Two Main Approaches to Rhinoplasty

Two Main Approaches to Rhinoplasty

1. Closed Rhinoplasty or Endonasal Rhinoplasty

• Incision Location: Hidden entirely inside the nostrils with no visible external scarring.
• Benefits: Shorter recovery time, less swelling, and no external scar.
• Limitations: Less visibility of internal structures, which may restrict certain adjustments.

2. Open Rhinoplasty or Open-Tip Rhinoplasty

• Incision Location: Inside the nostrils plus a small transcolumellar incision (across the strip of tissue between the nostrils) to connect both internal access points.
• Benefits: Enhanced visibility for the surgeon to make detailed structural corrections.
• Limitations: Slight visible scarring in the early healing phase and slightly longer recovery time.

Choosing the Right Surgical Technique

The decision between open and closed rhinoplasty isn't based solely on the type of incision but also on the patient’s goals and the specific nasal concerns that need to be addressed. For

example:

• If the goal is to reshape the nasal structure to correct deformities or imbalance, open rhinoplasty may be the more suitable option.
• If the objective is simply to augment the nasal bridge using silicone implants to achieve a higher profile, closed rhinoplasty may be sufficient.

More Than Just the Incision

The key factor in selecting a surgical method isn’t just where the incision is made—it’s what the surgeon needs to do inside the nose. Whether it's restructuring the bone and cartilage or inserting a silicone implant, sometimes an open approach is necessary to allow for precise adjustments that meet the patient’s desired outcome.

Rhinoplasty—commonly referred to as nose augmentation—is a procedure that enhances the shape and harmony of the nose. There are various techniques available, such as silicone augmentation, cartilage grafting, or nasal contouring to better match the overall facial proportions.

Silicone Nose Augmentation

At BDMS Wellness Clinic, we emphasize a personalized approach. Our experienced surgeons begin by thoroughly discussing your concerns and evaluating your facial features to recommend the most suitable rhinoplasty technique. Multiple factors are considered to ensure optimal results that align with each individual's expectations.

A harmonious nose should not only look aesthetically pleasing on its own, but also complement the forehead, bone structure, cheekbones, teeth, and chin to enhance overall facial balance and even facial harmony based on the Physiognomy or science of Face Reading beliefs.

Once a treatment plan is finalized, the surgeon will sculpt a custom-fit silicone implant to suit the patient’s unique facial proportions. This bespoke technique allows for a refined and natural-looking result. Whether the goal is to correct nasal asymmetry or enhance the nose bridge, the silicone implant is carefully placed beneath the nasal periosteum (the bone’s outer membrane). This positioning ensures the implant remains securely in place and integrates smoothly with the natural nasal structure.

Pre-Surgery Preparation for Rhinoplasty

1. Medical Consultation
   Schedule a consultation with a qualified specialist to assess your nasal and facial structure. The surgeon will advise on the most appropriate augmentation method for your individual needs.
2. Discontinue Certain Medications
   Stop taking medications that may increase bleeding, such as aspirin or certain anti-inflammatory drugs, at least 1 week prior to surgery.
3. Avoid Alcohol and Smoking
   Refrain from consuming alcohol or smoking before surgery, as both can impair the healing process and increase the risk of complications.
4. Fasting Before Surgery
   Do not consume any food or drinks for at least 6 hours before surgery to reduce the risk of aspiration or nausea during the procedure.

Is Silicone Nose Augmentation Right for You?

Silicone nasal implants are an ideal option for individuals seeking a natural enhancement with minimal recovery time. This approach may be suitable if you:

1. Have a low or flat nasal bridge
   Silicone implants can enhance the height and structure of the nose, adding definition and balance to the face for a more refined and dimensional look.
2. Wish to correct a crooked or asymmetrical nose
   For those experiencing nasal deviation or irregular contours, silicone augmentation can help reshape and align the nose, restoring symmetry and harmony to your facial profile.
3. Have had previous nose surgery or trauma
   If you've undergone prior nasal surgery or sustained an injury that altered the shape of your nose, silicone implants can assist in restoring a more natural and aesthetically pleasing form.
4. Prefer to avoid rib cartilage grafting due to age or health conditions
   For older adults or individuals who may not be suited for more invasive procedures such as rib cartilage grafting, silicone offers a safe, reliable, and less invasive alternative.
5. Want quick results with shorter downtime
   Silicone rhinoplasty typically involves less recovery time compared to more complex techniques. It’s an excellent choice for those looking for noticeable improvement without an extended healing period.

