Nose Augmentation

Nose Augmentation

 

 

 

Nose augmentation is the rhinoplasty performed to correct a flat nose. The main objective of nose augmentation is to increase the height and length of the nasal bridge to create a nose that looks sharp and well-defined. Another effect is enhancement to the nasal tip. Augmentation rhinoplasty can be performed as a standalone procedure or combined with other procedures such as tip-plasty. The surgeon can use either a closed rhinoplasty approach or an open rhinoplasty approach in augmentation rhinoplasty. Traditionally, the closed rhinoplasty approach using an L-shaped implant is a standard 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 management depends on the patient’s specific 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.

 

In nose augmentation, the materials used to augment the nasal bridge come from 2 primary sources: implant or autologous tissues (tissues from the patient’s own body).

 

Implant is a medical device manufactured to to replace, support or enhance a biological structure. There are 3 types of nose implants: 

      1. Silicone implant: silicone is the commonest material used in nasal augmentation. It is safe and easy to use. Silicone implants do not change in shape and provide long term stable support to the nose.
      2. Gore-Tex implant: The material in the Gore-Tex implant is PTFE (polytetrafluoroethylene). PTFE allows tissue in-growth, minimizes capsular formation, and gives a more natural look to the augmented nose. PTFE is softer than silicone and thus is suitable for those with fragile nasal skin. However, because of its softness, PTFE implants provide slightly less support to the nose’s shape than silicone implants. Compared to silicone implants, removal of PTFE implants is more difficult because of tissue ingrowth.
      3. Composite implant: also known as chimera implant, is a composite implant consists of a silicone core covered by a thin layer of PTFE on its surface. The silicone core provides adequate rigidity to support the nose’s shape, while the PTFE envelope ensures good tissue-ingrowth and blending to give a natural look. Removal of a composite implant is also easier than a pure Gore-Tex implant. Thus, composite implants combine the advantages of both silicone and Gore-Tex implants.

 

Autologous tissue is tissue that is from the patient own body.  The options of 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 in Asian because they are too thin and the volume is too small. 

 

Theoretically, autologous tissues should be a better option for nose augmentation because the tissues are coming from the patient’s own body. In reality, however, most nose bridge augmentation cases in Asians use implants instead of autologous tissues. The reason is that there are several limitations and disadvantages of autologous tissues in nasal bridge augmentation. Rib cartilage is hard, and the rib cartilage graft’s sharp margins tend to be visible through the thin nasal skin. Rib cartilage grafts may also have issues with the shape and contour because they need to be hand-carved. Another potential problem is warping, in which the rib cartilage graft undergoes spontaneous bending and distortion over the time. The results of diced cartilage, dermofat graft, and fascial graft may be unpredictable because of tissue absorption. The use of autologous tissues also involves an additional surgery to harvest the autologous tissues, which patients may be reluctant to do, especially those involving rib harvesting. For nasal bridge augmentation, implants remain a more popular option for Asian patients.

 

In general, most cases use implant for augmentation of nasal bridge and cartilage grafts are used for nasal tip reshaping (tip-plasty)

 

 

 

Preparation

      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. Closed rhinoplasty: The surgeon makes small incisions inside the nostrils, creates a pocket space inside the nose, and inserts the implant through the nostril incisions into the pocket space. There are no external scars.
      2. Open rhinoplasty: In addition to incisions made inside both nostrils, the surgeon makes an additional incision on the columella. This additional columellar incision enables the surgeon to lift the nose’s skin to open up the nose. This technique provides excellent exposure, allows the surgeon to perform various procedures, including the insertion of the implant and other rhinoplasty procedures such as tip-plasty. (see Tip-plasty)

 

 

 

Post-operative Care**

      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.

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