In addition to the low starting point of the nose root, insufficient height of the bridge of the nose and short back of the nose, the nose shape of orientals is usually accompanied by the characteristics of low tip, thick tip, upturned tip, short nose column, weak support, wide base of the nose wing, large nose and lip angle and exposed nostrils. I used to be an L-shaped prosthesis, basically regardless of your foundation. With the appearance of long-term complications of L-shaped prosthesis rhinoplasty, the development of plastic surgery technology and the improvement of people's aesthetic level, plastic surgeons and patients are more and more dissatisfied with the effect of traditional L-shaped prosthesis rhinoplasty, and prefer plastic nose subunit.

For an Asian woman, the proper height of the back of the nose is of course very important, but in fact, the nose is the focus of nasal aesthetics and the core of nasal plastic surgery. The nose can be roughly divided into the tip of the nose, the alar, the columella, the nostril, the bottom of the nose, the forehead and nose angle, the nose olive and other subunits, each of which has its own standards and precautions.

Seen from the base, the ideal nose should be an equilateral triangle. The ratio of columella to lobule is 2: 1, and the nostrils are in the shape of water drops.

Viewed from the side, the ideal nasal tip angle and nasolabial angle need to have a suitable angle. The ideal nasal frontal angle, nasal tip angle and nasal lip angle are different between westerners and orientals, and men and women are also different. There are some references in the field of ideal nasal frontal angle, nasal tip angle and nasolabial angle for Asian women/men, but the standards have not been finally established.

Nasal tip plastic surgery

The morphology of the tip of the yellow race is generally characterized by poor skin plasticity, thick fat pad on the tip of the nose and weak alar cartilage. The ideal nose tip should have proper protrusion and rotation. Nasal tip plastic surgery is the key and difficult point of rhinoplasty, which tests the doctor's skills very much.

Traditionally, silicone prosthesis is used for nasal tip plastic surgery, and "L" silicone prosthesis is used for rhinoplasty, which can improve nasal dorsum and nasal tip at the same time. But because silicone is too hard and foreign, it is easy to be exposed, so we don't advocate taking a vacation at the nose now. Rhinoplasty head has also been used, but rhinoplasty is too soft and easy to be infected, and it was soon given up by plastic surgeons. Up to now, there are still many L-shaped prostheses used in rhinoplasty, and most of them are usually combined with auricular cartilage to pad the tip of the nose to prevent the long-term complications of L-shaped prostheses.

L-shaped silicone prosthesis+auricular cartilage

In view of the shortcomings of "L" silicone prosthesis in rhinoplasty, plastic surgeons and prosthesis manufacturers not only improved the nasal prosthesis (the effect is very limited), but also improved the surgical method, that is, using "L" silicone prosthesis to pad the bridge of the nose and the tip of the auricular cartilage. This operation is also called compound rhinoplasty. The method is to sew the auricular cartilage on the top of the L-shaped prosthesis and then implant it into the nose as a whole.

This method increases the thickness of soft tissue at the tip of nose, so it plays a great role in the complications of L-shaped prosthesis easy to slip, deform and twist, and the stressed part of skin easy to be damaged, which leads to silicone rubber wear.

The biggest problem of this method is that there is a certain probability of absorption rate due to the poor blood supply of ear cartilage after transplantation, and the "L" prosthesis rhinoplasty style can not meet the aesthetic requirements of modern people's nose subunits for exquisite shaping.

For this kind of operation, my personal opinion is that if the nasal base is not good, it is recommended to do comprehensive rhinoplasty with autologous cartilage as the main part. If the base of the nose is acceptable, it can be used as a compound augmentation rhinoplasty with "I" prosthesis and Gall cartilage pad. These two methods can basically survive and have ideal long-term effects.

The cost reference of compound rhinoplasty with "L" or "I" prosthesis pad for the bridge of nose and auricular cartilage pad for the tip of nose;

Please refer to the above for the cost of using silicone prosthesis or expansion pad for nose bridge. Generally, the cost of ear cartilage pad removal from the bridge of the nose is 5000-8000 yuan, and the overall operation cost is about 1-20000 yuan.

