Asian Rhinoplasty

Introduction to Asian Rhinoplasty

Asian rhinoplasty is a cosmetic procedure that aims to improve the appearance of the Asian nose. Due to the unique Asian nasal anatomy, there are differences between what is typically done in Asian rhinoplasty when compared to Caucasian rhinoplasty. Many ideals of beauty are shared across all cultures, thus many sought after qualities in Asian rhinoplasty will also reflect classic ideals of Western beauty. However, the goal of Asian rhinoplasty is not to create a Caucasian nose. The surgical modifications in Asian rhinoplasty are often performed to create features that are seen as aesthetically desirable in Asian culture. The end result should ideally be ethnically congruent, although an individual patient’s input is equally essential in formulating any surgical plan.

For Asian Rhinoplasty surgery, Toronto-area residents trust Dr. Lawrence Tong. As a Board-Certified Plastic Surgeon with specific expertise in helping patients of Asian descent achieve their cosmetic goals, Dr. Tong has earned a reputation as one of the best Asian Rhinoplasty surgeons in Toronto and beyond.

Benefits of Asian Rhinoplasty

The goal of Asian Rhinoplasty for the vast majority of Dr. Tong’s patients is to improve the appearance of the nose, though this procedure can also improve a patient’s breathing function. Specific cosmetic matters addressed by Asian Rhinoplasty include:

Differences Between Caucasian and Asian Rhinoplasty

Many ideals of beauty are similar across all cultures, so Dr. Tong’s Asian patients and his Caucasian patients frequently express the same goals for their rhinoplasty procedures. It is the anatomical differences between Asians and Caucasians that lead to differences in approach to achieving these goals.

In very general terms, Caucasian rhinoplasty is a reductive procedure, meaning that the nasal anatomy is usually reduced or made smaller. Asian rhinoplasty is frequently augmentative, which means features are usually made larger. This is a generalization and is not universally true for all attributes or patients. Still, Dr. Tong’s deep understanding of ethnic anatomical differences helps him achieve the most harmonious and natural-looking results possible for each patient.^1</sup.

The Asian Rhinoplasty Procedure

Asian rhinoplasty is performed in a CPSO-accredited surgical centre at 199 Avenue Rd., under either general anesthesia or sedation anesthesia. Under general anesthesia, a patient is totally unconscious and unaware of his or her surroundings. With sedation anesthesia, a patient is semi-conscious and has some degree of awareness from time to time during the procedure but should feel no pain. Depending on the particulars of the surgery and the patient’s health status, Dr. Tong will recommend the type of anesthesia, or the patient may have the option to choose the anesthetic.

The Asian Rhinoplasty procedure takes approximately 2.5-3 hours if using an implant to elevate the bridge and approximately 4 hours if using the patient’s own tissues to elevate the bridge. After the patient is placed under anesthesia, the face is prepped with an antiseptic solution and draped in preparation for surgery. The nose is further anesthetized with freezing medication (local anesthesia) that is injected around the nose and any other areas required (e.g. when using tissues from the ear and scalp).

The procedure begins by making the incisions and exposing the underlying cartilage and bone. At this point, various surgical maneuvers are performed to improve the appearance of the nose according to the surgical plan. Some more details of specific modifications are provided in the next section. After all modifications are performed, the incisions are closed and a nasal splint or dressing is applied. Afterward, the patient is awakened from anesthesia and subsequently taken to the recovery area to be monitored by nurses until the effects of the anesthesia wear off.

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Specific Modifications Utilized for Asian Rhinoplasty

In the next several sections, the most common surgical maneuvers used in Asian Rhinoplasty will be described.^{2</sup. These include:}

• Increasing bridge height
• Increasing bridge height using a patient’s own tissues
• Increasing bridge height using an implant
• Increasing tip projection
• Lengthening the nose
• Refining the appearance of the tip
• Narrowing the alar base (“nostrils too wide”)
• Correction of flaring (“nostrils too rounded”)
• Modifying the nostril rim
• Repositioning of the bones

Increasing or elevating bridge height in Asian Rhinoplasty

Elevating the bridge is the most commonly sought after change in Asian Rhinoplasty. A high, narrow bridge is deemed attractive in Asian culture. Most Asian Rhinoplasty involves augmenting the bridge whereas most Caucasian Rhinoplasty patients seek a reduction of the bridge (e.g. removal of a hump). The bridge elevation is typically done in a conservative manner to preserve ethnic harmony. Elevating the bridge is accomplished by either placing an implant or using a patient’s own cartilage in the low area of the bridge. There are advantages and disadvantages to each method. With both methods, the elevation of the bridge will make the bony width of the nose look narrower and usually negate the need for nasal bone repositioning.