Silicone Nose Augmentation Procedure

At BDMS Wellness Clinic, every silicone rhinoplasty procedure is meticulously tailored to suit the patient’s facial structure and aesthetic goals. Here’s what you can expect from the procedure:

Surgical Steps:

Incision Placement
The surgeon will create a discreet incision—typically hidden inside the nostrils or beneath the nasal base—to ensure scars are virtually invisible.

Customized Silicone Sculpting
A medical-grade silicone implant is individually sculpted by the surgeon to harmonize with the patient’s facial proportions. This personalized approach ensures a natural, well-balanced result.

Implant Placement & Closure
Once shaped, the silicone implant is placed precisely in the desired position. The incision is then closed using absorbable sutures that do not require removal.

Benefits:

• Creates a more refined and proportionate nose shape
• Corrects nasal asymmetry and may improve breathing
• Long-lasting results with a natural appearance

Considerations:

• As with any surgical procedure, there is a risk of infection or incomplete wound healing
• Some swelling and a recovery period are expected after surgery

Post-Rhinoplasty Care Guidelines

Proper aftercare is essential for optimal healing and long-lasting results following your rhinoplasty or revision surgery. Below are key recommendations to support a smooth recovery:

1. Take Medications as Prescribed

• Follow your surgeon’s instructions carefully, including antibiotics to prevent infection and anti-inflammatory medications.
• Avoid taking any non-prescribed drugs, especially blood-thinning medications, unless approved by your doctor.

2. Apply Cold Compress (Days 1–4)

• Use a clean cold towel or cotton pad to gently compress the cheeks and forehead to minimize swelling.
• Tip: Cold compresses are most effective during the initial inflammation phase (first 72–96 hours).

3. Switch to Warm Compress (After Day 4)

• Begin using a warm compress to ease lingering swelling and bruising.
• Gently apply a warm towel around the nose and forehead area.

4. Keep Your Face Clean and Avoid Makeup

• Use a damp cotton pad with clean water to gently wipe the face, avoiding the surgical site.
• Refrain from applying makeup for at least 7 days post-surgery to prevent irritation. Makeup can be resumed once healing is sufficient.

5. Sleep with Head Elevated

• Sleep with your head elevated at a 30–45 degree angle using supportive pillows to reduce swelling.
• Avoid sleeping flat or on your side for the first 1–2 weeks to prevent pressure or distortion to the nose.

6. Avoid Certain Foods and Substances

• Refrain from consuming fermented foods (e.g., pickled items, shrimp paste) that may trigger inflammation.
• Stop smoking and avoid alcohol for at least 1 month after surgery to promote proper healing and reduce infection risk.

7. Limit Physical Activity

• Avoid lifting heavy objects or engaging in vigorous exercise for 4–6 weeks to protect the nasal structure during recovery.

8. Clean the Internal Incision Area After Suture Removal

• Use a cotton bud soaked in saline or warm water to gently clean the internal nasal area daily.
• This helps prevent infection and ensures the wound remains free of bacteria or buildup.

9. Keep Incisions Dry and Ventilated

• Avoid exposing the incision area to water directly during the early healing phase.
• Instead of splashing water on your face, use a damp cotton pad to cleanse gently while keeping the surgical site dry.

Preventing and Managing Nasal Tip Thinning

Silicone augmentation rhinoplasty is a popular procedure known for enhancing nasal shape with natural-looking results. However, if not properly planned and cared for, it can lead to nasal tip thinning—an advanced complication that may result in long-term issues.

Common Signs and Risks of Nasal Tip Thinning

1. Thinning Skin at the Nasal Tip
   The skin may appear translucent or feel sensitive at the tip. If left untreated, the silicone implant may eventually push through the skin, leading to visible exposure, infection, and permanent nasal deformity.
2. Infection at the Tip of the Nose
   Thinner skin is more prone to inflammation, increasing the risk of infection. Severe infections may lead to pus formation and require implant removal.
3. Tissue Damage
   If the implant is too large or incorrectly positioned, it can place excessive pressure on the nasal tip, damaging the tissue. This may lead to scar tissue formation and complications during future revision surgery.
4. Permanent Deformity
   In cases where the implant breaks through the skin, it must be removed. The resulting deformity may require months—or even a year—of healing before corrective surgery can be performed.

Solutions & Prevention Strategies for Nasal Tip Thinning

If you notice early signs of thinning at the nasal tip, consult your surgeon promptly to prevent further complications. Recommended approaches may include:

1. Temporary Removal of the Implant
   Allows nasal tissue to rest and heal before undergoing any corrective procedure.
2. Reinforcement with Autologous Tissue
   Cartilage from the ear or fat grafts can be used to cushion the nasal tip, reduce pressure, and strengthen the area.
3. Use of Synthetic Grafts
   Biocompatible artificial materials can be inserted at the tip to support and protect the tissue while minimizing long-term risks.
4. Reshaping or Downsizing the Silicone Implant
   Selecting an appropriately sized implant that suits the nasal structure helps reduce excess pressure and potential complications.
5. Alternative Techniques (e.g., Tip-Only Grafts Without Silicone)
   Techniques such as open rhinoplasty with no silicone at the tip offer a more natural result and eliminate the risk of thinning or extrusion altogether.

