Rhinoplasty

Rhinoplasty alters the structure of the nose to address functional, aesthetic, or combined concerns. It may be appropriate where nasal form or airflow causes persistent dissatisfaction or limitation.

The focus is on determining whether surgery is suitable and what degree of change is appropriate, keeping in mind individual anatomy, structural balance and long-term stability.

My Approach · Technique · Recovery · FAQ

My Approach

The nose sits at the centre of the face, both literally and emotionally. Rhinoplasty, when done with respect for anatomy and structure, should enhance facial harmony rather than create distraction.

My approach follows the principles of preservation rhinoplasty, using autologous-only tissue and gentle contour refinement to deliver anatomical results that are natural and long-lasting.

Other procedures that may enhance facial balance include forehead and chin augmentation to balance one's overall profile. This is typically achieved with structural fat grafting while periorbital skin rejuvenation can be addressed with nanofat.

Achievements in Rhinoplasty

My work in rhinoplasty has been recognised internationally - I was awarded the ISAPS Bronze Medal for Rhinoplasty (2025) and Best Abstract Award (2024) at the London Rhinoplasty Course, Techniques in Rhinoplasty with an Integrated ENT-Plastics Approach for my contribution to advancing closed preservation methods for tip reshaping. This work has now been published in the European Journal of Plastic Surgery.

Request Consultation

My Approach

Planning & Technique

I believe that most noses do not require radical reconstruction. Instead, beautiful rhinoplasty begins with preservation. I seek to carefully understand your aesthetic goals and to make sure we are aligned, while ensuring that you do not have functional issues such as nasal obstruction.

I prioritise minimal disruption to soft tissues, preserving native ligaments and blood supply. Hence, I favour closed (endonasal) techniques when appropriate, to reduce scars, swelling, and recovery time; open approaches can and will still be used when indicated. Interventions are always based on proportion, not fashion. I reshape, refine and restore balance to the nose.

This philosophy is similar to how I treat hand fractures - if alignment can be restored without unnecessary exposure, that is the safer and smarter approach.

To further this philosophy of precision, I integrate Point-of-Care Ultrasound (POCUS) into my consultations, especially for revision rhinoplasty. By visualising the nasal anatomy, I can measure soft tissue thickness (skin vs scar) and assess structural integrity in real-time. This enables me to formulate a surgical roadmap based on objective data rather than guesswork. Further investigations such as nasal endoscopy, X-rays and CT scans will only be ordered if clinically necessary.

Tip Refinement - Tissue, Grafts & Cartilage Strategy

In general, cartilage is used to improve rotation and projection of the nasal tip, as well as augmentation in height of the dorsum (nose bridge, see next).

My preference is autologous tissue only - no implants (silicone), no synthetic grafts or materials (Goretex), and no cadaveric rib grafts.

- Septal cartilage: In many Asian noses, the septum offers limited cartilage and is critical for long-term support. I adopt a septal-sparing graft philosophy, avoiding overharvest (if at all) to preserve structural integrity. Importantly, septal cartilage used for tip augmentation not only avoids the stiffness typically associated with silicone implants or rib cartilage, it can also allow customisation of the nasolabial angle (between the nose and the upper lip). Conversely, in Western noses that tend to be disproportionate with the rest of the face, reduction of the septal cartilage and the anterior nasal spine, in combination with a cephalic trim of the lower lateral cartilages (LLC) is often required to reduce the overall size of the nose and derotate the drooping tip.

- Ear cartilage: For mild to moderate refinements (typically for the dorsum, tip and alar), harvested ear cartilage is often sufficient as it is soft, adaptable, and affords low morbidity.

- Rib cartilage: Reserved only for major reconstructive needs (severe collapse, trauma, major revision) in my hands. It is never routinely used.

This strategy keeps the nose's natural structural support intact while providing safe, stable refinement.

Dorsal & Radix Refinement - Diced Cartilage & 3D-Printed Splint Support

For patients seeking bridge or radix enhancement without implants (ie silicone), depending on assessment, I may offer a technique using finely-prepared (aka diced) cartilage. This achieves natural dorsal contouring with minimal grafting, avoiding harsh edges and foreign material.