Using a patient’s own cartilage (Diced Cartilage Fascia Graft) to augment the bridge

A patient may augment the bridge by utilizing his or her own cartilage. This is accomplished by harvesting cartilage from the nasal septum and the concha bowl region of the ear(s). Harvesting cartilage from this part of the ear is safe and does not change its appearance. Nasal septum cartilage harvest is very commonly performed in Rhinoplasty and also does not affect the appearance. Once the cartilage is harvested, it is broken up into tiny pieces. A piece of connective tissue (temporal fascia) in the shape of a rectangle is also harvested from under the scalp in the temple region. This fascia is used to create a tube-shaped envelope, and the morselized cartilage is placed inside. The result is a bean bag-like construct that is used as a graft. The graft is placed in the low region of the bridge to augment the area. The graft may also be molded to conform in the most appropriate manner. With time, the graft heals with the surrounding tissue.

The advantage of this method is that the graft is natural and from the patient’s own body. There is a low likelihood of infection or movement after surgery. However, this method of augmentation takes more surgical time, has more surgical scars, increases the healing time, and may use up some of the cartilage that would be used to increase the tip region. Due to these and other aesthetic reasons, Dr. Tong typically recommends using a short style nasal implant instead of the patient’s own cartilage for the purpose of bridge elevation.

Using an implant to augment the bridge

An implant made from solid silicone can be used to elevate the bridge. Dr. Tong uses a short Flowers dorsal nasal implant that sits in the upper bridge at the lowest area. He prefers using this type of short implant as opposed to a longer implant (that extends to the tip), as longer implants present a higher risk of postoperative complications such as:

• Higher risk of malposition with a long implant
  To prevent a ‘crooked’ appearance, a longer implant must be placed in a near-perfect position from the top of the nose to the tip. The short implant sits at the lowest portion of the bridge, which is concave and allows the implant to conform more effectively for a straighter alignment. The shorter implant size also means that the pocket of dissection is smaller, resulting in less variability of placement. Finally, even if the implant is placed slightly imperfectly, the short length of the implant makes any imperfections virtually undetectable.
• Higher risk of long-term movement with a long implant
  The longer implant has a higher risk of postoperative movement because the length of the implant requires a larger pocket to be made, resulting in significantly more mobility. Movement postoperatively is also more likely because part of the implant sits on the convex portion of the bridge, which may act as a fulcrum for potential movement.
• Higher Risk of extrusion with a long implant
  Extrusion refers to the implant coming through the skin. This type of complication is associated with pressure on the skin from the presence of the implant and usually occurs at the tip (the heel of the “L” shape) with the longer type implants. Even if the pressure from a long implant is slight, the skin over this area can become thinned out over many years to create the very serious problem of extrusion. In cases or extrusion, the implant needs to be removed and no implant can be reinserted for at least one month to allow contamination of the implant pocket to clear. The short implant has no corners or angled portions that can exert pressure on the skin like this. Due to the simplicity, low complication rate, and aesthetic consistency afforded by short nasal implants, Dr. Tong usually recommends this method to increase bridge height over use of a patient’s own cartilage.. This recommendation is based on his years of experience with Asian Rhinoplasty and is also consistent with how Asian Rhinoplasty is most often performed in South Korea and other Asian countries.

Increasing tip projection in Asian Rhinoplasty

Individuals of Asian descent often complain of the nose looking under projected and describe their noses as ‘flat’ or ‘low.’ Increasing tip projection refers to enhancing the degree to which the tip of the nose ‘protrudes’ or ‘sticks out’ from the face. Dr. Tong usually increases projection in Asian Rhinoplasty by using the patient’s own cartilage. Cartilage is taken from the septum and secured to the cartilaginous framework in order to augment the nasal tip region.

