Rhinoplasty Korea

Removing nasal filler is often required due to diverse reasons. Acute side effects such as blindness, skin necrosis, infecton are representative reasons. Recurrent skin reaction, nodule or granulation formation, and pressure sense are other reasons for filler removal. Hyaluronic acid filler is easily removed with hyaluronidase injection. Non-resorbable fillers such as auqamid can be squeezed out after making a small incision on the skin, but sometimes it is difficult to completely remove all the fillers injected into the dermis. Trying to attempt all the fillers has the danger of damaging dermis. Sometimes open approach is required when simultanous rhinplasty after filler removal is required. At least a week prior to surgery, absorbable fillers are removed with hyaluronidase injection for accurate shape control in revision rhinoplasty. Fillers at the nasal tip can be removed at the time of open approach and you can often observe inflammation of the soft tissue around the tip. ...

This lady developed short nose after multiple previous rhinoplasties. By using folded temporalis fascia on the dorsum, conchal cartilage onlay graft on the tip, and conchal composite graft on the vestibule, a natural looking nose that has lengthened tip with mildly elevated dorsum. 

This gentleman had multiple rhinoplasties before. He has a Gore-Tex implant on the dorsum, pinched and upturned tip, narrow middle vault, and nasal obstruction. Surgery included replacing Gore-Tex with rib cartilage, septum and middle vault reconstruction, tip lengthening with new septal extension grafts, and medial and lateral reinforcement with cartilages. After surgery, his nose looks normal and he can breath much better. I used special technique called "grated cartilage paste" on the tip area. Grated rib cartilage was made as paste using patient's own blood and used as tip onlay graft. This gives volume not only on the tip but also on the lateral margins of the tip, which makes a more natural tip apprearance.

Management of bone in rhinoplasty includes bony hump resection, septal bone correction, and deviated nasal bone osteotomies. All these can be done efficiently with ultrasonic instrument. Advantages of ultrasoninc instrument over conventional method are less bleeding, less swelling, and greater control of fine bone adjustment. Patient can benefit a lot from this instrument, while doctors are more confient in bone managing techniques. I delcalre that I have no financial interest with the manufacturing company.

Diced cartilage in fascia was used in silicone-related contracted nose patient. She had a silicone implant on the nose and the tip was up-rotated due to contracture. Her nose looked short and the tip was upturned. Silicone was removed from the dorsum and the deficient dorsum was filled with diced rib cartilage in temporalis fascia. Her tip was elongated using septal extension graft and tip grafts. After surgery, her dorsum looks natural and the tip was refined with optimal lengthening.

Bone cutting in rhinoplasty is an essential part for nasal bone modification. It is necessary to correct a deviated nose, to remove the hump, and to narrow/widen nasal bone. It is the most invasive surgical technique in rhinoplasty and causes edema and brusing of the nose. Most surgeons use osteotome for cutting the bone. It literally cuts the bone with physical strength like we cut apple with knife. The common problem of cutting the bone with conventional osteotome is difficulty in fine control of the cut. It is also blindly done under the skin relying on the tactile sense of the surgeon. New ultrasonic osteotome called Piezotome uses the ultrasonic power to cut the bone. It enables fine cutting of the bone with easy control and causes less bone loss. It is done under direct vision after wide skin elevation, which causes less edema and brusing on the contrary to the common belief that edema will increase with wide skin elevation. The use of this equipment is slowly increasing rec...

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...