HomePhilippine Journal of Otolaryngology Head and Neck Surgeryvol. 29 no. 2 (2014)

Principles of Structural Rhinoplasty in South East Asian Noses

Eduardo C. Yap



What makes the majority of noses beautiful? It is the tip.1,2,3 South East Asian noses are usually small and short with bulbous tip and thick skin and soft tissue envelope (SSTE).2 The tip is determined by the shape and strength of the lower cartilages.2,3,4 The lower cartilages are usually soft and weak so there is a need for a strong support system for the attachment of the lower cartilages. Thus, the surgical term is called “Structural Rhinoplasty.”2,3 The concept of the surgery involves re-structuring the tip to a new position for elongation and projection. Since the septum is the most stable structure, a central part of the septum is harvested and is used as extended septal support graft for fixation of the lower cartilage for a whole new tip position.2,3 The open approach is often used. The SSTE dissection is wide up to the pyriform aperture laterally, nasal spine inferiorly and glabella superiorly. Make certain that the dissection plane is below the superficial muscular aponeurotic system (SMAS) in the upper cartilage (UC) and lower cartilage (LC) and below the periosteum in the nasal bone.