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This ethnic Asian rhinoplasty case of Filipino origin was featured by the typical anatomical peculiarities of Far Eastern ethnicities, including a very short nasal length, a very short and flattened tip which also was underprojected, null tip definition and a very low dorsum, finally the nose was upturned and the tip too high or piggy.
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The main findings were a massive fibrofatty layer covering the tip and the alae underneath the skin and thus making the nose bulky and undefined, very weak and unsupportive lateral cruras of the lower lateral cartilages which needed full replacement with handmade new ones, the same scenario was found about the medial cruras but worsened since they were almost nonexistent, short upper lateral or triangular cartilages, an extremely short caudal septum requiring septal lengthening by means of a one on one septal lengthening grafts, and a total loss of tip shape and definition which was treated by a shield tip grafting suitably customized.
The grafting donor site had to be both ear concha bowls, the deep septum and the seventh rib cartilage; note how important is respecting and preserving the helix crus not that the ear support is lost ending in a ptotic or droopy ear deformity; only the cymba and cavum fossae of the concha bowl can be harvested without compromising ear structure; it is of paramount importance is harvesting only the core or central shaft of the rib cartilage, since is the only one maintaining a straight shape, the cortex or outer layers of the rib cartilage have to be discarded because they do warp, as can be indisputably seen in this case images.
The main goals of lengthening the nose by massively adding extension structure to the upper lateral or triangular cartilages, the caudal septum, the lateral cruras and the columella, as well as reprojecting and redefining the tip and raising the dossal level were successfully achieved, including a totally horizontal nasolabial angle to prevent an upturned nose.
Probably the most difficult part of this technical case was the always challenging task of lengthening a short nose and augmenting it in three axes, like dorsal height, caudal length and tip projection; the massive harvesting required was as delicate and important as the rhinoplasty itself.
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#1The lateral cruras of the lower lateral cartilages are massively covered by a thick layer of fibrofatty tissue, a very common finding in Asian noses.
#2Note how bulky is the adiposity and its unsightly effect on the lower third of the nose; the tip is nonexistent, literally, the domes of the tip are not developed in Asian noses.
#3After meticulous and careful debridement all the fibrofatty layer has been removed, to slim down the nose and make it more defined; the circle spots the area were the tip domes should be present; nothing exists there instead, the tip needs to be reconstructed and hand made.
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#4The circle spots is where the tip angle and the domes of the lower lateral cartilages should be present; note how thin and filmy are the lateral cruras, the medial cruras are barely detectable.
#5The forceps grasps the inner mucosa lining to tighten the right lateral crura, this shows how extremely thin and weak they are; where is the tip? And the medial cruras? Never were developed.
#6The forceps grasps mucosa to tighten and show the left lateral crura thin and filmy structure; arrows point to both lateral cruras and the circle spots the stumps of the remains of the medial cruras, which in practical terms are congenitally unborn; the septum is visible in between.
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#7The circle spots where theoretically should be the left medial crura and tip dome, nothing exists there instead but a mere fibrotic cord without any supportive role.
#8See the very short septum and its 45 degrees angle from the horizontal plane; this is one of the main causes of nasal shortness and lack of tip support.
#945 degrees from the horizontal plane; ideally should be between 0 and 20 degrees, depending the anatomy and the aesthetic racial canons.
#10See the gap between the columella and the caudal or lower end of the septum, this space is the actual lengthening requirement.
#12One on one septal lengthening, the key reconstructive pillar in this case; see how the caudal missing gap of septum was restored using deep septum cartilage grafting; the vertical arrow shows the juncture point; note how the columella is significantly pushed down about 8 mm lower than the original medial cruras.
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#13Columella pushed down by the caudal septal extension graft; the original 45 degrees angle and the new 0 degrees angle of the caudal septum.
#14Original septum and the one on one septal lengthening graft, a very delicate high end maneuver; note the new horizontal columella compared with the previous upturned angle one.
#15Perfectly customized caudal septal extension graft; it has a triangular shape due to the peculiarities of this case.
#16The septal lengthening graft has to be think and strong enough to support the entire nose and push down the columella.
#17Close up detail of the sutured septal extension graft.
#18The right ear donor site; the posterior access allows a hidden scar behind the auricle; the crus of the helix is essential for the ear support and has to be preserved; the areas that can be safely harvested are the upper concha fossa or cymba and the lower concha fossa or cavum; in this case the maximum amount of cartilage possible was harvested. ...Read more
#19The cartilage portions harvested are shown in correspondence with the anatomical creases and fossae were they do belong to; the helix crus is firmly supporting the ear as a beam.
