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African-American and Asian Nasal Augmentation

Nasal Augmentation in African-American, Asian and Ethnic Rhinoplasty

Ethnic Nose Anatomy

Dorsal Nasal Augmentation is one of the most common requests from Ethnic Rhinoplasty patients. Understanding the surgical anatomy of the Ethnic nose is crucial for successful Dorsal Augmentation in Ethnic Rhinoplasty.

Layers of the Ethnic Nose:

1.) Skin.
2.) Subcutaneous fat layer.
3.) SMAS or fibromuscular layer.
4.) Periosteal and perichondrial layers.
5.) Bone and Cartilage.
6.) Internal Mucosal Lining.

Ethnic Nasal Anatomy

An Ethnic Rhinoplasty Surgeon must have the technical knowledge and proficiency to dissect into the correct surgical planes to develop a suitable pocket for an implant. Accurate surgical dissection will also reduce bleeding and swelling during the procedure, as well as after the procedure. Open Rhinoplasty technique enables the surgeon to directly visualize and dissect the correct planes, versus Closed Rhinoplasty, which is mainly blind dissection.

Implant Material Selection and Implant Placement

Many patients are worried about the type of implant material used for Dorsal Augmentation. The type of material used is not the key to successful Nasal Augmentation.

Keys to successful Nasal Augmentation include:

1.) Surgeon experience and skill.
2.) Custom 3-dimensional size and shape of implant.
3.) Accurate surgical plane insertion.
4.) Implant must be secured with a permanent stitch to avoid migration.

Once the correct pocket has been created, a 3-dimensional implant with the correct cephalic and caudal height and width can be inserted.

Ethnic Dorsal Nasal Augmentation
Nasal Implant Insertion

Implant placed in the Sub-periosteal, Sub-perichondrial Plane.

Material Types for Nasal Augmentation

Silicone is the most common implant used worldwide. This includes breast implants, chin, cheek, jaw implants, and most other body cosmetic implants. Early studies that studied nasal silicone implants are old and outdated and mostly poorly designed to test the reliability of silicone implants.

Silicone Nasal Implants are not faultless; they can extrude or migrate off center (if not inserted properly), reveal contour abnormalities if not carved or inserted properly, and even get infected; however, this is true with any nasal implant material including Medpor, Gore-tex, Mersilene, or even cartilage.

Medpor Nasal Implants are extremely challenging to carve into the right 3-dimensional shape because they are brittle. If they become infected or have to be removed for any reason, it is highly problematic, mainly as a result of tissue in-growth into the Medpor Implant as shown in this video:

 

 

Gore-tex Implants present the same challenges as Medpor. The implant material is also manufactured in sheets and is difficult to create the exact 3-dimensional shape necessary for accurate aesthetic augmentation for Ethnic patients. In my practice, I have removed both Medpor and Gore-tex Implants and there is usually a great deal of scar tissue associated with removal, which can cause contour irregularities post-operatively.

Septal or Auricular Cartilage typically do not provide enough 3-dimensional volumes to create an appealing Dorsal Implant, unless only 1 to 2 mm of augmentation is needed. In my experience, Ethnic patients typically require more implant volume for successful augmentation.

Rib grafts can work well but have the indisposition of a chest incision. The Ethnic Rhinoplasty Surgeon only has one opportunity to carve the correct 3-dimensional shape with a piece of rib graft, if the carving is not 100% accurate, contour irregularities will be obvious. Rib grafts can also warp over time, distorting the nasal bridge.

Custom silicone implants are carved from a block. If the Ethnic Rhinoplasty Surgeon, carves the wrong shape at first, a new implant can be carved from the silicone block until the shape is flawless; moreover, if a custom carved silicone implant needs to be removed for any reason: infection, extrusion, digression, or the patient doesn’t like the look, they can be easily removed in a quick, 10 minute office procedure under Local Anesthesia. In my practice, removal of silicone implants that I insert for any reason, is less than 1%.

In my opinion, L-shaped silicone implants should not be used, as they tend to to extrude through the tip. Silicone implants should not extend past the supratip area, as this can increase chances of extrusion.

