Rhinoplasty Korea

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.

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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.

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...

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.

Narrowing the nose is needed in patients with wide dorsum for aesthetic improvement. Widening the dorsum is needed when the bony pyramid was pinched by previous osteotomy and the patient complains of nasal obstruction. Sometimes, widening the dorsum is necessary for aesthetic purpose, too. Narrowing and widening the dorsum all need osteotomy for bone management. Osteotomy is the most invasive technique among rhinoplasty techniques. It is totally different from breaking the nose unintentionally. It finely cuts the bone according to the surgeon's plan. Brusing and edema are unavoidable side effects of osteotomy, but they can be minimized with proper techniques. Cast is necessary for a week to reduce edema.

Deviate nose is often associated with chin deviation. If the nose is deviated to the opposite direction as the chin is deviated, centering the nose in the midline makes the face less asymmetric. On the other hand, when the nose is deviated to the same direction as the chin is deviated, correcting the nose can make the face more asymmetric. In this case, the chin needs to be centered after rhinoplasty. Correcting the deviated nose not only makes a straight, well-breathing nose but also can make the asymmetric face more harmonious.  

Septal deviation is associated with nasal obstruction, snoring, and deviated nose. Correction of septal deviation has a wide spectrum from simple excision of deviated portion to total septal reconstruction or replacement. High revision rate tells there are pitfalls to avoid. I analyzed 100 cases of revision septoplasty patients and published it in the journal. It shows the most common mistakes they make during the septoplasty is timid separation of bone and cartilage. It also shows caudal septal deviation is difficult to correct and septal batten graft is the solution. I hope that nose surgeons can get a little help from my article. read more