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隆鼻 or 低鼻:どちらが簡単か
Which is easier:
Nose Lift or Reduction

Asians consider rhinoplasty(nose cosmetic care) equivalent to nose lift、an enhancement procedure. On the other hand,
Westerns think of it as nose reduction、to minimize the contour of the nose.
Of course, there are rare exemptions.

Ever thought of the question: which procedure is more complicated to perform?

Actually, every cosmetic surgeon has the same answer.

Making it smaller and compact is more difficult.

This is good news to the tiniest noses.

Of course, people with perfect nose are luckier with this news, you might think.
However, with our strange human nature, only few see their nose perfect,
that even with a minute deviation which needs an aggresive method,
some think it is worth taking the risk.






Let's take a look at the details of nose lift/reduction and the degree of their difficulties.

First, nose lift procedures in easiness order(nose reduction explained later):

1.Hyaluronic Acid(HA) Injection    With seconds of injaction your nose pumps up as simple as it sounds.
This is the typiical 'petit nose job' we say in Japan.




HA brands

Lately、there are lots of brand names for HA.
Well-known ones are the original Restylane and Juvederm.







HA injection bef/aft


It is not advisable to use a regular sharp needle
because it might cause congestion of blood vessel when accidentally injaected,
and subsequently necrosis of the skin occurs.

Thread procedure which is stated below,
is the main stream of petit nose job recently because of its safety.

If HA filling is the only method that works with the patent,
injection with a blunt needle called cannula must be used to avoid necrosis.






cannulae




2.Y-ko Thread Nose Lift     This is the main procedure of the 'petit' nose job done lately.
The thread used in thread face lift is applied to this procedure.
Having firmer texture, a solid material, easily being inserted by a blunt cannula, meaning never hurts any blood vessels, made this thread method to be the newest generation of 'petit rhinoplasty'.








Y-ko thread for nose ridge


Used originally for the thred facelift, Y-ko thread is a dissolvable material that is capable also of enhancing nose contour, and with its spirally aligned barbs along its length, it can hold and show more effect than the fillers.






   before Y-ko            after Y-ko  
By partiallly introducing it to the ridge may correct hump issues.












  before Y-ko    after Y-ko
Showing more effect on the tip is a highlight of this procedure.







Y-ko for nose tip


It lifts the tip to show more sharper contour on bulbous nose tip.




The downtime(recovery time) for this procedure is the same with filler injections. Faster and swells less, but more effective and long lasting than fillers such as HA(hyaluronic acid).
Since it is made of safe dissolvable thread, it is expected to melt away within 6 months. But during this process, collagen fibers interact with the thread to take place of its function as the lifter of the nose tip.




Humps on nose bridge sometimes make nasal tip look lowered, and in this case Y-ko threads can help lift the lowered tip of the nose.









In actual insertion of the thread, a set of a blunt cannula and a thread is introduced directly along the columella(nose part that connects nose tip and nose base) to push or lift the tip with the thread and its barbs(spikes), leaving a needle point on the tip. Performed under local anesthesia.












3.Silicone Prosthesis Implant Method    By inserting a silicone implant into the nose, an enhanced, slimmer nose contour.






nose silicone implants

This procedure has been around for over 50 years
and still is the main demand in permanent nose lift practice
because of lack of other alternatives that have more advantages than disadvantages.






silicone implant bef/aft

This falls into 3rd easiest or 2nd hardest,
but the procedure itself is as easy as a 20-minute job
for a permanent outcome.
The approach is done unnoticeable inside the nose.







L-ahape & I-shape types


An L-shaped type down to tip and an I-shaped type only for the ridge
are available.
These implants must be inserted deeper under the nose bone membrane
in order to secure their stability,
that is to prevent having the movable tumor-like touch underneath the nose skin.

Another point to keep in mind is
not to be greedy to have a large implant,
which is not gentle to the sensitive nose tip skin
that sometimes it might expose through it.
An adequate and not stressful implant is recommended
for a long lasting effect.


4.Cartilage Transplant      This is a little complicated among these
enhancement methods.
It is because of the shortage of cartilage supply
that can compensate with that of the silicone.
But this differs positively from the other(1 thru 3) methods
with its permanent outcome.
Autologous(derived from the same self) cartilages must be used,
and mostly auricle cartilage is the choice.








Enhancing the tip is the main aim of this procedure.
The part that is not resisitant to a larger silicone.





Since this is a surgical procedure, a short duration of downtime is expected, mainly due to the 4-day(at least) taping of the nose tip and the stitches for securing the transplanted graft not to deviate to the unwanted loation. Swelling after nasal tip operation is not that of great deal. Might be easy to cover with make-up after tape and stitches removal.









To be specific, the irregular-shape cartilage taken from the ear auricle is cut into smaller rhombus or rectagular shapes that can fit the nose tip. 2-3 pieces of these chips will be piled in the center of the tip cartilages, secured by stitches to the skin. Wounds for approaches are done inside the nose, not noticeable at the exterior.






