Injection rhinoplasty

Rhinoplasties with injectable fillers are very popular in Asia and are used extensively. The advantages of injection rhinoplasty include:

Short learning curve for clinicians
Minimal tooling necessary
Inexpensive injectables
Local anesthetic procedure
Quick operative time
Immediate result
Per-operative client defined endpoint
Minimal postoperative downtime for patient

The idea of a simple local procedure with immediate results is very attractive to the Asian clients. Furthermore the down time is minimal; this minimizes the social exposure and questioning that some Asian clients may not welcome as plastic surgery on the nose remains a taboo in some Asian communities. The traditional injectables e.g. silicone gel and Teflon paste are generally falling out of favor due to their associated and recognized complications. The newer synthetic NASHA and PAAG injectables are increasingly being used. The skill-training time required for a clinician is very short and hence, many general practice clinicians have embraced this practice. Coupled with the marketing forces, this area of rhinoplasty has increased significantly.

The injection rhinoplasty technique depends primarily on:

• the desired aesthetic result and
• the injectable filler used.

It can be employed either as:

• a primary injection rhinoplasty procedure to augment the nose or
• as a secondary procedure to enhance a surgical rhinoplasty result (See Figures 3a-c)

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

The Asian nose

The archetypal Asian nose discussed in this chapter is typified by the Asian Malay nose or the East Asian (Chinese, Japanese and Korean) type of nose. There is indeed a spectrum of these noses, with northerners e.g. from north China and Korea having higher dorsums compared to their Asian southerners with lower dorsums. The Asian nose primarily discussed here is typified by petiteness and flatness. The overall mid-facial bony components and nasal septum can be thought of as being "underdeveloped". Hence the radix tends to low with a low rhinion and low mid-third dorsal profile height. The shorter nasal septum with a less projected anterior septal angle results in a nasal tip that lacks projection. A less projected tip, in turn, is more rounded with less tip definition. There usually is also relatively thicker skin overlying the nasal tip and lobules. The ala basal width is also wider.

From the basal view, the nostrils of the Asian nostril appear more rounded compared to the tear-drop appearance of the Western nose. This is due to the lack of projection. The columella may appear short and retracted, lacking support from the caudal septum. Internally, the cartilaginous septum of the Asian nose is generally less generous which explains the deprojected tip; this smaller size will impact upon the availability of septal donor material too. The medial and lateral crura of the lower lateral cartilages are smaller, weaker and softer than Caucasian noses, and tend to have a more oblique to vertical lie. The upper lateral cartilages are similarly small in size too.

Overall the description of the Asian nose is one of petiteness and flatness. Asian clients seeking rhinoplasty therefore not surprisingly request for higher radixes and dorsums with more tip projection and narrower alar bases. The contemporary trend is to request for augmentation and tip projection whilst retaining their Asian ethnicity.

In a small sample study by the authors at The Chinese University of Hong Kong, nasal pictures of Chinese male and female individuals were evaluated to determine their aesthetic outcomes. These subjects with a group of independent local Chinese male and female judge observers, were requested to freely simulate with computer software, the nose they would wish to have. There was notable agreement and concordance on the final nasal profile simulated i.e. everyone had the same aesthetic endpoint. What this sample work demonstrated was, whilst all these Asian clients and peer judges preferred higher radixes and dorsums with greater tip projection, the measured parameters differed significantly from accepted Western aesthetic references (see Figure 1 - Graph of Asian aesthetics). This suggested that even though Asian individuals wanted a pointier and higher nose, they wanted to retain their "Asian" sense of aesthetics.





With this in mind, the following subchapters discuss in more detail the commoner techniques for Asian rhinoplasty surgery. The discussion below is not intended to be comprehensive due to surgeons' preferences, the wide availability of products and techniques. Readers should instead focus on the underlying principles to permit a more flexible practice of Asian rhinoplasty, as this field and product technology develops.

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Preoperative evaluation of the Asian nose

Before any surgery, a preoperative evaluation of the Asian client's expectation is critical for a good outcome. An evaluation on the functional and/or cosmetic objective of the rhinoplasty should be discussed with the patient. Wherever possible, it should include the following:



An assessment of the nasal characteristic of the patient

The Asian nose usually has a low radix, low dorsal height, weak lower lateral cartilages, de-projected tip, columella retraction, narrow ala base and thicker skin overlying the supratip & tip.



