What is a “Nose Job”?

Nose job is a layman term for Rhinoplasty. Basically, it is about reshaping the nose for aesthetic and functional correction.  Noselift, which is a very common procedure among Asians, is just one part of the Rhinoplasty. There are several ways to improve the shape of the nose, among these are the:

1. Alaplasty –enhancement  of the nostrils.
2. Tip Plasty –enhancement of the tip of the nose.
3. Nasal augmentation - noselift.
4. Septoplasty -correction of deviated septum for those with difficulty in breathing.
5. Osteotomy – fracturing of nasal bone for wide nasal width, correction of nasal hump, correction of old nasal bone fracture.

Rhinoplaslty is one of the most common cosmetic surgeries that are well sought. However, it is also one of the difficult surgeries to perform.  Noselift is not just about inserting whatever implant into the nose.  Doing rhinoplasty should be dealt structurally.  Example, if one patient requires a tip procedure, putting a synthetic implant like silicon or goretex is not structurally wise.  We can address the tip by either performing a suturing technique, cartilage grafting and sometimes just removing dermal fats around it.

Who are good candidates for Rhinoplasty? 

If you are self-conscious with regards the shape of your nose, you might be a good candidate.  Feeling good about oneself boost self confidence and self-esteem.  Person who wants to undergo this procedure should be physically fit with no underlying medical conditions or should be medically fit for the procedures. Patient with hypertension or diabetes should have medical clearance before this procedure.  Sometimes, a psychiatric evaluation is needed for some special cases.

Who are “bad candidates” for Rhinoplasty?

Unfortunately, some patients would manifest themselves as bad candidates after the surgery.  The problem of identifying them early during the consultation had become unresolved until today because reliable criteria have not been defined.  Sometimes this long list of attributes such as obsessive, perfectionist, impolite, flattering, compulsive and narcissistic have been proposed to help doctors.   A psychiatrist condensed the role of instinct into the phrase “if you cannot illicit a smile from your patient, don’t operate”.

Who are qualified to perform the procedures"?

There are many implants being use for noselift.  Among these are the autologous implants which came from the patient himself.  Rib cartilage, ear cartilage, pelvic bone graft, dermal fats and facia lata can be used but all of them have different pros and cons, and different uses.  Common disadvantage is the need for separate wound incision for the donor site which means additional scar.  One good advantage of using our own graft is no rejection.  Among the autologous implant, the rib cartilage is the common preference of most rhinoplastic surgeons.  If the rib cartilage is shaped properly, warping is less common

A fully qualified doctor who specialized in Otolaryngology (E.N.T), Maxillofacial Surgery or General Plastic and Reconstructive Surgeon are the one who can perform this procedure.   Most of these surgeons are accredited in a hospital centers that check their qualifications before allowing them to use their operating room facilities, although rhinoplasty can also be done in office clinic with minor operating room.  Cosmetic surgeons are also qualified as long as they were able to attend several preceptorship training or have attended several workshops in rhinoplasty.

Nowadays, “noselift” are being done in beauty parlors or salon by many scrupulous beauticians. They allegedly inject Collagen but in reality is just industrial paraffin or silicon oil. We’ve seen some of these cases on TV news which shows horrifying results.  Don’t trust your face to non-qualified persons or doctors because of cheap cost.  Person who does a medical procedure even though they don’t claim that they are doctors are punishable by laws due to illegal practice of medicine. (Calling all victims of this kind of procedure, you can sue them).

Silicon Implants

Filipinos are among the many Asians which have a low nasal dorsum or have a flat nose.  Noselift has become one of the well sought and number one cosmetic procedures in the Philippines recently.  Silicon implant is a solid but firm material that has been widely used since noselift is introduced in our country in early 1950’s or 1960’s.  It is a good implant among good surgeon with good hands.

However, using silicon has its disadvantages even in good hands. Patients with silicon implants are advised not to play any contact sports because it might deviate from the middle during accidental hit. Many patients complain of “Operated Nose Look”.  Numbers of patient developed complications like protrusion or rejection of the silicon.  Some patients developed psychiatric depression because of these complications.

Are there any safe alternative implants for noselift?

There are many implants being use for noselift.  Among these are the autologous implants which came from the patient himself.  Rib cartilage, ear cartilage, pelvic bone graft, dermal fats and facia lata can be used but all of them have different pros and cons, and different uses.  Common disadvantage is the need for separate wound incision for the donor site which means additional scar.  One good advantage of using our own graft is no rejection.  Among the autologous implant, the rib cartilage is the common preference of most rhinoplastic surgeons.  If the rib cartilage is shaped properly, warping is less common.

Several synthetic implants are now available in the market. One of them is Medpore which is a porous material.  Being porous it allows soft tissues to grow inside and eventually becomes part of the nose. However, it is hard and most surgeons find it difficult to shape.

Recently, Gore-tex was introduced in the Philippines. It is also a porous material but soft compare to Medpore.  Gore-tex is expanded-polytetraflouroethelyn or e-PTFE.  It’s use started way back in 1950’s for heart, lungs and vascular surgery which until now is useful for that purposes.  It is also vastly use for cosmetic purposes in countries like USA, Korea and Japan because of its low complication rate.

Compare to silicon, Gore-tex is soft and light.  Gore-tex as an implant for noselift is safe.  Is has low rejection rate (<1%). It also provides a natural look.