Short nose correction

In short nose, the dorsal length is shorter than normal, the tip is upturned, and the nostril show is exaggerated. It can be congenital or more commonly, it is caused by complications of previous rhinoplasty. Repeated silicone insertion, infection, and traumatic manipulation of the tissue build up scar tissue around the tip which contracts and pulls the tip upwards. While overresection of cartilage is a common casue of this phenomenon in Caucasian rhinoplasty, implant related scar contraction is common cause in Asian rhinoplasty.

Correction needs a lot of work because the skin is contracted with decreased elasticity, the framework is damaged and weak, and often the inner mucosa is deficient. In severe cases, rib cartilage is a must material for grafting and wide skin undermining to move it downwards is necessary. Not infrequently, a staged operation is required. Deficiency inside the nose needs a composite graft from the ear. With all these efforts, the result is often not satisfactory. The key point for satisfactory result is lenthening the alar compartment with lengthening of the central tip compartment. When the tip and alar lobules are not in harmony, the result is unsatisfactory.

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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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