Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

I kind of hate asking, as I don't want you to think I wasn't listening to you yesterday when we discussed my nose.
I hope you won't mind telling me again...Did you say 'open roof deformity' ? and if so, is this something I presently have OR something that may occur during rhinoplasty due to my situation?

I'm not asking for any promise, but do you suspect significant refinement* of my tip is even possible? And narrowing overall? I have a while to mull the whole thing over, as I would likely schedule for June. I'll also see you once before then.

I am seriously considering going forward and doing this, but then I think perhaps I should forget it and be happy with what I have. I know I've always considered my nose inelegant, save the profile, which I actually think is nearly perfect. The flare is what I especially dislike.

*I added the asterisk because that's where I bet you'll pause to point out that's quite vague. I'll be precise: Heidi Klum's nose. J/K!!!!!!!!

Thanks for everything and the time you use for us here.

MM

Hi,
No worries. That is why I have a forum. As you know, I have done everything in my human powers to talk you out of a rhinoplasty. I simply think you are a beautiful lady who does not need that. However, I can get more refinement from your tip than bridge. Your bridge looks more like what I get after I take down a hump and before I close down the two sides of the nose bones during a hump-reduction rhinoplasty. It looks like an open roof deformity where you have a flat bridge with prominent nasal bones showing on either side. This is much much much harder to get a great result with. Rasping the bony edges followed by osteotomies (bone fracturing), which are pretty easy for me to do will not lead to a perfect bridge. As I said, i almost WISHED you had a hump so that I could create an open roof deformity then take it down. The problem with your situation is that you already have one meaning the bridge is wide but harder to close the open portion because it is just filled with scar tissue and cartilage that if I take down to close it, I will lower the profile which I do NOT want to do as I said for you. Also, with your tip to bridge ratio, your tip is bigger than your bridge so if I reduce your bridge any much, your tip may look too big. Your tip is a bit easier to narrow. In short, I really do not think you need your nose done. I love doing noses but only in someone who would really benefit from one. It is sometimes impossible with a nose to marry your ideal with your result. For example, having Heidi Klum's nose in your head may make for a very difficult postoperative course in terms of what you want. I think your gains will be modest, and I want you to know that.
Best,
SML

Ahh. I understand. Using your explanation, I imagined sewing/seams, trying to pull edges together without ample, or sound, fabric. Not a nice or stable seam and maybe a pucker or depression. I can feel that flat spot on my bridge and the sharp, bony edges. If I'm understanding correctly, I need to remember that flat spot is not viable 'fabric'. Taking that spot out of the equation, those bony edges aren't 'enough' to keep the bridge height where we like it.

I appreciate your keeping in mind what's salient to me, and for seeing this, MY particular issue, now rather than (too) later.

THANKS!!

Let me just clarify to make sure we are on the same page. I would rasp the bone edges and then move them inward. The only problem is that I can't open the roof further (i.e., reduce the bridge height), o/w your bridge will be too low. With that in mind, when I move a pre-existing open roof in to narrow it without lowering a hump, the existing tissues are in the way for me to more effectively close the roof in as much as I would like. That is a limitation. Hope that is clearer.
Best,
SML

Thanks Dr. Lam. I do think you are a frustrated professor. I thought I had it, but you weren't convinced! You go the extra mile for clarity, always.

THANKS!

E=MC2. say that 5 times please!
good night!