#22Note how the helix and antihelix creases are not deformed or distorted if the surgeon is proficient harvesting the grafts.
#23Rear view of the left ear donor frames of cartilage; harvesting cartilage from the ear is not a trivial or simple maneuver at all.
#24Left ear anterior vision showing the harvested cymba y cavum fossae; now the surgeon has to close the donor sites and carry out the customization, tailoring and shaping of the new structural elements to fit in the newly planned nasal shape.
#27Left ear's anterior view showing no anatomical deformity or distortions.
#28Seventh rib access to its cartilage once the perichondrium ha been lifted off the rib cartilage; the arrows point the first cuts made at the outer cortex.
#29Reference view of the inframammary access to rib cartilage harvesting.
#30The outer cortex of the seventh rib cartilage fully separated from the core cartilage shaft.
#31This portion grasped by the forceps must be discarded; it belongs to the outer layers and they are featured by warping.
#32As soon as it is separated the outer layers warping effect is immediate and evident; the arrows point to the core shaft or central rib cartilage which is the safe and optimal donor area to be use in rhinoplasties.
#33Deep surface of the warping outer layers of rib cartilage; this has to be discarded.
#34The core cartilage of the rib has been extracted, tailored and shaped as nasal dorsum graft; here there is a comparison between the warped outer layers and the central shaft which stands firmly straight.
#35The straight graft is precious and form stable, it belongs to the central portion of the rib shaft; the warped item should not be used unless a curvaceous effect is sought.
#36The nonexistent medial cruras were replaced by the grafts pointed by the arrows, fixed to the new caudal septum in a tongue in groove maneuver.
#37The new columella will be lower and horizontal.
#38The new medial cruras, made from ear cartilage.
#39Note the massive advancement achieved, the forceps pull down the lateral cruras and they are not long enough to meet the new nasal angle; see the gap pointed by the arrow at the lower lateral or triangular cartilages, once the nose is lengthened there is a gap at the nasal wall and this needs also grafting since the triangular cartilages are also short.
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#40The original lateral cruras are so short that they can't reach to the new nasal length; the triangular cartilages need lengthening to fill the gap at the nasal wall.
#41The original lateral cruras were re used as triangular cartilages caudal extension graft; the lateral cruras were rebuild using hand made ear cartilage pieces; T for triangular cartilage, NT for new triangular cartilage, NC for new lateral crura, NS for new caudal septum.
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#42Comprehensive view of the new nasal structure, massively lengthened.
#43D for dorsum, T for triangular cartilage, NT for new triangular cartilage, NC for new lateral crura, NS for new caudal septum.
#48Onlay columella graft to rebuild it, ear harvested.
#49Lateral view of the new tip support tripod, with the onlay columella graft applied and secured by sutures.
#50Hand made and customized new tip made with a shield tip graft from ear cartilage, located at the new nasal angle and secured in place by sutures.
#51Note how a grid of scoring was made unicortically to achieve a softer and more elegant effect of curvature at the tip.
#52Lateral view of the final assemble with the tip graft applied and secured by sutures.
#53The core rib cartilage fully shaped, tailored and thoroughly tested to fit into the dorsum as onlay graft to raise its level; note how the upper and lower ends are beveled and made, respectively, round and triangular to mimic the natural shape of a dorsum.
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#54Lateral view of the dorsal raise onlay grafting allowing vision of the tricky tailoring of its upper and lower ends.
Complex Nose Job | Complex Rhinoplasty | Ethnic Nose Job | Grafting Nose Job | Grafting Rhinoplasty | Non Caucasian Nose Job | Non Caucasian Rhinoplasty | Open Structure Nose Job | Open Structure Rhinoplasty | Racial Nose Job | Racial Rhinoplasty | Reshaping Nose Job | Reshaping Rhinoplasty | Supporting Nose Job | Supporting Rhinoplasty
This information is indicative only and does not represent an obligation with patients or a prediction of forthcoming events, since is based on statistical means for large groups of patients, with the variability that implies, and the biased experience of medical professionals.
Medicine and Surgery are not exact sciences, therefore it is not possible to foretell the most likely evolution neither establish the most suitable management for each individual case until the moment the physicians can preoperatively evaluate the patient and receive feedback about the postoperative.
One surgical process can't be fully predictable or be rigidly scheduled on a previous protocol, so the management plan may be modified at any time based on the requirements that could be considered as necessary or most suitable.
Healing is an imprecise and always unpredictable process due to the uniqueness nature of each patient; even with your physician prioritising post-op patient care excellence and scar minimisation techniques and treatments your evolution and results may be likely different to the information contained on this website, therefore your physician cannot guarantee any specific scenario and outcome commitment regarding your procedures.
