Facial Plastics

Rhinoplasty

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Rhinoplasty are commonly performed for 2 main reasons: to improve nasal obstruction (Functional Septorhinoplasty) or for cosmesis (Rhinoplasty). Dr Dennis Chua is frequently invited overseas to share his experience on rhinoplasty surgery. He also does a lot of research concerning rhinoplasty and publishes his results in book chapters and research publications. 

Book Chapter published by Dr Dennis Chua in Facial Plastic Surgery (Thieme) June 2015 on “Correcting the Post-traumatic Nasal Deformities”

Download here

 

Dr Dennis Chua- Part of the International Consensus on Functional and Aesthetic Rhinoplasty, Paris IFOS ENT Meeting 2017

Dr Dennis Chua- Part of the International Consensus on Functional and Aesthetic Rhinoplasty, Paris IFOS ENT Meeting 2017

 

Patients have nasal obstruction that can be worse on 1 side. The nasal cavity will have to be assessed and the nasal valves in particular will have to be checked. A deviated septum combined with enlarged inferior turbinates  are the commonest reasons for nasal obstruction.

Functional septorhinoplasty can be performed via an open (external) or closed (endonasal) – “scarless” approach. Either technique is possible depending on the patient’s wishes and surgical condition.

Endonasal rhinoplasty approach (“Scarless rhinoplasty”

A typical healed transcolumellar incision after an external approach rhinoplasty. They usually heal well with adequate post-operative care.

A typical healed transcolumellar incision after an external approach rhinoplasty. They usually heal well with adequate post-operative care.

The alar batten graft is a commonly used technique to improve nasal obstruction with documented nasal valve obstruction.

Picture of Silicone implant extrusion in a patient who had surgery performed outside Singapore. Whilst using implants, it is important to avoid L-shaped implants for the nose to minimize the risk of implant extrusion.

Picture of Silicone implant extrusion in a patient who had surgery performed outside Singapore. Whilst using implants, it is important to avoid L-shaped implants for the nose to minimize the risk of implant extrusion.

 

The rib graft is a fantastic source of autologous cartilage for augmentation rhinoplasty in asian noses. It is safe and has the lowest complication rate compared with alloplasts (eg silicone). The 7th rib is also the straightest and longest available for dorsal augmentation. This helps to achieve a long-lasting natural look after a cosmetic rhinoplasty.

A cosmetic rhinoplasty is performed to enhance the aesthetics of the nose. Frequently in an Asian nose, augmentation is necessary either with patient’s cartilage or an implant (eg silicone). Using an alloplasty (eg silicone) comes with risks and it is important a detailed discussion takes place so that one understands the pros and cons of each technique.

Skin cancer on the nose is fairly common in Singapore and ranks within the top 10 list of cancers. When it happens, it has to be excised and the resultant defect will have to be closed in an ideal manner that achieves excellent aesthetic and functional outcome. Occasionally, a traumatic accident can also lead to skin loss on the face and neck requiring precise repair for a good outcome.

Picture of patient with a nasal defect from a chemical burns

Picture of patient with a nasal defect from
a chemical burns

Patient 6 months after repair with a forehead flap

Patient 6 months after repair with a forehead flap

 

Facial trauma can result in facial fractures that may need fixation. The commonest area on the face that is traumatised is the nose (Nasal trauma link). Other areas include the maxilla and mandible fractures.

Pre-operative CT scan 3d reconstruction of patient with parasymphyseal mandible fracture and subcondylar fracture treated with open reduction internal fixation and MMF - “wiring”

Pre-operative CT scan 3d reconstruction of patient with parasymphyseal mandible fracture and subcondylar fracture treated with open reduction internal fixation and MMF – “wiring”

Post-operative CT scan with 3d reconstruction of patient

Post-operative CT scan with 3d reconstruction of patient

 
Sanmugam post op

It is important the occlusion of the patient is preserved and recovers well without trismus post-operatively. In these 2 pictures, patients has recovered completely and resumed normal diet in 4 weeks.

 

Functional and cosmesis goes hand in hand in treating patients with facial fractures. It is important the occlusion (“bite”) is normal post-operatively for patient with mandible fracture and also to reduce any asymmetry that may be present.

Facial paralysis can occur from a variety of conditions eg trauma, tumor resection, idiopathic. Facial asymmetry can be disfiguring and may affect the self-esteem of patients. Additionally, severe asymmetry can also result in nasal congestion due to paralysis of the dilator nares (muscles around the nostrils)

This is a patient with severe right facial paralysis from acoustic neuroma excision. He underwent a gold weight implant to upper eyelid, browlift, lateral tarsal strip procedure and hypoglossal-facial anastomosis.

This is a patient with severe right facial paralysis from acoustic neuroma excision. He underwent a gold weight implant to upper eyelid, browlift, lateral tarsal strip procedure and hypoglossal-facial anastomosis.

 

Gold weight implant for lagopthalmos – facial paralysis

Other services include:

  • Non-invasive: Botox, Fillers, Lasers, Threadlifts
  • Blepharoplasty
  • Browlift,
  • Rhytidectomies (facelifts)
  • Facial implants

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