As the noses of Oriental people are generally smaller than those of the Westerners, the traditional L-shape artificial nasal bone rhinoplasty in the past, while raising both the nasal dorsum and nose tip, ignored the importance of extending the length of the nose, so the postoperative results were often unnatural or not in proper proportion. Furthermore, there was no method to directly improve cases with bent nose bridge, hump on the nasal dorsum or overly-wide nasal bones. Therefore, if you want to have a nasal shape that is suitable to your proportion, I would recommend using the so-called "two-stage nose-sculpturing surgery" method.

What is a two-stage nose-sculpturing surgery? This is an operative method that divides the handling of the "adjustment of nose bridge curve" and "sculpturing of nose tip" into two stages. Different from the traditional L-shape artificial nasal bone (1-stage) rhinoplasty surgery, the two-stage nose-sculpturing surgery is a rhinoplasty method that can also correct the bent nose bridge, the hump on the nasal dorsum, or overly-wide nasal bone at the same time.

We currently still choose to use artificial materials to reconstruct the curve and length of the nose. Although some physicians recommend the fully autogenous costal cartilage nose-sculpturing surgery that even uses autogenous costal cartilage on the nasal dorsum, after all, autogenous costal cartilage does have excessive hardness and possible bending issues, so unless the patient is undergoing the nose-sculpturing reconstruction surgery, we would not recommended the first-time surgery patients to use the fully autogenous costal cartilage nose-sculpturing surgery.

As for the nose tip sculpturing, we recommend using the autologous tissues such as the autologous auricular cartilage, nasal septum cartilage, autologous fat, autologous fascia or autologous costal cartilage, so as to avoid the potential issues of unnatural nose tip or prosthesis protrusion that may occur when using the artificial materials.

As for the concept of the three-stage rhinoplasty surgery, it is an extension of the two-stage rhinoplasty but mainly aimed for patients with insufficient glabella. The Oriental people have a myth of always wanting to have long and prominent noses. However, how "long and prominent" can be implemented in the nose-sculpturing operation? Does "long and prominent" really meet everyone's needs? How to have the nose to achieve the golden ratio on the face? To create a perfect nose, I think the curve between the glabella and the nose is very important as it affects the three-dimensional quality of the nose on the face. Clinically, when performing rhinoplasty surgeries in the past, many physicians emphasized the length and prominence of the nose so it looks like the nose of a foreigner. However, because the nasal dorsum in many cases were too prominent, it seemed like the nose protrudes directly from the forehead, and it looks like a wax figure and very unnatural (see figure).

Actually, in many cases there were concaves at the glabella, so simply increasing the length of the dorso nose won't solve the problem. This is the concept of three-stage rhinoplasty surgery. We call the curve between the glabella and the nose the "brow-nose curve" (see figure on the left).

We even have to often educate our patients that the reason why many people like Angelababy (see figure on the right) is not for the length of her nasal dorsum, but because of the fullness and smoothness of her "brow-nose curve".

The past two-stage nose-sculpturing surgery cannot establish a perfect "brow-nose curve", so we must design an additional infill for the junction between the glabella and the nose bridge, and we call it "three-stage nose-sculpturing surgery." Usually we use silicone or Goretex to design a suitable implant (see figure).

Tomography for two-stage nose-sculpturing surgery

Tomography for three-stage nose-sculpturing surgery

3D Tomography for two-stage nose-sculpturing surgery

3D Tomography for three-stage nose-sculpturing surgery

The above is purely a case description, and the actual situation will vary from person to person.

The patient in this case study strongly urged the surgeon to pad the junction between the glabella and the nose bridge to as high as possible to improve her short and flat nose. During the consultation, the surgeon told the patient that the problem was mainly with the insufficient glabella. If the surgeon only pad the junction between the glabella and the nose bridge, it would not be able to smoothen the curve between the glabella and achieve the effect of extending the nasal shape, so the surgeon recommended the three-stage nose-sculpturing surgery, which would handle the glabella, the curve of nose bridge, and the sculpturing of nose tip separately. For the adjustments of glabella and curve and length of nose, the doctor chose to use the I-shape artificial nasal bone material. As for the sculpturing of nose tip, the surgeon chose the nasal septum cartilage to extend the nose tip, while using the auricular cartilage for re-shaping. Afterward, the surgeon would sew the ala nasi cartilage to achieve the effect of reducing the nose tip. Finally the surgeon performed a three-in-one ala nasi lifting and reducing surgery so that the entire nasal shape is more refined.