Increasing nasal length in Asian Rhinoplasty

The nasal length refers to the distance between the root of the nose (between the eyebrow area) to the tip of the nose. Many Asians seeking Rhinoplasty have a short nasal length, which can cause the nose to look somewhat ‘upturned’. Patients with a shorter nose may complain that the nostrils are too visible or that the nose appears ‘pig-like.’ In contrast, patients with an overly long nose may describe the nose as looking droopy or ‘witch-like.’ Increasing the length of the nose is often done in conjunction with increasing nasal projection, as deficiencies in length and projection are usually found together. When performed together, the septal cartilage is harvested and is secured to the tip region’s cartilaginous framework in a manner that pushes the nasal shape/envelope outward as well as downward.

Refining (thinning) of the tip appearance in Asian Rhinoplasty

Even after the nasal length and projection are corrected, the tip can still look rounded, bulky, or bulbous. Tip refinement is very commonly requested in Asian Rhinoplasty. Refinement or thinning of the tip refers to altering the cartilage to make the tip look thinner and more aesthetically pleasing. The tip cartilage in Asians are typically broad, floppy (unable to hold shape), and/or more widely spaced apart than Caucasian noses. Refining the tip usually involves a combination of trimming the cartilage, repositioning the cartilage, bending the cartilage, and/or adding cartilage grafts in a manner that achieves that thinner and more refined look.

Another factor that affects the appearance of a tip is the thickness of the nasal skin. A patient who has significantly thick nasal skin will require an exaggerated degree of cartilage alteration in order for the changes to be externally visible. Sometimes the skin thickness limits refinement, despite what is done on the inside. Unfortunately, the thickness of the nasal skin cannot be radically altered without the risk of complications. This is something that Dr. Tong will address during your Asian Rhinoplasty consultation.

Refining the alar base (decreasing nostril width) in Asian Rhinoplasty

Asian patients seeking Rhinoplasty may complain that the nostril area looks too wide or the nostrils look too rounded. These two complaints can be corrected with alar base refinement as part of the Rhinoplasty. A wide nostril base is typically corrected by removing a portion of the floor of the nostril. After the tissue excision is performed, the width of the nostril floor and the entire nasal base looks slightly narrower. If a patient requires more aggressive narrowing, additional dissection, and placement of stitches to cinch the base more assertively
can be utilized.

Correction of flaring in Asian Rhinoplasty

Exaggerated rounding of the nostrils is also known as nostril flaring. The ideal aesthetic nostril base has a triangular appearance when viewed from below. The appearance of flared nostrils creates a triangle with the sides curving outward and away from the face before coming back towards the tip. Flaring is corrected by removing some length of the nostril sidewall. Incisions are placed at the junction between the outer nostril skin and the cheek. A small amount of sidewall tissue is removed. The nostril sidewall then becomes shortened when the incision is stitched back together again. This maneuver makes the nostrils appear less rounded or flared.

Altering the nostril rim in Asian Rhinoplasty

Asian noses often possess a nostril rim that ‘hangs’ at the lateral portions of the nostril. The appearance may be undesirable if it is too exaggerated. This can be corrected by trimming some of the skin in the area to elevate and correct the nostril rim, while hiding the scar on the inside of the nose.

Nasal bone repositioning in Asian Rhinoplasty

Nasal bone repositioning involves a surgically controlled break of the nasal bones to move them (typically) closer together. Narrowing generally achieves a sleeker, thinner, more aesthetically pleasing look. Nasal bone repositioning is only sporadically performed in Asian Rhinoplasty. There are two main reasons for this:

Augmentation of the bridge in Asian Rhinoplasty usually creates the appearance of a narrower bony width, which mitigates the need for nasal bone fracturing
Narrowing may not be recommended, as this may create symptoms of nasal obstruction (because Asian noses generally start off smaller than Caucasian noses)

Despite this, some patients may require repositioning if the bones are asymmetric or crooked.

Asian Rhinoplasty Recovery

Our nurses will monitor you in the post-anesthesia recovery area following your Asian Rhinoplasty surgery. You will be allowed to go home once the effects of the anesthesia have worn off, accompanied by a friend, companion, or family member.

Once at home, you should relax and protect your nose from accidental injury. A splint or nasal dressing will be placed at the time of surgery. The dressing should be left undisturbed and dry until you see Dr. Tong. You may shower the day after surgery, but you must keep your face away from the spray to prevent the nasal splint or dressing from becoming wet. You may perform non-strenuous activities, such as watching television and reading. You should expect your nose to feel very stuffy, as most patients will breathe only through the mouth during the first week. You should sleep with your head and back slightly elevated on multiple pillows to decrease swelling and discomfort. Glasses may be worn by taping the midportion of the glasses to the forehead so that the glasses do not touch the nose.

