Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam,

I have a typical wide and flat Asian nose, but it is only wide at the base. When I smile, my nose is not a "static" nose, but it tends to spread out and look even wider. I think this puts my face out of facial harmony. I would describe my nose as having a little bit of tip projection (my nostrils are not completely circular, but a little more oval) but for the most part it is bulbous. I have a little bit of a bridge but my tip is very fleshy and the bottom sides of my nose very wide.

Is there any way to correct a fleshy tip and also thin out the bottom sides of the nose, or can it only be thinned out to a certain extent on an Asian nose? I would say I have pretty thick skin on my nose. I am interested in radical plastic surgery, but I do not want to come out looking like Michael Jackson.

Thank you so much,
Amanda

Oftentimes, you don't need "radical" plastic surgery. And oftentimes, creating a very narrow tip is not achievable and also may make you look artificial. I would have to see your nose in consultation to make that decision. My Asian nose results are very natural and that is more important to me than anything else. No one should be able to detect the work.

Yes, nasal skin can be thinned down within reason. I just answered that question in another forum entry. Again, everything must be personalized based on your anatomy and desires and also what I can do for you.
best,
sml

Dear Doctor,
I have the same problem as the original poster (what she refers to as static nose) and would like to ask you something : is there a risk after having alar base reduction that when I smile my nose will look weird because of that, I mean the base will be too narrow and the upper part of the nostrils which is not touched in alar base reduction as far as I know would extend too much?

obviously, anything is possible. i would have to see you in consultation to really answer your question. suffice it to say, that i think alar bases are way over done and unnecessary in asian patients even though most asian patients think they need them. i think the two risks is making the two look actually worse and changing the alar base enough that there is prolonged risk of visible scarring and alteration in the natural shape. i only do an alar base in about every 5 asian noses.
best,
sml

would it possible for you to give me a rough evaluation from that picture? if i were to reduce only the tip then i feel it'd really look weird. what do you think?

here's the link
http://img4.imageshack.us/img4/1017/nse.jpg

thanks

just from that photo, you could be a candidate for an alar base reduction.

http://img697.imageshack.us/img697/9678/nse1.jpg
it tends to look like that when I smile (btw that's photoshop, i don't look that dramatically stupid..). So is there a risk after alar resection it could look like an inverted triangle shape? because if I remember correctly when you do alar resection you cut out a strip from the lower part of the nostrils don't you?

i always say that i am not affecting the smile, in other words i am working to improve a nostril in a static state not necessarily one in dynamic state. i am not too certain what you mean by triangular shape. there are two types of alar base reduction: a sheen flap and a nasal sill flap. you will probably need both. a nasal sill flap reduces the nostril width but makes the curve of the outer nose more accentuated. a sheen flap does not reduce nostril width but takes in the outer flare. the sheen flap unfortunately can lead to prolonged visible scarring and even be somewhat always present even on close inspection.

by triangular shape I meant when one smiles the sides of the nose are more or less vertical and I fear that by doing alar resection the lower part of the nostrils could be too close to the columella as compared to the upper part which wouldn't have been touched during the surgery and the sides would be going down towards the middle of the nose instead of the opposite and so on. but that's because I don't know exactly how it's done, so better drop it.

the thing is it ought not look unnatural when one smiles.
do you happen to have any documentation and/or pictures on sheen and nasal sill flaps so I can understand better what it's about?
by prolonged scarring, do you mean on the order of the several weeks, months or years?

thank you

sorry, i don't have a lot of documentation on this stuff. i should have it but i don't. also, it is hard for me to get asian before and afters that i am allowed to use because of their privacy. i cannot make any promises as to changes during smiling. my focus is on when you don't smile but i doubt there would be an unfavorable change.
best,
sml

I understand. but now I'm worrying about the scarring. anyway, i am sure i can find stuff on the internet. thank you

my pleasure.