Dr. Sam Lam Plastic Surgery Forum

I imagine you've seen a lot of nose tips like this. How easy/hard is it to make this type of tip more angular and defined. Although each person is different, have you had good results generally when working with this basic tip structure in asians? I'm happy with the profile of my nose but unhappy about the view from the front; the tip just looks too round.

yes, i have had success. success is obviously limited in the sense that it will not be a perfect button nose but that would not look good on you anyway. the trick is not to try to shrink the nose smaller because the skin envelope will not shrink down onto a tinier framework. the trick is to expand the framework and push the skin forward like a tent pole pushing through thick fabric to create definition. the definition would be established by septal and/or ear cartilage to create a sharper bottom part of the nose along with thinning of the skin in the upper portion of the nose so that the new skin which would be slightly thinner would sit down onto a stronger framework. think of your nose like a tent. the goal in western rhinoplasty is to sculpt and shrink the tent poles (cartilage) so that the thin skin will redrape. this is the opposite. you have thin tent poles and thick envelope of skin. the method is to strengthen the tent poles and thin the skin envelope followed by 3 months of taping the nose at night so that the skin sits down well on the new framework. hope that is somewhat clear. if you have not watched this video, watch it:
http://www.lamfacialplastics.com/galler ... y.flv.html

do you have a picture of what a realistic result might look like?

typically it is very hard to see refinement on frontal views in asian noses. a natural nose does not look obvious on a photo. that is why i show mainly profile views. when i was doing silicone implants the photo would look impressive but the person would look fake. that is what i have found with asian noses.

that's an interesting point about the difference between pictures and reality; i find that to be very true. but my main concern is not the profile view, which i actually like. my tip looks bulbous from the front in real life, and so the frontal view is what id like to correct. would that be possible at all?

yes, you should look a lot better after my rhinoplasty in person. it just might not photograph as being a lot better in standardized lighting.

okay, i re-read your response and i think i understand what you mean... the frontal view looks more defined in person post surgery, but the refinement doesn't translate that well in pictures, which is why you'd rather not post a picture that doesn't really reflect the real life difference. is that correct?

bingo. well said.

is this type of procedure less invasive than a bridge rhinoplasty? can it be done with a closed method?

i prefer to do it open because it requires a precisely placed graft at the tip. doing it closed does not permit me to suture in perfectly the graft that is critical for the tip. i do not believe that an open procedure is that much more invasive than a closed. it is the same dissection except for the transcolumellar incision, which btw should heal beautifully.
best,
sml

mostly nose tip surgeries are useless or just cause your whole look changed after it and you never ever satisfy after the surgery .babyliss pro nano titanium wet to dry

hmm, that is a pretty radical comment. i think the results can be subtle but still dramatic.