Facial Plastics & Reconstructive Surgery is a sub-specialty within the Ear, Nose, and Throat (ENT) field that specifically deals with cosmetic and reconstructive procedures related to the face. It encompasses a range of surgical treatments aimed at improving the aesthetic appearance and functionality of facial features, including the nose, ears, eyelids, and facial contours.
Rhinoplasty, in particular, is a surgical procedure that focuses on reshaping or resizing the nose to enhance its appearance or address functional issues. It can involve altering the nasal bones, cartilage, and tissues to achieve the desired outcome.
Rhinoplasty serves two primary purposes: functional improvement and aesthetic enhancement. It is important to note that nasal plastic surgery goes beyond cosmetic goals and can also address issues related to nasal obstruction and improved breathing by realigning the sinuses. Rhinoplasty is not solely focused on beautification but also encompasses the functional aspect of the nose.
Open Rhinoplasty: In open rhinoplasty, the surgeon makes an incision across the columella, the strip of tissue between the nostrils. This allows the surgeon to lift the skin and soft tissues, providing a clear view of the nasal structures. It is particularly useful for complex or extensive nasal reshaping as it offers greater visibility and control during the procedure. However, it leaves a small external scar on the columella, although it tends to fade over time.
Closed Rhinoplasty: In closed rhinoplasty, all incisions are made within the nostrils, resulting in no visible external scarring. The surgeon accesses the nasal structures through these internal incisions, allowing for reshaping and modification. Closed rhinoplasty is commonly preferred for cases that require less extensive changes or for patients who desire a quicker recovery time. It may have certain limitations in terms of visibility and access compared to open rhinoplasty
The choice between open and closed rhinoplasty depends on the specific goals, individual anatomy, and the surgeon's expertise.
The same patient with the nasal tip strengthened giving support to the nasal valves with improved airflow.
Patients commonly seek functional rhinoplasty when faced with a complex septal deviation and narrow nasal valves. In such cases, a thorough assessment of the nasal cavity is essential, with special attention given to both static and dynamic obstructions in the nasal valves. The most prevalent cause of nasal obstruction is a deviated septum combined with enlarged inferior turbinates.
To address these issues, functional septorhinoplasty can be performed using either an open (external) or closed (endonasal) approach, with the choice depending on the patient's preferences and surgical requirements.
Functional rhinoplasty in Singapore offers patients the opportunity to enhance both the function and appearance of their nose simultaneously. By strengthening the nasal tip support, the patency of the nasal valves is improved, resulting in better airflow and overall nasal function.
Scarless rhinoplasty, also known as endonasal rhinoplasty, is a surgical technique used to reshape and enhance the nose without creating any visible external scars. Unlike open rhinoplasty, which involves an incision on the columella (the strip of tissue between the nostrils), endonasal rhinoplasty utilises internal incisions within the nostrils.
During the procedure, the surgeon gains access to the nasal structures through these internal incisions. This approach allows for the modification of nasal bones, cartilage, and tissues to achieve the desired results. Avoiding external incisions means there will be no visible scarring on the nose's surface, making it an appealing option for those concerned about visible scars.
However, it is important to note that not all cases are suitable for scarless rhinoplasty. Complex or extensive nasal deformities, significant tip work, or the need for increased visibility and access may require an open rhinoplasty approach.
The alar batten graft is a widely employed technique in nasal graft reconstruction, aimed at addressing nasal valve obstruction. It can be implemented through both open and closed rhinoplasty approaches. The graft itself consists of cartilage, which can be harvested from either the nasal septum or the ear (known as conchal cartilage graft).
The purpose of the alar batten graft is to reinforce the lateral nasal sidewall, which is prone to collapse and contributes to nasal valve obstruction. By strategically placing the cartilage graft in this area, the strength and stability of the nasal valve are enhanced. This straightforward yet highly effective technique offers significant improvement in cases of nasal valve obstruction, helping to alleviate breathing difficulties.
Click here for Dr Dennis Chua’s book chapter on Surgical Pearls: Alar Batten Grafts.
Alloplast (a type of silicone implant), Gore Tex and Medpor are implants commonly used for nasal dorsum augmentation in Singapore. These implants, when employed with appropriate surgical techniques, can yield striking and natural-looking enhancements to a patient's appearance in a safe manner. However, caution should be exercised when selecting implants, as L-shaped implants carry a higher risk of extrusion. To mitigate this risk, several strategies can be employed. These include avoiding excessive pressure on the implants, placing them in a deeper subperiosteal plane, and utilising softer implants to minimise tissue trauma.
During the consultation process, a qualified surgeon will evaluate the patient's specific needs and goals, considering both the advantages and potential risks associated with each implant. The choice of implant will depend on factors such as the patient's anatomy, desired outcome, and the surgeon's expertise.
Rib graft, apart from septal or ear cartilage, is an excellent source of autologous cartilage for augmentation rhinoplasty, particularly for Asian noses. Compared to synthetic implants like silicone, rib grafts offer a high level of safety and the lowest complication rates. Among the available rib choices, the 7th rib is often preferred due to its straightness and optimal length for dorsal augmentation. This contributes to achieving a long-lasting and naturally appealing outcome in cosmetic rhinoplasty.
When performed correctly, the harvesting of rib cartilage poses minimal morbidity and associated risks. A small incision of approximately 2.5cm, strategically placed within a skin crease, allows for the extraction of a straight piece of rib cartilage. With proper surgical techniques, this incision can heal nicely, resulting in minimal visible scarring.
To achieve the desired outcome, it is essential to consult with a skilled and experienced plastic surgeon who can assess the patient’s specific needs, guide them through the surgical process, and deliver the most appropriate approach for nasal augmentation.
Dr Dennis Chua is an Ear, Nose, and Throat (ENT) Doctor in Singapore, specialising in Facial Plastics & Reconstructive Surgery and helms a clinic located in Mount Elizabeth Hospital. Dr Chua completed his medical training at the National University of Singapore (NUS) before obtaining further qualifications in Edinburgh (UK). He also pursued a fellowship in the United States.
He is fully accredited as an ENT surgeon by the Ministry of Health (MOH) and Singapore Medical Council, with a specialisation in Otorhinolaryngology. Notably, Dr Chua is one of the few ENT specialists who are internationally board certified in Facial Plastics & Reconstructive Surgery, which encompasses expertise in rhinoplasty.
He is actively involved in research on rhinoplasty, regularly sharing his experience through international invitations, book chapters, and research publications. Dr Chua is dedicated to educating and mentoring young professionals in his field, offering lectures and mentorships to future medical service providers.
Dr Dennis Chua- Part of the International Consensus on Functional and Aesthetic Rhinoplasty, Paris IFOS ENT Meeting 2017
Phone: (65) 6235 3886
Fax: (65) 6235 4243
Email: enquiry@entsurgeons.com.sg
Monday to Friday: 9:00 am – 5:00 pm
Saturday: 9:00 am – 12:00 pm