Nasal Tip Support with Ear Cartilage Grafting

Using ear cartilage grafts is a highly effective technique for nasal tip support, especially in cases where the nasal skin is thin or the nose is naturally short. Instead of relying solely on silicone, this method involves harvesting cartilage from behind the ear to reinforce the tip of the nose—enhancing projection while minimizing the risk of complications such as implant extrusion or tip irregularity.

Benefits of Using Ear Cartilage for Nose Augmentation

1. Naturally Refined Tip Appearance
   Ear cartilage provides gentle, natural lift to the nasal tip, creating a smooth contour without the sharpness that can sometimes occur with silicone alone.
2. Reduced Risk of Implant Extrusion
   For patients with thin nasal skin or shorter nasal structure, ear cartilage adds strength and elasticity, significantly reducing the risk of silicone implant pushing through the tip.
3. Biocompatible Tissue from Your Own Body
   Since the cartilage is harvested from the patient’s own body, there is minimal risk of allergic reaction or tissue rejection.
4. Smooth, Natural Feel
   Ear cartilage blends seamlessly with the nasal tissue, avoiding visible edges or irregularities and delivering a more natural touch and aesthetic.

Considerations & Limitations

1. Limited Graft Volume
   In cases requiring extensive augmentation or structural correction, the amount of cartilage from behind the ear may be insufficient. Additional techniques or materials may be needed.
2. Longer Recovery Period
   Because the procedure involves two surgical sites (the nose and the ear), recovery may take slightly longer compared to silicone-only augmentation.
3. Minor Scarring Behind the Ear
   A small incision is made behind the ear to harvest the cartilage. While typically well-hidden, this may result in a faint scar—patients with a tendency to develop keloids should take this into account.

Who Is Best Suited for Nose Augmentation with Ear Cartilage Grafting?

Individuals with Thin Nasal Tip Skin

Ear cartilage grafting helps reinforce delicate tissue, reducing the risk of implant-related complications.

• Patients with Short or Under-Projected Noses
  This method provides a natural boost in nasal height and contour.
• Those Seeking Long-Lasting, Natural Results
  Cartilage grafts maintain structural integrity over time and are less likely to require future replacement compared to silicone.

Nose Augmentation with Ear Cartilage Grafting Procedure

1. Evaluation and Surgical Planning
The surgeon will assess the nasal shape, skin thickness at the tip, and examine the condition and availability of ear cartilage to ensure there is sufficient volume for grafting.

2. Pre-Surgery Preparation
Patients are required to fast—no food or drink—for at least 6 hours prior to surgery. Additional instructions may include pausing specific medications as advised by the physician.

3. Surgical Procedure

• Harvesting Ear Cartilage
  A small incision is made behind the ear to harvest cartilage. This tissue is flexible and ideal for reinforcing the nasal tip.
• Nose Augmentation
  The harvested cartilage is carefully grafted to the nasal tip and sculpted to achieve the desired shape, enhancing both projection and definition.
• Wound Closure
  Once the cartilage is in place, incisions at both the nose and ear are closed neatly—typically using fine sutures to support optimal healing and minimal scarring.

Frequently Asked Questions: Ear Cartilage Grafting for Rhinoplasty

Does harvesting ear cartilage hurt?
The procedure involves minimal discomfort. Ear cartilage is soft and located near the surface, so harvesting it causes little pain. You may feel a slight pinch when the local anesthesia is administered, but the surgery itself is painless. The incision is small, and the structure of the ear remains unaffected.

Is it normal to feel sharp pain after surgery?
Mild tingling or sharp sensations at the donor site are normal during the healing process. These symptoms generally improve over the course of 3 months and typically resolve completely within 1 year. Recovery time may vary by individual. To support healing, avoid sleeping on the affected side or pressing the ear against surfaces like phones or pillows.

Can I wash my hair after ear cartilage surgery?
It’s recommended to avoid washing your hair for the first 2 weeks, or until the stitches are removed, to prevent infection. If needed, you can use a dry shampoo or spray to keep your scalp clean. After 7 days, if the gauze and dressing have been removed and the wound is dry and healing well, gentle hair washing can resume.

