To first understand the complexity of rhinoplasties, one must understand the anatomy of the nose, with it's 4 distinct layers –
- the lower lateral cartilage
- the upper lateral cartilage
- nasal bone
- alar cartilage
A “nice” nose differs for various ethnic groups, and requires specific procedures to achieve the best cosmetic result. In addition to the aesthetic angle, I also have to consider the functional aspect of your nose (ie whether you have any existing nasal obstruction).
Common rhinoplasty requests amongst my patients range from “just make my nose a little higher”, to “make my tip more pointed and sharp” and “I want that Korean actress's nose”.
Below I discuss the pros and cons of the 2 most common rhinoplasty procedures in Singapore: Silicone implant rhinoplasties and autologous rhinoplasties.
1. Silicone implant rhinoplasty - Advantages vs drawbacks
The silicone implant rhinoplasty is a nice simple technique if you want to increase the height of your nose bridge – nothing beats a silicone implant to give that high, defined-looking nose bridge. Silicone implant nose jobs are very much an oriental thing, as most westerners require a reduction of their nose bridge, rather than an augmentation.
It's important to remember however that a nose job is not only about the height of your nose bridge, but also the mid-vault of your nose, the definition and projection of your nose tip, the width of your nasal base and the shape of your nostrils.
Problems arise if the silicone implant is asked to take on more tasks then it should in a nose job, in particular, tip re-shaping. In this situation, one runs the very significant risks of implant exposure, extrusion and infection.
The Koreans realized this very early on due to the high volumes of silicone implant rhinoplasties that they perform. Hence, when I was training there, I learnt unique hybrid techniques of silicone implant rhinoplasties used to great effect in Korea. I still employ these techniques in my practice today.
2. Autologous rhinoplasty - Pros vs cons
Apart from using a silicone implant, there's also the option of using your own tissue – also known as an autologous rhinoplasty.
Autologous rhinoplasties involve using tissue such as cartilage, dermofat and fascia to create the framework for your nose.
The main benefits are that it reduces the risks of implant exposure or extrusion, has a much lower risk of infection, and is often the only solution for revision procedures where the skin is already thinned out.
Autologous rhinoplasties are a much larger endeavour than using a silicone implant, involving a longer operative time and a higher level of surgical finesse.
Getting it wrong could mean having a worse nose than you started off with, or developing nasal obstruction when there was previously none. Your donor sites for tissue (eg. rib cartilage or scalp fascia) could also develop complications, should the harvesting be done poorly.
It takes years of training and practise to gain the necessary expertise to carry out autologous rhinoplasties.
What other challenges do a plastic surgeon face with rhinoplasties?
Beyond the anatomical and technical difficulties of rhinoplasties, it's an open secret that rhinoplasty patients can be amongst the most demanding of all patients who come for aesthetic procedures.
It's easy to understand why, as the nose is truly the centerpiece of the face and the most prominent part of your face in photos, whether in frontal, side or ¾ view.
Unlike other procedures, the swelling of your nose after a rhinoplasty can take 6 months to a year to completely resolve, thus obscuring the final aesthetic result of the nose for a long time. This can be especially distressing to patients who want a quick result. Not every plastic surgeon is prepared to “hand-hold” patients through this arduous process!
Why then do plastic surgeons like myself still persist in doing autologous rhinoplasties? Well, beyond relishing a challenge and appreciating the finesse that it requires, I personally find it extremely gratifying when it is well done - A perfectly executed rhinoplasty is a work of art!
Before I left my fellowship in Seoul, South Korea, my mentor for rhinoplasty advised me to just concentrate on rhinoplasty surgery in my practice, as he does. I told him then that this was simply not possibly in Singapore, where the demand would not justify the sacrifice – I would be operating on one or two patients a week!
Five years on, I am slowly understanding his reasoning. Excellent rhinoplasty surgery is truly, to paraphrase a popular tagline, surgical perfection that requires a relentless pursuit.
To ensure that you get the best results possible, find out all you need to know about rhinoplasty here.
Dr Samuel Ho is a plastic surgeon at Allure Plastic Sugery. He has worked alongside top plastic surgeons at plastic surgery centres in Korea, such as the Hanyang University Hospital, 101 Plastic Surgery Clinic and BIO Plastic Surgery Clinic. Aside from regular work, Dr Samuel is a supporter of a not-for-profit medical volunteer organization that provides reconstructive facial surgery to young children in Indonesia.
- Palma, P., Khodaei, I., Bertossi, D., Vasilenko, I., Alqahtani, A., Alaa Shawkat, S., & Wills Villarraga, D. (2013). Hybrid rhinoplasty: beyond the dichotomy of rhinoplasty techniques.
- Bellinga, R. J., Capitán, L., Simon, D., & Tenório, T. (2016). Technical and Clinical Considerations for Facial Feminization Surgery With Rhinoplasty and Related Procedures. JAMA facial plastic surgery, 19(3), 175-181.