Q: Dr. Eppley, I am a 27 year-old Asian female who would like to change the shape of my nose. I have a low nasal bridge and a flat tip of my nose with low projection. I would like to get my nose more Westernized with a higher bridge and more tip projection. I have read that this takes cartilages grafts that either come from my nose or from my rib. I definitely do not want a rib graft done so I am considering implants instead. I know about the implant used to build up the bridge but how does the tip get more projection as well? Is cartilage used to do that or can implants be used for it?
A: In changing the tip and columella of the Asian nose, a septal extension graft as well as a columellar strut graft is used. The septal extension graft is placed along the caudal edge of the septum and out onto the anterior nasal spine. This graft not only helps tip projection but also improves a retracted columella and opens up the nasolabial angle. When combined with a columellar strut, these two tip grafts together give more tip support for the weaker lower alar cartilages and is a standard technique in my practice. It is entirely possible, and very likely, that the septum of the nose may not provide an adequate donor source for the amount of grafts needed. If the septum is inadequate, one can use synthetic implants instead. The best choice of implants would be Medpor or porous polyethylene sheeting from which to fabricate these grafts. Usually a combination can be used, using the septum or the columellar strut and Medpor for the septal extension graft for an Asian rhinoplasty.
Dr. Barry Eppley