Doctor's Column

The true core of rhinoplasty is not "height," but "structure." Rather than simply raising the tip and augmenting the bridge, understanding the anatomical structure and function of the nose ensures natural, long-lasting surgical results. In this post, SH Plastic Surgery anatomically examines the roles of the nose's foundational structures—bones, cartilage, and soft tissues—as well as the purposes and limitations of each surgical approach (closed, open, revision). In particular, based on cases of side effects from artificial materials (Medpor®, silicone, mesh, etc.), we explain the pros and cons of autologous costal cartilage, donated costal cartilage, septal cartilage, and ear cartilage—frequently used in revision surgeries—through actual clinical experience. The reason for using human-derived tissues is not merely for "safety," but because they are "biocompatible" in every aspect, including inflammation, deformity, absorption rate management, and reconstruction potential.

This article informs all patients considering rhinoplasty that "understanding the structure of your nose" is the start of the safest surgery.

Facial Designer, Dr. Sung-hoon Kim, Director of SH Plastic Surgery

"Rhinoplasty is a surgery that deals with 'structure,' not just 'shape.'"

When many people come for rhinoplasty consultations, they ask:

"Doctor, my nose is low, should I elevate it? My tip is drooping, should I lift it?"

However, the nose is not a structure that can be evaluated simply by height.

Medically, the nose is a complex organ where bone, cartilage, and soft tissues interlock to form a single "framework."

If this structure collapses, no matter how high the nose is built, deformities can occur over time, breathing may become difficult, or the tip may sink.

International plastic surgery journals clearly emphasize this point as well.

The American Journal of Plastic Surgery

The paper *"Evidence-Based Nasal Analysis for Rhinoplasty: The 10-7-5 Method"* published in Aesthetic Plastic Surgery explains:

"A systematic preoperative analysis of the patient's nose from frontal, lateral, and basal views

serves as the foundation for identifying and restoring aesthetic proportions.

Performing corrections without understanding the key structural relationships of the nose

causes one to overlook the cascade of effects that a small change can have on the entire structure."

explains that

Furthermore, the paper *Surgical Anatomy of the Nose: A Fundamental Pillar in Modern Plastic and Reconstructive Surgery* states:

"The nose is a complex framework of intricately linked bones, cartilages, skin, soft tissues, blood vessels, and nerves.

Without this structural understanding, rhinoplasty results cannot be stable in terms of either aesthetic outcome or functional stability,

and achieving aesthetic harmony without functional impairment is difficult."

is saying that.

Ultimately, understanding "structure" in rhinoplasty is not merely an academic study of anatomy.

It changes the surgical design, changes the choice of materials, and changes the longevity of the results.

That is why at SH Plastic Surgery, we always explain the structure first, even when consulting on nasal tip plasty or revision surgery.

This is because within that framework, we determine which cartilage needs reinforcement and which human-derived tissues are necessary.

In this post, we will examine that structure step by step.

We will explore how the nasal bones, cartilage, and soft tissues must harmonize,

and why human-derived tissues are the most definitive answer for preserving that structure.

Nasal Structure: Bone + Cartilage + Soft Tissue

Upper 1/2 of the nose: Nasal bone (nasal bone)

Consists of bones, with two nasal bones fused together in the center

A structure that supports the upper nasal bridge

Because bone is hard, it is not easy to manipulate, making it difficult to create significant deformities/changes.

Lower 1/2

— Upper lateral cartilage

It is an important structure that maintains the airway (nasal valve).

Excessive manipulation of this area can lead to nasal congestion or a deviated nose.

— Septum (septal)

It is the cartilage that plays the most crucial role as a pillar supporting the nasal tip.

If the septum collapses, it can result in a collapsed nose known as a saddle nose.

— Lower lateral cartilage (alar cartilage)

It is the cartilage that forms the nasal tip and nostrils (ala), playing a key role in determining the shape and direction of the nose.

It is the cartilage where various modifications/transformations are made during rhinoplasty.

If these three components do not maintain a balance, over time, issues such as drooping of the nasal tip, deviation to one side, or functional breathing difficulties may occur.

Therefore, the essence of rhinoplasty is not simple reshaping, but the restoration and reinforcement of the structure.

Direction of Rhinoplasty in Asians

In Asians, rhinoplasty should not be approached with the simple concept of "raising the nose."

Most people want to improve a low/flat nose, but a truly ideal nose is one where both "height" and "length" are harmonized.

If the nasal tip is simply raised upward, it can easily look upturned.

