Nose Surgery
by Type

About ‘Low Nose’ The low nose tends to generate a flatter and bigger face image due to loss of a face volume. Therefore, the main goal is to add heights and project out the nose structure. However, one of the major reasons of revision rhinoplasty is that people insert a foreign implant all the way from the beginning to the end of the nose; eventually, the foreign implant slowly develops side effects such as skin reddening or contraction (piggy nose/pinched nose.) Ultimately, using autologous tissues to elongate nose length and projecting the structure is the safest method rather than solely using the foreign implant. VIP Plastic Surgery discovers the balanced ratio and considers one’s nose condition to create a harmonized line from forehead, glabella, nose bridge, nose tip, philtrum, and lips. Low Nose Distinct Characteristics

01    Low nose bridge or small nose

02    People with low nose and flat face who wants more volume

03    Low nose with wide mid-vault

04    Low nose with a bulbous nose

05    Low glabella (between eyes)

Low Nose Surgery Point

01    Use septal cartilages to create a supporting pillar in the nose tip.

02    VIP exclusive technique: Use rib cartilage or silicone implant to add volumes in the mid-face (basement of nostrils and philtrum) to create a 3D image.

03    Add ear cartilages in the nose tip for an enhanced nose shape and heights.

04    Use autologous tissues (usually rib cartilage) to add the nose height.

About ‘Deviated Nose’ The deviation in nose usually appears innately or due to physical accidents during the adolescent period. This deviation causes a deformation in the nasal bone, lower cartilage, and septal cartilage which all of these need to be precisely analyzed to decide which combination of surgery methods will be performed. The challenging part of the deviated nose is that not only the nose shape deviates aesthetically but also the deviation causes functional problems causing discomforts. Dr. Lee Myung Ju has presented ‘Septoturbinoplasty’ academic paper for the first time in Korea (2007). VIP’s Septal Deviation Rhinoplasty creates the highest quality of aesthetic and functional result from a single surgery maximizing the usage of septal cartilage whereas the traditional methods needed two separate surgeries to achieve these two goals. Deviated Nose Distinct Characteristics

01    Imbalanced face due to deviated nose structure

02    Allergy symptoms or functional issues due to deviation

03    Deviated nose with a hump in the nose bridge

04    Deviated nose towards the specific direction

05    One side of nostrils is more deviated than the other nostril

Deviated Nose Surgery Point

01    Synergic effect – This combination surgery allows both correcting the functional deviation and creating an aesthetic nose shape.

02    Correct the tip structure when the nose tip cartilage is not balanced from left to right.

03    Place the nasal bone in the center to improve the deviated nose.

04    Strongly support the tip structure and straighten the septal cartilage.

05    Shape the nose in an aesthetic sense and add heights of the nose bridge depending on the condition.

06    Alleviates the various functional symptoms due to the deviation such as rhinitis, runny nose, and nasal congestion.

About ‘Droopy (Long) Nose’ Droopy and long nose is commonly known as a ptotic nasal tip which is a type of nose shape that many people consider to undergo the rhinoplasty. The droopy, long, or hook nose main concern is a lengthy nasal tip; this is due to weak cartilage structures on the nose tip. The rhinoplasty allows patients to achieve a softer and more defined image by refining the length and shape. It is also important to recognize how much the nostrils should be showing. Most people who have long and droopy nose do not show nostrils from the front view which should be adjusted for the balanced ratio. During the rhinoplasty, it is important to adjust and re-shape the extrinsic and intrinsic side of lower lateral cartilages to prevent a recurrence of a drooping situation; the angle between the columella and philtrum needs to be balanced as well. If necessary, the muscle inside the columella needs to be incised depending on the patient condition.

At VIP, the droopy (long) nose rhinoplasty focuses on reconstructing the lower lateral cartilage and columella structure that are main causes of the droopy appearance. The nose bridge and basement must be strongly supported to fundamentally create a balanced nose length. Droopy (Long) Nose Distinct Characteristics

01    People with a droopy nose due to a long nose tip

02    People with narrow angles between the nose and lips due to a long nose length

03    People with imbalanced facial ratio due to a droopy nose

04    People who have a droopy nose when smiling

05    People who look aggressive due to a droopy and long nose

Droopy (Long) Nose Surgery Point

01    Build the nose basement structure to support the droopy nose tip.

02    Create a balanced angle between the nose tip and lips.

03    Use autologous tissues or foreign implant on the nose bridge for a smooth line.

04    May or may not use ear cartilage for the nose tip.

About ‘Hump Nose’ Hump nose is a type of nose that has a protruded nose bridge, wide nasal bone, and droopy nose tip. One of the main characteristics of a humped nose is that the septal cartilage underneath the nose is weak and uneven that creates a hump shape. The surgery method depends on how severly the nose is deviated and humped. If severe, functional problem like rhinitis occur from the deformation of nasal bone, septal cartilage, structural cartilage, and muscles. Therefore, this would not be a simple surgery which is simply carving the hump and adding the foreign implants. It is important to precisely diagnose the fundamental causes of a humped nose before choosing the surgery method. Depending on the situation, osteotomy, structural cartilage plasty, and septal cartilage correction may be necessary to remove the hump and create a smooth nose shape. Hump Nose Distinct Characteristics

01    People who have a nasal hump

02    People who desire to achieve a smooth nose shape

03    People who have a large or droopy nose tip

04    People with an imbalanced facial ratio due to a long nose

05    People who have a high nose bridge but needs an improvement in the shape

Hump Nose Surgery Point

01    Remove the nasal hump in the bridge to create a smooth line.

02    Perform osteotomy to create a slimmer nose width.

03    Prevent the nose to shape droopy when smiling

04    Depending on the situation, various osteotomy, structural cartilage rhinoplasty, and septal cartilage rhinoplasty are necessary.