Reconstruction of nasal support structure with autologous cartilage transplantation as support rod

At present, the common method of nasal tip plastic surgery is to lengthen the nasal septum to make the protrusion and angle of the nasal tip more ideal. The method is to raise or lengthen the tip of the nose with the nasal septum bone or costal cartilage as the support rod in the nasal columella, and to modify the tip of the nose with auricular cartilage shield transplantation, so as to realize the reconstruction of the internal structure of the tip of the nose.

A method of drawing alar cartilage to shape the tip of nose is popular in Europe and America, and it is also used by Asian counterparts. However, the cartilage on the lower and lateral sides of the eastern alar is relatively weak, so the effect of simply sewing the cartilage on both sides to improve nasal tip protrusion is not ideal. This method is always used by Asian counterparts to supplement the shortage of plant tissue transferred from the tip of the nose. Orientals still need to use nasal septum or costal cartilage as a solid supporting structure to shape a satisfactory nose tip protrusion and angle. Drawing alar cartilage to shape the tip of the nose is suitable for excessive separation of alar cartilage on both sides of the nose chin. The distance between the highest points of alar cartilage is obviously greater than the width of nasal columella in the dome, and the nose is flat without the cusp of normal tip.

In addition to this situation, there are usually two cases of nasal tip hypertrophy in orientals: nasal tip cartilage hypertrophy and nasal tip soft tissue hypertrophy. The nasal tip cartilage is thick and needs to be thinned or trimmed. The soft tissue at the tip of the nose is thick, and it may be necessary to remove part of the soft tissue, but this may lead to serious hyperplasia after operation, which may not only shrink the nose, but may lead to more serious conditions.

Therefore, if you find that the tip of your nose is not as delicate as you thought before operation, it may not be because of the doctor's skill, but because your organizational foundation limits the extent that doctors can achieve. Doctors are moderate and conservative. You may not be very satisfied with the result, but it may really be the best choice. Of course, the doctor should explain this to you during the preoperative face-to-face consultation.

You want a perfect nose, and doctors want to complete beautiful surgery, but perfection is never an option, improvement is the only choice!

Advantages and disadvantages of autologous nasal septal cartilage

Advantages of nasal septum cartilage: biological characteristics are the same as those of nasal tip cartilage, the bone is easy to cut and carve, and it is convenient and stable to suture after placement. After operation, it can grow together with the skin of nasal tip, and there is no need to worry about complications such as excessive local skin tension, blood supply disorder and skin puncture. Nasal septal cartilage can provide the best transplantation support for the repair of nasal dorsum, nasal columella and nasal tip, so it is regarded as the first choice material for nasal plastic surgery by domestic plastic surgeons. In addition, if the patient has nasal septum deviation, it can be corrected at the same time, killing two birds with one stone.

Disadvantages of nasal septal cartilage: holes will be formed after removal. If the resection amount is not properly grasped, it may damage the supporting function of nasal septum cartilage, and if it is not properly operated, it may cause perforation of nasal septum. Removal of the cartilage of the nasal septum may affect the development of the nose, so this method is only suitable for adults with basically intact noses. In addition, nasal septal cartilage is as easy to obtain as turbinate cartilage, but the amount of cartilage available is limited, and the strength of nasal septal cartilage as a support rod is still insufficient.

Advantages and disadvantages of autogenous costal cartilage

Advantages of autogenous costal cartilage: rich source, large amount of materials, unlimited application, strong supporting function, easy material acquisition, and no obvious deformity in donor site; Costal cartilage has good plasticity, easy molding, easy to make into a three-dimensional skeleton, moderate texture, will not break through the skin due to excessive tension of the skin of the nasal tip, and can reshape the nasal tip according to aesthetic standards without scruple; Autologous costal cartilage is autologous tissue, which will not cause immune rejection and has little absorption, so it can become a part of the body.

Disadvantages of autogenous costal cartilage: obvious postoperative pain in donor site, chest scar, chest perforation and pneumothorax during the process of harvesting costal cartilage. In addition, due to the "memory ability" of cartilage, cartilage still tends to maintain its inherent curvature after transplantation, leading to postoperative deformity. In addition, costal cartilage still has a certain probability of being absorbed, and my personal probability is 30%.

