Asian rhinoplasty

What repeats

Five findings that hold across the literature.

The anatomy the papers describe is low, soft and thickly covered

Reviews of Asian augmentation rhinoplasty state the same three features: a lower nasal dorsum, limited septal cartilage, and thicker soft tissue coverage. A second review adds a weak cartilaginous framework to the list. An older operative account of the Asian nose describes a thick skin envelope, low radix and dorsum, bulbous tip, weak lower lateral cartilages and a short columella.

Rests on: Frederick and Yoo, Asian augmentation rhinoplasty · Yoo and Jang, augmentation rhinoplasty in Asian patients · Kim and Daniel, operative techniques · and nasal anatomy.

The operation is described as augmentation rather than reduction

The stated main concept for the Asian nose is augmentation rather than reduction, because the dorsum is poorly developed and the tip poorly defined. Hump noses do occur, and one review sorts them into generalised humps, isolated humps and relative humps with a low tip, where the relative hump is treated by raising the tip rather than by taking the dorsum down.

Rests on: Jang and Yu, rhinoplasty for the Asian nose · Jang and Moon, hump noses in Asians · and component dorsal hump reduction.

There is measurably less septal cartilage to work with

Harvestable septal cartilage area and length were measured on fine-cut maxillofacial computed tomography in 200 patients across four self-described racial and ethnic groups, preserving a 1 cm L-strut. Older age, shorter height, African American or Asian American self-described race and female sex were each independently associated with smaller harvestable area and shorter length, all at p < 0.05. That is the measured version of the clinical statement that the septum runs out.

Rests on: Urban et al., donor cartilage availability · and rib cartilage grafts.

The tip is built on the septum, not propped on a strut

Septal extension grafts are named as the primary method of stable structural reinforcement for the Asian tip, controlling projection and rotation, with tip-onlay or shield grafts used for refinement. A series of 407 septorhinoplasties used a septal L-strut extension graft to advance the lower two thirds of the cartilaginous dorsum and the tip, and reported satisfaction, tip hardness, Nasal Obstruction Symptom Evaluation scores and pain scores over the follow-up period.

Rests on: Yoo and Jang · Moon et al., septal L-strut extension graft · and the pinched tip.

Skin thickness is now measured rather than estimated

Nasal skin and soft tissue envelope thickness was measured at six nasal subsites on maxillofacial computed tomography in 200 adults without nasal deformity, blinded, to compare thickness across races and subsites. The point of the study is that thickness varies by site as well as by group, so a single description of a patient's skin does not carry across the whole nose.

Rests on: Eggerstedt et al., soft tissue thickness.

By what the operation adds

The same nose is raised with different material, and the material drives the risk.

A synthetic dorsal implant

Silicone and expanded polytetrafluoroethylene are named as the materials Asian surgeons most often reach for, on grounds of handling and operating time. A retrospective review of 1054 Southeast Asian patients given expanded polytetrafluoroethylene reported 1030 desirable outcomes and 24 undesirable ones, with implant deviation in 1.04%, a visible implant in 0.47% and implant infection in 0.38%.

Rests on: Jang and Yu · Yap et al., expanded polytetrafluoroethylene · and alloplastic implants.

Diced cartilage held in a wrapper

Diced cartilage grafting is the technique the 2025 review emphasises. A series of 80 patients used glued diced cartilage shaped in a purpose-made mould, with three-dimensional scans in 23 of them to track dorsal width and height at the radix and rhinion over time. A smaller series of 15 patients used diced cartilage in deep temporal fascia for major augmentation, costal cartilage in 11 cases and a septal and conchal mixture in the other four, with acceptable aesthetic and functional results in 10 of the 15.

Rests on: Frederick and Yoo · Yoo et al., glued diced cartilage · Park and Jin, diced cartilage in fascia.

The patient's own rib

Costal cartilage is the fallback when the septum is short and the augmentation is large. It carries its own donor site and its own failure mode, which is warping, and the diced techniques above exist to answer that.

Rests on: Park and Jin · and rib cartilage grafts.

Length, when the nose is short

Lengthening the Asian nose is treated as its own problem with its own set of techniques. A series of 113 Chinese patients with shortened noses used a modified septal extension graft, on the stated grounds that a strong septal extension is needed to raise tip projection and lengthen the nose when the skin is inadequate and inflexible.

Rests on: Ng et al., lengthening of the Asian nose · Huang and Liu, septal extension for the short nose.

What to ask about Asian rhinoplasty

Questions the evidence supports asking.

What are you putting in my nose, and what happens if it fails

The material decides the revision picture. In a three-year Korean series, 52 of 623 rhinoplasties were revisions, and 33 of those 52 were related to an alloplastic implant, the commonest reason being implant deviation, followed by extrusion. Ask what the surgeon uses, and what the plan is if it has to come out.

Rests on: Won and Jin, revision rhinoplasty in Asians · and revision rhinoplasty.

