The most common complaints in Asian patients are a flat nasal bridge, a round and bulbous tip, and a short, wide nose. Dr Huang uses advanced open rhinoplasty techniques involving the use of cartilage grafts for the nasal tip and silicone or Medpor implants of the nasal bridge to create enhanced but natural looking noses.
Cartilage grafts are most commonly harvested from the nasal septum, which is the wall in the midline of the nose that divides the nose into right and left sides. Alternatively, the ear is also a good source of donor cartilage.
It is not uncommon for patients seeking rhinoplasty to also suffer from nasal airway obstruction due to deviation of the nasal septum. This condition causes obstruction when breathing through the nose. Correction of this condition to improve nasal breathing is a medical procedure that can be covered by insurance and Medisave.
Open rhinoplasty can be performed under local anesthesia with oral sedation, or for maximum comfort, under intravenous sedation. It is usually a day surgery procedure. The length of the procedure depends on how much work is done, and it can range from three to six hours. The basic steps are as follows. Incisions are made along the inside of the rim of each nostril and connected in the midline structure known as the columella. The cartilages in the nasal tip are identified and modified to make the tip narrower. Cartilage grafts are harvested from the nasal septum or the ear. The grafts are fashioned into precise shapes and sizes, added to the tip and positioned carefully and secured with fine sutures to create a new tip that is longer, narrower, and more defined.
An implant of suitable dimensions is then placed on the bridge of the nose directly on top of the nasal bones to increase the height of the bridge and create an aesthetically pleasing profile between the beginning of the bridge at its junction with the forehead (the radix) and the area just before the tip (the supratip). If necessary, the sides of the nose are then reduced and narrowed using appropriate techniques. The wounds are accurately and meticulously closed to produce optimal healing and scars. Finally, tapes are applied over the nose to minimize swelling and maintain the implant in the correct position.
Postoperative pain following a rhinoplasty is minimal and well controlled with oral pain medications. Swelling is usually mild to moderate. Bruising is normally absent or minimal. The nose will feel blocked for the first few days due to internal swelling. The tapes and stitches are removed after one week. Downtime is usually ten to fourteen days. By then, about half of the swelling will have subsided and the nose looks fairly presentable. Exercise can be resumed after one month.
Rhinoplasty is generally a safe operation with minimal blood loss and a low risk of infection. This risk of infection is especially low if use of an implant is confined to the bridge of the nose and the tip of the nose is made up entirely of cartilage. Not only does this approach tend to produce a more natural and aesthetically pleasing result, it also greatly reduces the risk of infection. In addition, this method of using implants virtually eliminates the risk of implant extrusion (breaking through the skin or inner lining of the nose and becoming exposed to the external environment).
The risk of the implant tilting or going out of position is minimized by judicious selection of implant dimensions, good surgical technique, and careful and frequent monitoring of the implant position during the recovery period.