An assessment of the Asian clients' expectation

Asian patients usually request a higher radix and dorsum and more projected tip. Counseling should define to the client about his/her functional and cosmetic expectation of the surgery so that a tailored solution can be offered. The use of simulation software is a powerful tool to help the patient better visualize and understand the expected aesthetic outcome. This preoperative simulated visual tool is important as more and more Asian clients are increasingly more sensitive about retaining their ethnic identity after rhinoplasty.



A discussion about the operative process and risks

A full discussion about the surgical process including incisions, donor graft sites, implant materials and their complications should be undertaken. It is possible that several combinations of grafts and implants can be used to achieve the same result so the client should be responsibly counseled as to the best approach that minimizes future problems.

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Injection rhinoplasty

Rhinoplasties with injectable fillers are very popular in Asia and are used extensively. The advantages of injection rhinoplasty include:

Short learning curve for clinicians
Minimal tooling necessary
Inexpensive injectables
Local anesthetic procedure
Quick operative time
Immediate result
Per-operative client defined endpoint
Minimal postoperative downtime for patient

The idea of a simple local procedure with immediate results is very attractive to the Asian clients. Furthermore the down time is minimal; this minimizes the social exposure and questioning that some Asian clients may not welcome as plastic surgery on the nose remains a taboo in some Asian communities. The traditional injectables e.g. silicone gel and Teflon paste are generally falling out of favor due to their associated and recognized complications. The newer synthetic NASHA and PAAG injectables are increasingly being used. The skill-training time required for a clinician is very short and hence, many general practice clinicians have embraced this practice. Coupled with the marketing forces, this area of rhinoplasty has increased significantly.

The injection rhinoplasty technique depends primarily on:

• the desired aesthetic result and
• the injectable filler used.

It can be employed either as:

• a primary injection rhinoplasty procedure to augment the nose or
• as a secondary procedure to enhance a surgical rhinoplasty result (See Figures 3a-c)

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

The Asian nose

The archetypal Asian nose discussed in this chapter is typified by the Asian Malay nose or the East Asian (Chinese, Japanese and Korean) type of nose. There is indeed a spectrum of these noses, with northerners e.g. from north China and Korea having higher dorsums compared to their Asian southerners with lower dorsums. The Asian nose primarily discussed here is typified by petiteness and flatness. The overall mid-facial bony components and nasal septum can be thought of as being "underdeveloped". Hence the radix tends to low with a low rhinion and low mid-third dorsal profile height. The shorter nasal septum with a less projected anterior septal angle results in a nasal tip that lacks projection. A less projected tip, in turn, is more rounded with less tip definition. There usually is also relatively thicker skin overlying the nasal tip and lobules. The ala basal width is also wider.

From the basal view, the nostrils of the Asian nostril appear more rounded compared to the tear-drop appearance of the Western nose. This is due to the lack of projection. The columella may appear short and retracted, lacking support from the caudal septum. Internally, the cartilaginous septum of the Asian nose is generally less generous which explains the deprojected tip; this smaller size will impact upon the availability of septal donor material too. The medial and lateral crura of the lower lateral cartilages are smaller, weaker and softer than Caucasian noses, and tend to have a more oblique to vertical lie. The upper lateral cartilages are similarly small in size too.

Overall the description of the Asian nose is one of petiteness and flatness. Asian clients seeking rhinoplasty therefore not surprisingly request for higher radixes and dorsums with more tip projection and narrower alar bases. The contemporary trend is to request for augmentation and tip projection whilst retaining their Asian ethnicity.

In a small sample study by the authors at The Chinese University of Hong Kong, nasal pictures of Chinese male and female individuals were evaluated to determine their aesthetic outcomes. These subjects with a group of independent local Chinese male and female judge observers, were requested to freely simulate with computer software, the nose they would wish to have. There was notable agreement and concordance on the final nasal profile simulated i.e. everyone had the same aesthetic endpoint. What this sample work demonstrated was, whilst all these Asian clients and peer judges preferred higher radixes and dorsums with greater tip projection, the measured parameters differed significantly from accepted Western aesthetic references (see Figure 1 - Graph of Asian aesthetics). This suggested that even though Asian individuals wanted a pointier and higher nose, they wanted to retain their "Asian" sense of aesthetics.