Following Asian Rhinoplasty, pain is typically mild to moderate. Pain medication will be prescribed and may be used during this time. You may have swelling and bruising around the eyes in the first 1-2 weeks. The majority of patients return to work (non-strenuous) at 7-10 days.

Dr. Tong will see you in one week to have stitches and the special protective dressing (splint) removed. You will likely be allowed to start light exercise (e.g. walking) at 2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery, especially sports where you could be hit in the face (e.g. hockey, basketball). After the initial post-surgical visit, you will have follow-up visits with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

It is important to recognize that the nose may look fairly swollen initially. This is entirely normal and it takes between 6-8 weeks for a majority of the swelling to resolve. Even beyond this, full resolution of the swelling can take 12 months or more. As the swelling subsides, you will notice that the nose gradually becomes thinner and smaller, with the tip taking the longest to fully settle. Patients like the look of their nose right after surgery, and the appearance will slowly continue to improve as time goes on until it reaches its final form.

As with any surgery, there are risks involved with Asian Rhinoplasty. Although the procedure has a low-risk profile, Dr. Tong will make sure to go through the pertinent potential problems associated with Asian Rhinoplasty at the time of your consultation.

How Much Does Asian Rhinoplasty Cost?

The cost of Asian Rhinoplasty in Canada ranges from $14,600 – $19,800 + HST, depending on the type of anesthesia utilized and the geographic location where the procedure is performed. In comparing plastic surgery costs, having the surgery performed under sedation (when appropriate) usually costs less than general anesthesia. Similarly, undergoing the surgery in a larger city usually costs more when compared to smaller cities. While the above figure can serve as a general cost estimate, the price of Asian Rhinoplasty will ultimately depend on factors unique to your procedure, such as:

• The nature and extent of surgical work to be done
• The technique used during surgery (implant vs. cartilage for augmentation)
• Whether your Asian Rhinoplasty is a revisional procedure

Scars After Asian Rhinoplasty

Any surgical procedure will leave some type of scar. Through careful placement and advanced surgical technique, Dr. Lawrence Tong specializes in obtaining the least visible scars for his patients.

Most of the incisions for Asian Rhinoplasty are made inside the nose, except for a 2-3 mm incision across the base of the columella (the central tissue that separates the right and left nostrils). The location of this single scar makes it easy to hide, and it tends to be almost invisible once healing is complete. Additional scars may be located along the junction of the nostril and the cheek or along the nostril sill if modifications are made to the nostril during Asian Rhinoplasty. These scars tend to be more visible than scars from the columellar incision, but are generally still very well hidden.

Dr. Tong will discuss the best ways to care for your incisions, and thereby minimize the resulting scars after your procedure. In general, scars tend to heal better when incisions are kept clean and sun exposure is limited. Keeping the area clean in the first week plays a key role in reducing the chances of infection, which can lead to poor scarring. Applying sunscreen on the scar starting one week after surgery can provide the necessary protection against UV rays that have the potential to darken immature scars. In addition to sunscreen, patients should avoid active or direct tanning of the area. If you plan on being outdoors for an extended period of time, you should wear a hat that will sufficiently cover the nose.

Most men and women find their Asian Rhinoplasty scars are virtually undetectable once they heal. Patients should be aware that all scars will evolve and mature as they heal, initially starting with a light pink colour and gradually fading to closely match the surrounding skin. Every person has a different timeline for scar maturation, but most patients have a fairly minimal scar even at 6 weeks after surgery. If the scar is visible to some extent during healing, patients can use makeup to hide it until it ultimately fades.

Is a Non-Surgical Nose Job Possible?

A non-surgical Rhinoplasty can be performed using volumizing dermal fillers to change the appearance of the nose. In contrast to a surgical Rhinoplasty, non-surgical Rhinoplasty is more limited in scope. The best and most common use of minimally-invasive nose alteration is to augment the bridge or hide small nasal bumps. In Asian patients, fillers are often used to elevate the height of the bridge. This can dramatically change the appearance of the nose and create a much more balanced profile. Patients with a small hump on the bridge can also have it minimized or hidden by placing some filler around the bump to smooth the appearance out.

