Rhinoplasty is a surgical procedure that reshapes or repairs the nose. It’s also known as a nose job, nose reshaping, or nasal surgery.
Asian patients commonly request for an improvement in the height of the nasal bridge as well as a more projected and well-defined tip. Caucasians, on the other hand, tend to have an “overdeveloped” nose, with an obvious hump and a drooping tip.
Some patients may present with post-traumatic nasal deformity after a nose fracture. Besides making the nose appear crooked, they may suffer from blocked nose and difficulty breathing. Rhinoplasty, also known colloquially as a nose job, can thus be performed to improve form and function.
Rhinoplasty relies upon analysing the nasal appearance and correlating it to the underlying structural framework. Similar to building a house, repositioning and reshaping of the cartilage is then undertaken to create a more attractive nasal contour. The aesthetics of the nose must be considered in the context of the proportions of the face. For example, a projecting nose does not fit in with a retruded chin – a chin implant may then be recommended to “balance the face”.
When there are functional problems such as nasal blockage, proper correction of the cause is very important to improve these symptoms. For example, this can include removal of deviated septal cartilage (septoplasty) or insertion of straight cartilage pieces to open up and support the nasal passageway (spreader grafts).
Cartilage can be harvested from the nasal septum, one or both ears or from the ribs. The donor site depends on the amount of cartilage that is required and varies from patient to patient. The incisions used are hidden and inconspicuous.
Cartilage from cadaver donors can also be used. This has advantages of avoiding scar and discomfort of harvesting one’s own cartilage. Some disadvantages to consider include additional costs and slightly higher risk of absorption.
Hyaluronic acid fillers can be injected for this purpose. These degrade over time, however they are preferred as they can be easily dissolved if the result is undesirable. If the patient likes the result, they can choose to continue with injections or undergo an augmentation rhinoplasty.
In Caucasian noses, fillers are used to smoothen out irregularities, elevate drooping nasal tips as well as to enhance the area between the eyebrows (nasion/glabella) which loses volume with aging.
Fat grafting has emerged as a minimally-invasive way to augment the nasal dorsum and nasion/glabella area. However, the results may not be comparable to surgical rhinoplasties if a more complex reshaping of the nose is required.
Injection techniques must be undertaken with caution due to the rare occurrence of blindness reported in the literature. This Is due to filler material entering blood vessels around the nose and travelling backwards into the eye. Proper injection technique is vital to avoid blood vessels and minimize this risk.
The low nasal dorsum can be raised using an implant (Silicone/Gortex) or one’s own tissue. This includes diced cartilage or dermal fat grafts. For the nasal tip, suture or cartilage graft techniques are employed to produce the desired tip projection and definition. The alar base (flared part of the nostrils) can also be narrowed if it is fleshy or bulky.
We also offer customised 3D printed silicone implants (FITme) based on each person’s individual anatomy.
A Caucasian rhinoplasty is usually very different from an Asian rhinoplasty. The profile of the nasal bridge can be too prominent or convex due to bone and cartilage humps. Other common complaints are that the tip is too bulky or droopy.
During surgery, the nasal bridge is reduced by removing the hump. The long tip is shortened and refined with suturing techniques and cartilage grafts to improve the shape. Osteotomy is sometimes performed to reposition nasal bones that are crooked or excessively wide.
Steristrips and nasal packs are placed to stabilize the nose in the initial post-operative period. These are removed with the sutures in 5-7 days. Mild bruising, swelling and a blocked nose sensation are not unexpected. The soft tissues of the nose tend to hold swelling longer than most other parts of the body. Therefore, even though there will be a marked difference after three to four weeks, the final nose contour may take several months to appear.