With this in mind, the following subchapters discuss in more detail the commoner techniques for Asian rhinoplasty surgery. The discussion below is not intended to be comprehensive due to surgeons' preferences, the wide availability of products and techniques. Readers should instead focus on the underlying principles to permit a more flexible practice of Asian rhinoplasty, as this field and product technology develops.

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

What is a rhinoplasty?

Rhinoplasty is an operation to improve both shape and function of your nose. The goal of the procedure is to make you happy with the way you can breathe through your nose and to make your nose look more pleasing and less conspicuous.

Should I, Should I not?

If you are unhappy about the shape or function of your nose, you may choose a surgeon from [link find a surgeon] for a consultation. The following points may help you to feel better prepared.

Is Rhinoplasty an operation to be afraid of?

No, life-threatening complications almost never occurr during a rhinoplasty. Surprisingly, in most patients a rhinoplasty causes very little pain after the operation. Of course you should be prepared for more or less swelling around the eyes for up to a week or so and breathing may not be optimal during this time. These inconveniences largely depend on the way your body reacts to the procedure and of course on the technique used by the surgeon and his or her skill. However, rhinoplasty is considered to be the most difficult of all plastic operations in the face and the risk of a result that is less than ideal is therefore higher than with other procedures.

How do I find the best surgeon?

An excellent result in a happy patient of course speaks for a good surgeon and you may rely on word of mouth advertisement. In addition, you should discuss your wishes in great detail and expicitely ask the surgeon about the chances of precisely obtaining the desired outcome. Don’t hesitate to ask how often the surgeon finds another operation necessary to obtain a satisfying result and what the conditions would be, should the need for a second procedure arise.

Remember that you may not require the most experienced surgeon if a simple procedure will satisfy your needs. Also note that even the most outstanding expert may have to redo an operation now and then. You will have found the right surgeon, if all your questions have been answered in a pleasant atmosphere of mutual understanding, if the surgeon precisely knows what you expect and you are well informed about the chances of getting the result you want.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your ENT specialist for diagnosis and treatment.
Reference information: www.eafps.org

Wrinkle Reduction Treatment (Commonly known as Botox) (Part 2)

Consultation and treatment 

During consultation a detailed medical history is obtained by your surgeon and assessment of the facial wrinkles is carried out to determine the exact areas of muscles that require the injection. An appropriate dose of botulinum toxin is then injected into the muscles using a tiny micro needle. Following the treatment with Botox, the skin over the muscles remains smooth and even. Injected muscles are paralysed in about 2-3 days while untreated areas continue to work as normal. As the needle used is very fine and small quantities are injected, the pain is minimal and therefore no anaesthetic is required. You may experience some discomfort over the treated area immediately after treatment. You may resume normal activities immediately however any strenuous activity and massaging the area should be avoided. You must follow the post injection instructions carefully to avoid any untoward effects. Some patients may experience mild headaches in the first week or so following the injection which resolve spontaneously, and the use of mild painkillers such as paracetamol is recommended to relieve the headaches.  

 

Reference information:  www.eafps.org/botox.html

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Wrinkle Reduction Treatment (Commonly known as Botox) (Part 1)

The gradual development of facial wrinkles is inevitable and generally represents the early sign of ageing. The most common areas of wrinkling include the forehead, the brows and the outer corner of the eyes (crow's feet). This is mainly related to muscle activity which can be effectively dampened by the use of botulinum toxin, which is a naturally occurring bacterial toxin. This type of treatment to paralyse muscles selectively and reduce wrinkles is commonly known as 'Botox' treatment. Botox is a trade name, and other similar preparations may also be used for this purpose. Botulinum toxin was initially used in the 1970s for treating patients with hyperactive muscles around the eyes. Currently, it is widely used for cosmetic reasons, such as wrinkle reduction and a wide variety of other medical conditions related to dysfunction of muscles.

 

Reference information:  www.eafps.org/botox.html

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.