If you are of East Asian ethnic descent and wish to make your nose higher, then you need to undergo what is called an “Augmentation Rhinoplasty” or augmentation nose job procedure in which your nose is reshaped by adding material to it to increase the height of the nasal bridge.
Most plastic surgeons will tell you that their preferred option is to raise the bridge of the material using the patient’s own cartilage (called “autologous cartilage”) which is harvested from another part of the patient’s own body. Using the patient’s own cartilage is less risky and provides better outcomes versus using foreign material which could, in some cases, be rejected by the body, protrude through the skin or cause infection.
How do you obtain “Autologous Cartilage” for augmentation rhinoplasty?
Autologous cartilage can be harvested from several places in the patient’s body with the most common being the nose, itself. However, since ethnic Asian noses are generally flatter, there is less cartilage available in the nose itself which can be used to increase the height of the bridge. The next material of choice is ear cartilage.
A small incision is typically made inside the “conchal bowl” of the ear and a piece of cartilage is removed before the skin on the ear is sown back again. Typically, there is no visible mark left on the ear and the external appearance of the ear does not change.
In some cases where ear cartilage is not available due to previous surgeries, the plastic surgeon harvests cartilage from between the ribs of the patient, also known as “costal cartilage”. The surgeon makes an incision under the chest and above the stomach area and removes a small piece of cartilage usually from the eighth, ninth or tenth rib. The incision site is then stitched back together. Experienced plastic surgeons ensure that only enough rib cartilage is harvested such that there is no resulting deformity in the rib cage.
Once the cartilage is harvested either from the ear or the ribs, it is then diced and re-shaped by the plastic surgeon and placed on the bridge of the nose to increase its height or even used as extension to increase the length of the nose.
When do you use synthetic materials or implants for augmentation rhinoplasty?
When there is not enough cartilage available in the patient’s own body, especially, when dramatic changes are required to shape of the nose, the surgeon has to use synthetic implants to achieve the desired outcomes. There are several choices of implant material available with the most common being Silicone and Gore-Tex.
Silicone Nasal Implants
Silicone nasal implants are one of the most common materials used for augmentation rhinoplasty. It uses a synthetic material, which is specially fitted and inserted over the existing nasal bridge. There are different shapes and sizes with the different shapes being an “L-shape” or an “I-shape” implant. The L-shape implant is typically used for Asian patients who seek to increase the height of the nasal bridge while also adding definition to the nasal tip.
While silicone is a well accepted material it is very hard and this can sometimes make the nose look a little unnatural particularly when the patient has thin nasal skin. There is also a risk that any trauma to the nose could result in the Silicone implant getting displaced from its original position.
Gore-tex is a porous material and relatively softer material compared with silicone. It is commonly used in making sports clothing. Because the material is porous (i.e., it has small holes), the patient’s own tissue can actually penetrate this material over time allowing the implant to bind with the body’s own tissue and become part of the nasal structure. This makes it less vulnerable to displacement compared with Silicone implants. Because Gore-tex is softer than Silicon, it can be shaped more easily by the plastic surgeon and, once in place, lends a more natural appearance to the nose.
The main disadvantage of Gore-tex implants is that, because it eventually binds with the nasal tissue, removing it is more difficult if there is an infection or an undesirable cosmetic outcome following the rhinoplasty. Also, because Gore-Tex is less rigid than Silicone, it can change shape over time, especially as the nasal anatomy changes with age.