Overly projected nose

Tip surgery becomes more popular in Asian patients. To overcome low and bulbous tip, many surgeons use a lot of techniques to modify the tip. One of the most common tip elevation techniuqes is septal extension graft. In this technique, cartilage graft on the caudal septum is used to support the new tip position. The advantage of this technique, when properly used, is stable and enduring tip modification. Disadvantages are stiff tip and possible nasal obstruction due to twisted caudal septum.

In Asian rhinoplasties, I often see an overly projected tip. Not only this pinocchio style nose gives unpleasant look, but also it causes too much tension and pain on the tip. Often it also causes nasal obstruction because the caudal septum twists due to skin pressure. Modest change harmonious with the elevated dorsum gives a natural look of the tip.

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Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

key to rib cartilage use in rhinoplasty

I had the joy to guest edit a special issue ' The key to costal cartilage in rhinoplasty' in journal 'Plastic and Aesthetic Research'. This special issue covers all issues of rib cartilage use in rhinoplasty; cutting edge techniques of harvesting and carving, application of rib cartilage in primary and revision rhinoplasty, practical points for proper preoperative and postoperative care, and diced cartilage and homologous cartilage applications. I invited world renowned rhinoplasty surgeons who are specialists in dealing with rib cartilage use. I hope rhinoplasty surgeons who wants to use rib cartilage in their practice will benefit from the wisdom of the experts.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

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