Remember that all surgery is likely to produce lasting swelling and a lifetime permanent scar, which is likely to partially evolve over approximately 12 to 18 months or longer because this is an issue of unpredictable kind; some patients may be prone to permanent swelling and bad scarring.
Information on our website is not a substitute for a personalised, individual consultation that includes a physical examination, history taking, a discussion of the potential risks including potential common complications, pros and cons of various procedural options, and the likely outcome expectations of your surgical procedure. Only an in-person consultation and examination can help your physician to provide you with information about what you, personally, as a unique individual, can expect.
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Even when you feel that you look very similar to another patient in their images, your results will likely vary significantly, because you are a unique person and every individual has not only a completely unique physique, but also uniquely individualistic body healing capacities, scarring tendencies and recovery processes, some of which are unpredictable even in very-healthy patients who rest adequately and do all the other right and prescribed things before and after their procedure.
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All the prices and quotations visible on our website belong to or are calculated out of the reduced price list and do already enjoy by default a -20% discount from the standard price list for our treatments as compensating remuneration for the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of our patients for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, unless they express the opposite at their surgery day booking by opting for the standard prices.
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Our prices are quotations valid for the majority of cases operated on; notwithstanding a few cases are non standard, atypical, requiring exceptional resources and, therefore, needing customized quote calculation; do seek the advice of our Medical and Sales Teams to find out whether your case lies within the standard protocol of management, which actually is the most likely scenario.
Standard quotations do cover the planned protocol of management, including preoperative consultation with the surgeon, preanesthesia examination, basic preoperative tests, surgeon, anesthetist and assistant fees, planned operating room, rental time, regular intraoperative surgical supplies (materials, drugs, etc.), agreed implants (breast, etc.), one recommended postoperative garment (brassiere, corset, etc.), 1 hour recovery unit stay, individual ward room, regular hospital supplies (materials, drugs, etc.) and postoperative office-based care.
Not included in standard quotations are, among others, non basic preoperative tests, pre and postoperative consultant referrals for assessment, additional garments, non hospital supplies (materials, drugs, etc.), postoperative tests and any kind of postoperative re-interventions, postoperative medical or surgical emergencies and costs exceeding the planned protocol of management like unplanned, unforeseeable and unavoidable extended surgical time rental of the operating room, extended hospital stay in standard ward or Intensive Care Unit (ICU) room and all the associated costs with any hospital-based assistance of complications, medicalized repatriation, hostelry accommodation, maintenance and travel costs; we do not take account of any costs not within the scheduled treatment pre and postoperative planned and agreed management.
We do not offer trip packages; the patient is bound to organize and pay for any trip, accommodation, food, transport, etc.
Prices do include the V.A.T.
Prices do not include any kind of travel or revision insurance; do read about the Surgery Shield for revision surgery here should you wish to be covered in such a case.
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Combo Specials discounts are percentages of reduction applied on the retail price of the standard quotations for the treatments of the price list; these discounts are not applicable on non standard cases, customized quotations and charges not included in the standard quotations.
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Combo Specials are applied and calculated for each purchase of treatments to be performed simultaneously; Combo Specials are not allowed on treatments to be performed in different anesthetic procedures or different surgical episodes; any given purchase of treatments to be performed simultaneously may include more than one Combo Special.
One given treatment cannot be affected by more than one discount, be it Combo Specials or other discounts; in the event of a conflict due to the coincidence of more than one Combo Specials discount affecting a given treatment, the discount that produces the greatest gross discount in favor of the patient calculated at the given treatment in conflict level will be applied.
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Due to the competitiveness scenario of the markets most plastic surgery clinics and plastic surgeons feel forced to invest large sums of money into advertising and marketing campaigns; this non medical additional cost is always and necessarily charged on top of the final price paid by patients, leading thus to an overprice of surgeries and treatments. No one patient wishes to bear that financial burden embedded in the surgical costs, furthermore neither surgeons nor clinics are happy to increase their retail prices and penalize their customers with costs not bringing any kind of special medical benefit, safety enhancements or results improvement; the promotion budget aims only to disseminate the public knowledge of a services provider and raise the awareness about its presence to potential customers, but not to make the service or the product a better one.
