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ASIAN RHINOPLASTY


ASIAN RHINOPLASTY

PATIENT 1
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Before                     After                       Before                    After

PATIENT 2
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Before                     After                       Before                     After

 
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Overview

The common concerns of Oriental nose are low nasal bridge, bulbous and round nasal tip, short nose, retracted nasal alae and wide nostrils. Asian rhinoplasty involves one or more of the following: augmentation of the nasal bridge, refinement of the nose tip (tip-plasty), reduction of bulbous nasal tip, correction of short or over-rotated nose, correction of wide nostrils, reduction of wide nasal alae(nose-wing) and correction of deviated nose.

 

Traditionally, L-shaped silicone nose implants have been used extensively in Asian rhinoplasty. Recently, the use of I-shaped implant to augment the nasal bridge combined with the use of  cartilage graft to support and refine the nose tip (tip-plasty) have become more popular. The critical point in Asian rhinoplasty is to construct a stable skeletal framework to provide support and to deliver a desirable shape to the nose. Asian rhinoplasty is a highly individualized procedure, each case should be assessed and managed individually based on the patient’s individual anatomy and desires.

 

The common materials used in Asian rhinoplasty are either artificial implants or patient’s own cartilage grafts.

 

Artificial Implants

1.     Silicone implant. Commonly used for nasal bridge augmentation. Simple to use and easy to remove if the need arises.

2.     Gore-Tex implant. Allows tissue in-growth and less capsular formation around the implant

3.     Chimera implant. Nose implant which the core is made of silicone and the outer layer is made of a Gore-Tex envelope.

 

Cartilage Grafts

1.     Ear cartilage. Harvest from the ear, the scar is well hidden behind the ear. The harvest would not change the shape of the ear.

2.     Nose septal cartilage. Harvest from the septum inside the nose. No external scar.

3.     Rib cartilage. Harvest from the rib. A short scar is located on the chest.  The cartilage can be used to reshape the nose tip and augment the nose bridge.

 

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Objectives

1.     To augment the nose bridge

2.     To reshape the nose tip

3.     To correct short nose

4.     To reduce big and bulbous nose tip

5.     To correct wide or over-exposed nostrils

 

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Preparation

1.     Treat and stabilize all existing medical conditions, if there is any.

2.     Stop smoking at least one week before surgery

3.     Stop the following AT LEAST ONE WEEK before surgery

a.    Supplements contain vitamin E, ginseng, ginko, garlic, fish oil and other ingredients that encourage bleeding during surgery

b.    Medicine that exacerbate bleeding such as aspirin, NSAIDs and warfarin. You may need to consult the physician who prescribed the medicine before stopping them.

4.     Don’t wear jewelry on the day of surgery

 

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Surgery

Duration: Closed rhinoplasty: 1 to 2 hours. Open rhinoplasty: 2-4 hours

Anaesthesia: Local anaesthesia

Hospitalization: none

 

Surgery Technique:

1. Closed rhinoplasty: Small incision is made inside the nostril. Implant alone or implant plus  cartilage graft are inserted.

2. Open rhinoplasty: Incisions are made inside both nostrils as well as on the columella. This technique provides excellent exposure, enables various modifications to be performed inside the nose.

 

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Post-operative Care

Wound

1.     Plaster dressing  or nasal splint can be removed on day 3

2.     Clean the wound and nostrils with cotton tip soaked with sterile or clean water

3.     Apple CMC ointment on the wound as instructed

4.     If there is unusual swelling or pain,  contact the clinic immediately

5.     Sutures usually are absorbable so no need to remove, unless informed otherwise

6.     Wound inspection in the clinic on day 7

7.     If needed, to start scar gel one month after surgery

8.     If ear cartilage graft is harvested, the sutured compression dressing on the ear is to be removed in the clinic on day 7.

 

Medicine

1.     Antibiotics MUST be finished as instructed

2.     To take painkiller as prescribed

3.     Apply CMC ointment on the wound three times a day

 

Personal Hygiene

1.     It is possible to shower normally on day one after surgery but avoid soaking the dressing

 

Diet

1.     Patient is encouraged to take more vegetables and fruits

2.     Avoid prawn, crab, fried foods, spicy foods, ginger

 

Exercise and Daily Activity

1.     Elevate the head with pillow during sleep

2.     Sleep on the back. Avoid sleeping on one side to prevent pressure on the nose

3.     Avoid light exercise for 2 weeks and heavy exercise for 4 weeks

4.     Resume normal daily activity after 3-5 days

 

Back to work

1.     Office work: 3-5 days

2.     Heavy/Outdoor work: 1-2 weeks

 

Other Special Instructions

1.     Avoid both active and passive smoking

2.     Avoid touching or applying pressure on the nose

3.     Avoid picking nose with finger

4.     Avoid wearing glasses for 2 weeks

 




 
 
 
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