How much septal cartilage do I have

This is measurable before surgery on computed tomography, and the answer changes the operation. If the septum is short, the cartilage comes from the ear or the rib, and the consent conversation changes with it.

Rests on: Urban et al. · and rib cartilage grafts.

What does thick skin do to the result

Thickness varies by subsite and was measured at six sites in the radiographic series. Thick skin hides fine cartilage work and holds swelling, so ask what the surgeon does about it and how long the tip takes to settle.

Rests on: Eggerstedt et al. · and recovery.

What happens to a nose that has already had an implant

A revision series of 84 Asian noses recorded a mean of 2.3 rhinoplasties per patient, with the deformities sorted by upper, middle and lower third. Where a silicone implant has left a capsule, one described method is to raise that capsule as a flap: a series of 95 Korean patients used a capsular flap with a new implant and tip work, with a mean follow-up of 31.7 months.

Rests on: Park et al., revision rhinoplasty of Asian noses · Jeong et al., capsular flap.

Am I choosing this for reasons surgery can fix

A meta-analysis of 15 studies covering 1977 Asian rhinoplasty seekers put the pooled prevalence of body dysmorphic disorder at 30.0%, with a confidence interval of 26.8 to 35.7. Screening before surgery is the stated response.

Rests on: Chua et al., body dysmorphic disorder in Asian rhinoplasty seekers · and the psychology of rhinoplasty.

The terms, defined

The words used about this operation.

• Augmentation rhinoplasty: an operation whose main step adds height to the dorsum rather than removing it. [20446203]
• Dorsum: the bridge of the nose, from the root down to the tip. [40389234]
• Radix: the root of the nose, where the bridge meets the forehead. [23110932]
• Septal extension graft: cartilage fixed to the septum that sets the position of the tip, controlling projection and rotation. [41962580]
• Columellar strut: a cartilage post between the medial crura, the alternative tip support to a septal extension graft. [23110932]
• Alloplastic implant: a manufactured implant such as silicone or expanded polytetrafluoroethylene, used to raise the dorsum. [20446203]
• Diced cartilage: cartilage cut into small cubes and held in fascia or glue, used to raise the dorsum without a carved block. [35877941]
• Capsule: the scar shell the body forms around an implant, which can be raised as a flap at revision. [25289365]
• Short nose deformity: a nose whose length has contracted after previous surgery, treated by lengthening rather than by augmentation alone. [33368078]
• Relative hump: a dorsum that reads as humped because the tip sits low, treated by raising the tip. [33368079]

Where else this is documented

Sources outside the journals, each one free to read.

The national guideline

The American Academy of Otolaryngology publishes a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what the surgeon should assess and record before operating, and it applies whatever technique is chosen.

Rests on: the clinical practice guideline · the plain language summary.

The surgeons' own textbook chapters

Rhinoplasty Archive, the free online rhinoplasty textbook edited by Daniel G. Becker, runs an ethnic rhinoplasty category. Six of its chapters cover this operation, the materials used to raise the dorsum and what happens at revision. They are written for surgeons and go further into technique than a patient page should.

• Asian Rhinoplasty
• Asian Rhinoplasty 2
• Rhinoplasty in Small Bulbous Asian Noses
• Spreader and L-Shaped Augmentation Rib Graft in Asian Septorhinoplasty
• Acellular Dermal Matrix in Asian tip and dorsal augmentation rhinoplasty
• Revision rhinoplasty in Asians

The reference summary

Rhinoplasty in StatPearls, on the National Library of Medicine's Bookshelf, gives the anatomy, the approaches and the complication list in full text at no charge.

The societies

• American Society of Plastic Surgeons, patient information.
• American Academy of Facial Plastic and Reconstructive Surgery, patient information.
• The Rhinoplasty Society, the surgeons' body, with its member directory. See associations.
• International Society of Aesthetic Plastic Surgery, which surveys its members every year and reports procedure counts by country.

The trials in progress

Dorsal augmentation and cartilage harvest are both under test in registered trials.

• Mastoid Bone Autograft for Dorsal Nasal Augmentation, completed, 15 participants.
• Effect of Costal Harvesting Technique on Postoperative Donor-site Morbidity, status unknown, 20 participants.

What is not settled

• The named anatomical features come from reviews and single-surgeon series rather than from population measurement, and a systematic review of regional variation makes the point that broad ethnic groups have been clustered by geography rather than by measured anatomy. [35725958]
• Septal cartilage availability is measured on computed tomography in one 200-patient study at a single centre. [35417206]
• Skin thickness is measured in one 200-patient radiographic series, at six subsites, without a linked outcome. [32212978]
• Comparative data between synthetic implants and diced cartilage in the same hands do not exist. The material series are separate, retrospective and single-surgeon. [21768557] [35877941]
• Follow-up in the diced cartilage series is measured in months, while implant failures in the revision series present years later. [27752742] [20841994]
• Whether a septal L-strut extension graft holds its position beyond the reported follow-up, in patients whose septal cartilage was thin to begin with, is not answered. [40493963]