Advantages and disadvantages of autologous auricular cartilage

Advantages of autologous auricular cartilage: the concha cartilage is elastic cartilage, with natural shape, good elasticity and easy carving. The application of turbinate cartilage transplantation can strengthen the supporting role of nasal columella and improve the collapse of alar caused by cartilage support. The incision of the donor site of concha cartilage is relatively hidden, which has no obvious effect on the appearance of the healed auricle. Because only a part of the cartilage in the concha cavity is removed, the scaffold function of the remaining auricle cartilage is still intact, and the shape of the external ear will not change.

Disadvantages of autogenous auricular cartilage: First, its strength is not enough to resist the contraction force of rhinoplasty in any part except the tip of nose and alar, so it can not be used in parts that need strong support, such as nasal tip lifting and lengthening as a support rod. In addition, the supply of concha cartilage is limited, and its application is limited when a large amount of transplantation materials are needed. In short, the use of autologous cartilage can completely avoid the long-term complications of L-shaped prosthesis rhinoplasty. Autologous cartilage can be produced by fusion with nasal tissue. It is basically equivalent to a normal nose after the operation. If properly operated, it can be basically done once and for all, without any sequelae and kneading problems. However, autologous cartilage rhinoplasty requires relatively high technology, and basically only senior plastic surgeons in the industry will do this operation.

As far as my personal preference is concerned, I like to use autologous nasal septal cartilage as a supporting rod+auricular cartilage to rebuild the supporting structure of the nose, and then use dilator or silicone prosthesis to cushion the bridge of the nose. I personally don't like to use costal cartilage. Unless there is no bone to take, I will consider using autogenous costal cartilage.

Alar-columella relationship

The relationship between alar and columella is also very important in rhinoplasty. From the front, the position of the column should be directly below the nose flange, and the contour line formed by the nose flange and the bottom of the column should spread its wings gently like a seagull. Viewed from the side, the ideal nostril shape should be oval, the alar edge of the nose forms the upper part of the ellipse, and the skin of the nasal columella connects with the skin of the nasal vestibule to form the lower part. Ideally, the vertical distance between the lobular angle of the nasal columella and the tip of the nose should be equal to or close to the horizontal line with the highest point of the alar edge, otherwise the alar-columella defect will occur.

Nasal alar-columella defect mainly includes columella protrusion, columella invagination, alar protrusion, alar invagination and compound defect. According to the needs of different situations, the specific surgical methods can be avoided by ordinary patients.

Remember these standards, you can take standard front and side photos yourself, and then refer to the above picture to see if your alar-columella relationship is ideal, and you can probably see whether you need corrective surgery. Of course, these questions should be explained to you by doctors or consultants during face-to-face consultations, but if you don't understand these things, you may also suspect that plastic surgery institutions will cheat you and let you have more operations.

Nasal alar reduction

There are many beauty seekers who claim that they have a wide alar when consulting me, and they want to have alar reduction surgery, but I actually found that there is basically no problem just because the alar is wide. But sadly, when I want to convince the beauty seeker that he/she needs to do more than just rhinoplasty, it is often difficult. Many beauty seekers prefer to trust their preconceived judgment, asking doctors to do only rhinoplasty, and then these people are basically dissatisfied or even the result of disaster.

Let's review again: the ideal nose should be an equilateral triangle from the base, the ratio of nasal columella to nasal lobule is 2: 1, and the nostrils are in the shape of water drops.

The ultimate goal of plastic surgeons to treat noses is this ideal nose. However, I have really seen many patients with enlarged nasal tip and low nose. Just choose to do alar reduction surgery, the result is often basically no improvement in aesthetics, and even blindly narrowing the alar may lead to the inability to rebuild the supporting structure of the nose with cartilage.

You know, if the tissue of the alar is cut off, it will be cut off forever and will never grow back. When you make a suboptimal or even wrong choice, you have no chance to spend ten times or a hundred times to undo the unsatisfactory surgical results. Nasal alar reduction is an operation to change the nose forever, and there is only one chance. Once done, no matter how rich you are, you can't throw more money and a beautiful nose like the taste of throwing clothes. Your taste in clothes can be improved gradually, but rhinoplasty doesn't give you the opportunity to have surgery again and again to improve your aesthetic level!

So, how do you judge whether you need to shrink your nose? First of all, it is natural to consult a plastic surgeon face to face, but considering that the plastic surgery industry is really a bit chaotic, beauty seekers should really know, so I will say a simple criterion.

