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Rhinoplasty Guide

The recent trend in rhinoplasty

is to properly reflect

patient needs,

while continuously demanding

minimally invasive,

natural,

and complication-free solutions.

At our clinic,

we perform natural,

complication-free surgery

using silicone, AlloDerm, microfat grafting, and more.

Indications for rhinoplasty

○ When the nasal bridge is low

○ When there is a curve on the bridge or it appears crooked

○ Hump nose with a crooked tip

○ Saddle nose with a collapsed bridge

○ When the nose is deformed due to an accident

○ Functional obstruction such as nasal blockage

○ Bulbous nose that makes the nostrils look wide

Nasal anatomy

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

The most important structure that determines the shape of the 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.

The implant shape is easy to modify, it maintains the designed shape well after insertion,

and it has the advantage of being easy to remove if needed, with almost no side effects.

Its safety and effectiveness have been recognized worldwide for decades,

and silicone is the implant material most commonly used by board-certified plastic surgeons.

Disadvantages of silicone	Advantages of silicone
So far, there are no disadvantages greater than any other surgical method.	Inflammation does not occur easily.
​	It is easy to design into the desired shape.
​	Even after decades, the shape rarely collapses or becomes deformed.
​	Removal is simple if side effects occur.
​	The surgical cost is lower than other methods.

Method using Gore-Tex

It was used as a softer material than silicone to compensate for silicone’s disadvantages,

but many side effects, including inflammation, have been reported so far.

Its disadvantages are that it is not easy to create the desired shape,

it may deform or become distorted after being inserted 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 for use as a rhinoplasty implant.

Disadvantages of Gore-Tex
Inflammation occurs frequently.
It is difficult to design into the desired shape.
After several years, the shape may collapse or become deformed.
It is very difficult to remove if side effects occur.
The cost is higher than silicone.

Method using septal cartilage

This cartilage is harvested from the septum inside the nose and is mainly used to raise the columella or augment the tip.

Unlike silicone, it cannot be used to raise the nasal bridge.

It is used when the bridge is too flat and only a slightly lifted tip is desired, like a Korean traditional shoe-shaped nose.

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 the shape is unsatisfactory, removal is difficult.
The surgery takes a long time and is expensive.

Method using auricular cartilage

The conchal cartilage of the ear is harvested and used, and like septal cartilage, it is mainly used for tip surgery.

The disadvantages are that the cartilage is curved and irregular in shape, making it difficult to shape,

there may be deformity in the ear from which the cartilage was harvested,

and if the shape shifts after grafting or is unsatisfactory, removal is very difficult.

It is mainly used when a slight tip augmentation is desired.

Disadvantages of auricular 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 the shape is unsatisfactory, removal is difficult.
The surgery takes a long time and is expensive.

Method using artificial dermis (AlloDerm, SureDerm)

Its purpose is almost identical to cartilage grafting.

Harvesting conchal cartilage or septal cartilage is cumbersome and time-consuming,

and to solve the problem of scars and deformity in the ear,

artificial dermis (AlloDerm) is made by processing human dermal tissue.

Because it is a biological material, it does not cause rejection and can be grafted into anyone,

and its advantages are a natural appearance and almost no side effects.

Disadvantages of artificial dermis	Advantages of artificial dermis
It cannot be applied to overall augmentation of the nasal bridge.	The surgery is simple and the cost is lower than cartilage grafting.
Artificial dermis may be partially absorbed over time and settle down.	It is effective for slightly lifting or lengthening the tip.
​	There is no need for postoperative tape fixation, so you can return to daily life immediately.
​	As a biological material, side effects such as inflammation rarely occur.
​	It is also effective for correcting curved areas of the nose.
​	If additional augmentation is desired later, additional artificial dermis grafting is possible.

Method using rib cartilage

This is not a method used for general augmentation rhinoplasty.

It is a method in which some rib cartilage attached to the ribs is harvested and grafted.

It is mainly used for upturned nose correction or to raise the nasal bridge,

but its disadvantage is that, unlike silicone, the shape is not natural,

and a very major drawback is that if you do not like the shape, removal is impossible.

There is also the problem of leaving a large scar at the 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 reconstruction with autologous tissue 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 method, so surgery using rib cartilage should be avoided without care.

Disadvantages of rib cartilage
In most cases, augmentation rhinoplasty using rib cartilage makes it difficult to achieve a natural nose shape.
Since rib cartilage must be harvested from the chest, it leaves a long scar on the chest.
If the shape is unsatisfactory, removal is impossible.
The surgery takes a long time and is very expensive.

Method using dermis-fat

Dermis-fat is mainly harvested from the border area between the buttocks and thighs, with the epidermal layer removed,

and grafted as a combination of dermis and fat tissue, which can be applied to those who are reluctant to have foreign materials.

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

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

Also, if you are dissatisfied with it, removal is very difficult.

Another drawback is that it leaves a large scar on the thigh area from which the dermis-fat is harvested.

Disadvantages of dermis-fat
In most cases, it is difficult to obtain a natural-looking nose shape because the result looks swollen and awkward after surgery.
Since dermis-fat must be harvested from the back of the thigh, it leaves a long scar on the back of the thigh.
If the shape is unsatisfactory, removal is almost impossible.
The surgery takes a long time and is expensive.

Method using microfat grafting

This is a method in which fat is harvested from the lower abdomen with a syringe and then grafted to the low nasal bridge area using a syringe again.

Because only syringes are used, there is no need to cut the skin at all,

and like other surgeries, you can return to activity immediately without having to apply tape after surgery.

Its disadvantages are that if the survival rate is low, a repeat procedure is needed, and

in some cases there is not enough augmentation to achieve the desired amount.

Disadvantages of microfat grafting	Advantages of microfat grafting
It is difficult to achieve a clear augmentation effect all at once like silicone.	The cost is low and the procedure is simple.
If the survival rate is low after one procedure, a second procedure is needed.	Natural augmentation with no obvious signs is possible.
It is difficult to apply when the nose skin is thin or firm.	There is little swelling, so daily life is possible within a few days.
In general, it is difficult to apply when the nostrils are to be raised.	It can correct a nose that is crooked or has a curve.

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

Problems with filler procedures
Side effects such as inflammation occur frequently.
Nasal blood vessel blockage 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.
It is very difficult to remove if you are not satisfied with the result.
If you later want correction with another method such as an implant or fat grafting, correction is difficult.

Main procedures at our clinic

Microfat grafting

This method is applied when you want to raise the nasal bridge just slightly and naturally,

or when the nose has a curve or is crooked.

Artificial dermis (AlloDerm) grafting

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

AlloDerm (SureDerm) is made by processing human skin,

and it is made so that it can be grafted into anyone without biological rejection, making it a material that can be used with confidence.

Like cartilage, it is mainly used for tip surgery.

It has the advantage of making it easy to perform surgery when you want to slightly lift only the tip to create a Korean traditional shoe-shaped nose,

or when the tip is short and you want to lengthen it a little.

Silicone insertion surgery

Around the world, silicone implants are still the most widely preferred material for augmenting the nasal bridge.

Their safety has been confirmed through decades of use by plastic surgeons,

and they are recognized as one of the best materials for augmentation because the shape is easy to design

and there are almost no side effects.

It is mainly applied to simple augmentation surgery to raise the nasal bridge.

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