About ‘Short Nose’ The characteristics of the short nose are that the nose is short in length and tend to show the nostrils; therefore, people commonly describe as a piggy nose. The short nose rhinoplasty is one of the most challenging surgeries than any other surgeries as it addresses not only the nose length but also the nose height. Especially, using a foreign implant is not recommended for a short nose type because there is a high possibility that there will be side effects such as skin reddening, contraction, and skin thinning. Therefore, the best material would be autologous cartilages such as septal cartilage and rib cartilage. However, harvesting a septal cartilage requires a high expertise as harvesting the good amount yet necessary amount to prevent a collapse is challenging in a short and small nose. The short nose is one of the common characteristics for Asians and African American. Short Nose Distinct Characteristics

01    Short nose with nostrils showing

02    Short nose due to Infection from foreign implants

03    Short nose due to contractions from multiple surgeries scar tissues

04    Short nose due to excessive high tip projection without sufficient amount of skin coverage

05    Short nose due to cartilage damage from physical accidents

Short Nose Surgery Point

01    Elongate the tip cartilage to cover the nostrils using septal cartilage or rib cartilage.

02    Insert ear cartilage on top of the nose tip if necessary.

03    Partially use a silicone implant or autologous tissues to add heights in the nose bridge. (Autologous tissues are safer.)

04    Perform rhinoplasty with mid-face augmentation to create a sophisticated profile line from the nose tip to lips.

About ‘Bulbous Nose’ Bulbous nose is one of the common characteristics of an Asian nose that many patients consider when considering the rhinoplasty. Bulbous nose usuaully appears due to few main reasons. When the patient has a large nasal tip fibrofatty tissues, these partial soft tissues should be eliminated to create a slimmer tip but not too much as it could give an unnatural result. Another main reason of a bulbous nose is due to the thick nasal skin itself. Patients with thicker skin tend to have round nose tips than the patients with thinner skin. When necessary, the alar reduction may be applied for patients who desire to achieve slimmer nostrils. Most patients do not recognize the precautions of an alar reduction, but the important part is that once the alar reduction is performed, it cannot be taken back anymore. Therefore, it is important to carefully decide whether or not to perform the alar reduction. Bulbous Nose Distinct Characteristics

01    Bulbous nose is common for Asian and African American.

02    People with a wide, thick, and bulbous nose.

03    People with a large size of nose

04    People with a wide nose tip cartilage (lower lateral cartilage)

05    People with large, wide, and thick nostrils

Bulbous Nose Surgery Point

01    Nostrils are the important features that determine the face impression. If possible, removing partial alar base must be carefully done only when necessary due to potential scarring problem.

02    Bublous removes excess nasal tip fat tissues to slim down the shape.

03    Reduce partial nasal tip cartilage (lower lateral cartilage) may be necessary sometimes.

04    When nose width or mid-vault (middle part of the nose) is wide, the mid-vault reduction surgery will be operated as well to slim down the nose width.

05    Depending on the nostrils shape, the surgery method is different and outer incision must be avoided to protect the skin from scarring.

Bulbous Nose Surgery Methods Two different methods of rhinoplasty

a)  Wide structural cartilage in the nose tip type -> Reduce nostrils When nostrils are large and nose width is too wide, structural cartilage should be reduced until 5-8mm. Septal cartilage or rib cartilage can be used to support the columella thus naturally reducing the width of the alar base and nostrils.

b)  Thick skin type -> Reduce the skin thickness and slim down the nose tip To create a beautiful nose tip from thick and wide nose tip, removing partial skin that is covering the nose tip is helpful. Inserting septal cartilage column that supports the nose tip structure creates a natural oval shape of nostrils. In addition, adding partial cartilage on top of nose tip is possible if patient desires to achieve higher nose tip.

About ‘Contracted (Upturned) Nose’ When the contraction occurs due to the side effects of the implant, the nose becomes severely turned up and the nostrils are more visible. There are many reasons that possibly cause the side effects in the nose. Most of the cases are due to adverse reactions of foreign implants from the body. When the body cannot take the foreign implants well, the inner nasal tissues start to become tight and contract eventually causing a shortening of the length. For the revision surgery, it is important to remove all the foreign implants in the nose to fundamentally prevent further side effects and strogly build a supporting structure in the basement of the nose. In serious cases, it is necessary to ensure the length and the structure first; then adding the height can be considered accordingly using an autologous tissue. Common Reasons for Revision Rhinoplasty

a)    Foreign implant side effect

b)    Flushed Nasal Tip

c)    Twisted nose, bent nose

d)    Nose with Silicone Line

e)    Deformation due to inflammation

f)    Injection side effects

Contracted (Upturned) Nose Surgery Point Depending on the severity and nose conditions, there are few possible methods to undergo rhinoplasty. The best method is to use your own 100% rib cartilage to re-build the constructive structure, tip, and bridge. Since revision rhinoplasty is for the patients who already went through difficult time suffering from foreign implants, we highly recommend using the most natural material as possible to prevent further side effects. Please click here to see 100% natural rib cartilage rhinoplasty. See why we use natural rib cartilage instead of the donor cartilage. Contracted (Upturned) Nose – Ear Compositive Reconstructive Surgery When the nose is severely damaged, reconstructive rhinoplasty is required. When the patient undergoes the multiple surgeries, there is definitely a limited amount of skin and tissues to be stretched and utilized during the surgery that limits surgeon’s performance. Ear compositive is a specialized reconstructive surgery that only highly expertised doctors can perform. Dr.Lee Myung Ju harvests ear cartilage, tissue, and skin wholly and performs ear compositive to maximize the patient’s nose condition during the revision rhinoplasty.