Surgical planning considering nasal height and three-dimensional definition

Hello.

I am Dr. Peter C. Kang, medical director.

Today, I would like to discuss the importance of three-dimensional definition in rhinoplasty.

This patient had undergone rhinoplasty with a silicone implant and ear cartilage 33 years ago.

The implant on the nasal bridge was clearly visible through the skin, and the bridge contour was very uneven. The nasal tip appeared blunt and spread out, and nostril asymmetry was present.

The patient had two primary requests:

1. 1. Lower the nasal bridge.

2. Raise the nasal tip.

Therefore, I decided that bringing natural three-dimensional definition to this nose, which appeared artificial and elongated, was the appropriate direction.

On the preoperative CT scan, calcification was progressing within the capsule surrounding the implant. Anticipating significant adhesions to surrounding tissues, I planned to remove the implant together with the capsule.

Sagittal CT view showing the silicone implant

Examining the implant removed during surgery revealed that the thickened capsule surrounding the silicone had become calcified.

In addition, I planned to reconstruct the blunt, spread-out nasal tip into a refined, well-projected shape using septal cartilage and donor rib cartilage.

Let us compare the preoperative photos with the photos immediately after surgery (Day 0).Immediate postoperative photos show swelling and may differ from the final result.

On the profile view, the radix is lower and the nasal tip is well-projected, creating clear three-dimensional definition.

On the oblique view, the nose, which previously looked elongated, appears noticeably shorter.

On the front view, the blunt and spread-out appearance has improved considerably, and the distinct show-through of the implant along the bridge has been addressed.

The basal view shows substantial improvement in the previously asymmetric nostrils.

People seek rhinoplasty for many reasons. The most fundamental reason, of course, is to enhance the appearance of the nose. However, even if the nose itself looks appealing, it will not enhance the overall look of the face if it does not fit the facial proportions or facial shape. Much like proportion, three-dimensional definition extends beyond nasal shape alone and significantly influences the entire face.

Three-dimensional definition becomes more pronounced when higher and lower contours coexist. In this sense, requesting a lower bridge and a higher tip essentially means aiming for greater dimensional balance in the nose.

What benefits does a nose with proper three-dimensional definition provide? First, the face appears smaller. Additionally, the mouth appears less prominent, and a shorter nasal appearance can create a more youthful impression. It also lends a softer, more feminine look.

I hope this information is helpful to those considering surgery for a flat, spread-out nose that lacks three-dimensional definition.

This was Dr. Peter C. Kang. Thank you.