雅丰時尚醫療事業　整形外科專科－曾文尚醫師

演講題目：Asian Rhinoplasty

作者：曾文尚醫師

曾文尚醫師於2012年9月29日應邀參加長庚醫院「第二屆長庚美容研討會」，並於會中演講，演講主題為：「Asian Rhinoplasty (適合東方人的隆鼻手術)」。

曾文尚醫師過去曾在林口長庚醫院任職近十年，在這段期間受到很多長庚整形外科師長前輩的提攜與指導，這些寶貴的專業經驗對執業後的技術精進與提升有莫大幫助。秉持這一份感恩，曾文尚醫師回到林口長庚，將多年來對於隆鼻手術的心得，向與會的整形外科醫師分享。

曾文尚醫師這次演講主題為：「Asian Rhinoplasty」，談的是適合東方人的隆鼻手術，而其精髓就是二段式隆鼻手術、三段式隆鼻手術，也就是曾醫師倡導的正統韓式隆鼻手術，屬於量身訂做的鼻子雕刻手術。



大會演講之英文摘要:

Asian rhinoplasty(適合亞洲人的隆鼻手術)
雅丰時尚診所 曾文尚醫師

Rhinoplasty is a highly specialized field that requires much knowledge and skill on the surgeon to have successful result .The concepts of beautiful nose are different from Asians and Caucasians with respect to ethnic and cultural backgrounds, anatomy of the face and nose, and psychological and aesthetic needs of the patients . Asian rhinoplasty is one of the most common aesthetic procedures in Taiwan. The specialty of Asian rhinoplasty surgery has grown and evolved with the refinement of many innovative techniques and the creation of new procedures.

Orientals have flatter noses than Caucasians because of insufficient bone and cartilage support for oriental nose. The common complaints told by orienta patients are bulbous tip, wide and low dorsum, retracted columella, flat nostril, weak and thin cartilage, and thick skin ( thick subcutaneous tissue). We can divide the oriental noses problems into 5 groups: short nose, bulbous nose, saddle nose, retracted columella, and insufficient nasal tip projection.

For the augmentation of oriental nose, alloplastic material ( L-shape silicone ) have been widely used for more than 30 years. Therefore secondary revision procedure is also increased because L-silicone implant are prone to exposure, infection, and displacement . And also in case of lack of skin envelope and short nasal framework , it is not enough to get good result by performing augmentation using L-shape silicone implant . Inadequate surgical technique and overaggressive augmentation with silicone implants have led to the potential of implant extrusion through the incision site, or, worse yet , through the overlying tip skin.

Which method is good for oriental nose? The critical points of decision for Asian rhinoplasty are selecting appropriate grafting material, control of nasal tip projection, and precise control of dorsal height. In my opinion, the better way for the augmentation of oriental noses is the Two-pieces of augmentation rhinoplasty . The surgical methods are I-shape silicone, Gortex, or Chimeric implant for radius and dorsum augmentation, septal cartilage graft for columella support and tip projection , and dome suture and ear cartilages for tip definition. I would like to use rib cartilages for dorsum augmentation and tip projection in some difficult cases.

The two-pieces of augmentation rhinoplasty is the sculpture of nose individualized! Now the autogenous cartilages ( septal , auricular, rib cartilages ) and alloplastic materials ( I-shape silicone, Gortex, Chimeric implant ) have been widely used ! And the result gets much improvement. I would like to present these cases.



大會演講之幻燈片內容摘要:

slide1 

感恩&感謝
長庚醫院整形外科的所有師長,師兄

slide2
Asian Rhinoplasty(two-pieces of augmentation rhinoplasty )

曾文尚 張松源 林孟羲 林敬鈞 黃俊源

雅丰時尚診所 雅丰麗緻診所
菲仕美診所

slide 3
Orientals have flatter noses than westerers

slide 4
Oriental noses:
insufficient bone and cartilage support

  
slide5
Oriental nose
Wide dorsum
Bulbous tip
Thick skin ( thick subcutaneous tissue )
Weak and thin cartilage
Retracted columella
Flat nostril

slide6
Thick skin ( Thick subQ)
Positive aspect: irregular minuteness or asymmetry could be camouflaged
Negative aspect:
pathological swelling and scar formation under the skin is extreme after operation
The recovering of the skin gets delayed
The extension of skin is limited

slide 7
The common problems in oriental nose
Short nose
Bulbous nose
Saddle nose
Retracted collumella
Insufficient nasal tip
Alar hyperplasia

slide8

For the augmentation of oriental noses, alloplastic materials ( L-shape silicone ) have been widely used in Taiwan for more than 30 years .

Therefore secondary revision procedures are increased because L-silicone implants are prone to exposure, infection, and displacement .
And also in case of lack of skin envelope and short nasal framework , it is not enough to get good result by performing augmentation using L-shape silicone implant .

slide9
Case 1

Inadequate surgical technique and overaggressive augmentation with L-shape silicone implants have led to the potential of implant extrusion through the incision site, or, worse yet , through the overlying tip skin

Tx: Asian Rhinoplasty (Two-pieces of augmentation rhinoplasty)

Radius and dorsum augmentation
Septal (cartilage) extension graft for tip projection
Ear cartilage and dome suture for tip definition

slide10
Csae2 Difficult Case (contracted nose)

Difficult Case
How to do ???

Difficult Case s/p 5 times of rhinoplasty with infection

Tx:Asian Rhinoplasty (Two-pieces of augmentation rhinoplasty)
Costal ( rib cartilage) extension graft for tip elongation
Ear cartilage and dome suture for tip definition

slide 11
The definition of Asian Rhinoplasty (Two-pieces of augmentation rhinoplasty)

1st piece: I-shape silicone, Gortex, or Chimeric implant for radius and dorsum augmentation
2nd piece: extension graft( septal cartilage, costal cartilage… ) for tip projection, and dome suture & ear cartilages for tip definition

slide 12
Critical points of asian rhinoplasty

Selecting appropriate grafting material
Control of nasal tip projection
Precise control of dorsal height

slide13
感恩&衷心感謝
長庚醫院整形外科的師長,師兄…

Thanks for your attension !