Nasal Augmentation in Ethnic, Asian and African-American Rhinoplasty

Anatomy of the Ethnic Nose

Dorsal Nasal Augmentation is one of the most common requests of Ethnic Rhinoplasty patients. Understanding the surgical anatomy of the Ethnic nose is essential for successful Dorsal Augmentation in Ethnic Rhinoplasty.

The Layers of the Ethnic Nose include:

1.) Skin.
2.) Subcutaneous fat layer.
3.) SMAS or fibromuscular layer.
4.) Periosteal and perichondrial layers.
5.) Bone and Cartilage.
6.) Internal Mucosal Lining.

Ethnic Rhinoplasty Nasal Anatomy
The Ethnic Rhinoplasty Surgeon must have the technical skill and experience to dissect into the right surgical planes in order to create the right pocket for an implant. Precise surgical dissection will also limit bleeding and swelling during the procedure, as well as after the procedure. Open Rhinoplasty technique allows the surgeon to directly visualize and dissect the right planes, versus Closed Rhinoplasty, which is mostly a blind dissection.

Implant Material Selection and Placement

There are many patients that are concerned about the type of implant material used for Dorsal Augmentation. The type of material used is not the key to successful Nasal Augmentation.

The keys to successful Nasal Augmentation include:

1.) Surgeon experience and skill.
2.) Custom 3-dimensional size and shape of implant.
3.) Proper surgical plane insertion.
4.) Implant should be secured with a permanent stitch to prevent movement.

Once the correct pocket is created, the exact 3-dimensional implant with the correct cephalic and caudal height and width can be inserted.

Dorsal Augmentation for Ethnic Rhinoplasty
nasal-implant-insertion

Implant inserted in Sub-periosteal, Sub-perichondrial Plane.

Types of Material for Nasal Augmentation

The most common implant used worldwide is silicone. This includes breast implants, chin, cheek, jaw implants, and most other body cosmetic implants. Early studies that looked at nasal silicone implants are old and outdated and mostly poorly designed to test the reliability of silicone implants.

Silicone Nasal Implants are not without risk; they can extrude or migrate off center (if not inserted properly), show contour irregularities if not carved or inserted properly, and even get infected; however, this is true with any nasal implant material including Medpor, Gore-tex, Mersilene, or even cartilage.

Medpor Nasal Implants are very difficult to carve into the right 3-dimensional shape because they are brittle. If they become infected or have to be removed for any reason, it is very difficult, primarily due to tissue in-growth into the Medpor Implant as demonstrated in this video:

 

Gore-tex Implants have the same issues as Medpor. The implant material also comes in sheets and is difficult to create the exact 3-dimensional shape needed for proper aesthetic augmentation in the Ethnic patient. Personally, I have removed both Medpor and Gore-tex and typically there is a lot of scar tissue associated with removal, which can leave contour irregularities post-operatively.

Septal or Auricular Cartilage typically do not have enough 3-dimensional volumes to create a pleasing Dorsal Implant, unless only 1 to 2 mm of augmentation is needed. In my experience, Ethnic patients typically need more implant volume for successful augmentation.

Rib grafts can work well but have the morbidity of a chest incision. The surgeon only has one shot to carve the right 3-dimensional shape with a piece of rib graft, if the carving is not exact, contour irregularities will be obvious. Rib grafts can also warp over time, deviating the nasal bridge.

In contrast, custom silicone implants are carved from a block. If the surgeon, carves the wrong shape initially, a new implant can be carved from the silicone block until the shape is exactly right; furthermore, if a custom carved silicone implant needs to be removed for any reason: infection, extrusion, deviation or the patient doesn’t like the look, they can be easily removed in a 10 minute office procedure under Local Anesthesia. In my practice, removal of silicone implants that I insert for any reason, is less than 1%.

L-shaped silicone implants should not be used, in my opinion, as they are likely to extrude through the tip. Silicone implants should not extend past the supratip area, as this will increase chances of extrusion.

I-shaped silicone implants are probably the most commonly used implants for Nasal Augmentation, especially in the Asian Rhinoplasty patient, but they are commonly too big, the wrong shape and inserted into the wrong tissue plane. These implants tend to look fake without the right anatomical shape and can migrate if not put in the right tissue plane.

Nasal Augmentation in African-American Rhinoplasty

Nasal Augmentation for African-American Rhinoplasty

Identify dorsal nasal area for augmentation.

1.) Custom carve nasal implant.
2.) Insert through Open Rhinoplasty approach, ensuring proper shape and fit.
3.) Secure implant and close Open approach.

Nasal Augmentation in Asian Rhinoplasty

Place custom carved silicone implant starting at the curvature of the naso-frontal angle not extending past the supratip area in Asian Rhinoplasty patient.

Nasal Augmentation for Asian Rhinoplasty

Securing custom carved silicone implant in Asian Rhinoplasty patient.

Nasal Augmentation for Asian Rhinoplasty patients

Nasal Augmentation in Ethnic, Asian and African-American Rhinoplasty.

Nasal Augmentation for African American Rhinoplasty

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