In recent years, there has been a huge surge in the number of cosmetic surgery procedures performed worldwide, especially rhinoplasties. But the popularity of rhinoplasty is not just limited to the Middle East, which has traditionally been known to have the highest rate of rhinoplasty operations in the world, as rhinoplasty in now second to blepharoplasty regarding popularity in Asians.
Due to globalization and a thriving economy, more Asians than ever are now seeking cosmetic surgeries such as blepharoplasty and rhinoplasty.
What are the specifications of Asians?
Asians have thick skin, lower dorsum, wide and small nasal bone, low projection of tip, retraction of collumella, low radix, weak cartilage, scarce of septal cartilage, wide alar base and less refined tips.
If I compare Asian noses with Middle Eastern noses I could coclude that, aside from both having thick skin and less refined tips, they are complete opposites.
Middle Easterns usually have big humps, high projection of tip, big nasal bone and downward-pointing tips.
In Middle Eastern surgery, we as surgeons must remove the hump and cut the bone to mold them into a narrower bony part. We use septal cartilage to insert some form of graft in order to refine the tip. We also remove some tip cartilage to make the nose smaller. However, in Asian rhinoplasty we encounter another set of problems entirely.
1. There is no hump and the dorsum is low so we should augment the dorsum to increase the height of dorsum.
In order to increase the height of dorsum, surgeons apply different materials. In Eastern countries like Thailand and China, the most common material used are silicon implants (alloplast). Eastern surgeons feel more comfortable with silicone because it is very easy to use and mold, so silicon is the most common due to the ease of handling it.
But experienced surgeons don’t always like silicone. There are some complications regarding silicone which could lead to potentially disastrous consequences. These complications include infection, displacement, extrusion and capsular contracture.
In Iran, because of the higher rate of rhinoplasty than the rest of the world, it is not uncommon to encounter over-resection of the dorsum, which ends up in a ski-slope dorsum complication. These patients are suffering from low dorsums (like Asians) so they come to us to reconstruct the dorsum again. For these reasons, I have a great deal of experience in reconstructiom of the dorsum.
As opposed to Asian surgeons, we implement another technique to augment the dorsum.
I harvest the fascia from temple area and cartilage from the ear. I should mention that the scar is very small and so no one can see the scar.
Then, I dice the cartilage into tiny particles and I sew the fascia like a pillow. Afterwards, I fill up the pillow with the aforementioned cartilage and finally I put it on the dorsum under the skin. Through this method we could augment the dorsum from 5 to 10 millimeters. It should be noted that in this technique, patients do not experience complications like infection or extrusion like they do with silicone. The only problems with this technique are difficulty in harvesting the fascia and cartilage and how time-consuming it is in comparison to using silicone, which is so fast and easy.
I recommend all Asian rhinoplasty patients to ignore the silicone and use this method instead.
2. Asians are suffering from low projection and less refined tips. In order to increase the height of the tip, I use some graft to fortify the tip so I could overcome resilience of thick skin in Asians which results in a more beautifull and refined tip.
3. The base of the collumella must be fortified in order to treat the acute angle between upper lip and collumella.
4. If we increase the height of the nose tip, the nose will look narrower which reduces the rate of alar base reduction.
5. Because of small bone, Asians mostly don’t need osteotomy.
Through these techniques we could obtain the best result for Asian nose rhinoplasty.