My preference for diced cartilage with fibrin glue (Tisseel) over solid rib grafts or silicone implants reflects several clinical advantages:

(1) Natural contour - the diced fragments consolidate into a smooth, integrated structure that conforms to the nasal skeleton without visible edges or sharp transitions

(2) Tissue integration - unlike silicone, which remains a foreign body, the construct integrates with surrounding tissue over time, reducing the risk of migration, extrusion, or chronic inflammation

(3) No fascia harvest - avoiding temporalis fascia harvest eliminates the risk of scar alopecia in the scalp and reduces operative time and donor site morbidity

(4) Revisability - if further refinement is ever needed, diced cartilage is far more forgiving to work with than a rigid, solid rib graft or silicone implant

(5) Mucosal safety - silicone implants require pocket dissection that risks mucosal breach; autologous cartilage in the event of mucosal breach carries far lower consequences such as infection which would necessitate removal

To optimise healing and contour stability, I may support this with a custom 3D-printed nasal splint, designed to gently conform to your anatomy and guide soft-tissue settling in the early postoperative period.

Together, these allow for refinement that feels natural, integrates with your own tissues, and supports long-term structural health.

Planning the Nose as a Complete Structure

While the tip and bridge (dorsum) often receive the most attention, rhinoplasty is never just about raising or lowering the bridge or improving tip projection, which is a common misconception, especially in Asian rhinoplasty.

For example, a nose that appears “large” or "flat" is not always due to projection problems. Sometimes, it reflects underlying issues with the bony skeleton, cartilage and hence tip support weakness, alar flaring, and a thick skin envelope. All of these will require different strategies, both surgical and non-surgical.

Careful pre-operative analysis thus allows the surgical plan to address the nose as a three-dimensional structure, rather than focusing on a single isolated feature. Additional techniques may include nasal osteotomies, septal extension grafts, septoplasty, cartilage reshaping sutures, alar reduction, turbinate reduction etc.

Alar reduction (alarplasty) is listed here for completeness, but in my practice it is genuinely a last resort. Once the tip has been properly augmented and projected, alar width frequently resolves without any direct intervention. Where alarplasty is performed, the scars have a tendency to widen over time (due to proximity to the muscles in facial expression) and are unforgiving - they can stigmatise the result as surgically altered. I will only perform alarplasty when it is clearly necessary after all other elements of the plan have been executed, and my preference is to approach it within the nostril to minimise the scar as much as possible.

Concurrent fat grafting to the forehead and chin can meaningfully improve overall facial harmony (especially in female patients) and profile by softening the forehead contour and improving chin projection without a foreign body implant. This is consistent with my preference for autologous tissue throughout, and where indicated, is planned and performed as part of the same procedure.

Skin & Soft Tissue Management

Thick, sebaceous nasal skin is common, especially in Asian patients. This can blur nasal definition and reduce tip finesse. Instead of aggressive surgical thinning (which risks devascularisation, fibrosis, and unpredictable healing), I advocate for safe, evidence-based skin and soft tissue optimisation:

- tip control through soft-tissue suturing techniques to reduce post-operative dead space and hence swelling and oedema which can contribute to pollypeak deformities

- medically guided retinoids for gradual skin remodeling

- selective CO2 laser for sebaceous hyperplasia or oily skin

- ultrasound evaluation for guided steroid injections to reduce scar tissue formation

- careful skincare and postoperative skin maintenance

This combined tissue + skin approach helps preserve vascularity while improving final definition for results that age gracefully.

Every patient’s anatomy and goals are different.

Dr Ng will discuss the best approach for you during your consultation.

