[Dr. Seungjo's Lecture Notes] Implant-Free Rhinoplasty Part 2⭐

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Hello everyone~

👃Your beauty universe! I'm Dr. Seo Seungjo, director of Wevers Plastic Surgery :)👃

Following ‘Implant-Free Rhinoplasty Part 1’,

Let's start Part 2!

First, implant-free rhinoplasty can be done only on the nose tip, but it can also be done on the nasal bridge, right?

Both the nasal bridge and nose tip can be done with cartilage and your own dermis.

However, most people who want implant-free rhinoplasty say the same thing:

‘I'm not very interested in my nasal bridge. I just want my nose tip to be slimmer.’

‘I just want to enhance the line a little more,’ they say when they visit the clinic.

This is because most people who want implant-free surgery

don't actually have very low nasal bridges.

They already have a certain degree of nasal bridge height.

And their face isn't overly flat either.

That's why they come in thinking that just a slight adjustment to the nose tip will improve things.

But there's a problem there, which is

Cases that should absolutely not be touched

When the side profile looks good, but the nose tip appears large from the front,

they come in saying, ‘It looks short. It looks long.’

It looks fine from the side, but the nose tip looks long or short.

So, how should the position of the nose tip be changed?

It might be necessary to change it like this.

Then, how do we create this line?

The line I marked in red cannot actually be created.

When told that implant-free surgery isn't possible, patients often say,

‘But there's autologous costal cartilage, isn't there?’

Sometimes they say, ‘Since I have autologous costal cartilage,

please use it here to create the line.’

Patients might think it's possible, but

in reality, it's harder than expected.

The reason it's not possible is that the part indicated by the blue arrow

needs to be made into a clean line

for autologous costal cartilage to create a line like silicone, as shown in the image above.

This length usually needs to be inserted in one go, at least 3 to 4 cm,

and sometimes up to 5 cm, for the nasal bridge.

If it's inserted in segments, there will naturally be a step, right?

This step becomes very noticeable when light hits it.

Therefore, autologous costal cartilage needs to be carved to create a clean line of about 3 to 5 cm,

And when carving, it's not just rounded from the side;

the bridge of the nose needs to be rounded along this line when viewed from below.

The line needs to be carved like this.

Can it be carved?

If we carve diligently, maybe it can be carved.

However, autologous costal cartilage has a phenomenon we commonly know as warping.

When used as a whole piece, it will eventually bend.

Since it will eventually bend, it will naturally become a crooked nose.

That's why it's very difficult to do.

In fact, cases where implant-free surgery should not be done are:

✔️Those with a good side profile

✔️Those with a good side profile who only want their nose tip touched

For these individuals, it's better not to do implant-free surgery.

There are people with a hump on their side profile like this.

For such individuals, implant-free rhinoplasty is very suitable.

This is because by carving it in this manner and creating the nose tip,

a beautiful nose can be achieved.

Ultimately, the amount removed is much greater than the amount lifted or filled.

When there's something bumpy, it's much easier to make it smooth by carving it down,

right?

If you want to create something by removing more flesh like this, what should you use to attach it?

You can't attach it with something hard.

You'd have to attach it with something like clay,

but do we have anything like clay in our bodies? No.

Even if we did, it would be dermis, and what happens to dermis?

The disadvantage of dermis is that it has an absorption rate.

Because of this absorption rate, even if it's attached, it will be absorbed later and become bumpy again.

But you don't just look at the nose from the side;

everyone will inevitably see your nose from 180 degrees,

and many photos are taken, so in cases where a lot needs to be carved,

it can be carved to make it smooth,

which leads to much higher satisfaction when using implant-free methods.

On the other hand, cases with low satisfaction are these types of humps.

These are humps where patients sometimes come in saying, ‘Please just fill in the sunken parts a little.’

From the side, it might seem easy to fill.

But why do difficult cases exist?

