The ENTific Centre
Principles of Asian rhinoplasty
The final result of any Asian rhinoplasty procedure is ultimately a function of the client's preference, the local/racial aesthetic sense, the available donor/synthetic materials and the surgical planning and execution. The surgeon is often faced with the dilemma of choosing from the different techniques and available materials in achieving the desired result for his client with a minimal complication rate.
As mentioned previously, the typical Asian nose lacks tissue in general, both internally as well as externally. The principle of approach for the Asian rhinoplasty is to augment the nose i.e. to increase its radix height, its dorsal height and to project the tip. Tip up-rotation and excessive nostril show should generally be avoided as discussed in our later subchapters. In order to add to the existing structure, additional augmentative implant materials are required. A list of augmentative implant solutions are listed below. This list is illustrative and not intended to be exhaustive; it will change as improved product technology comes to the market.
Fascia e.g. temporalis fascia, tensor fascia lata
Bone eg iliac crest, calvarium
"Diced cartilage" in temporalis fascia
Tutoplast (Processed human fascia)
Permacol (Porcine dermal collagen)
Medpor (Porous polyethylene)
Goretex (Expanded polytetrafluoroethlyene)
NASHA (Non-acidic synthetic hyaluronic acid)
PAAG (Polyacrylamide gel)
Autologous cartilage is generally preferred with their lower complication rates. Donor site morbidity and resorption are issues to be addressed with the patient before surgery. The nasal septal cartilage is regarded as the best implant option for rhinoplasty as a structural or camouflage graft. However in the Asian patient, there is usually insufficient septal grafting material available to achieve the augmentation desired.
So the surgeon tackling Asian rhinoplasties should familiarize themselves with alternative autologous conchal cartilage, autologous costal rib and synthetic material solutions. A single-material solution may not suffice and a combination-material solution may be necessary. The different options are discussed in more detail below. The alloplastic materials can also be categorized as above based on their respective consistency. Their rigidity or softness confers different structural and aesthetic outcomes, and understanding these properties further shapes where they are best applied in the Asian nose