Rhinoplasty Korea

Dermis is one of the skin layers, which is in between the epidermis and subcutanous layer. It is the thickest part of the skin. The thinnest one is 0.6 mm in the upper eyelid and the thickest one is about 3 mm in the palm, sole, and back. For rhinoplaty purpose, dermis is harvested from the buttock, which has the thickest layer. After elliptical skin excision, epidermis and subcuatenous tissue are removed to obatin dermis (below photos). Dermis is commonly used to cover the tip grafts to prevent showing. It is also used to camouflage damaged skin after failed rhinoplasties. Some surgeons use it to augment the dorsum after silicone removal. Augmenting the dorsum with dermis has two potential disadvantages: one is infection and the other is resorption. Once the dermis graft is infected, there is a high possibility of comcomittant skin damage, so absolute sterile technique is important. Resorption of dermis is somewhat unpredictable. In severe revision cases that has decreased bloo...

Medpor is porous polyethylene which has many pores that tissue grows in. Thin sheet of Medpor is commonly used as septal extension graft, columellar strut, and splinting graft of the septum. Sometimes it is used as dorsal implant, too. Common problems of Medpor used for rhinoplasty are bad smell from the nasal cavity, hard and painful tip, extrusion of implant, and infection. Removal of implant is the only solution for these problems. As tissue grows into the pores, removal is sometimes difficult, but it can be safely removed in most cases. Important point is maintaining the septal support or tip support after removal. After removal, often the septum or tip cartilage is weak with loss of dorsal or tip height, needing support with autologous cartilages. Below is a case of Medpor removal. She complained of overly projected tip with stiffness and  pain. From the surgical photo, you can see the L-strut made with Medpor. After removal of Medopor, septum was reconstructed and tip an...

Recently an Australian patient had a revision surgery using rib cartilage. She posted a thorough review of her journey on the web. You may want to look at it, so here is the link. So impressive not because she said good things on me, but because I could feel her pain and incredible efforts during her journey of revision rhinoplasty. https://forum.purseblog.com/threads/my-revision-rhinoplasty-at-dr-jins-premium-nose-clinic-2018-pt-1.994030/

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.