SURGICAL RHINOPLASTY INCISION TYPES

1. CLOSED RHINOPLASTY

     Incisions are made along the inner border of the upper and medial nostrils making the scars less visible when recovered. Used by surgeons for silicone rhinoplasty or for limited tip plasty procedures.

2. OPEN RHINOPLASTY

     Closed rhinoplasty incisions are connected by another incision over the Columella. This allows the surgeon to lift the front flap of the nose for better exposure of the cartilages of the lower nose.

NEU Advanced Aesthetics Center

The Penthouse 29F
Centuria Medical Makati, General Luna Street, Barangay Poblacion, Makati City, NCR (Metro Manila), Philippines

Type Neu Advanced Aesthetics Center @Centuria Medical Makati on your WAZE app or ask any TAXI/UBER/GRABCAR to bring you to "CENTURY CITY MALL" near Makati Avenue.

Centuria Medical Makati is located at the back of the mall.

Alternatively, type Neu Advanced Aesthetics Center in GOOGLE search or click NEU LOCATION MAP.

RHINOPLASTY 

NOSE ENHANCEMENT 
NOSE JOB 
NOSE RE-SHAPING

     Rhinoplasty is a cosmetic surgery procedure to change the shape of the nose, usually performed for enhancement.

     Rhinoplasty can make profound differences to the symmetry, size, and shape of the facial features, not to mention the effect on the person's esteem.

     During rhinoplasty, the nose cartilages (tip), bones (bridge), and ala (sides) are modified to make the nose narrower, lower, or higher.

​RHINOPLASTY  

nose reshaping sale!

WHERE TO FIND US?

Your rhinoplasty will be done by doctor Al, a board certified cosmetic plastic surgeon.

The facility where he does the procedure is well-equipped and licensed by the Department of Health (DOH).     

MESSAGE DR. AL via the contact form below or Viber/Whatsapp +639189853668          

REDUCTION RHINOPLASTY

1. dorsal hump reduction or shaving

> This procedure addresses nose bridges that are a bit too high or have humps.

> Involves breaking or shaving the nasal bone.

> Recovery may take longer than other rhinoplasties.

2. Alarplasty or Nose Trimming

> Alarplasty procedure is sometimes required for optimal result of nose enhancement.
> For patients with wide noses, large nostrils, or those with overhanging or thick Ala (sides).
​> Nose trimming is performed concomitant with other nose procedures (i.e. bridge augmentation or tip plasty) 
> It involves removal of chunks of tissue from each side of the nose. Excision can be horizontally or vertically oriented.
> Alar plasty requires patient's cooperation to follow certain instructions after surgery like avoiding opening of the mouth widely (i.e. yawning, eating large food like burgers, frequent smiling) for 3-4 weeks.

3. Tip plasty

> Tip plasty is a general term to indicate a cosmetic surgical procedure to modify the nose tip. The aim could be to reduce, make more pointed, lift, or to de-rotate the tip (bring down).

> Depending on the aim, the surgeon can either do de-fatting (removal of fat), approximation of the nose cartilages or place grafts (ie cartilage, PCL).

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Where and how are cartilages harvested?

     For grafting over the nose bridge or tip, cartilage is harvested from the ear because it is softer.

     For structural support of the nose, a more firm cartilage is taken from the midline and inner part of the nose called septum. This can provide stronger support to correct septal/nose deviation (Septo-Rhinoplasty). Typically this procedure needs sleep anesthesia.

     Incision for ear harvest is made at the crease at the back of the ear. When it heals, marks are essentially invisible. The shape of the ear will be maintained. A good surgeon will not touch the part of the ear (frame) that is responsible for its shape. Only the inside portion is taken.

OUR COSMETIC SURGEON

AUGMENTATION RHINOPLASTY

Other terms: 
Nose lifting, Nose job, Nose enhancement

          Nose lifting is a cosmetic surgery procedure that enhances the nose by increasing the height of the nose bridge including projection of the nasal tip. 
          It involves insertion of either a Silicone implant or Goretex (ePTFE) or Osteopore (poly-Caprolactone PCL). Patient’s own cartilage (usually from the ears) can also be harvested and used as a natural graft.

1. Silicone (Implant) Rhinoplasty

> It is the gold standard, being used for the past several decades (tried and tested).
> Higher rejection rate (2-3%) compared to Goretex and Cartilage. 
> Best result because it can be carved or shaped according to what fits the patient’s features.
> Good lifting effect but may cause some pressure around surrounding tissues when implant is too big. This can lead to implant extrusion (most commonly over the tip).
> Body forms a capsule around the Silicone, thus easier to remove or replace in case patient decides to have a new look or shape in the future.
> Lower in price.
> Very minimal incisions – closed-rhinoplasty (barely 50% around the rim of the nostrils).
> Fast recovery.
> Stitches out in 7 days.

> Best outcome when combined with cartilage or Osteopore tip plasty.

