Rhinoplasty for the Asian nose.

When compared with Caucasian noses, the typical Asian nose appears to be relatively small and flat and has poor tip definition. Therefore, the main concept of rhinoplasty for Asians is augmentation rather than reduction. In selecting the dorsal implant material, skin thickness should be considered. Although autologous cartilage has the lowest risk of infection among graft materials, autologous cartilage including costal cartilage is associated with a significant risk of revision surgery due to aesthetic failure. Alloplastic implants, including silicone and Gore-Tex, are easy to use and can reduce operation time. But they carry significant risks of complications including infection, deviation, extrusion, and delayed inflammation, which must be seriously considered by rhinoplasty surgeons. Cartilage grafting procedures, including shield graft, onlay graft, modified vertical dome division, and septal extension graft, are mainstays in proper projection and better refinement of the Asian tip, which is intrinsically round and underdeveloped in its appearance. In placing a shield graft, it is important to place an additional supporting graft at the cephalic border and additional tip grafts at the caudal aspect, so that the final tip graft complex has an antero-caudal projection on the profile view. Thieme Medical Publishers.