Dr. Sam Lam Plastic Surgery Forum

Hi dr Lam!

I heard Silicone has an unnatural look IF u place a BIG one in ur nose, and it has a higher infection and skin warping risk..

Goretex can give u a more natural look however it's harder to remove THAN silicone, as i've heard from numerous doctors and patietns who've actually had it removed...

What about medpor? Is medpor a better option than silicone when it comes to adding more height and keeping it natural?

And are the risks and infection rate using medpor in a revision lower than if you were to use silicone?

Also.. is SIlicone the only implant thats known to cause contraction in the tip? Or can the same thing happen with medpor and goretex?

If the answer is yes to all 3 implants, is the chance of contraction much higher in revisions? ANd if so, is there any way to catch a ''contraction'' before it really happens by monitoring ur nose everyday and then remove it before any serious damage is done?

can contraction happen years down the line or does it normally happen within the first year or the first few months?

Thanks!

I heard Silicone has an unnatural look IF u place a BIG one in ur nose, and it has a higher infection and skin warping risk..
YES, THAT IS CORRECT. BUT SILICONE IS NOT ALWAYS BAD. BUT IN MY OPINION IT HAS A HIGHER CHANCE OF PROBLEMS SO I STOPPED USING IT.

Goretex can give u a more natural look however it's harder to remove THAN silicone, as i've heard from numerous doctors and patietns who've actually had it removed...
YES, THAT IS TRUE IF YOU USE A GORE-TEX BLOCK. I USE GORE-TEX SHEETS THAT ARE STACKED. I HAVE REMOVED A FEW SHEETS IN 5 MINUTES IN THE OFFICE THROUGH AN INCISION INSIDE THE NOSE. HOWEVER, I DO USE LIGHT IV SEDATION. IT IS NOT THAT HARD, AT LEAST NOT FOR ME. I DON'T KNOW ABOUT OTHER DOCS.

What about medpor? Is medpor a better option than silicone when it comes to adding more height and keeping it natural?
NO, NO, NO, NO, NO, NO, NO, NO. HAVE I MADE MYSELF CLEAR? I JUST GOT BACK FROM A MEETING AND I TALKED TO 3 SURGEONS WHO ALL AGREED WITH ME. BIG TIME PROBLEMS IN THE PAST WITH INFECTIONS DOWN THE ROAD AND ALSO TALK ABOUT LITERALLY IMPOSSIBLE TO REMOVE. THAT IS MED-POR. IF YOU WANT MED-POR, DON'T COME HERE. FIND SOMEONE ELSE TO DO IT FOR YOU.

And are the risks and infection rate using medpor in a revision lower than if you were to use silicone?
SEE ABOVE.

Also.. is SIlicone the only implant thats known to cause contraction in the tip? Or can the same thing happen with medpor and goretex?
CONTRACTION CAN THEORETICALLY HAPPEN WITH ANY PRODUCT USED AGGRESSIVELY TO PUSH THE TIP FORWARD BUT WITH A MUCH HIGHER INCIDENCE WITH SILICONE. I PERSONALLY HAVE ONLY WITNESSED IT WITH SILICONE. I HAVE NEVER HEARD OF GORE-TEX OR MED-POR CAUSING THAT BUT THEORETICALLY ANYTHING IS POSSIBLE.

If the answer is yes to all 3 implants, is the chance of contraction much higher in revisions? ANd if so, is there any way to catch a ''contraction'' before it really happens by monitoring ur nose everyday and then remove it before any serious damage is done?
YES, CONTRACTION IS HIGHER WITH A REVISION SURGERY DUE TO REPEATED SKIN STRETCH AND DECREASED BLOOD SUPPLY. EVEN IF YOU HAVE A SILICONE IN AND YOU WANT IT OUT TO PREVENT CONTRACTION, YOU CAN ACTUALLY GET A CONTRACTION SINCE THE SILICONE THAT WAS HOLDING THE NASAL TIP DOWN IS NOW GONE AND THE SKIN SHRINK WRAPS UPWARD. THE ANSWER TO YOUR SECOND QUESTION IS DIFFICULT SINCE CONTRACTION SORT OF CREEPS UP ON YOU. BUT IF YOU SEE IT HAPPEN, YOU WOULD NEED A MAJOR REVISION AT THAT POINT TO BRING THE TIP DOWN USING EXTENDER SPREADER GRAFTS AND POSSIBLY WHAT I CALL SEAGULL EAR GRAFTS TO REBUILD THE TIP.

can contraction happen years down the line or does it normally happen within the first year or the first few months?
ALL THINGS ARE POSSIBLE. CONTRACTION IS EXTREMELY RARE BUT SINCE YOU ASK THE QUESTION, I HAVE TO ANSWER IT TRUTHFULLY. HOPEFULLY YOU HAVE NOT SCARED THE PANTS OFF SOME PEOPLE THAT HAVE SILICONE IN THEIR NOSES.

Thank you so much doctor for answering these questions truthfully. I think it's important for everyone to know all the risks involved with each material because not many doctors are willing to disclose everything. I don't know why more people don't know about you since you're skilled and obviously passionate about your work.


By the way, about the nose skin getting stretched and lacking blood supply with revisions, you can't take supplements or do anythign to ''increase'' blood supply? and how could ur nose possibly lack blood supply if all u do in the revision is trade the old implant out with a new one that's a little bigger.. technically all the doctor would do is cut open the nose, switch implants, and sew it back together? and we're talking about a revision 10 months after the primary.

anytime you make an incision you can risk loss of blood supply. however, the risk is typically minimal, especially if you are moving to a smaller implant. I think the major risk occurs when you really try to augment the size of a nose that was too small to begin with, i.e., revise the nose by really making it much bigger when the skin envelope is already tight. i really hope that i am not scaring patients unduly. that is not the point. i think revision nose surgery is very safe in the right hands. however, if someone chooses to ask me all the risks, then I have to answer the question posed.
best,
sml

You've probably saved me 10 times already by answering questions i had regarding several procedures

Thank you Dr Lam.

i'm glad.
best wishes,
sml

[quote="dr. lam"]ALSO TALK ABOUT LITERALLY IMPOSSIBLE TO REMOVE. THAT IS MED-POR. [/quote]

Why would one want to remove their implants?

1. infection
2. malposition
3. too high
4. too low
5. shrink wrapped appearance
6. etc.