Ethinic Rhinoplasty FAQ

Q: Is a silicone implant the only way to achieve a sharp tip in Asian rhinoplasty? What kind of cartilage/implant/strut is needed to achieve that profile?

A: For Asians, cartilage grafts are the best way to shape the tip of the nose during rhinoplasty. Though silicone is commonly used in Asia to raise the nasal profile, commonly referred to as an L-Strut; the problem lies in the longevity of the material. Silicone (silastic) is my least favorite. Silicone can become infected and even erode through the skin or into the nose decades after it is placed. It can also shift and if you get hit in the nose it can poke out years after surgery. The likelihood increases if the tip is also made of silicone as well.

Other options for implants include:

• Cartilage from the septum
• Ear cartilage - They do not work as well in the bridge because the pieces are short and curved
• Rib cartilage - I think it is too extreme for a rhinoplasty
• Gortex
• Medpor

My preference is to use Gortex. However, ultimately it is a discussion you need to have with a rhinoplasty specialist.

Q: Does the "preferred" shape for Asian men differ from Caucasian men?

A: Asian noses, or any Ethnic noses, can be improved but still should retain their ethnic character. There is significant variability in Asian noses and ethnic noses in general from different countries and regions. It is very difficult to pinpoint a "typical" nose. In my practice, the most common improvements that are performed are:

• Augmentation of the bridge of the nose
• Strengthening and shaping of the tip of the nose with cartilage grafts.

The most important goal I have is to maintain a nose that looks natural on your face and not strive to create a "Caucasian" or "Typical" nose.

Q: Can a small bump(s) be removed without the need of a rhinoplasty? And is this procedure minimally invasive and less costly? Also, will you need to "break my nose"?

A: Removing any bump or any part of rhinoplasty, for that matter, should never be considered minimally invasive in my book. It is still surgery and needs to be taken with the same seriousness. In terms of cost, that is hard to judge without a consultation. However, if it is only a bump, it will cost less than undertaking a full rhinoplasty. Breaking the bones in the nose depends on how much of the bump is removed. If a significant portion of the bump needs to be removed, breaking the bones will probably be a necessity. Breaking the bones is done precisely and delicately with micro-osteotomies and not as violent as it sounds like or as it seems on TV. Doing these osteotomies actually makes the procedure more precise and usually yields better results.

There are also minimally invasive alternatives. Fillers can be used to fill the area above and below the bump.

Q: Is there a different approach when it comes to "African American" rhinoplasty?

A: Generally, African American noses can be characterized as having thick skin and thin weak cartilages (these usually go together). Patients that exhibit the opposite characteristics, thin skin and strong cartilages, carving the tip cartilage and using sutures is usually enough to get a fine sculpted tip.

In African American noses, we do the opposite. Since removing cartilage will only make the tip softer and even more round, I add stability by adding a strut of your own cartilage to strengthen the tip of the nose. Next, we create definition and the appearance of a smaller tip by pressing into the thick skin with a shield graft. Although the skin can be thinned out, with the use of grafting and strengthening the tip, a more natural look can be achieved.

Other common procedures are:

• Augmenting or raising the bridge of the nose
• arrowing wide nostrils

Q: I am an African American and I have a wide nose bridge. Can a rhinoplasty help a wide nose bridge?

A: There are many ways the bridge of the nose can be narrowed. The nasal bones makes up the upper 1/3 of the nose. However if the nasal bones are already small, as is common in African American noses, narrowing them often has little to no effect. Sometimes raising the actual profile of the nose by adding a dorsal graft can give the appearance of a narrower bridge.

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