The Asian nose is sometimes lacking in height and commonly has a broad and fleshy tip. This can be improved with various methods. These include:
1. Injection of filler or fat graft into the bridge of the nose
2. Surgical augmentation using an implant
3. Surgical augmentation using a implant or cartilage graft with tip refining procedures
Injection of filler or fat into the bridge of the nose
A number of patients request a quick and simple augmentation of the nasal bridge using tissue fillers. These come in syringes and can be injected in the clinic for an instant result. The fillers come in different viscosities and with different duration of effect.
One limitation is that fillers are best used in the bridge of the nose where the filler is placed between the bone and the skin for an optimal result. In the tip, the filler can spread out and make a bulbous nasal tip more bulbous. This is not desirable. Another limitation is the fact that these fillers are not permanent. For this reason, some patients use fillers to “try out” a look before proceeding to more permanent solutions.
Fat graft from a patient can be used in a similar way and has the advantage of being long lasting or even permanent. However, this is more complex. It is done as a day surgery and there is a separate donor site needed for harvesting of the fat.
Surgical Augmentation using an Implant
A permanent augmentation of the nose can be obtained by insertion of an implant into the bridge and tip of the nose. This is done as a day surgery under local anaesthesia, intravenous sedation or general anesthesia. The scars are not visible as they lie in the nostrils. The implants can be made from Silastic, porous polyethylene or even be cartilage grafts taken from the patient.
This is a surgery and has a higher risk than the filler procedures. The advantage is that the change is permanent and the fact that both the bridge and the tip can be augmented and refined. The downtime is one week as the skin of the nose is taped up after the procedure.
This is sometimes combined with narrowing of the nostrils called an alar cinch and other tip refining procedures. This is individualized according to each patient’s needs.
Surgical Augmentation Using an Implant or Cartilage Graft with Tip Refining
A surgical augmentation can be combined with an open rhinoplasty, trimming and stitching of the alar cartilages and insertion of a cartilage graft to the tip. This cartilage graft is usually taken from within the nose so that there is no additional scar. This gives the best result in terms of augmentation and refinement of the tip. Although there is a scar in the area between the nostrils called the columella, this heals well and is not obvious.
This is done as a day surgery under intravenous sedation or general anesthesia. There is one week of downtime as the skin of the nose will be taped up after the procedure.
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