Seems like this model is a no-way-out labyrinth from which no one can be freed, furthermore it is such a tempting, easy and hassle-free way that actually most patients and plastic surgery providers are locked into it, happily or with resignation, paying a high price due to being non collaborative; however there is an ideal alternative, based on keeping up a good hard work based on a strive for providing quality service and achieving patients' satisfaction, which necessarily requires the decided support of the clients and somehow their involvement in such virtuous business model grounded on top-notch results
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When plastic surgery providers and patients do actively engage into a collaborative economy scenario a win-win basis is set for their relationship, since the clinics and surgeons obtain the best promotion ever possible with no budget for marketing investment and the patients get in return rid of any additional and unnecessary costs; such a price reduction does not represent any loss in the quality of the treatment they are receiving, furthermore this saving achieved will actually reward customers with a reinforced confidence and guarantee the service providers will strive to perform the best job possible and obtain results second to none.
It is not a paradox or contradiction; under a collaborative economy umbrella plastic surgery patients enjoy a greater plus of confidence that clinics and surgeons will do their very best and beyond to satisfy their customers, in spite the price is lower than in marketing-based non collaborative models; plastic surgery providers who found their business sustainability on the pillars of exclusively or mainly incremental budget investment in ongoing promotion campaigns do have little incentive in achieving first-class results and the best patient experiences, since their business model is not based on returning patients after word-of-mouth dissemination of their reputation but on the attraction of cold clients with sophisticated advertising methods of higher or lesser moral acceptability, attracting customers as parachutists randomly landing on unknown land, which is a perverse business model frequently leading to an unavoidable degradation of safety and results quality besides an uncontrollable increase in costs and prices; this marketing-based model creates no incentives to keep up the good work and pushes the prices higher on and on due to require increasing promotional investments.
On the other side, which is definitely our side, clinics and surgeons who rely solely or mostly their existence and survival in the competitive plastic surgery market enjoying the widespread of their excellence extended by their own patients results and satisfaction, like a mill driven by the winds of prestige, have the strongest ever incentive to be the best service providers around, sourced from the support of happy clients and their operated cases as proof of their excellent jobs; needless to say such supporters, the patients, have to enjoy a share of this benefit so that the incentive is reciprocal; under this scenario clinics and surgeons strive to provide the best service and accordingly patients release and transfer in a fair exchange the materials and tools required to build a marketing-budget-free and virtuous business model which creates the perfect incentives to build the best sponsorship-free reputation, based on the grounds of medical quality thus allowing prices control within affordability thanks to the minimal cost of its maintenance.
This is the deal; patients give in our favor the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of their cases for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, and they receive in exchange a compensating remuneration of a -20% discount from the standard price list for our treatments, as it is publicly visible by default in all the prices and quotations on our website.
As can be observed our visible prices are highly competitive if compared with other plastic surgery providers, actually the difference is approximately a -20% from the average price of each particular treatment in other clinics and surgeons from similar economical areas and countries of comparable development; this is not due to any quality or safety downgrading but to our collaborative business model; in other words, the budget which theoretically should be invested in marketing and promotion campaigns is discounted from the retail prices and, unlike other plastic surgery providers, is not wasted into pointless advertising to patients which entails no kind of added value for them; such campaigns are replaced with our superb results publicized thanks our patients support by letting us use their cases' Before & After and Intraoperative & Technical images and medical details; this explains that price gap between us and other clinics and surgeons.
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MODEL KEYNOTES
Patients gain a highly affordable pricing model with yet world-class standards of medical practice, safety and results, and we gain competitiveness within the industry by means of saving the budget theoretically bound to be wasted in marketing.
Patients contribute with their images and medical details and we compensate them with a -20% discount from the expectable average price quoted by comparable clinics and surgeons.
We receive a boost of unbeatable promotion and market penetration by using our awesome operated cases and the patients enjoy a plus of guarantee that we will strive to conduct ourselves to the highest level of excellence and obtain results better than one can imagine.
We help you access the best plastic surgery results and you help us win the race of the market.
Should you feel not interested in collaborating with our business model and still wish to be our patient? No worries, this perfectly possible under the same philosophy of professionalism, devotion and quality, you have to simply express your opposition at surgery day booking by opting for the standard prices and thus give up the -20% discount of the collaborative model, budget which will be used to promote our business in sponsorships, campaigns or one-time actions aiming to attract new customers who, without your help to take the right decision for their surgery, may need sponsored channels to know about us.
Keep in mind that taking part in our collaborative business model is also an altruist way to help other prospective patients to find the medically right and commercially suitable plastic surgery provider, besides collaborating in the medical education of other surgeons and medical professionals.
We offer a flexible consumer-to-business relationship by letting our patients choose between a release & transfer quotation model in which the standard price list receives a -20% discount becoming thus the reduced price list, and a no disclosure quotation in which the standard price list applies and the patient misses such compensating remuneration.
Two models under the same quality involving different prices and marketing-building strategies; you receive always one guarantee: our commitment we will give you our best.
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