery involves the creation of a nasal pocket for insertion of the specially designed implant. The incision is made inside the nose, with dissection along the dorsum or top of the nose to create the appropriate space for the implant. Rarely, sutures are used to hold these implants in place; instead a tight fit pocket will hold in the nasal implant in the appropriate place. After surgery, the implant is kept in the correct place by wearing a nasal splint for a week.
Besides augmenting the nasal dorsum, often times, the flare of the nasal ala or the nostrils are reduced. This is accomplished by making an incision in the nasal alar crease, removing excess ala, and reducing the size of the nostril opening.
Sometimes nasal “strut grafts” are used as a “post” to increase the height and projection of the nasal tip. Other times, grafts are used in the pre-maxilla, or the area between the nose and the upper lip, in order to reduce the appearance of a sunken mid-face.
Nasal augmentation is an outpatient surgery that can be performed under sedation or with general anesthesia. The procedure takes about one hour, and usually the patient can be back at their usual activities within one to two days.
In general nasal augmentation is a very safe procedure. Typically, the nasal implant surgeries that carry a higher risk for complications are revision surgeries. It is not unusual to encounter people in such circumstance who have had a history of multiple nasal surgeries. In these instances the circulation to the nasal skin is sub-optimal, thus there is a higher chance for implant extrusion or displacement, infection, skin breakdown, and scarring. The best way of minimizing complications with nasal implant surgery is to have realistic expectations, use autologous grafts when feasible, and to seek a plastic surgeon who has had adequate experience in nasal implant surgery.
Dr. Younai is a Board Certified Plastic & Reconstructive Surgeon with experience in all aspects of Facial Cosmetic Surgery including Nasal Augmentation with Nasal Implants, Facelift or Rhytidectomy, eyelid surgery or blepharoplasty, neck lift, forehead or brow lift, rhinoplasty, etc. He is skilled and experienced in all techniques of Nasal Augmentation and Implant Surgery and strives to create a face that is harmonious and natural looking. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, recovery course, as well as what to expect after surgery. You will also have an opportunity of seeing and trying on different types of facial implants. At that time Dr. Younai will also show you before-and-after pictures of other patients with Facial Implants, such as Cheek, Chin, Jaw, and Nasal Implants.
Our center also includes the Regency Surgery Center which is a state-of-the-art outpatient surgery facility certified by Medicare and accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc., (AAAASF).
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