Assuming there's a nasal bridge like this,

to fill it, it needs to be filled in a rounded way like this.

But can it be filled like this?

You can't carve cartilage and fit it perfectly like Lego blocks.

That's why mistakes occur at these connection points.

Then, when strong light hits it and a photo is taken, it shows.

That's why people visit for revision surgery.

Therefore, you must clearly

understand that it won't be smooth.

There are people whose nose side profile is fine like this.

They say, ‘Please improve my protruding mouth.’

To eliminate a protruding mouth,

this angle needs to be sharp like a dagger. Then, how far will the nose tip go?

Doing it this way would result in an upturned nose, so it's not possible.

The position of the nose tip needs to be further forward relative to the mouth's position,

and the tip needs to extend to the part I marked above.

Then the nose tip would look like this.

The nasal bridge also needs to be created somehow in the hatched area. It's the same.

Ultimately, the key to good cases for implant-free rhinoplasty is:

✔️If the amount of nasal bridge and hump to be removed and lowered is large,

implant-free surgery is good.

✔️If the amount of nasal bridge that needs to be filled is large, implant-free surgery has many disadvantages.

So, what is the standard for what I just said?

Whether there's a lot to remove or a lot to fill isn't simply based on the current nasal bridge alone.

It needs to be considered based on when the nose tip is moved.

Most people who opt for implant-free surgery only want their nose tip changed,

and when the nose tip is moved, the connection with the nasal bridge might not be smooth,

So, we consider whether there's a lot to be done by carving down this uneven part

or if there are many cases where the line needs to be created by filling.

This leads to the following conclusion:

Therefore, when there's a lot to remove, implant-free surgery can yield very good results.

Using silicone itself isn't ideal,

and when a lot needs to be filled, implant-free rhinoplasty

is not suitable.

I hope you undergo surgery knowing this.🙏

Recommended Implant-Free Cases

High hump nose (when a large amount of hump needs to be removed and lowered)

▼

Can be carved smoothly

▼

When there's a lot to remove

Not Recommended Implant-Free Cases

Low hump nose (when a large amount needs to be filled around the hump)

When only nose tip improvement is desired

When only protruding mouth improvement is desired

▼

It's difficult for the nasal bridge to be perfectly smooth

A step may occur at the connection between the nose tip and nasal bridge

▼

When filling is required

https://youtu.be/_3NmuR64o3Y?si=OPV9PqK3mLDwnLq-

💖If you have more questions?

Frequently Asked Questions

Which nose type is most suitable for non-implant rhinoplasty?

Non-implant rhinoplasty is most suitable for noses that require a significant amount of reduction, such as a prominent hooked nose. By shaving down the protruding hump, a smooth line can be created, making it advantageous for achieving a natural and beautiful nose shape without implants.

Is non-implant surgery good for slightly raising only the tip of the nose?

No, non-implant surgery is not recommended for only raising the tip of the nose. When the nasal tip is raised, a step is likely to form where it connects to the existing bridge, and attempting to fill this with autologous cartilage or dermis carries a high risk of an uneven surface.

Can autologous costal cartilage be used to raise the nasal bridge?

It is possible, but there is a high risk of warping. Autologous costal cartilage needs to be carved into a long piece, 3-5 cm in length, to fit the nasal bridge, but it has a tendency to warp over time, potentially resulting in a crooked nose.

What happens if a sunken nasal bridge is filled with dermis?

Dermis has the property of being absorbed by the body, so over time, the nose line can become uneven again. Therefore, for noses that require significant filling, such as a low hooked nose, it is better to consider other methods rather than non-implant surgery.

What are the criteria for determining the feasibility of non-implant rhinoplasty?

The key criterion is whether the nasal bridge needs to be shaved down or filled when the nasal tip is moved to the desired position. If a large amount needs to be shaved down, non-implant surgery is suitable; if a large amount needs to be filled, it has many disadvantages and is not recommended.