Q: Dr. Eppley, I have an ethnic rhinoplasty question. Is there a medical term for putting a building block or supporting structure under the nose tip if you don’t have much under there? (i.e such as that in Asian and African American noses) I thought it was a nasal strut but I don’t think that is it because that is only used when someone’s nose tip is drooping. Would a nasal strut make someone’s nose more turned up than it already is? Mine is already turned up. I am just asking because I am trying to figure out exactly what I need before I do anything. Thanks.
A: Your question appears to relate specifically to ethnic rhinoplasty. What you refer to as a nasal strut is more specifically called a columellar strut. This is a vertical strut of cartilage placed between the base of the nose up to the tip between the medial footplates of the lower alar cartilages. This is a very versatile support graft that can be used for a variety of nasal reshaping. purposes such as long-term support to prevent tip collapse/rounding to being long enough to increase actual nasal tip projection.
The use of a columellar strut is of critical importance in just about every Asian and African-American ethic rhinoplasty to change the rounded tip of the nose to a more narrow one with better definition. It is not the only rhinoplasty maneuver done to create that effect but it would be considered the ‘building block’ of the tip of the nose. A columellar strut, in and of itself, will not necessarily increase nasal tip projection. When combined with a variety of other cartilage grafts (e.g., septal extension graft) it may even be used to decrease tip projection while also making the nasal tip less wide and more defined.
Dr. Barry Eppley
Q: Dr. Eppley, My desire for rhinoplasty surgery is purely a cosmetic one. I am a healthy and active 25 year old who has never had any complication or surgeries before. That being said I’ve also wanted this procedure done for some time now but never had the opportunity to speak to a physician about it. I have a very typical Arab/Roman nose with a bump on a wide bridge and somewhat bulbous drooping tip. Which with my slender face it looks disproportionate I believe. Furthermore I have a deviated septum which is not noticeable but make the tip look bigger and the hook worse from the right than from the left. I will attach pictures of my nose which will show that from one side nose looks more straight than the other. All in all I would like my nose to be a tad smaller yet still maintain a natural look to my ethnicity (I believe it’s called a ethnic rhinoplasty?). What do you think can be achieved with my nose? Thank you for your time I hope to hear from you soon!
A: When one uses the term ‘ethnic rhinoplasty’ that could mean one of two things. An ethnic rhinoplasty could be any non-Caucasian patient that has nasal features typical for their race and they want a more ‘westernized’ nose change or a radically different nose look.. Or an ethnic rhinoplasty could mean a non-Caucasian patient that wants to undergo rhinoplasty but with changes that still fit their face and to not lose most of their natural ethnic look. I believe you are referring to the latter with the term ethnic rhinoplasty and that is how I usually interpret it and attempt to achieve for my non-Caucasian patients. Whaty this translates in your nose is that some of the bump would be reduced and the nasal narrowed and the tip would be straightened and lifted somewhat so that the nasolabial us closer to 90 degrees rather than the 75 degree angulation you now have. It is very important in a male to keep the dorsal line straight (or even maintain a avery small bump) and that the tip is not overlhy rotated upward.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in ethnic rhinoplasty. I have a very flat noseand would like to narrow bridge significantly to enhance my facial features as well as narrow the tip. My ideal nose features are those of Halle Berry, Beyonce and Vanessa Williams. Can you achieve this finish by reshaping my nose?
A: The first issue about ethnic rhinoplasty, and any rhinoplasty for that matter, is that trying to have the nose of someone can never be achieved. It is good to have a desired rhinoplasty goal. But in the end, no matter how well executed a rhinoplasty is done, factors such as the thickness of the overlying nasal skin will have a major influence on the final nose shape result.
I have done some imaging work on your pictures. The picture quality is not great but they are useable. Your nose is interesting because it looks the way it does because the nose has little cartilage support from the underlying septum which is why the tip is flat, the bridge is low and the nostrils are flared/wide. This is not unusual in African-American noses who often has weak septal support and widely splayed nasal cartilages with short nasal bones.