2. Goretex (Implant) Rhinoplasty

> Newer than Silicone in implant technology.
> Also called PTFE or Polytetrafluoroethylene
> Natural looking but more expensive.
> Almost nil rejection rate.
> Newer Goretex implants can now be carved and shaped.
> Softer in consistency thus lesser pressure over surrounding skin.

> More stable because tissue gets integrated into the implant through time.

> May be hard to remove or replace.
> Alternative for those with Silicone rejection.
​> Requires open rhinoplasty.
> Best result when combined with tip plasty using Cartilage from the ear or Osteopore.
> Stitches out in 7 days.

3. Cartilage Rhinoplasty

​> Guaranteed all natural.
> Lifting material will be taken from the cartilage at the back of your ear.
> 100% no rejection.
> May require an open-type rhinoplasty plus ear incision.

> Uses cartilage graft to increase the height of the bridge and to lift or define the tip.
> Lifting not as high as Silicone and Goretex implants (for the bridge) or as projected as an (Osteopore for the tip).
> Longer surgery/recovery and pricey.
> Best alternative for those with Silicone rejection or problems with Goretex.
​> Stitches out in 7 days.

4. PCL (Polycaprolactone) or Osteopore

> Osteopore is made of material called Polycaprolactone (PCL) that was developed in 1999 in Singapore and was initially used as scaffolding for bone defects in Neurosurgery, Orthopaedic surgery, and Maxillofacial surgery.
> Recent advancement allows the use of PCL in aesthetic surgery (see youtube video below).
> Osteopore implant resorbs after 18-24 months when placed in the body but allows tissues in the surrounding area (where it is placed) to migrate and replace the initial shape of the implant thereby facilitating natural tissue regeneration.
> In aesthetic surgery, 3 shapes of Osteopore were recently developed:

     Osteopore Plate - for septal extension grafting to give more tip support or de-rotation of the nose tip.

     Osteopore Ball - for tip grafting to make it more narrow and projected.
     Osteopore Drone - same as the ball but more stable on tip positioning because of its wider implant base.

> Osteopore (PCL) implants or grafts allows the surgeon to do tip plasty without the need for harvesting cartilage (usually over the ear/s).
> Osteopore implants are US FDA , European CE, KFDA approved, and also with ISO certification.
> Dr. Al Jaafar of NEU Advanced Aesthetics Centre in Makati, Philippines is pioneer in the use of Osteopore in the country and is Key Opinion leader for the product.

5. Combination Silicone or Goretex implant 
with Cartilage Tip plasty

> Pure Cartilage rhinoplasty gives a good tip construction and lift, but will not be able to give good bridge height. 
> Cartilage harvested from the ear/s are usually not adequate in size and thickness like synthetic implants.
> By combining materials, we can now achieve better and natural outcome using the following:
1. Silicone or Goretex for the bridge lifting and, 
2. Ear Cartilage or Osteopore for tip plasty. 
> Cartilage tip or Osteopore tip will prevent pressure complication of Silicone over the nasal tip resulting to implant extrusion. 
> Cartilage tip or Osteopore tip also helps lower the infection risk inherent to Goretex implants. ​​

THERE ARE 3 MAIN OBJECTIVES OR PURPOSES OF RHINOPLASTY

A. AUGMENTATION rhinoplasty

Involves increasing height to the nose bridge or adding projection to the nose tip by a wide variety of materials like cartilage or implants.

Types
1. Silicone Rhinoplasty
2. Goretex or PTFE Rhinoplasty
3. Cartilage Rhinoplasty
4. Osteopore or PCL Rhinoplasty

B. REDUCTION rhinoplasty

Involves reduction of the height of the nose bridge, an overly projected tip, a bulbous tip, a wide or overhanging ala (sides).

Types
1. Dorsal Hump Reduction
2. Alar Plasty
3. Bulbous Tip Reduction/ Tip plasty

C. RECONSTRUCTIve rhinoplasty

Is a surgical procedure to correct asymmetry, deformity or deviation of the nose.

Types
1. Septo-Rhinoplasty
2. Osteopore or PCL Septal Grafting

NON-SURGICAL RHINOPLASTY

1. Hyaluronic Acid (HA), FILLER RHINOPLASTY

> Hyaluronic acid fillers are absorbable (12-18 months) and are relatively safe if used correctly (in the right places).
​> HA is used to correct deep lines in the face (i.e. nasolabial folds, tear troughs etc)
> They are also used to augment areas in the face like the chin, lips and cheeks.
​> Recently HA is being used as a substitute for surgical rhinoplasty.
> Has no downtime and treatment is fast.
> Reserved for correction of minor nose defects or for subtle nose enhancement.