Book a Consultation

Recovery & Expectations

- Day 0: Most patients return home the same day after surgery - Day 1-2: Bruising and swelling (esp below the nose) typically peaks around now. You will look your worst at this time but it will get better as this is not the final result - Day 7: Splint comes off and overall swelling is much improved except for the nasal tip as it is not covered by the splint. Avoid wearing glasses. - Day 14: Some bruising around the eyes (especially if osteotomies were performed) may still persist but can be covered with makeup. Continue to sleep with your face up and most desk jobs and simple exercise can be resumed. - Week 6: Swelling and bruising should be much reduced at this stage although the nasal tip can still be slightly swollen. Breathing should be unobstructed, or improved even, if there were additional procedures done during surgery. - Week 12: More or less back to normal activities, some swelling of the tip may persist. Ongoing subtle changes in the overall nasal profile and tip and this can take up to a year. - 6-12 months: 90-95% of swelling should have resolved by now. Final results as the skin and soft tissue has now settled over the refined, underlying cartilage framework and bones.

A custom 3D-printed splint may be used to support healing and contour stability when indicated
In around 10% of cases, minor irregularities may occur due to natural cartilage and bone remodelling. These are easily refined with a small amount of filler, often producing a permanent smoothing effect

Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch , an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng for attentive, discreet, and consistent care throughout the recovery journey.

Technique

Recovery

Frequently Asked Questions

1. Will I still be able to breathe normally after surgery?
Yes, one of the goals of thoughtful rhinoplasty is to preserve or improve nasal airflow. Function is considered alongside aesthetics during planning.

2. Why do you use a preservation approach?
Preservation rhinoplasty focuses on minimal disruption of soft tissues, maintaining native ligaments and blood supply to achieve natural, proportionate, long-lasting results. If necessary, I will still use an open approach as indicated.

3. Will there be visible scars?
With closed (endonasal) techniques when appropriate, there are no external scars. Your incisions are placed inside the nostrils, and healing typically leaves no visible surface scarring.

4. Do you use implants for rhinoplasty?

No. My preference is autologous tissue only, using cartilage (if required) from your own ear, nasal septum, or in selected cases, rib. No silicone implants, no synthetic materials.

5. I'm considering rhinoplasty in Korea or Bangkok. Why should I consider Singapore?

For an honest answer - see my blog posts on rhinoplasty issues I commonly see following overseas procedures and my perspective on overseas surgery.

6. What is diced cartilage grafting and why do you prefer it for dorsal augmentation?

Diced cartilage grafting involves harvesting cartilage, from the ear or rib, and cutting it into small fragments of approximately 0.5–1mm (think minced garlic) to form a malleable construct that is placed along the nasal dorsum.

The technique was originally described using fascia as a wrapping, the so-called "Turkish Delight" technique. My preference is Tasman's modification, which uses fibrin glue (Tisseel) instead of fascia as the binding scaffold. This avoids the donor site morbidity and risk of scar alopecia associated with harvesting temporalis fascia, while preserving the key advantages of the technique. Studies have shown that fibrin glue enhances chondrocyte viability and proliferation. Fibrin glue causes chondrocyte proliferation and cartilaginous tissue formation with the development of cartilage-specific extracellular matrix components including glycosaminoglycans and collagen Type II, and the fibrin scaffold is gradually replaced by fibrous tissue over time. Tasman reported on 28 patients with minimal shrinkage and stable grafts between the third and fifteenth postoperative months.

It is worth noting that not every rhinoplasty requires dorsal augmentation, and not every augmentation requires diced cartilage. The technique is selected based on the degree of augmentation required, cartilage availability, and individual anatomy. This is assessed at consultation.

Rhinoplasty

My Approach

Planning & Technique

Tip Refinement - Tissue, Grafts & Cartilage Strategy

Dorsal & Radix Refinement - Diced Cartilage & 3D-Printed Splint Support

Planning the Nose as a Complete Structure

Skin & Soft Tissue Management

Recovery & Expectations

Frequently Asked Questions

Related Reading

Next Steps:

Rhinoplasty

​My Approach

Planning & Technique

Tip Refinement - Tissue, Grafts & Cartilage Strategy

Dorsal & Radix Refinement - Diced Cartilage & 3D-Printed Splint Support

Planning the Nose as a Complete Structure

Skin & Soft Tissue Management

Recovery & Expectations

Frequently Asked Questions

Related Reading

​Next Steps:

My Approach

Next Steps: