Redefining Asian nose using implants an art in itself by Leslie Sabbagh

Procedure

An average of 7 to 8 mL of buffered lidocaine with epinephrine is injected in the nasal dorsum, the tip, and the gingivallabial area. After 10 minutes, an incision is made in the gingival-labial area and, tith sharp and blunt dissection, is tunneled up the the columella. Then scissors and a periosteal elevator are used to undermine the skin of the nose and the periosteum to create a pocket for the implant.

Dr. Haddad used a preformed, L-shaped Silastic implant. "I like the preformed models because they require almost no carving. Many surgeons will carve the unformed Silastic at the time of surgery. This usually takes longer and the end results are not as pleasing as those achieved with preformed Silastic. I prefer Silastic over harder implants because the feel is better," he explained.

Closing the wound

The wound is closed with chromic or polyglactin 910 (Vicryl) sutures. "if the implants is placed deep the the periosteum, then it is well secured," he said. If necessary, Steristrips can be placed on top of the nose.

Projecting the tip of the nose will sometimes narrow the nasal alae. If this does not occur after he places the implant, then Dr. Haddad removes a wedge of skin at the junction between the nasal alae and the floor of the nose which he cuts from the inside or from the outside along the crease of the nostril.

Asian eyes also require special attention, and the patient dictates the outcome based not just on personal preference, but on cultural factors as well. (See Asian eye article on p.16). CST

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