1. What is a rhinoplasty – pleas describe the procedure and what it results in.
Rhinoplasty is surgery performed to improve the functional as well as aesthetic outcomes of the nose. Rhinoplasty is probably one of the most complex and fascinating aspects of plastic surgery. It requires an intimate knowledge of the nasal anatomy as well as an aesthetic eye to create a nose that is harmonious and in balance with the rest of the facial features. For Asians, the ideal nose is one with a high and thin nasal bridge, with a sharp refined tip. The nose must look congruous with the rest of the facial features, especially the chin. Hence, rhinoplasty is frequently performed with genioplasty (chin surgery) to create the desired look. When performed by an experienced plastic surgeon, rhinoplasty can greatly improve the balance of facial features, helping patients discover newfound confidence.
There are two approaches to rhinoplasty, the “open” approach and the “closed” or “endonasal” approach. The “open” approach involves a small incision at the base of the nose called the columella. Dr Leo prefers the “open” approach for the more complex as it allows the surgeon direct visualisation of the nasal anatomy and hence a very accurate reconstruction of the nose in terms of nasal height and tip projection. The “closed” method is used for a simple nasal augmentation cases as well as septoplasty cases where the septum or cartilage in between the nostrils is deviated. This is a “scarless” technique.
2. What factors make it medically necessary for a patient to have a rhinoplasty, and what factors make it a procedure of choice for people for aesthetic reasons?
There are many medical reasons for rhinoplasty. Common ones include crooked nose with breathing difficulty, previous nasal trauma and cleft noses. These medical cases tend to be more complex and typically require a “open” rhinoplasty approach. Further, additional tissue for structural support from the patient’s own body is usually needed. The ear cartilage or rib cartilage are frequently used to strengthen the nose structurally. In cases where the nasal bones are deviated, osteotomy or fracturing of the nasal bones and subsequent repositioning of the nasal bones is carried out.
For Asians, the most common aesthetic reasons the patient complains of is a bulky nose or a flattened nose bridge. For a bulbous or bulky nose, debulking of the nasal tip is carried out. Here, the excess cartilage and skin are trimmed off and the remnant cartilage is sutured together to create a more elegant and refined tip. Further, the alar or “wings” of the nose is frequently trimmed so that the nasal tip appears smaller and narrower.
For patients who desire a higher nose bridge, nasal augmentation using alloplastic materials such as silicone or goretex is commonly carried out.
For Caucasians, the common complaints include a large nose, hump on the nasal dorsum or widened nostrils. The common surgeries for them would include a reduction rhinoplasty together with rasping of the dorsal hump of the nose.
3. How commonly is rhinoplasty carried out?
Rhinoplasty is a very common surgery among plastic surgeons. In the 2013 statistics published by the American Society of Plastic Surgeons, rhinoplasty is the second commonest cosmetic surgical procedure performed after breast augmentation with more than 220,000 procedures done that year in North America alone. In Singapore, rhinoplasty is also increasing in popularity. The young adults in their twenties typically start off with simple nasal augmentation using filler injection first before progressing to full surgical rhinoplasty years down the road.
4. Is rhinoplasty gender/age/profession-specific so far? Please elaborate.
Overall, there are definitely more females than males seeking rhinoplasty surgeries. However, the percentage of male rhinoplasty patients is definitely increasing. Patients are typically in their twenties to forties. They usually have been disturbed by the appearance of their noses for some time before mustering the courage to go for surgery. A lot of my patients are in sales or customer oriented jobs and they realise the importance of looking good and feeling good.
5. Advice for a successful, natural-looking result – please provide 5 tips.
The most important thing for patients hoping to achieve a successful natural looking result is to look for an experienced rhinoplasty surgeon with a resume of proven results. Further, the patient must be able to establish a very good rapport with the surgeon as rhinoplasty is about making very fine adjustments to the appearance of the nose. The patient should choose a doctor who truly listens to their concerns, answers their questions and creates a treatment plans that addresses the patient’s concerns.
Rhinoplasty is also unique in that it can take 6 months or even a year before the patient sees the final result. There is initial swelling which takes time to resolve. Patients must be prepared to wait patiently to see the desired outcome.
Harmony is the key word in facial aesthetics and in nose surgery. The ideal nose should look congruous with the patient’s gender and ethnicity. A good surgeon will avoid “feminization” of the males noses as well as “westernisation” of Asian noses. Nowadays, the best results are obtained with composite rhinoplasty, whereby a combination of alloplastic material together with patient’s own tissue is used for reconstruction. We commonly use an implant for the nasal dorsum together with the patients’s own septal or ear cartilage for the nasal tip to create an ideal nose for the patient.