Is nasal tip redness normal after using ear cartilage?
Yes, mild redness at the nasal tip is common during the first 2–4 weeks. This occurs due to skin tension and the visibility of fine blood vessels after grafting. The redness typically fades as the tissue adapts and heals.

Why does the nasal tip redness come and go?
Intermittent redness may be triggered by several factors:

• Facial scrubs or skin exfoliation
• Sudden changes in weather or allergic reactions
• Intense physical activity that increases blood circulation and highlights surface capillaries

These symptoms are usually temporary and subside on their own.

How Effective Is Nasal Tip Support with Artificial Tissue Grafts?

Artificial Tissue Grafts for Nasal Tip Support

Using artificial tissue to reinforce the nasal tip is a highly effective technique for patients who seek lasting structure and shape without harvesting grafts from their own body. This method offers several distinct advantages:

Key Benefits

• Long-Term Shape Retention
  Artificial grafts maintain their form longer than natural tissue, which may resorb or shift over time.
• Consistent and Predictable Contour
  Synthetic materials provide a stable, well-defined shape that aligns with the desired outcome.
• No Need for Donor Tissue
  Avoids the need to harvest tissue from other body parts such as the ear or rib, reducing surgery time and postoperative discomfort.
• Increased Nasal Tip Thickness & Protection
  Ideal for patients with thin skin at the nasal tip or less definition. The graft adds thickness, helping prevent silicone exposure over time.
• Soft and Flexible Texture
  Artificial grafts are typically softer and more pliable than traditional silicone, offering greater comfort and a more natural feel.
• Reduced Friction
  By acting as a buffer between the silicone implant and nasal tissue, the graft helps minimize friction that could otherwise lead to irritation or ulceration over time.

Who Is This Technique Suitable For?

This technique is ideal for individuals who:

• Desire a well-defined and long-lasting nasal tip result
• Have not achieved satisfactory outcomes with standard silicone implants
• Prefer to avoid harvesting tissue from their ear or rib
• Seek lower risk of rejection or adverse reactions related to autologous tissue

Is Post-Operative Care Different from Standard Silicone Augmentation?

In general, recovery after artificial tissue grafting is similar to standard silicone rhinoplasty. However, a few specific considerations may apply:

• Infection Control
  As synthetic materials may carry a slightly higher infection risk than natural tissue, extra care is needed to maintain cleanliness and adhere to your surgeon’s wound care instructions.
• Monitoring for Movement or Distortion
  During the healing phase, careful monitoring is required to ensure the graft remains properly positioned.
• Long-Term Follow-Up
  Artificial grafts may require longer-term monitoring compared to silicone alone, as there is a small chance of shifting or material-related concerns over time.

Alar Base Reduction (Alarplasty)

Alar base reduction, or nostril reduction surgery, is a cosmetic procedure that addresses concerns such as wide, thick, or flared nostrils that may cause facial imbalance or self-consciousness. This technique helps create a more refined nasal shape by reducing the width of the nostrils, resulting in better facial harmony and overall proportion.

Key Benefits of Alarplasty

• Slimmer, More Refined Nostrils
  Reduces nostril width, especially for those with wide or flared alar bases, to better match the facial structure.
• Enhanced Nasal Balance
  When combined with rhinoplasty, it improves nasal projection and overall contour, offering a natural, well-balanced look.
• Boosted Confidence
  Aesthetic refinement of the nostrils can significantly enhance self-image and confidence in one’s facial appearance.

Alarplasty Techniques

Depending on the individual's nostril shape and goals, several surgical approaches may be used:

1. External Base Reduction

• Removes 1–2 mm of tissue from the outer base of the nostrils.
• Ideal for patients with significantly wide nostril flares.

2. Combined Internal and External Reduction

• Reduces both nostril flare and inner nostril size for a more dramatic refinement.
• Suitable for individuals with large nostrils and wide alar bases.

3. Internal Base Reduction Only

• Targets the inner corner of the nostrils to reduce puffiness without altering nostril width.
• Recommended for patients with small nostrils but prominent outer contour.

4. Hidden Incision (Scarless Technique)

• Incisions are placed within the natural creases of the alar to minimize visible scarring.
• Best for patients who want noticeable reduction with no visible external scars.

Surgery Time & Recovery

• Procedure Time: 15–30 minutes, depending on technique and anatomy.
• Recovery: Most patients can return home the same day. Mild swelling or bruising may occur and typically resolves within a few days.
• Aftercare: Avoid touching, pressing, or manipulating the nose in the early recovery phase to ensure proper healing.

Ready to Enhance Your Confidence?
Schedule a consultation today to explore the right nasal refinement technique for your facial structure and goals.