The normal alar width should be approximately equal to the medial canthus spacing. If the nose height is normal and the alar is really wide, then the alar should be removed according to different situations.

Short nose lengthening (nasal correction)

Nose facing the sky is a common nose deformity in the East (Westerners are often over-developed aquiline nose deformity). Due to the dysplasia of nasal bones and cartilage, the nose facing the sky is short and upturned. From the front, the nostrils are exposed, the angle of nose and lip is greater than 105, and the length of nose is less than 1/3 of the length of middle face. Therefore, the nose is also called short nose deformity.

The causes of rhinorrhea can be divided into two categories: primary rhinorrhea caused by congenital factors or acquired chondrodysplasia, and secondary rhinorrhea caused by rhinoplasty or tissue contracture after nasal trauma.

Short nose lengthening is to increase the length of the nose and correct the exposed nostrils, and it is also the most challenging and difficult operation in rhinoplasty. In the early stage of short nose correction, L-shaped prosthesis is often used to prolong the tip of nose. The effect of this operation is limited (generally 1-2mm), which will lead to complications such as excessive skin tension, redness, whitening, skin thinning, "parrot mouth" deformation, and even prosthesis exposure. The improved operation of L-shaped nasal augmentation is to suture the auricular cartilage at the top of the L-shaped prosthesis to lengthen the tip of the nose. The essence of this method is to resist the retraction of nasal tip skin in the later stage through the strength support of prosthesis, which is no different from the abduction of nasal tip of prosthesis.

Implanting ePTEF to lengthen the nasal tip, the probability of prosthesis exposure is relatively small, but the nasal tip will still turn white when the tension of the nasal tip is too high, and the shape of the expanded alar is easily changed by external force, so the shape of the expanded alar is not ideal and the effect of extending the length of the alar cannot be achieved.

At present, it is common to use nasal septal cartilage (or costal cartilage) as a supporting frame and reconstruct nasal supporting structure with auricular cartilage shield transplantation to prolong the nose. This method can prolong the nose by 5-8mm, and has no sequelae of traditional methods, so it is highly recommended by most plastic surgeons. The disadvantages of this method are fine operation, difficult operation and high technical requirements for plastic surgeons. A few patients may have insufficient cartilage in nasal septum, but it is difficult for ordinary patients to accept costal cartilage resection.

Reference on the cost of nasal plastic surgery based on autologous cartilage

Nose shaping probably includes rhinoplasty, nasal septum cartilage lengthening, nasal constriction, nasal tip shaping, alar defect repair, alar shaping, columella lengthening, rhinoplasty, nostril shaping and so on. The cost of a single operation of these operations is generally between 5000- 18000 yuan, except nose repair, which is generally more than 20000 yuan.

Generally speaking, rhinoplasty based on autologous cartilage tissue can solve a variety of nose types, which is also often called comprehensive rhinoplasty. Comprehensive rhinoplasty, as the name implies, is total rhinoplasty, including the shaping of nasal root, nasal dorsum, nasal tip, nasal columella, nasal wing, nostril, nasal floor, frontal nasal angle, nasal olive and other subunits. Therefore, in addition to the different influences of doctors and materials, its final cost also depends on the individual basis to decide how many nasal subunit operations need to be performed. The charge range of comprehensive rhinoplasty industry is about 8 yuan 3- 1 10,000, generally around 40,000.

Here, I would also like to review the cost of common rhinoplasty and conforming rhinoplasty for your reference. The cost of simple L-shaped prosthesis rhinoplasty is generally 3000-8000 yuan. Compound rhinoplasty, using silicone prosthesis, the total cost is generally between 1- 1.5 million yuan, and the total cost of using rhinoplasty is about1.5-25 million yuan.

Common complications of rhinoplasty

There are more than 30 common complications in rhinoplasty. Including acute infection, chronic infection, recessive infection (irregular skin congestion), incision dehiscence, skin perforation (inside nostril, in front of nasal columella, tip of nose and root of nose), chronic skin ulcer, scar contracture of incision, scar hyperplasia of incision, extensive scar hyperplasia under nose, total nasal contracture, soft tissue deformity (nostril deformation and contraction, shortened nasal columella, too wide and skewed), nose width and deviation. Prosthesis alignment deviation, beak deformity (L-shaped prosthesis slipping), prosthesis calcification, exposed contour of prosthesis edge, nose bridge collapse (caused by nasal septum) and nasal septum perforation (caused by nasal septum).

