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This 40 year old Virginia Beach woman came to me for a consultation because she wanted the bridge of her nose built up and a narrower tip. After looking at her photos together, we had a very detailed discussion about all aspects of her nose in relation to her concerns.  We agreed that the tip of her nose was turned upward and it would be more attractive and appropriate with more length.  I pointed out how her midface or upper jaw was set back, or lacked projection, leading to the appearance her entire nose was set back as well.  Using video imaging, I was able to give her an idea of what we could accomplish with surgery.  To build up her nose, we began with a peri-pyriform implant which is silicone that sits on the upper jaw so the entire nose can rest in a more normal position.  From this foundation, her own rib cartilage was used to bring the tip out and also lengthen her nose.  There is no other reliable way to lengthen a nose, or in other words tilt the tip down and project it at the same time with narrowing, other than using one’s own rib cartilage.  Especially in Asians, the septal cartilage and ear cartilage are far inferior and are not adequate to accomplish these changes.  Finally, with the tip projected out and the nose lengthened, I chose a reliable way to raise the bridge of the nose with “diced wrapped cartilage”.  This is taking rib cartilage and dicing it very finely, to less than 1 mm.  It is then wrapped in the patient’s own thin film of temporalis fascia tissue and placed on top of the bridge for a very smooth contour, creating significant augmentation.  She is extremely pleased with the refined proportions to her face and all the new, natural appearing features.  These techniques are some of the more advanced and difficult in modern rhinoplasty.  It takes a surgeon years of experience to become comfortable with these methods.  Dr. Hubbard has been using rib cartilage for over 20 years and wrote a major rhinoplasty textbook chapter on methods to control the tip with cartilage grafting. 

Surgeon: Dr. Thomas Hubbard

Case Number: 461

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