What Happened to Gao Liu’s Nose?

What happened to Gao Liu’s nose? A startling transformation leaves many fans of this up-and-coming Chinese actress wondering. In this short segment, Dr. Zelken describes the decision-making that may have led a budding actress to seek cosmetic surgery, what her goals may have been, the surgery that was performed, and why a complication may have occurred. He also talks about major differences between Eastern and Western rhinoplasty, and why certain pitfalls are more likely in Asian patients.

In summary, Asian rhinoplasty tends make the nose bigger and more defined. Asian noses are classically typified as having a low bridge, a short length, and ill-defined tip with thick skin, and possibly nasal alar flaring. Operations and nonsurgical procedures to address this typically involve making the dorsum, or the top of the nose, bigger and better defined. Also, creating the appearance of contour between the top of the nose and the sidewalls of the nose, and a cuter, more defined tip.

In this case, the actress decided to get the procedure after a friend suggested her nose was too short. There are myriad reasons that people seek cosmic surgery, but let us face it, selfies in social media are a significant part of the drive to get plastic surgery. This patient sought plastic surgery at a hospital in Guangzhou, China. She was promised that she would recover within two weeks, just in time to resume work on a film. The procedure (the first one) apparently took 4 hours. According to some reports, cartilage was taken from the ear and transplanted to the nose tip to make it bigger and more defined.

After she woke up, Ms. Liu learned that her nose appeared irritated during the procedure, was becoming infected, and some days later, she underwent a second procedure to remove something inside her nose. Whether the something was an additional nasal implant, or the ear cartilage graft is unknown based on a review of the recent media reports. Unfortunately, a second procedure was not sufficient to prevent nasal tip necrosis. Pictures reveal the tip of the nose turned purple before turning black and now the patient has a deformity warranting serious reconstruction.

I present this sad and interesting case to identify potential pitfalls in Asian (and all) rhinoplasty. In this case, I imagine the surgeons may have been a little too liberal in resecting or defatting the nasal tip. Because Asian noses typically have fibrofatty tissue underneath thick skin, many doctors will de-fat this tissue somewhat to allow the nose to have a more pointed or defined appearance by showing the cartilage framework better. If this is done too aggressively, a result much like the one shown here can occur. Also, it identifies the importance of placing oversized and solid grafts and over building the underlying framework to achieve a good long-term result. In this case, ear cartilage was used. In other cases, implants and even rib cartilage may be used.

Dr. Zelken wrote a paper about how nasal septal cartilage alone is sufficient in many cases to achieve a desirable result without using ear cartilage or rib. (Zelken J, Hsiao Y-C. An Economical Approach to Ethnic Asian Rhinoplasty. Facial Plast Surg. 2016 Feb). This sad case should serve as an important reminder of the potential pitfalls of cosmetic surgery. Even with small planned changes, devastating results can occur. Please be sure you seek a board-certified plastic surgeon if you are considering cosmetic surgery of the nose.

If you or a loved one have suffered an injury much like the one presented here, Dr. Zelken can help. A case like this may require reconstruction using the forehead. While the subsequent scar is not ideal in the forehead, and the reconstruction is a major one with its own risks, Dr. Zelken has also written a paper about how to minimize the subsequent scar using neurotoxins like Botox. (Zelken J, Yang S-Y, Chang C-J, Yang J-Y, Chuang S-S, Chen H-C, Hsiao Y-C. Donor Site Aesthetic Enhancement With Preoperative Botulinum Toxin in Forehead Flap Nasal Reconstruction. Ann Plast Surg. 2015 Sep 28.)