In addition to the material itself, the complications of rhinoplasty are generally related to improper operation by doctors: the nose is red, and the most common reason is that the prosthesis is too long and too big; The wear of the prosthesis is usually due to the wrong length of the nose column of the L-shaped silicone prosthesis to support the tip of the nose, thus achieving the effect of raising the tip of the nose. Prosthesis floats up, generally because the prosthesis is placed too shallow, which leads to the prosthesis floating up in the soft tissue of the nose, and also leads to redness or whitening at the back of the nose; Prosthesis displacement is generally due to the wide separation of the insertion cavity of nasal dorsum prosthesis, which may not pay attention to the symmetry of the cavity and not put the prosthesis in the midline position.

Rhinoplasty is a mature cosmetic surgery. Maturity refers to the full development of surgical techniques and the full understanding of surgical complications. The complications of rhinoplasty exist, but they are very low. There is no reliable statistical data about the incidence of these complications. I personally estimate that the overall incidence of these complications is about 5- 15%. Note that I am talking about the overall incidence of these complications, not the incidence of each complication. Generally speaking, the probability of these complications is not high, and the relatively high probability is prosthesis movement, prosthesis dislocation and prosthesis wear.

In addition, the complications of rhinoplasty with different materials and methods are different, and the incidence of complications of different doctors is also different, which is one of the reasons why different doctors charge different fees. Comprehensive rhinoplasty based on autologous cartilage, if the doctor operates properly, basically has no sequelae, and the nose after operation is similar to that of a normal nose, which can be done once and for all, but comprehensive rhinoplasty based on autologous cartilage can only be done by senior experts in the industry.

Summary and suggestions

Nasal basic self-examination

Among the beauty seekers who consult me online and offline about rhinoplasty, they complain a lot about their noses, but few people have a correct understanding of their nose types. Personally, I think that beauty seekers have a correct understanding of their personal nasal foundation and reasonable expectations for rhinoplasty, which will be of great help to communicate with doctors before operation and help them obtain ideal surgical results.

How to know your nose shape? Take the standard front photo, half side photo, side photo and back photo. The requirements for taking pictures are: eyes off, hair tied up, no makeup, no retouching after taking pictures; When taking a frontal photo, look straight ahead and don't look up or down. The left and right ears in the photo should be symmetrical. The half-side viewing angle is 45 and the side viewing angle is 90. When taking pictures, you should look straight ahead and look back about 45 to see the sky.

It is relatively easy to judge the height of the nasal root at the back of the nose, which can be seen from the front, half-side and side photos. The nose should be an equilateral triangle when viewed from the base, and the ratio of columella to lobule is 2: 1, and the nostrils are water droplets. Then look at the relationship between the nose wing and the nose columella from the front and side to see if there are nose columella drooping, nose columella receding, nose wing drooping and nose wing receding; In addition, it is necessary to pay attention to whether the nose is short from the front and side, and whether the nose is round and blunt from the front and back.

Some basic principles:

If you find that your nose root is low and there is nothing wrong with your nose, you can consider injecting hyaluronic acid for rhinoplasty, or you can consider the compound rhinoplasty with "I" prosthesis and Gall cartilage pad. Hyaluronic acid can not be injected into the nose, otherwise it will easily lead to serious complications of vascular embolism. The nose is cartilage, so it is recommended to have three operations at most, and it is not recommended to have a holiday at the nose. If you have many conditions, such as a low nose, a dull and fat tip of the nose, a bad relationship between the alar and the columella, and a wide alar, consider a total rhinoplasty. Every method and every material has advantages and disadvantages, so how should I choose? My personal preference is a comprehensive rhinoplasty with nasal septum as the support rod to lift and lengthen the nose, ear cartilage shield transplantation pad the tip of the nose and swelling pad the bridge of the nose as the main body. (Excerpted from: Kaohsiung Fabo Clinic, Kaohsiung Fabo Plastic Surgery, Rhinoplasty, Qiu)