In spite of unavailability of reference, a desire to have higher nose like Caucasians led to the rise in simple surgical techniques for Asian rhinoplasty in the past. While the simple augmentation using endonasal approach was popular in the 1980s, a trend has evolved to a tip pasty with septorhinoplasty using open approach since the 2000s. Many rhinoplasty surgeons in Asia, especially Korea, have tried to improve the level of Asian rhinoplasty on numerous accumulated data and studies.
This week, we share the Differences of Asian Rhinoplasty from Caucasian Rhinoplasty, an abstract from Rebuilding Nose: Rhinoplasty for Asians by IFAAS faculty, Dr. JaeYong Jeong, MD, Seoul, South Korea:
Definition of Asian Rhinoplasty
"Knowledge and surgical techniques are important for making a beautiful nose as the final goal" - IFAAS Faculty, Dr. JaeYong Jeong, MD. Seoul, South Korea
Asia is a large continent with various tribes. In fact, more than half of whole global population reside in Asia. The continent has a mongoloid background including countries such as China, Japan, Korea, Taiwan, Singapore, Thailand, Vietnam, Philippine, and Indonesia among other counties. It can also be divided as East, Southeast, and South Asia by region. Tribes that inhabit Southwest Asia including KSA (Kingdom of Saudi Arabia) and Iran are excluded from Asian plastic surgery in general.
East-Asian rhinoplasty is more focused on techniques useful for patients from China, Japan, Korea and Southeast Asian countries. However, the term Asian rhinoplasty will be used in this case because Asian rhinoplasty has been used as a comparison with Caucasian rhinoplasty in many references, and most of the patients come from China and Korea. The term East-Asian rhinoplasty is often used to give a more definite meaning in conferences and references.
Reduction vs. Augmentation
A stereotype about Asian external appearance is described as thick and yellowish skin, black hair, low and wide nose along with small and puffy eyes. However, there are considerable differences by tribes and regions along with Asians. Therefore, it is prejudiced to analyse Asians with fragmentary sight in the field of plastic surgery (refer to definition of Asian rhinoplasty above). A different approaching concept is necessary for Asian rhinoplasty that focuses on augmentation differing from Caucasian rhinoplasty that focuses on reduction.
Although it is ideal to operate with the patient's own autologous tissue in overall field of plastic surgery, it is inevitable to use implant in Asian rhinoplasty. In fact, it is difficult to obtain favourable results by merely using autologous tissue since the dorsal augmentation and volume expansion are crucial in Asian rhinoplasty, this incidence in use of an implant is much higher, compared to Caucasian rhinoplasty.
Nasal Envelope in Asian
A nasal envelope in Asian tends to be thick, tough and less elastic. There is a thick and dense fibrofatty tissue attached onto the alar cartilage. This is the reason why Asian nose requires relatively strong internal structure to obtain favourable outcomes. Therefore, it is important to check preoperative condition of the nasal skin, especially caudal one third and to predict postoperative result based on preoperative analysis. Characteristics of Asian skin are diverse with wide range of variations including SMAS (superficial muscle-aponeurotic system). It is well defined at the level of nasal bone and upper lateral cartilage, but attached tightly to alar cartilage at nasal tip area.
In Asians, a nasal bony and cartilaginous structure is relatively small, but a skin flap is relatively thick. It requires surgeon's caution while reducing width of nasal bone using osteotomy since nasal bone in Asian is smaller and shorter than Caucasian; having 25mm in length in average. In addition, it is possible for excessive pressure to be applied due to inserted big implant, which may be harmful to nasal bone and underlying supportive structures in the long run. Alar cartilage is not exceptional. Underdeveloped medial crura make for more difficult to construct supportive nasal structures. The height of caudal septum is also low and weak in Asians.
Possibility of Severe Deformation
There are advantages with using implant in Asian rhinoplasty, but a secondary contracted nasal deformity might happen severely if complications such as postoperative inflammation, visible implant, implant extrusion and so on to occur under compressive force of nasal envelope in Asians. Therefore excessive intra-operative manipulation or indefinite surgical method that might aggravate injury of tissue should cautiously avoided.
Cultural and Religious Characteristics in Asian
Some different views during consultation between surgeon and patient that originates from regional, religious and cultural difference occurs frequently. For example, there is baseless superstition that "if the nostril is more visible, money leaks". This stereotype has an effect on patient and also affects decision and result of the operation. It is quite interesting to interpret wide nostril makes for more money in another country.
Therefore, high dependency on Western textbook follows the method without integrating such concept, which might cause disappointing results in Asian rhinoplasty. A cartilage modifying-development procedure such as Tebbett's suture technique is effective for Caucasian with thin skin and well developed cartilage framework, but might to be effective for Asians.
The understanding of concept and anatomy is more important than applying learned knowledge and new surgical techniques during the operation. In short, it is necessary to understand a nose itself rather than surgical methods. Although the knowledge and surgical technique are important for making a beautiful nose as the final goal, it is more important to predict nasal shape balanced with other facial features and proper patter as preoperative consult and analysis.
Rhinoplasty is an attractive operation because it stimulates a surgeon's challenging spirit even though that it is important for both surgeon and patient to recognise the limitations of the postoperative result considering patient's characteristics in real practice.
Hope you have enjoyed the article! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!
Rebuilding Nose Rhinoplasty for Asians by JaeYong Jeong (Translated by TaekKyun Kim) - 2018
Learn the Differences of Asian Rhinoplasty from Caucasian Rhinoplasty through Observation of Live-Cases in Dr. JaeYong Jeong's very own OR at our Seoul, South Korea Mini-Fellowship this July!
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