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Guide to rhinoplasty

Trends in the rhinoplasty field are

actively reflecting patients’ needs,

and continuously calling for

minimally invasive,

natural,

and side-effect-free approaches.

Our clinic performs surgery using

silicone, Alloderm, micro fat grafting, and more

to achieve natural results with no side effects.

Indications for rhinoplasty

▷ When the nasal bridge is low

▷ When the nasal bridge is curved or appears bent

▷ Hump nose with a bent nasal tip

▷ Saddle nose with a sunken nasal bridge

▷ Upturned nose with a short nose

▷ When the nose has been deformed due to an accident

▷ Functional obstruction that causes nasal blockage

▷ Bulbous nose that makes the nostrils appear wide

The anatomy of the nose

The basic structure of the nose consists of the nasal bone and nasal cartilage forming the framework, with soft tissue such as muscle and skin covering it.

The most important structure that determines the shape of the nasal tip is the alar cartilage, and the shape of the nasal bridge is determined by the nasal bone.

Methods of rhinoplasty

Method using silicone

This is the most widely used and safe method for augmenting the nasal bridge.

It is easy to adjust the shape of the implant, and it maintains the designed shape well after insertion. It has almost no side effects, and if removal is desired, it can be removed easily.

For decades, its safety and effectiveness have been recognized worldwide, and silicone is the material most commonly used by board-certified plastic surgeons.

● Disadvantages of silicone

So far, it has no disadvantages compared with any other surgical method.

● Advantages of silicone

• Inflammation does not occur easily.

• It is easy to design into the desired shape.

• Even after decades, the shape rarely sags or deforms.

• If side effects occur, removal is simple.

• The surgery cost is lower than with other methods.

Method using Gore-Tex

This softer material than silicone was used in an attempt to compensate for silicone’s shortcomings, but many side effects such as inflammation have been reported so far.

Its disadvantages are that it is not easy to create the desired shape, the Gore-Tex shape may change or become distorted after insertion into the nose, and side effects such as inflammation occur frequently, often requiring removal again.

There is also the problem that if you want to remove it because you do not like the shape, removal is very difficult.

It is not a good material to use as a rhinoplasty implant.

● Disadvantages of Gore-Tex

• Inflammation occurs frequently.

• It is difficult to design into the desired shape.

• After several years, it may sag or deform.

• If side effects occur, removal is very difficult.

• It is more expensive than silicone.

Method using septal cartilage

This is cartilage taken from the nasal septum and is mainly used to raise the columella or enhance the nasal tip.

It cannot be used to raise the nasal bridge like silicone.

It is used when the nasal bridge is too flat and you want to slightly raise only the nasal tip, like a traditional Korean shoe tip.

● Disadvantages of septal cartilage

• It cannot be applied to raising the nasal bridge.

• Because the cartilage is very thin, effective augmentation is often difficult.

• If you are not satisfied with the shape, it is difficult to remove.

• The surgery takes a long time and is expensive.

Method using ear cartilage

This uses conchal cartilage taken from the auricle and is mainly used for nasal tip surgery, like septal cartilage.

Its disadvantages are that the cartilage shape is bent and irregular, making it difficult to shape; deformity may occur in the ear where the cartilage was harvested; and if the shape changes after grafting or you are not satisfied with it, removal is very difficult.

It is mainly used when you want to slightly raise the nasal tip.

● Disadvantages of ear cartilage

• It cannot be applied to raising the nasal bridge.

• Because ear cartilage must be removed, scars and deformity may occur in the ear.

• If you are not satisfied with the shape, it is difficult to remove.

• The surgery takes a long time and is expensive.

Method using artificial dermis (Alloderm, SuerDerm)

Its use is almost the same as cartilage grafting.

Artificial dermis (Alloderm) was created by processing human dermal tissue to solve the problems that come with harvesting conchal cartilage or septal cartilage, which is cumbersome, time-consuming, and may cause scars and deformity in the ear.

Because it is a biological material, it does not cause rejection and can be grafted into anyone. Its advantages are that the shape is natural and side effects are rare.

It is mainly used for tip plasty to slightly lengthen the nasal tip or raise it a little.

● Disadvantages of artificial dermis

• It cannot be applied to raising the entire nasal bridge.

• Over time, some of the artificial dermis may be absorbed and sink.

● Advantages of artificial dermis

• The surgery is simple and cheaper than cartilage grafting.

• It is effective for slightly lifting or lengthening the nasal tip.

• No bandage fixation is needed after surgery, so daily life can resume immediately.

• Because it is a biological material, side effects such as inflammation occur rarely.