To make any significant changes to your nose, you would need an L-shape cartilage graft to both build up the tip and the bridge. Much like making a roof on a house, underlying support is need to build up your nose to give it more projection which is what will make it look more narrow and refined. This amount of support can only come from a shaped rib cartilage graft. Your nostrils would also need to be reduced/narrowed at the same time. The imaging predictions show some of the changes but be aware the frontal view image does not do justice to what would really happen when the entire bridge and nose comes forward as the computer software can not really show what happens as the nose is pulled forward. In short, the real result would look much better from the front that the imaging shows. I don’t know if your nose would look exactly like Vanessa Williams but it would be a lot closer than it is now.
Dr. Barry Eppley
Q: Dr. Eppley, I definitely want to remove my acne scars, but other than that, I’ve been given so many different suggestions, I’m not even sure anymore. For the acne scar laser resurfacing, I was told my skin type has a high chance of pigmentation. What are safe options? I do want a rhinoplasty, but I want it to be very subtle, and I’m mainly interested in fixing the tip that sort of goes down like a beak. How is this usually corrected? Also, you mentioned that it appears my buccal lobe was removed. Does this mean the maximum amount was taken out? I am now 2.5 weeks post op. Do you think my final results will give me the skeletonized appearance I desire? I still feel 2 grape sized bumps, hard as rock, when I push down on my cheeks.
A: What would structurally benefit your face is not a mystery and is very straightforward…it lies with your nose and chin. Your chin is very deficient, by at least 9mms, and is one feature that will keep your face from ever having a very defined and angular appearance., By using a sliding genioplasty to bring it forward it will improve your facial profile and help create a more defined appearance in the front view.
You have a very classic ethnic nose with a broad flat tip that has little support and no projection, hence a rounded tip that droops down. An open tip rhinoplasty will reshape the tip and give it a better profile and a more narrow appearance in the frontal view. You would also need some upper dorsal/radix augmentation.
Fractional laser resurfacing is the only type of acne laser resurfacing that you should have as this has a very low risk of any hypopigmentation problems. It will take more than one treatment and the best result you can hope for is about a 50% improvement in the appearance of your facial acne scarring.
It takes a full 3 months for the buccal space where the fat pads were removed to become soft and not feel as hard lumps, this is perfectly normal to feel what you are feeling at just 3 weeks after surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I have some questions about the best material to use in an ethnic rhinoplasty. (I happen to be Asian) Surgeons seem to prefer rib cartilage because they feel it is safer. How big would the scar to take it be? Could you provide me with more information about using rib cartilage. I have looked at some before and afters with a couple of different docs and it seems you are able to do more with rib cartilage to achieve the rather large difference I am looking for as far as height of the bridge and tip goes. What do you think of the noses in the desired result photos I have attached?
A: In further detail about rhinoplasty augmentation, there is no question in my mind that the better long-term material for many ethnic rhinoplasties thqt require significant dorsal augmentation as well as tip projection by grafting is cartilage. To not limit oneself by the amount of graft material, rib cartilage is always better because there is no restriction on volume. While rib graft rhinoplasty is harder on both the patient and the surgeon, and there is a resultant scar, your own tissue is always best over the rest your long remaining lifetime. Speaking of the scar, it is about 3.5 cms long low along the costal margin on the left or right side. (lower end of the middle of the rib cage) I usually take it from the opposite of the patient’s hand dominance so there may be less discomfort afterwards with less arm/body motion. While some surgeon’s use the rib graft as a whole block that is carved for dorsal augmentation, I find it much better to cut the rib grafts into tiny 1mm pieces (cubes) and rhen placed those inside a wrapped collagen sheet, making a moldeable implant. (aka diced cartilage graft) Then once it is placed it can be shaped into the desired form and amount of augmentation. Once held together for a week with the nasal splint, it becomes quite firm amazingly quickly. This not only makes for a customized shaped graft but avoids the biggest problem with dorsal rib grafts…malposition and warping. There is also the possibility of a little external molding when the splint is removed for adjustment until it becomes one firm solid graft.
In looking at some of the noses you sent, the question is whether your nose can achieve that look. I think the best way to think about it is probably not. There noses are more refined and, most importantly, they have thinner skin…the final determinant that ultimately influences much of a rhinoplasty result. But with significant dorsal augmentation, a columellar strut to increase nasal projection and a tip graft, you will end up a lot closer than where you are now.
Dr. Barry Eppley