From here are reduction methods(in simplicity order):

1.BNLS Lipolysis Injection    This is mainly for slimming down the nose tip
by melting a bit of the fat layer under the skin.
Bulbous tip usually is an indication of the excessive volume of nose tip cartilages and subcutaneous tissues over them. 
BNLS is a lipolysis injection substance that can react with the fat tissue richly found in the soft subcutaneous tissue.
Melting the fats creates narrower nose tip that is a good remedy for the bulbous nose shape.











BNLS is the newest mesotherapy that contains 8 types of lipolysis and lymph circulation enhancing substances.
It is different from the previous mesotherapy
that required 10 to 20 weekly treatments.
Even with 1 treatment you can soon observe changes with BNLS few days later.
3 or more treatments are recommended.








Treatment is done with a blunt
canulla to avoid swelling or bruises.



BNLS injection bef/aft


This method focuses mainly in fat melting,
so nose that has an accompanied excessive cartilages concern
should be treated with the conjunction of another procedure
such as 
Y-ko Thread, or cartilage transplant which is mentioned in the later statement.



BNLS injection bef/aft




2.Alar Base(Nostril)Reduction    Nostrils that are excessive to the sides
are the good candidate for this surgical remedy.
30 min. is enough to finish this method,
so as a surgery,
it is not that complicated.
Especially the
inner method is the one has less downtime,
meaning faster recovery to your daily routine.
inner method

Operation is done inside the narrow inner nose
with a significant effect.



inner method bef/aft

If the issue is to an extent
outer method might be more effective.
outer method

Removal of the excess ski at the sides is necessary
to achieve a better result.


outer method bef/aft




3. Nose Tip Reduction          The remedy for a bulbous tip.
Cartilage grafts mentioned above might be the answer for cases
that need more volumes on their tips.
But if the volume itself is the problem, such as
thicker skin and excessive tip cartilages,
transplanting graft is not enough.
Nasal Tip Reduction surgery is necessary to correct these issues. 

The actual procedure goes as follows:
first, removal of the soft subcutaneous(under skin)tissues is performed,
then the pair of tip cartilages are bound together in the middle to narrow the tip,
upper half of them removed to reduce volume,
finally, transplant some grafts if more detailed tip contour is desired.




steps for tip plasty


The process postoperatively proceeds similarly with cartilage transplant method.
Compression with taping and the swelling is not severe if the surgery is just limited at the nose tip.
Wounds are made inside the nose, calling it the "
close method" (some clinics performed with "open method).



tip reduction bef/aft


During Nasal Tip Reduction, correction of lowered nose tip (
Nasal Tip Elevation) or can be performed simultaneously
The cartilage in the middle of the nose that divides both nostrils
is called
septum.
This is shortened at its tip to allow the tip to draw back from its saggy position.







shortening of the septum


This is how an elevated tip can be achieved.





nose tip elevation bef/aft


Opposite to this issue,
meaning if the short nose tip is the concern,
Nasal Tip Elongation is the procedure to performed,
by transplanting a pile of cartilages on the tip of the septum.





tip elongation bef/aft




4.Hump Reduction    Hump reduction is the actual
lessening of height
of the nose ridge.
The challenging part of rhinoplasty rises higher in ths procedure
because this involves the nosal bone.
Hump is the
raised portion of the nasal bone on the nose ridge,
usually called '
washibana' in Japanese,
meaning hawknose.
This hump is shaved with medical chisel and file.




hump shaving diagram



A straight contour line of the nose ridge can be attained
with this procedure.






hump reduction bef/aft

Methods explained so far are possible with just local anesthesia alone.
Of course, genera anesthesia is also a choice.

Excessive hump might create a wider nose ridge on the front view
after shaving.
In this case, conjunction with osteotomy(bone dividing) is recommended,
or just enhancement with silicone implant is also a wise choice.


5.Osteotomy(bone dividing surgery)    Osteotomy is the only means
to reduce the bony content of the nose ridge,
and since it is a bone surgery
that means this method is not an easy task to do.
Nose tip procedures are easier due to its soft-tissue contents.






hump shaving then dividing







Of course, under general anesthesia.

After dividing the nasal bone, it is fractured into the middle part of the nose
to slim down the nose ridge.
At this stage, it is still half through the whole process
to attain a successful outcome of the surgery.
The other half relies on how the
plaster compression is done
during the 1-week duration postsurgically.




osteotomy bef/aft

Since it is a bone procedure,
dealing with more active blood vessels is the main concern,
meaning lots of bleeding that turn into lots of swelling,
which might oppose the compression
and consequently lessen the pressure
to push the bone fragment into the center line.

If more detailed nose ridge is what is wanted,
rather than minimizing the nose volume,
adding silicone implant or cartilage graft to emphasize the thinning of the ridge
is also a smart decision.



osteotomy+silicone bef/aft



This has been the details for enhancement and reduction rhinoplasty.


さらなる詳細
 、 further details

Miyagi Cosmetic Surgery宮城美容外科クリニック

〒900-0016
沖縄県那覇市前島2−2−1(3F)

2-2-1-3F Maejima, Naha City
Okinawa, Japan 900-0016

TEL 098-860-9120
FAX 098-860-9176

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