Asian rhinoplasty

Plastic surgeons in China evaluate the efficacy of Teflon implants for augmenting the nasal bridge and tip in Asian rhinoplasty.

Rhinoplasty is defined as a surgical procedure to cosmetically alter the nose, but as any plastic surgeon can tell you, not all patients are the same.  For example, those of Asian descent may have desires for their nose that can be very different from Caucasian patients.

The differences of the Asian nose are evident; a smaller amount of bone and cartilage means that the nasal profile is much lower and flatter. The thicker amount of skin over the tip also gives it a blunter appearance. These are the most commonly requested revisions in Asian rhinoplasty—increasing the profile and defining the tip.

As the nose is already deficient in cartilage, surgeons take these from other areas of the body, with the most common sources being the ears or the ribcage.  This limits the amount that can be obtained, and patients may baulk at the increased number of incisions.

An alternative is to use alloplastic materials made from inert substances like silicone or polytetraflourene (Teflon). Nasal implants can be fashioned to produce the augmentation without any foreign body reactions. However, the projecting tip of the implant can cause the skin over the nose to thin out—extrusion of the implant has been known to occur, much to the distress of both patient and surgeon.

Surgeons attempt to prevent this complication by placing ear cartilage over the projecting tip of the implant, essentially creating a shield between the implant and the soft tissue of the nose. However, since this may go back to the patient’s aversion for more incisions, doctors are looking to see if this extra manoeuvre is really needed.

In the February 2018 edition of JAMA Facial Plastic Surgery, Chinese plastic surgeons published a study on the use of Teflon implants and the value of adding cartilage grafts.  A total of 129 patients seeking a rhinoplasty were randomized into two groups, one receiving Teflon implants with the cartilage shield graft and the variable group with just the implant alone.

From their results, the surgeons concluded that outcomes were similar. Cosmetic results were comparable for both groups, and perhaps more importantly, no implant infections or extrusions were noted.  The study also implies that the complications seen in these implants may be less a function of the material used but more attributable to operative technique.  That simply validates the credo of choosing the right surgeon for the right procedure.

Written by Jay Martin, M.D.

Reference: Gu, et al. “Safety and Efficacy of Cosmetic Augmentation of the Nasal Tip and Nasal Dorsum with Expanded Polytetrafluoroethylene:  A Randomized Clinical Trial.” JAMA Facial Plastic Surgery February 2018. Doi:  10.1001/jamafacial.2017.2423.

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