Rhinoplasty Korea

Nasal obstruction developing after rhinoplasty is increasing. Diverse etiologies are involved and evaluation is not always straightforward. Analyzing the anatomic etiology needs thorough physical examination, radiologic evaluation, and functional tests. There are a lot of armamenterium to improve the nasal airway, but a wise choice of these techniques is very important. In addition to the improvement of the airway, patient also requests aesthetic improvement. Achieving these two goals is often tricky and requires experience and skill.

Silicone is the most widely used alloplastic implant for dorsal augmentation. Gore-Tex, an expanded polytetrafuoroethylene, is also a commonly used material. Unlike silicone implant, Gore-Tex is soft and feels natural. It has micropores, so tissue grows inside and the implant is fixed to the tissue. While Gore-Tex has many advantages, its disadvantages are also distinct. Firstly, it can erode nasal bone a little when the implantation duration is long. Erosion causes pain and heaviness on the dorsum. It is common to see a 'rail road deformity' after longstanding Gore-Tex removal. 'railroad deformity of the dorsum after Gore-Tex removal' Second, it is more difficult to remove than silicone implant. Because tissue grows inside the micropores, it adheres to the tissue. If the implant is inserted deep to the radix, sometimes complete removal is extremely difficult. In this case, endoscopic observation of the nasofronta area helps to completely remove the silicone piec...

This short video clip shows how I harvest a 4 cm rib cartilage from a 1.7 cm incision. Initial 1.5 cm incision changed into 1.7 cm incision with stretching. No muscle is cut during the dissection and it minimized postoperative pain. Incision heals well with meticulous suture. There is no need for admission and the patient can go home on the day of surgery.

This short video clip shows how a rib cartilage is changed into a graft for dorsal augmentation. It usually takes about 10 minutes to finely carve the rib and this process is repeated for 2-3 times before it is finally seated on the dorsum. Artistic sense of carving, relaxed mind, concentration, and perseverance are needed for this work. 

People may think rhinoplasty is a clean surgery like heart surgery. But actually it is not. Rhinoplasty is a clean contaminated surgery. This means there are bacteria found in the surgicla field. It also means there is a chance of surgical field infection. In many cases, rhinoplasty is combined with septoplasty. Sepum is centered in the nasal cavity, where many normal bacterial flora exist. Thus, rhionplasty filed is always exposed to danger of bacterial infection from the nasal cavity. Even in surgeries without touching the septum, chance of infection from the nasal cavity and surrounding facial skin is high. I did a prospective study about the effect of chlorhexidine pretreatment on the rhinoplasty surgical filed contamination. What I found is rhinoplasty filed is not sterile (even with strict aseptic technique), is continuosly exposed to contamination from the skin flora, and chance of infection has a tendency to decrease with chlorhexidine pretreatment. This study results i...

Many people who seek rhinoplasty in Korea want to know the surgery price. There are hospitals where they post the price on the web site. For example, primary rhinoplasty 3,000,000 krw (Korean won), tip surgery 500,000 krw, revision rhinoplasty 4,000,000 krw, alar base resection 500,000 krw, rib cartilage use 1,000,000 krs... I have a critical point of view on this issue. First of all, rhinoplasty is not divided into dorsum augmentation, tip surgery, alar base resection, rib cartilage harvesting, ... It is an all inclusive term. Setting price per each technique seems not rational. In addition, rhinoplasty cost differs according to the difficulty of operation, materials used, techniques applied, anesthesia, and most of all surgeon's ability and experience. One simple revision operation can be done in 1 hour but another difficult revision operation may take 6 hours. How can we set all different revision rhinoplasty cost as one same price?  Why people buy luxury items? It is because...

Correction of saddle nose is a challenging issue. The technique varies according to the severity of saddle and septum status. Slight depression of the dorsum with intact septal support is mostly corrected with dorsal onlay graft. When the septal support is poor and sadlde is severe, the septum needs reinforcement so that dorsal graft does not distort or sink. Reinforcing the septum includes batten graft, spreader graft, and septal extension graft. Rarely, subtotal or total septal reconstruction or replacement is necessary. When septum reinforcement is necessary, rib cartilage is the best choice. Due to its ample amount and rigidity, autologous rib cartilage is the best graft material for most moderate to severe deformity patients.

Most of the patients who seek rhinoplasty want a natural looking, yet charming nose. How do you define a natural looking nose? Ethnicity, cultural background, facial shape, height, and especially patient's wish are all considered to define a 'natural look'. Doral height and width, profile shape, starting point of the nose, tip shape and volume, tip rotation angle, columelllar show, alar base shape... These are all considered to make a natural looking nose. So 'natural' does not necessarily mean a mediocre, plain, and not charming nose. It looks normal at a glance and does not draw any attention. However, if you closely look at the nose, it is harmonious with the face, yet every detail of the nose is alive! For surgical results, the most wonderful compliment that I hear is: "Hey! you look different recently. You look more charming, but I don't know what has been changed in your face!"  

Nasal tip must be in harmony with the dorsum. When there is slight hump with low radix and tip ptosis, most surgeons project the tip with septal or conchal cartilage, remove the hump, and augment the dorsum with silicone. This may be an easy way to do, but better result can be obtained with autologous materials. The patient below had blunt nasal tip, mild hump, and low radix. Instead of using silicone implant on the dorsum, this patient had radix augmentation and tip refinement using autologus rib cartilage. After surgery, his dorsum and tip was augmented with more refined tip shape and natural dorsal profile. Too high radix or too much projected, pointed tip is not harmonious with flat Asian face. The best result that you can get is having a natural looking nose that does not draw other people's attention to the nose itself.

Removing deviated, problematic silicone implant and immediately replacing it with autolgous rib cartilage is a difficult job but it is worth trying. After removal of either deviated or protruding silicone implant, the dorsum is even more depressed than preoperative status. It is because the skin is thinned due to long-term stretching and the bony/cartilaginous dorsum is slightly resorbed due to pressure of silicone. After removing the silicone, the dorsum is closely observed and any irregularities or deviation of the dorsum is corrected if present before rib cartilage graft. Rib cartilage, harvested from the chest, is carefully carved without hurry. It is carved into a canoe shape so that the forehead to nose and face to nose transitions are smooth. Warping is prevented by using the central core portion and careful symmetric carving. Secure fixation of the rib cartilage to the dosrum is also important. Suture fixation, grafting perichondrium on the undersurface of the radix portion,...

Nasal filler injection is a simple, effective method to fill small depression of the nasal dorsum or low radix. It is also used to augment generalized low profile nose. Hyaluronic acid filler is most commonly used for this purpose and its effect lasts for about 6 months. With all these merits, nasal filler injection has dangerous traps to avoid. One of them is nasal vessel obstruction causing necrosis. Faulty technique and excessive amount of injection are common causes of this disastrous event. Aggressive initial treatment including hyaluronidase injection is of utmost important when symptoms or signs of vessel obstruction appear. Below are the serial photographs of one patient who developed nasal partial necrosis after filler injection. He is now waiting for wound to heal and future nasal reconstruction using forehead flap.