Fillers can also be placed in areas to correct asymmetries or contour irregularities from prior trauma, surgery, or normal growth. Occasionally, fillers are used in the tip to augment size or slightly increase projection. One unique advantage regarding the use of fillers in the nose is that they tend to last much longer than application elsewhere on the face. In the bridge, it is not unusual to see results that last for one year or more. A surgeon with experience performing ‘liquid rhinoplasty’ can provide the best advice regarding the benefits and limitations of this procedure.

Revision Asian Rhinoplasty

Sometimes individuals who have undergone a previous Asian Rhinoplasty with another surgeon are disappointed that they did not achieve the results they initially envisioned.. If a primary Rhinoplasty failed to correct the cosmetic or functional concerns you sought to improve, Dr. Tong can perform revision Asian Rhinoplasty to enhance the outcome of your nose surgery. This intricate procedure involves working with the bones, cartilage, and structures of the nose that have already been operated on, necessitating the advanced training of a qualified revision Rhinoplasty surgeon to achieve the ideal outcome.

Some of the common issues corrected during revision Asian Rhinoplasty include:

• Correction of a malpositioned implant
• Replacement of an implant
• Conversion of the implant to a cartilage graft
• Removal of an extruded or infected implant
• Improvements in nasal projection
• Nasal lengthening
• Tip refinement
• Nostril and alar base concerns

During your revision Asian Rhinoplasty consultation, Dr. Tong will closely examine the appearance and anatomy of your nasal framework to assess how your results can be improved within the context of your goals. He will listen closely to your concerns and surgical objectives to ensure a mutual understanding of the desired outcome is achieved. Dr. Tong generally recommends waiting 10 to 12 months after the initial procedure before undergoing revision surgery. After Rhinoplasty, the appearance of the nose may still change during the first year and even afterward. These changes are related to the very slow and gradual resolution of edema (swelling), as well as the softening of internal scar tissue. Due to the changes that occur after Rhinoplasty procedures over time, there are multiple reasons to delay performing revision surgery:

1. A revision procedure may be avoided altogether if the nose is afforded time to heal and settle. As the nasal edema continues to resolve and scar tissue progressively softens, the appearance of the nose will change and the problem area(s) in question may correct on their own. This is especially true in the nasal tip region, as the edema in the tip takes the longest to subside.
2. Evaluation of the nose in the first 10 months after the initial surgery may not be accurate, therefore it can be difficult to judge the ‘true result’ of your Rhinoplasty. Even if the problem area(s) are not expected to resolve on their own, it is still important for Dr. Tong to have an accurate picture of the anatomy that is not muddied by unresolved edema and scar tissue. An incorrect picture of the anatomy may lead to a sub-optimal surgical plan.
3. Performing a revision surgery too early is more difficult for the surgeon. The scar tissue will be too firm, and the qualities of the scar will make it difficult to differentiate between planes of tissue. These factors lead to a higher risk of failure in correcting the problems in question, and may even create new concerns.
4. In general, the longer a patient waits to pursue revision Rhinoplasty, the greater the likelihood that the surgery will be successful.

Please do not hesitate to contact our practice for a revision Asian Rhinoplasty consultation with Dr. Tong to discover how we can help you fulfill your original goals for surgery.

Learn More About Asian Rhinoplasty in Toronto

At Yorkville Institute of Plastic Surgery, we believe in empowering our patients to make fully-educated, confident decisions about their surgery and their surgeon. To that end, it is important that you never feel rushed during your interactions with Dr. Tong or our team. During your initial consultation with Dr. Tong, he will take the time to make sure that you understand every important detail of the procedure(s) you are considering.

To learn more about how Dr. Tong can help you improve the appearance of your nose with Asian Rhinoplasty at our Toronto practice, set up consultation by giving us a call at (416) 972-0999. Alternatively, let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No physician’s referral is needed.

See Dr. Tong’s work in our Rhinoplasty before and after photos.

¹ Ishii, C. Current update in Asian rhinoplasty. Plast Reconstr Surg. 2014;2(4):113. doi: 10.1097/GOX.0000000000000081. Accessed May 5, 2020.
² Bergeron L, Chen PK. Asian rhinoplasty techniques. Semin Plast Surg. 2009;23(1):16‐21. doi:10.1055/s-0028-1110097. Accessed May 5, 2020.