Rhinoplasty: The entire spectrum

April 26, 2016

Q: What aspects of the nose do most patients want correction?

A: A Rhinoplasty or commonly referred to as a “nose job” can be done for cosmetic or corrective purpose. Common problems include a low nasal bridge, bony hump, crooked, broad and drooping nasal tip, widened alar base and retracted columella.

Q: How does a nose job change the face ?

A: A good nose job can make the face appear slimmer, sharper and more three-dimensional. From the side profile, the angle between the columella and the lip would be improved. For patient with a receded upper lip (which makes them appear older than their age), this can make them look younger.

Q: What are the various methods to augment the nose?

A: These are minimally invasive and surgical procedures. Minimally invasive procedures are unable to produce all the features of an ideal nose.

Examples include hyaluronic acid filler injection and thread insertion. The latter technique is still fairly new and the long term risk of scar formation and thread extrusion is unknown.

Surgical techniques include closed and open rhinoplasty which is more versatile.

Q: Can filler injection alone do the job ? Is it safe?

A: Filler injection can improve the height of the nose bridge. It is not able to narrow a broad nose tip or wide alar base. It provides immediate result which lasts for about six months. Infrequent complications include alar skin tissue loss and blindness.

Dr Ng Siew Weng, a consultant plastic and reconstructive surgeon of Sweng Plastic Aesthetic and Reconstructive Surgery, said “I have encountered several patients who had received repeated filler injections by their previous doctors, resulting in a broad and undefined nose bridge due to migration of filler. Filler in this region may take longer to resolve compared to injection elsewhere in the face.”

Q: Tell us more about rhinoplasty using a L-shaped implant.

A: This short procedure can improve the dorsal height and tip projection. It has limited ability to augment a contracted columella or narrow the nose tip and alar base.

“In Korea where I had my advanced training, the L-shaped implant is infrequently used by rhinoplasty surgeons due to frequent implant extrusion and deviation,” said Dr Ng.

Q: What are the different types of rhinoplasty ? What is involved ?

A: Rhinoplasty can be divided into open or closed procedure. Closed rhinoplasty involves only a small cut inside the nose. Its efficacy is limited compared to open rhinoplasty which visualises all the structures in the nose for definitive correction.

The typical Korean-style open rhinoplasty for an Asian nose involves a small cut across the columella, placement of silicone implant, cartilage from the nose septum and ear cartilage to achieve a natural-looking and refined nose profile. Some patients do not have sufficient cartilage of their own and rib cartilage may be used.

Q: Recovery process after rhinoplasty ?

A: After surgery the nostrils are sponge dressed to prevent bleeding for 24 to 48 hours. Patient wears a supportive splint over the nose for one to two weeks. Sutures are removed after one week.

Most patients are able to return to work in one to two weeks. The swelling subsides after a month and the final result will be assessed in about three to six months.