Nose Augmentation

Nose Augmentation

Nose augmentation, also known as augmentation rhinoplasty, refers to a type of rhinoplasty that is performed to correct a flat nose. The main objective of nose augmentation is to enhance the nasal bridge in order to create a nose that looks sharp and well-defined. At the same time, minor to moderate enhancement of the nasal tip is also possible. Nose augmentation can be performed as a standalone procedure or combined with other nose procedures such as tip-plasty. In nose augmentation, the surgeon can use either a closed rhinoplasty approach or an open rhinoplasty approach (see Introduction to Rhinoplasty). Traditionally, the closed rhinoplasty approach using an L-shaped implant is a popular option. In recent years, the open rhinoplasty approach using an I-shaped implant to augment the nasal bridge combined with cartilage graft for tip-plasty has become more popular. As in all rhinoplasty, augmentation rhinoplasty is a highly individualized procedure. The exact approach depends on the patient’s existing anatomy and the results that she/he desires. The critical point in augmentation rhinoplasty is to achieve a harmonious balance between the nose and other facial features, so that the nose appears sharp and attractive and yet looks natural.

In nose augmentation, the materials used to augment the nasal bridge come from two primary sources: implant or autologous tissues (tissues from the patient’s own body).

Implant is a manufactured biomedical product used to replace, support or enhance certain structures in the body, such as the nose and the breast. There are 3 types of nose implants: 

1. 1. 1. Silicone implant: silicone implant is the commonest implant used in nasal augmentation. Silicon nose implants are inert and resist tissue ingrowth. After insertion into the nose, they become surrounded by a thin layer of fibrous capsule. This capsule helps to maintain implant position. Generally, silicone is easy to handle, has minimal complications, and good overall patient satisfaction. Silicone nose implants are cheaper than Gore-Tex implants and composite implants.

      2. Gore-Tex (PTFE)implant: Gore-Tex implants are made of ePTFE (expanded polytetrafluoroethylene). ePTFE has a spongy consistency, thus a Gore-Tex implant feels softer than other types of implants. A Gore-Tex implant allows tissue in-growth, has minimal capsular formation, and gives a more natural look to the augmented nose. ePTFE is softer than silicone and thus a Gore-Tex implant is suitable for those with fragile nasal skin. However, because of its softness, ePTFE implants offer slightly less support to the nose than silicone implants. Gore-Tex implants also tend to shrink a little over time. Compared to silicone implants, removal of PTFE implants is more difficult because of tissue ingrowth.

      3. Composite implant: Silicone-polytetrafluoroethylene (PTFE) composite implant, commonly called composite nose implant, is a nose implant consists of a silicone core covered by a thin layer of PTFE on the outside. The silicone core does not shrink or change shape over time and provides good support to maintain the shape of the nose. The PTFE envelope on the outside ensures good tissue-ingrowth and tissue blending to give a more natural look. Removal of a composite implant is also easier than a pure Gore-Tex implant. Composite implants combine the advantages of both silicone and Gore-Tex implants.

Autologous tissue is tissue that is from the patient own body.  Autologous tissues that can be used to augment the nose bridge include rib cartilage, fascial graft, and dermofat graft. Ear cartilage and septal cartilage are suitable for tip-plasty but are not ideal for augmentation of the nasal bridge because they are too thin and too small. 

Preparation

1. 1. 1. Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

      2. Stop smoking at least one week before surgery. Smoking is harmful to wound healing and increases the risks of other post-operation complications.

      3. Stop the following medications and supplements from one week before surgery until one week after surgery.

         1. All supplements containing vitamin E, ginseng, ginkgo, garlic, fish oil, and other ingredients that increase bleeding during the procedure. Other supplements, traditional medicine, and herbs, in which ingredients are unknown, have to stop as well.

         2. Medicine that increases bleeding during the procedure such as aspirin, NSAIDs, and warfarin. However, you may need to consult your physician who prescribed the medication before you stop them.

      4. On the day of surgery, wear simple and comfortable clothing. Do not wear any makeup. Do not wear any jewelry and metal objects on the face and body.

      5. Don’t wear glasses on the day of surgery.

Surgery

Duration: Closed rhinoplasty: 1 hour; open rhinoplasty: 2-4 hours.

Anaesthesia: Local anaesthesia

Hospitalization: Not required.

Recovery*: Back to work in 3-7 days, light exercise after 2 weeks, heavy exercise after 3-4 weeks. * The actual speed of recovery may vary from person to person.

Surgery Technique*:

1. 1. 1. Closed rhinoplasty: The surgeon makes small incisions inside the nostrils, creates a space inside the nose, and to inserts the implant through the incisions. There are no external scars.

      2. Open rhinoplasty: In addition to the incisions made inside both nostrils, the surgeon makes an additional incision on the columella. This additional incision enables the surgeon to lift the skin to open up the nose. This technique provides excellent exposure, allows the surgeon to perform other nose procedures at the same time besides augmenting the nose bridge.

Post-operative Care**

1. 1. 1. What to expect: Swelling usually peaks on the second to third day after surgery and will gradually subside after that. Post-operative pain is usually minimal.

      2. General care:

         1. Apply the cold pack in the first 3 days. Elevate the head during sleep to reduce swelling.

         2. Avoid smoking for at least one month. Smoking increases the risk of wound complications.

         3. Good rest and adequate sleep are helpful for a speedy recovery.

         4. Avoid applying pressure on the nose. Sleep on the back and do not sleep on one side to avoid pressure on the nose.

         5. Do not pick the nostrils with a finger. Instead, use a cotton tip to clean the nose.

         6. Be relaxed and calm. Contact the clinic if there are any queries.

      3. Medicine: Finish the oral antibiotics as prescribed. Take the painkiller when necessary.

      4. Wound care: Clean the wound with a clean cotton tip soaked with sterile water/saline. Apply antibiotic ointment. No wound dressings are required. Remove the adhesive strips applied on the nose after 3 days.

      5. Physical activity: Avoid heavy physical activity and exercise for at least one month.

      6. Follow-up: Come back one week after surgery to remove the ear and columella sutures. Sutures within the nostrils are absorbable, and removal is not required.

      7. Emergency: If there is heavy bleeding, a rapid increase in swelling or severe pain, contact the clinic/doctor for advice immediately.

** The instructions in this list are only for general guidance. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.