Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

I am interested in having rhinoplasty. I am of Southeast Asian descent and have what I would call "combo" nose problem. In general, my "lower" nose is high like that of a Caucasian person. As a matter of fact, a the "lower" part needs a reduction because of the hump.
However, my "upper" nose (the part between my eyes) is rather flat. Therefore, I would like to have it raised a bit. Is this possible? What kind of implant is suitable? So it seems that I would need a reduction plus an augmentation. Is this something you have encountered before?

Thank you in advance.

all the time. in fact, this is a rather common problem in many respects. the big lower part can still be quite different than most caucasians in that the tip usually (but not always) lacks shape. so what i do differently is that i reduce the upper part (of the nose tip, i.e., lower part) of the round part of the nose and i actually bring the base of the nose (the very bottom of the nose) forward so that there is better tip definition and less of a bulbous roundness to the nose. believe it or not, i also augment the bridge of the nose not just to raise it but to make it blend better with the bottom of the nose, i.e., the relative sizes are closer to one another thereby making the bottom part of the nose appear smaller. i'm sorry. this is difficult to explain but could be done better at some point with an in-person consultation.
best,
sml

Hi Dr. Lam,

Thank you for your response. I read various learning modules on your website. I learn that the part the I need implant is the radix. Also, you prefer to use Gortex for implant. However, Gortex is no longer on the market. What you tell me what material you would use? If augmentation is needed, will that be for the whole bridge or just the radix area.

With regard to cost, it seems like you often quoted 7.5K all inclusive (or at least to my understanding). Some rhino cases are more difficult than others. I think my case falls on the "more difficult" side. Therefore, will it cost more. Again, thank you for your time.

Sincerely,
A

1. Gore-Tex as a brand has been off the market for cosmetic purposes for the past 2 years. However, two companies manufacture "Gore-Tex" or generically "expanded polytetraflouroethylene" or "ePTFE". These "Gore-Tex" equivalents come in sheets and blocks. I prefer the sheets because they create a softer look that is not over augmented in my opinion like blocks. I have been using the Surgiform manufactured ePTFE for the past 2 years and have been very happy with it. In fact, if I closed my eyes I couldn't tell the difference although I think it is better. The reason is that Gore-Tex sheets in the past were mainly 1 mm but now I purchase 1, 2, 3 mm sheets that I don't even have to fold. I get the right size and I think the results look even smoother than previous Gore-Tex brand models.
2. Technically, the radix is only the very top of the dorsum (bridge). I use the ePTFE (which I still love calling Gore-Tex as we call Kleenex when we mean tissue paper even if we use Scott's or something. Or coca-cola when we mean soda, pop, or soft drinks. So you will still see me refer to it as Gore-Tex even though W.L. Gore really only manufactures Gore-Tex for the cardiac industry and also non-medical outerwear, tooth floss (Glide), etc.) So I augment the entire dorsum not just the radix. The radix is just a reference to the top area of the nose where it ends between the eyes. You may have seen that I end the nose roughly at the height of the mid-pupil on profile rather than the top of the eyelid crease where most surgeons who do Asian noses stop it. It just is too high to look natural in my opinion.
3. I typically only charge more for revision rhinoplasty cases, i.e., a secondary or redo cases. I really can't remember charging more for a virgin case. I hate having any floating prices out there because I have been asked not to quote prices. If you want an accurate quote, please email marcy@lamfacialplastics.com or constanze@lamfacialplastics.com and ask for one that is a "primary rhinoplasty" or "non-revision rhinoplasty". They can give you an accurate price quote.
best,
sml

Hi Dr. Lam,

I appreciate your answers and will ponder on those.

Sincerely,
A

my pleasure.
sml

Hi Dr. Lam,

I have pondered on your responses. However, I still have an question to ask you. I very much appreciate your patience and your responses. Other problem of my nose is the lower part, which is very large. It is not really "flaring out" perse. It is just thick and "meaty" as I would describe it. I dont think it is fatty tissue as African folks. Therefore, there is not much of definition. I am wondering about your approach to reducing "meatness" the lower nose. Is this something cannot be done.

Again, Thank you.

Aeneid

Dr. Lam,

I realize that you did answer my query about the big lower nose. To make my question more clear; that is, do you do any actual tissue removal. My is extremely "meaty". I am not really looking for a causian definition kind, just so you know. Again, thank you.

Aeneid

yes, in most cases i remove some of the fat and cartilage from the upper rounder portion of the lower nose to make it less round at the same time that i augment the bottom portion with nose/septal cartilage to make the overall effect less round and bulbous.
best,
sml

Dear Dr. Lam,

I am still curious about the fatty tissue you mentioned about. Do we have really have fat on the lower nose all around our lower nose including the alar.

Another surgeon that I consulted with said that he never remove any soft tissue unless in cleft patients. His reason being that the removal of soft tissue usually results in unpredictable healing. What are your thoughts on this comment. Again, I appreciate your response very much.

Aeneid

Every surgeon has his or her own thoughts. I would say that might be the case in Caucasians but in most Asians you simply won't get enough definition to the tip without doing it (in most cases). The skin in most Asians is thick enough to tolerate a small degree of fat removal. I think in thin skinned patients, your physician is right. However, in this case, I would beg to differ.
best,
sml