The most common complaints in Asian patients are a flat nose bridge, a round nose, wide nose, bulbous and short tip, and wide and fleshy alae (the “wings” or the sides of the nose). Deficient height in the bridge of the nose is corrected with a nasal implant of appropriate dimensions and shape. There are several implant materials available, but Dr Huang prefers to use Medpor implants for the tip. Medpor is like an artificial bone that has similar physical properties to coral. Because it is porous, integrates well with the tissues and is less prone to warping than other materials, such as silicone. It also has a very low infection rate in this location (lower than silicone and Gore-Tex). He fashions the implant meticulously until it fits your nose as well as possible. This takes time, and it explains why Dr Huang never does a rhinoplasty quickly. If the tip is only mildly bulbous and not short, the right and left cartilages in the nasal tip are stitched to each other to narrow and sharpen the tip slightly. Placing an implant to increase the height of the bridge and narrowing the tip by stitching its cartilages is done through an internal nostril incision. This is a closed rhinoplasty, and there are no external scars.
If the tip is significantly bulbous and/or short then more extensive work is required: modification and repositioning of the tip cartilages to make the tip smaller and narrower, and the addition of cartilage grafts to lengthen the tip and create shape and definition. Dr Huang prefers to harvest cartilage from the nasal septum for grafting purposes. The septum is the wall that divides the nose into right and left sides. The cartilage from this donor site is usually sufficient in quantity and of good quality. It is also convenient to harvest it from the nose, which is already being operated on. A second donor site which also provides adequate cartilage for grafting is the ear, which Dr Huang uses as required. The harvested cartilage grafts are carefully designed, shaped, positioned and secured in order to lengthen the tip and create tip definition.
When extensive cartilage work is required for the tip, an open rhinoplasty is performed. This means the incision is made inside each nostril rim and the two incisions are joined by one that goes across the columella (the column in the middle of the nose between the nostrils). These connected incisions allow complete access to and visualization of the inside of the nose, which is essential when a more complicated procedure is carried out. Although it leaves an external scar across the columella, this scar is positioned in the lower part of the columella so it is not obvious. It also tends to fade well with time.
As for the wide alae, these can be reduced by a procedure called alar reduction. The external scars from this procedure are tucked into the alar groove and are inconspicuous.
Who can perform rhinoplasty?
According to the Singapore Medical Council (SMC), only plastic surgeons and ENT (ear, nose and throat) surgeons are allowed by regulations to perform rhinoplasty. This regulation is found the SMC’s Guidelines for Aesthetic Practices for Doctors, which can be accessed in the link below:
But some general practitioners (GPs) are offering and performing rhinoplasty…
Yes, that is true. Therefore, patients need to be aware that this practice violates the SMC’s guidelines.
Why are these GPs able to continue to offer and perform this procedure if they are not allowed to?
Because of inadequate enforcement of regulations to ensure compliance of these regulations by doctors.
How do I tell if the doctor offering rhinoplasty is a GP or a plastic or ENT surgeon?
The safest way is for you to verify this yourself by checking if the doctor in question is on the list of recognized specialists on the Ministry of Health’s website (see link below):
You can perform this search according the doctor’ name or search by specialty. Either way, you will be able to determine if the doctor is a GP or specialist.
If your search reveals that the doctor is a plastic surgeon or an ENT surgeon, you can be assured that your doctor is a bona fide specialist. Otherwise, he or she is not, no matter what appearances may otherwise suggest.