Dr. Sam Lam Plastic Surgery Forum

Dr Lam,

If my doctor remove the grafts that extending my tip will i be able to have something close to my original tip shape back? Maybe it will be narrower, since he mentioned something about sewing the two sides together. What he did was extend my columella, the tip area inbetween the nostrils. Its the kind of tip found in caucasian noses. But i feel it doesnt look right for my face, and its too obvious i had something done. If he just removes that part will recovery time be pretty fast?

Hi,
I know that you trust my opinion, and I appreciate that. I am very cautious to offer advice about a nose in which I was not there when it was done. I did read the very detailed explanation of what you had done, and if I use that information that you supplied I can at least say that if the "extended spreader graft" is shortened, your nose should angle more upward. Keeping the "interdomal suture" in place will retain the narrow configuration of the tip. Recovery is variable and can be shorter than your first surgery since the procedure may be shorter. However, it could be longer since working in a previously operated nose is harder and can lead to more swelling. There really is too much variability to surmise. I always advise toward a more conservative estimation of your recovery so that you would not be disappointed. As I always do, I recommend that you seek dialogue with your original surgeon who has your best interest at heart, and I am sure would like to help you in your situation. I would expect the same level of fairness if I were the original surgeon.
best,
sml

Dear Dr Lam,

I have decided to go back to Taipei in early December to revise my tip back to the original shape. I have contacted my doctor and he says that should be ok. I want to thank you for all your help, your truely a great doctor. I regret not choosing to do my surgery in the US, as going to Taipei is so stressful. I'm just in debate if i should change my implant from 3.5mm to 1.5mm? Currently i feel my bridge is too high and thick for my face, but it could be due to swelling. One side is higher and thicker than the other. In your opinion does 1.5mm make very little difference, because thats what i've read on several forums. Thanks.

Hi,
Interestingly, I thought you lived in Taipei and I didn't want you to fly all the way over here to the U.S. for a revision procedure. Sorry for the misunderstanding. Nevertheless, I think your surgeon would like to take care of you given the chance. I know I would if I had a patient that needed a revision rhinoplasty from me.

Since you have a silicone implant and are not happy with the height, I always caution about putting even a slightly smaller implant in since there is scarring and encapsulation of the implant that will already create bridge height. I have found in my patients who were not satisfied with my silicone implant in the past (or the silicone done elsewhere) that simply removing the implant provided enough height in many cases that the nose looked good. Now, since you are returning to your surgeon, you should really trust his experience in this matter rather than my subjective opinion for a patient whom I have not seen or treated.

My heart is with you for your revision procedure. I wish you all the best in the skilled hands of your surgeon.
best,
sml

Dear Dr Lam,

Sorry but i dont understand about the implant scarring part, is that permanent? I thought my bridge will return to its original height after deswelling? I have thought about just removing everything, but i paid so much and went through so much effort to get this done. From my pictures do you think my nose looks abnormally big? All the pictures ive seen of noses after a month and a half of surgery seems nicer and smaller than mine. I just feel very dissapointed. I now just want something similar to my old nose, except aittle higher bridge and a sharper tip. I also want my original tip shape back.

Obviously, I cannot predict how much scarring occurred. However, I know that in most cases there is just a slight elevation to the bridge that remains and your nose will probably be ever so slightly higher than before you had surgery in my estimation (That is probably a good thing in my opinion). If you really want to have a conservative nose height AFTER having had a silicone implant you may want to express that to your surgeon. He may elect not to put anything back inside in that case. But that is up to a discussion between you and him.
best,
sml

Dr Lam,

Sorry just one more question, does the scarring occur in the tip as well? If my doctor removes the cartilage will my tip go back to the original length and shape? Thankyou.

it does occur in the tip too to varying degrees. however, the ring of encapsulation that occurs around solid silicone implants adds additional "scarring" that in turn maintains some bridge height even after removal of an implant...at least that is what i have observed in my practice.

Dear Dr Lam,

How about the bridge wideness due to scarring and encapsulation? Because i feel my bridge is alot wider than before, especially on one side. I'm now scared that this will remain permanent even with smaller implant or complete implant removal.

most likely the bridge wideness is due to the implant and will be improved with implant removal but obviously there are no guarantees.
sml