• It is also effective for correcting curved areas of the nose.

• If additional augmentation is desired in the future, extra artificial dermis grafting is possible.

Method using rib cartilage

This is not a method used for ordinary augmentation rhinoplasty.

It involves harvesting part of the rib cartilage attached to the ribs and grafting it.

It is mainly used to correct an upturned nose or raise the nasal bridge, but the disadvantage is that, unlike silicone, the shape is not natural, and if you do not like the shape, removal is impossible, which is a major drawback.

There is also the problem of leaving a large scar at the donor site where the rib cartilage was harvested.

Therefore, rib cartilage is not applied to general rhinoplasty, and in principle it is used when the nose has been severely damaged by an accident and autologous tissue reconstruction is required.

In other words, it is a method used when tissue restoration is needed due to tissue loss.

Using rib cartilage for simple augmentation is a very unreasonable approach, so surgery using rib cartilage should not be done carelessly.

● Disadvantages of rib cartilage

• In most cases, augmentation rhinoplasty using rib cartilage makes it difficult to achieve a natural-looking nose.

• Because rib cartilage must be harvested from the chest area, it leaves a long scar on the chest.

• If you are not satisfied with the shape, removal is impossible.

• The surgery takes a long time and is very expensive.

Method using dermis and fat

This usually involves harvesting dermis and fat from the boundary area between the buttocks and thighs, removing the epidermis, and grafting the dermis and fat together. It can be used for people who are reluctant to have foreign materials in the body.

Its disadvantages are that swelling lasts a long time and it is difficult to create the desired shape of the nose.

In most cases, a nose that has undergone dermis-fat grafting does not look refined and often appears puffy and swollen, which can seem unnatural.

Also, if you are not satisfied with it, removal is very difficult.

Another disadvantage is that it leaves a large scar on the thigh area where the dermis and fat were harvested.

● Disadvantages of dermis and fat

• In most cases, it is difficult to achieve a natural-looking nose, with a swollen and awkward appearance after surgery.

• Because dermis and fat must be harvested from the back of the thigh, it leaves a long scar on the back of the thigh.

• If you are not satisfied with the shape, removal is almost impossible.

• The surgery takes a long time and is expensive.

Method using micro fat grafting

This method involves harvesting fat from the lower abdomen with a syringe and then grafting it into the low nasal bridge area using a syringe again.

Because only a syringe is used, no skin incision is needed at all, and unlike other surgeries, you can return to activity immediately without having to apply bandages after surgery.

The disadvantages are that repeat treatment may be needed if the survival rate is low, and in some cases, sufficient augmentation may not be achieved.

● Disadvantages of micro fat grafting

• It is difficult to achieve the clear, one-step augmentation effect of silicone.

• If the survival rate is low after one procedure, a second procedure is needed.

• It is difficult to apply when the nasal skin is thin or firm.

• In general, it is difficult to apply when trying to raise the nostrils.

● Advantages of micro fat grafting

• The cost is low and the procedure is simple.

• It can produce subtle, natural augmentation without being noticeable.

• There is little swelling, so daily life is possible within a few days.

• It can correct a bent or curved nose.

Method using fillers (Juvederm, Restylane, Aquamid, Perlane)

● Problems with filler rhinoplasty

• Side effects such as inflammation occur frequently.

• Nasal vessel occlusion due to embolism can cause skin necrosis on the nasal bridge.

• Filler may move or sag, causing nasal deformity.

• Filler has a weak augmentation effect due to absorption or spreading.

• If you do not like it, it is very difficult to remove.

• If you later want to correct it with another method such as an implant or fat grafting, correction is difficult.

Main procedures at our clinic

Micro fat grafting

This method is applied when you want to slightly raise the nasal bridge naturally, or when the nose has curves or is bent.

Artificial dermis (Alloderm) grafting

This is a method to compensate for the disadvantages of cartilage grafting.

Alloderm (SuerDerm) is made by processing human skin, and it is designed so that it can be grafted into anyone without a biological rejection reaction, making it a material that can be used with confidence.

Like cartilage, it is mainly used for nasal tip surgery.

It has the advantage of allowing a simple operation when you want to lift only the tip slightly to create a traditional Korean shoe-shaped nose, or when the tip is short and you want to lengthen it a little.

Silicone insertion

Among materials used worldwide for augmentation of the nasal bridge, silicone implants are still the most popular to this day.

Their safety has been confirmed through decades of use by plastic surgeons, they are easy to design into shape, and they have almost no side effects, so they are recognized as one of the best materials for augmentation.

They are mainly applied to simple augmentation surgery to raise the nasal bridge.

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