THE ASIAN TROPICS
Plastic Surgery and Cosmetic Surgery
RHINOPLASTY or NOSE LIFTING
Augmentation Rhinoplasty, Silicone Rhinoplasty, Silicone Nose lift, Goretex Rhinoplasty,
Goretex Noselift, Cartilage Rhinoplasty, Cartilage Nose lift, Noselift, Implant Rhinoplasty (for Silicone and Goretex), Alloplastic Rhinoplasty (for Cartilage)
Nose lift is a cosmetic surgery procedure that enhances the nose by increasing the height of the nose bridge including protrusion of the nasal tip.
It involves insertion of either a Silicone implant or Goretex (ePTFE). Patient’s own cartilage (usually from the ears) can also be harvested and used as a natural implant.
Silicone (Implant) Rhinoplasty
> It is the gold standard, being used for the past several decades (tried and tested).
> Higher rejection rate (2-3%) compared to Goretex and Cartilage.
> Best result because it can be carved or shaped according to what fits the patient’s features.
> Good lifting effect but may cause some pressure around surrounding tissues when implant is too big. This can lead to implant protrusion.
> Body forms a capsule around the Silicone, thus easier to remove or replace in case patient decides have a new look or shape in the future.
> Lower in price.
> Very minimal incisions – closed-rhinoplasty (barely 50% around the rim of the nostrils).
> Fast recovery.
> Stitches out in 7 days.
Goretex (Implant) Rhinoplasty
> Latest in implant technology.
> Also called PTFE or Polytetrafluoroethylene
> Natural looking but a bit expensive.
> Almost nil rejection rate.
> Newer Goretex implants can now be carved and shaped.
> Softer in consistency thus lesser pressure on the surrounding skin.
> Alternative for those with Silicone rejection.
> Requires open rhinoplasty.
> Usually combined with tip plasty using Cartilage from the ear.
> Stitches out in 7 days.
> Guaranteed all natural.
> Lifting material will be taken from the cartilage at the back of your ear.
> 100% no rejection.
> May require an open-type rhinoplasty plus ear incision.
> Lifting not as high as Silicone and Goretex implants.
> Longer surgery/recovery and a bit pricey.
> Best alternative for those with Silicone rejection.
> Stitches out in 7 days.
Combination of Silicone or Goretex implant
and Cartilage Tip plasty
> Pure Cartilage rhinoplasty typically with have a good tip construction/lift but may have inadequate bridge height. This happens because the cartilage harvested from the ear/s may not have enough volume and thickness like synthetic implants.
> We now do combination materials for augmentation rhinoplasty to achieve better and natural outcome using the following:
1. Silicone or Goretex for the bridge lifting and,
2. Ear Cartilage for tip plasty,
> The tip Cartilage will prevent common long term complications (not all) of Silicone protrusion on the nasal tip because of pressure. These commonly occurs when Silicone implants inserted are oversized to exert pressure under the skin or when the skin over the Silicone implant is thin.
> Tip Plasty using Cartilage also helps lower the infection rate of Goretex implants alone rhinoplasty and achieve the best result possible.
Alarplasty or Nose Trimming
> Alarplasty procedure is sometimes required for optimal result of nose enhancement.
> This procedure is done on patients with wide noses or those with overhanging sides (Ala) or wide and large nostrils.
> Nose trimming is performed concomitant with other nose procedures (i.e. noselift, alar plasty) and involves removal of a small chunk of tissue from each side of the nose.
> The excised portions of the sides of the nose are sutured/stitched back and are taken out after 10-14 days.
> Alar plasty requires the cooperation of the patient to follow certain instructions after surgery like avoiding mouth opening widely (i.e. yawning, eating big food like burgers, frequent smiling) for 3-4 weeks as this will stretch again the narrowed repaired nose.
> Because of fads and new innovations, there are new ways or techniques/materials that have propped up to lift or enhance the nose.
> These new materials or techniques are often less proven to achieve real nose enhancement. Below is a list of these materials and some are dangerous/toxic to the body while most are notorious for its migratory property because of its semi-liquid form.
1. Soft Paraffin, Petroleum Jelly, or Petrolatum
> Is a white, colourless, semi-solid material widely used as skin protectant.
> This material was never intended to be used internally but many unlicensed practitioners in salons and clinics (ran by non-doctors), heat the Petroleum Jelly to liquify and inject it under the skin to enhance the nose (and other body parts like the face, breasts, and buttocks).
> In the short term, the result may be deceivingly good.
> Medium to long term (2-5 years), will migrate to the sides of the bridge (Avatar-look) and the nose tip (witch-look). Further, the body will react to the material and cause chronic inflammation and granuloma (multiple nodulations) resulting to visible skin bumpiness.
> End point of injecting paraffin (long-term course) is skin necrosis or skin losing its blood supply then turning to bluish-black color.
> Removing petroleum jelly on an injected nose is very challenging for surgeons as the granuloma will make extraction difficult (especially if they are superficial to the skin). Bleeding and too much swelling are expected after removal (typically incomplete). > Permanent skin damage can be an unwanted consequence.
> Many surgeons will refuse patients with this kind of problem.
2. Hard Paraffin
> Is a harder material used in candles, crayons, and as lubricating material.
> Unscrupulous aestheticians (non-doctors) also use this the same way (as soft paraffin) as filling materials to enhance body parts on unsuspecting patients.
> It has the same course with petroleum jelly in terms of damage to the tissue and management.
3. Silicon Oil
> Another industrial material used as lubricants and abused for medical use in facial and body augmentation as fillers.
> Has the same poor effect/outcome and complications as with the materials above.
> Has higher propensity to migrate to surrounding tissues.
> May be easier to remove surgically because of its liquid form.
> Is a polymer that has found its way in aesthetics via Europe in 2001.
> It is non-absorbable and thus is permanent.
> As a permanent filler injected into tissues, it poses a risk of tissue reactions (in the long term) in the form of fibrosis and granuloma (not to mention its propensity to migrate by gravity).
5. Hyaluronic Acid
> Hyaluronic acid fillers are absorbable (18-24 months) and are relatively safe if used correctly (in the right places).
> They are used to correct deep lines in the face (i.e. nasolabial folds, tear troughs etc)
> They are also used to augment areas in the face like the chin, lips and cheeks.
> Recently some doctors have been using HA as a substitute for surgical rhinoplasty with a promise of minimally invasive and no-downtime.
> However, because of its gel consistency, outcome were good only during the first few months after injection.
> Migration of the fillers around the nasal dorm or bridge results to widening of the space between the eyes (Avatar-look).
> Migration of fillers injected into the nasal tip down to the Columella, results to the lengthening and bulging of the area between the nostril (witch-like look).
> Most of the patients with fillers would have a common and typical look of wide bridge and big tip.
6. Cog Threads or PDOs
> Threads are made from a material called Polydioxanone (PDS or PDO) used mainly in sutures.
> With the presence of cogs or barbs on the threads, their application in aesthetics is into pulling or lifting of sagged tissue.
> The are fully absorbed from the tissue in 6 months.
> Although they present less tissue reaction, its use as a lifting material (especially in nose lifting) is questionable for its short life.
> Its tensile strength decreases to about 70% at 14 days and 25% at 42 days (see reference). Thus sagging can recur as early as 1.5 months.
> Its deceivingly good effect is also demonstrated only during the first few weeks but definitely never after 6 months.
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