I-shaped silicone implants are probably the most commonly used implants for Nasal Augmentation, especially in the Asian Rhinoplasty patient, but they are commonly too big, the wrong shape and inserted into the wrong tissue plane. These implants typically seem fake without the right anatomical shape and can migrate if not placed in the right tissue plane.

Nasal Augmentation in African-American Rhinoplasty

African-American Dorsal Nasal Augmentation

 

Isolate dorsal nasal area for augmentation.

1.) Custom carve nasal implant.
2.) Place through Open Rhinoplasty approach, ensuring proper shape and fit.
3.) Secure implant and close Open approach.

Asian Rhinoplasty and Nasal Augmentation

Position custom carved silicone implant starting at the curvature of the naso-frontal angle not extending past the supratip area in Asian Rhinoplasty patient.

Asian Rhinoplasty Nasal Augmentation

Custom carved silicone implant is secured in Asian Rhinoplasty patient.

Ethnic Rhinoplasty Nasal Augmentation

Nasal Augmentation in African-American, Asian and Ethnic Rhinoplasty.

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  • I’m a good-looking, middle-aged African-American male. I have always had an issue with the thickness of my nose. I've considered surgery for years, but was always overly-concerned with what the reaction would be toward a black man getting Cosmetic Surgery. I finally decided I have always lived my life on my own terms. Why stop now? I ventured out to find the right Dr. I was referred to a well-known Cosmetic Surgeon in Philadelphia. My interaction with him was the most humiliating experience I’ve ever had with a medical professional. The Dr....

  • I am so thankful to have come across Dr. Oleh Slupchynskyj of The Aesthetic Institute of New York and New Jersey. 'Dr. S.' (as I like to call him for obvious reasons, haha) is a Double Board Certified Facial Plastic Surgeon, and it turns out he has an entire website dedicated to his work with African-American patients: www.africanamericanrhinoplasty.com. I was immediately impressed with the wealth of information that he has on his site, including information about his practice, his stellar credentials, his surgical inventions (i.e., the SLUPi...

  • I was terrified of having surgery but after two consultations with Dr. S., my anxiety was alleviated, and this was my biggest hurdle. I was able to see what my results would be after surgery through 'computer imaging'. He spent as much time with me as needed and said I could come back as many times as I wanted before making a decision. That was refreshing. I asked to speak with at least 3 other patients of Dr. S. and did. They shared my initial fear and they helped me by explaining their experiences from a patient's point of view! Dr. S. specia...

  • The doctor is very approachable and personable and I felt that he is really listening to me. He made every effort to be easily accessible via email or phone. He also followed me every step of the process, not only during the surgery but also during the recovery period.

  • Double Board Certified with specialized training and loads of experience in Nose Surgery. I was able to see and discuss my results beforehand thru computer imaging so I felt very comfortable with what my result would be. Having consulted with other Drs. who did not have same training, imaging and were twice the surgical cost, I made my decision.

  • Dr. S. is excellent. From the first visit to the follow-ups I always felt comfortable. Look great and feel great, have recommended him others. Really great bedside manner and I was not the best patient. Thanks Dr. S. I really appreciate your patience!!

  • I had a Rhinoplasty done by Dr. S. and he did exactly what I wanted, which was a custom bridge implant.

  • As a 74 year old African-American woman, I was apprehensive regarding the SLUPlift Surgery. In the past, when I discussed Plastic Surgery with family and friends they spoke negatively about the surgery. Eventually I decided it was something I wanted to do for myself. I found Dr. Slupchynskyj while surfing the Internet and reviewing several of his before and after photos. After meeting the Dr. he assured me that I would be OK — and he was correct. After the surgery, I did not have to take any pain medication and I was out shopping within 4 day...
  • Worth It
    I am a 27 year old, African-American female from the Midwest and I just recently had a Rhinoplasty procedure performed on February 9, 2012. I had known for a long time that I wanted to have the procedure done to correct a bump in the bridge of my nose, reduce the width of my nose, as well as to refine my down-turned nasal tip. This was an operation that I was not going to trust to just anybody, so I spent countless hours researching and looking for a surgeon who had significant experience working with African-American patients. Because I liv...
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