ABC Nightline's Lead Story - Interviewing Dr. Sam Rizk and his patient about teen rhinoplasty and facial plastic surgery
Rhinoplasty surgeries in patients of Asian heritage are quite different than Caucasian rhinoplasties, since this group mostly needs an augmentation of the nose, instead of a reduction. Therefore, it is important to find a facial plastic surgeon who understands the aesthetics of Asian noses and facial structures as well as accepts and respects the uniqueness of each individual, his/her beliefs, as well as the ever-lasting beauty of that ethnicity. A sensitive and experienced surgeon will not try to “put” a Caucasian’s nose on an Asian face.
Traditionally, Asian or Oriental nasal features consist of noses with flat bridges, lacking bony height in the bridge, and soft, floppy and ill-defined nasal tips. Their cartilages tend to be weak and thin and their skin thick with flaring nostrils. However, there is significant variability between the different Asian countries. The hallmarks of this group in the U.S. have changed with inter-marriage, giving a hybridized look. Many Asian patients now seek a change in their noses and seek a more hybrid melting-pot Euro-Asian look.
One of the most popular cosmetic surgery procedures for Asian patients is nose augmentation combined with double eyelid surgery for a more complete, enhanced look. Many of the patients need to undergo nasal lengthening to make a nose appear longer. Normally, Southeast Asians noses (Malaysian, Thai, Filipinos, Burmese, Cambodian, Laotian, Vietnamese, and Indonesian) require more dorsal augmentation (3 mm. or more) and greater alar reduction than those of Northeast Asian heritage (Japanese, Korean, Chinese and Northern Chinese).
These are the typical Asians nose characteristics:
- Thick skin with excess sebaceous glands.
- Deep and flat radix (root of the nose).
- Low nasal bridge with wide and flat dorsum.
- Minimal tip definition with an abundant of fibro fatty tissue.
- Flaring nostrils.
- Minimal columella.
- Often has a retracted maxilla.
Dr. Sam Rizk, a Manhattan double board certified facial plastic surgeon, usually performs a rhinoplasty surgery on Asian patients in a conservative fashion, making subtle changes to the nose to keep some of its Asian characteristics and to make sure it fits better and looks more attractive combined with the rest of the patient’s face.
Traditional beliefs sometimes play a role in Asian Rhinoplasty. Some patients come from cultures who believe that having visible nostrils will drive away their wealth. Therefore, many of them require the surgeon to reduce their nostrils and make them less visible.
There are mainly two types of techniques used to perform Asian rhinoplasty:
- Closed Rhinoplasty – the surgeon performs an incision inside the patient’s nose. This technique leaves no visible scars but requires a skilled surgeon since it can damage the surrounding tissues resulting in swelling and bruising. Dr. Sam Rizk will perform a closed rhinoplasty technique by using the 3D technology that he pioneered, defatting the nose’s tip more precisely and preventing tissue damaging, bruising and swelling for faster recovery.
- Open Rhinoplasty – performed with a small incision outside of the nose between the nostrils. Surgeons normally use this technique for more complex rhinoplasty surgery cases. The flare and width base needs to be corrected by narrowing it and avoiding excessive elevation of the nose to prevent unnatural outcomes.
The Rhinoplasty procedures for Asians usually require a dorsal graft and are often done in combination with tip grafting for a better tip definition and projection. Dr. Rizk preferences are using the patient’s own cartilage; the first choice would be a nasal septum, and then the back of the ears. The cartilage is used to build the tip or the bridge of the nose. If more material is needed, Dr. Rizk uses Medpor, never silicone. Cartilage taken from the back of the ears is safe for the patients since it does not create any ear deformities or interferes with hearing ability. Medpor is a synthetic material, punctured with small holes that allow body tissue to wrap around and fill the space, creating a strong connection that stabilizes its location. The body forms a "bubble" around a Silicone implant and does not integrate with it, in a natural protection against foreign objects. Dr. Rizk custom sculpts the medpor implant to fit your nose during your procedure, It is not a one size fit all implant.
Dr. Rizk has done many revision rhinoplasty surgeries for Asian patients who previously had surgery in the U.S. or abroad. Often, other surgeons use silicone implants with their patients and the material extrudes after the rhinoplasty. Dr. Rizk will remove the silicone and insert either cartilage grafts or Medpor.
There is a chance of swelling after a rhinoplasty surgery. If the swelling stays for a few months, it can create scar tissue. In order to try to avoid scar tissue formations, Dr. Rizk recommends patients to receive steroid injections to reduce scar tissue and swelling about a month or two months post surgery.
For more information about Nose Implants for Asian Patients, click here.
For Frequently Asked Questions, click here
Dr. Rizk has performed many cases of rhinoplasty on Asian patients who would like to remain private. Additional Asian Before and After Photos are available at the office.
27 year old Asian female who had a previous rhinoplasty with silicone implant which became infected and extruded through her tip and also became crooked. Patient underwent revision rhinoplasty with Dr. Rizk to remove silicone implant and Dr. Rizk used cartilage from inside her nose to lengthen her nose and define her tip.
29 year old Asian female who wanted a more refined nasal tip and to remove her bump. The rhinoplasty was done using endonasal techniques in 3D with no external incision. Cartilage was harvested from patient's septum to create tip definition.
29 year old asian female who had a flat dorsum and tip with thick skin 1 year after rhinoplasty with dorsal septal cartilage implant and tip cartilage grafts for definition and support of thick asian skin. Notice the increase in tip projection and natural angle between nose and forehead and nose and upper lip.
50 year old asian female requesting refinement in her nasal bridge and tip. Patient shown 4 months after open rhinoplasty with tip grafting using her own cartilage, nostril reduction and a dorsal medpor implant.
23 year old asian female complains of lack of tip definition as well as a deviated nose to the right. Patient underwent rhinoplasty with auricular (ear cartilage) graft into her nose to give her more definition. The patient's own septum was too thin and inadequate for creating the definition necessary in her nose. Patient is shown one year after rhinoplasty with auricular cartilage graft.
29 year old female who is both African American and Asian who wanted a revision rhinoplasty to improve her bridge and nostril symmetry as well as give her more tip definition. Patient had an open rhinoplasty with medpor implant custom sculpted onto her bridge as well as ear (auricular) cartilage graft into her nasal tip. Patient also had revision nostril reduction. Patient is shown 1 year after revision rhinoplasty.
NOTE: ALL THE IMAGES USED ON THIS PAGE ARE ACTUAL PATIENTS THAT DR. RIZK PERFORMED RHINOPLASTY ON WITH APPROVED CONSENT.