2. Mono Threads (PDO or PCL), THREAD OR HIKO RHINOPLASTY

> Threads are made from materials called Poly-dioxanone (PDS or PDO) or Poly-caprolactone (PCL)
> Mono threads are used as volume enhancer in non-surgical rhinoplasty. 
> 7-10 threads can be inserted using needles from the tip to the bridge to increase the height.
> They are fully absorbed from the tissue in 6 to 12 months.
> Its disadvantage is the short life span.
> Good substitute for patients who do not want to undergo surgery but willing to have temporary nose enhancement.
> Has one day downtime.

Listed below are injectable materials NOT SAFE and NOT APPROVED for nose enhancement. We do not use them at NEU clinic but have encountered many patients injected with these illegal and dangerous materials who came for management of complications.

1. Soft Paraffin, Petroleum Jelly, or Petrolatum 
> Is a white, colourless, semi-solid material widely used as skin protectant. 
> This material was never intended to be used internally but many unlicensed practitioners in salons and clinics (ran by non-doctors), heat the Petroleum Jelly to liquify and inject it under the skin to enhance the nose (and other body parts like the face, breasts, and buttocks).
> In the short term, the result may be deceivingly good.
> Medium to long term (2-5 years) course will result to migration of the material to the sides of the bridge (Avatar-look) and the nose tip (witch-look). Further, the body will react to the material and cause chronic inflammation with granuloma (multiple nodulations) resulting to visible skin bumpiness. 
> Long-term course results in tissue necrosis making skin turn to bluish-black color. 
> Attempt to remove the material is very challenging for surgeons as tissue swelling and hardening make extraction difficult.
> Removal are usually incomplete and permanent skin damage can be an unwanted consequence.
> Many surgeons will refuse patients with this kind of problems.

2. Hard Paraffin
> Is a harder material used in candles, crayons, and as lubricating material.
> Unscrupulous aestheticians (non-doctors) also use this the same way (as soft paraffin) as filling materials to enhance body parts on unsuspecting patients. 
> It has the same course with petroleum jelly in terms of damage to the tissue and management.

3. Silicon Oil
> Another industrial material used as lubricants and abused for medical use in facial and body augmentation as fillers.
> Has the same poor effect/outcome and complications as with the materials above.
> Has higher propensity to migrate to surrounding tissues.
> May be easier to remove surgically because of its liquid form.

4. Polyacrylamide
> Is a polymer that has found its way in aesthetics via Europe in 2001.
> It is non-absorbable and thus is permanent.
> As a permanent filler injected into tissues, it poses a risk of tissue reactions (in the long term) in the form of fibrosis and granuloma (not to mention its propensity to migrate by gravity).

RECONSTRUCTIVE RHINOPLASTY

1. SEPTO-RHINOPLASTY

2. OSTEOPORE OR PCL SEPTAL GRAFTING

Reasons for nose-reshaping:

1. Nose is small or large in comparison to facial features.
2. Over-projected nose bridge or presence of hump.
3. Over-projected or bulbous tip
4. Big and flaring or uneven nostrils
5. Flat or low nose bridge
6. Drooping or tension nose tip
7. Pinched nose
8. Nose deviation that causes breathing issues

RHINOPLASTY FAQ

Who are candidates for a Nose Job?

     The nose is the most prominent feature of the face, and changing its shape can drastically alter the appearance of a person.

     When considering rhinoplasty, it is essential that you have a realistic expectation and that you are really certain that it is what you want. Your goal should be compatible with what can be surgically achieved.

     A patient should be at least of legal age(18 years old), to be able to give his/her own informed and signed consent. At this age, the facial bones are way past its growth phase and the nasal bone is already matured and the shape stable.

How Rhinoplasty is done?

     Rhinoplasty is an office procedure usually done painless under local anesthesia. Sedation or GA (sleep anesthesia) may be requested by the patient.

     After markings (drawing) and infiltration of anesthesia, semi-circular rim incisions around the inner portion of both nostrils are done (closed rhinoplasty). If the surgeon needs a wider exposure (especially for tip procedures), these 2 incisions may be connected by another incision over the body of the columella to convert it into an open rhinoplasty.

     When implants are used (Silicone or Goretex), the surgeon does initial carving then inserts it through the incision towards the nose bridge just overlying the bone where a pocket was created via blunt or sharp dissection.

     If cartilage is used (harvested from the back of one or both ears), the surgeon shapes the graft then inserts it the same way as with implants. When tip plasty is contemplated, several shaped cartilage pieces are arranged and stitched over the tip.

Silicone Implant P45,000.00
Goretex implant P95,000.00
Cartilage graft (bridge and tip) P150,000.00
Cartilage tip plasty P75,000.00

Drone Osteopore tip plasty P95,000.00
Alar plasty  P45,000.00

​Combi Silicone and Cartilage tip plasty P120,000

​Combi Goretex and Cartilage tip plasty P170,000

Call or message 0918 985 3668(Viber/KakaoTalk/WhatsApp) or email mail.doctorjaafar@gmail.com for reservation. You may also use the contact form below.