Therefore, elevating the height of the nasal tip while simultaneously extending the length of the nose naturally,

Satisfying both of these aspects creates a beautiful facial proportion and a well-balanced nasal line.

"Raising the nose" = The height of the nasal tip increases. X

-> The nose becomes naturally longer and higher without looking upturned. O

Satisfying both of the above conditions creates a beautiful facial proportion and a well-balanced nasal line.

What is important here is not simply "how much it is raised," but in what manner and with what materials it is built up.

Since it is ultimately the cartilaginous structure that supports the length of the nose,

An incorrect surgical approach or an implant-centered augmentation using artificial materials can cause the nasal tip to droop or turn upward over time.

In Asians especially, because the skin is thick and the cartilage is weak,

A surgical approach that builds up the structure (open approach, centered on structural correction) and

The selection of human-derived materials with sufficient support (autologous rib cartilage, septal cartilage, etc.)

determines the stability and longevity of the results.

Comparison of Major Cartilage Materials Used in Surgery

Why human-derived components, not artificial materials, are important

The nose is not simply an organ for decorating appearance.

Because it is a complex structure where skin, cartilage, and mucous membranes are interlocked,

when a foreign substance enters, the body immediately reacts, saying, "This is not mine."

In this way, the nose is an organ that is highly sensitive to foreign substances.

Artificial materials such as silicone, Medpor®, or Mesh hold their shape initially,

but over time, they often cause problems such as inflammation, contracture, deformation, and absorption.

As a result, inflammation, contracture (a phenomenon where tissue shrinks), absorption, and, in severe cases, deformation due to impaired blood flow to the skin can occur.

On the other hand, human-derived components (autologous tissue, donated tissue, etc.) have high biocompatibility.

Furthermore, the incidence of inflammation is significantly low.

Reduced risk of inflammation: Almost no foreign body reaction.

Predictable absorption rate: The engraftment rate can be calculated for autologous tissue.

Minimization of tissue damage: No secondary damage occurs from removing artificial implants.

Flexibility secured for revision surgery: Reconstruction is easy, and deformation is minimal.

In the end, the reason human-derived components are important in rhinoplasty is because of their "natural resilience."

In other words, human-derived components are not chosen simply "because they are safe,"

but are the most fundamental choice for preserving the structure and maintaining the results for a long time.

Reflections of Facial Designer, Director Kim Sung-hoon

When performing rhinoplasty, I always think of "structural restoration" first.

Because the nose is not merely an organ for aesthetics,

but the central axis that breathes and determines the balance of the face.

Autologous rib cartilage is the most superior in terms of structural strength and engraftment stability,

but it cannot be applied to all patients.

Donated rib cartilage is a good alternative,

but results may vary depending on the absorption rate or the donor's age.

Therefore, a comprehensive evaluation before surgery is absolutely essential.

The key is anatomical understanding.

Only when the direction of tissue, cartilage tension, skin thickness, and elasticity are all considered can a truly 'natural nose' be created."

FAQ

Q1. Does using autologous costal cartilage leave a scar?

It is harvested through a minimal incision under the areola or near the armpit, so it is mostly unnoticeable.

Q2. Is donated costal cartilage safe?

Because it undergoes sterilization and decellularization processes, rejection reactions are extremely rare. However, the absorption rate varies from person to person.

Q3. Isn't ear cartilage structurally weak?

That is correct. However, it is very suitable for areas requiring curves or for auxiliary grafting.

Q4. When is revision surgery possible after removing artificial implants?

It depends on the inflammation state, but reconstruction surgery is usually performed during a stable period after 3 to 6 months.

Q5. What is the criteria for choosing between autologous and donated costal cartilage?

The decision is made comprehensively based on scar burden, body type, tissue condition, and surgical difficulty.

Q6. Why shouldn't artificial implants be used?

Infection, contracture, and show-through (implant visible through the skin) can occur, and tissue damage is extensive upon removal.

Q7. How long does the pain last after rib cartilage surgery?

Most of it subsides within 3 days, and you can return to daily activities within 1 week.

Q8. What if the donated costal cartilage is absorbed later?

If necessary, re-correction is fully possible by supplementing with autologous tissue.

Q9. Can breathing become difficult after rhinoplasty?

This is due to nasal valve damage, and functional correction must be performed simultaneously.

Q10. What is the most important thing during revision surgery?

Accurately analyzing the structures damaged from the previous surgery and selecting materials that allow for anatomical restoration.

(22) When can you get #RevisionRhinoplasty? Check out how to achieve a perfect #AlarReduction as well! - YouTube

Is non-surgical #alar reduction possible?

SH Plastic Surgery Clinic