Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam,

I recently had a Rhinoplasty. I had a slight hump that I wanted removed. During consultation I expressed my wishes to the Dr. I knew all I wanted removed was the hump but I somehow let the doctor convince me that I should have an alar base reduction to keep the nose proportioned since he explained that there would be a slight narrowing at the bridge.

With that said, I am not happy with the size of my nostrils. I did have what you can say where larger than average nostrils but that never really bothered me since I do have a wide smile/laugh and they kind of went together. The doctor told me the difference was going to be so small that It wouldn't be noticeable unless you knew it had been done. Trusting that he was the professional and after telling me that my nostrils would look too big when the bones where brought together to close the bridge, I foolishly went against my better judgment an agreed to the procedure.

The difference is noticeable and it does bother me a great deal. I know that tissue has been taken and I don't know if it is possible to widen the nostrils again.

Most people would think that smaller nostrils are great but as i mentioned before, I never had a problem with my larger ones. I should have stuck to my gut and not let the doctor persuade me the way he did.

Do you have any advise? Is this fixable?

I hope to hear back from you soon I cant seem to get a resopnse on this anywhere please help.

Thank you,

Diana

diana,
i'm sorry about what happened to you. obviously, i really cannot tell unless i saw you in person. in general, it is not very easy to reverse an alar base reduction. i don't have an easy answer for you. have you asked your surgeon?
best,
sml

Hello Dr. Lam,

I did express all my concerns to my doctor. I told him I was very unhappy with the results of the nostril and that I regret the fact that I let him convince me to do it. I did express to him that I had invested hours of research and that from my understanding it was not a revesable procedure. He agreed and said that generaly it is not. He told me that in some cased you can take a graft to enlarge but that it was a very difficult thing to do. Which wasn't much help. I proceeded to ask him if he had ever done the procedure himself and his answer was no. His next statement was "You'll get used to it". I find myself regreting the whole thing which I have to overcome since I feel there is no soultion. In your experience have you ever seen this done or done the process yourself? If done how successful are they and is it even worth taking the chance. I fell that I've lost my smile.

Hope to hear from you soon.

hi,
again sorry to hear of your situation. as far as the graft goes, it all depends on what was done surgically. if you had what is known as a nasal sill reduction, i.e., the cut was inside the nose where the nose touches the face, then the graft can work to fix this situation without any degree of definite certainty. You will need an ear cartilage "composite" graft to space it. in my experience the success rate is not very consistently high. and yes, i have done a case, but it was years ago. the patient had slight improvement but the problem is scar contracture can bring the nose back in a bit over time.

if the outside of the nose was cut then this is much much harder to undo. if you put a graft on the outside of the nose to fix this, it will leave a visible scar from the graft sitting out there. i actually have never even heard of this being done to be honest. you might want to seek an in-person consultation with someone in your area that specializes in rhinoplasty to ask.

there is one more thing to consider, and i don't mean this to be meant as a dismissive comment. i think sometimes when we face a difficult situation to fix that we don't drag ourselves deeper into a personal torment. when the doctor said, "you'll get used to it", i can see how that can be deemed as dismissive. however, i would say that like what Viktor Frankl said who survived the concentration camps, "when all freedoms are taken from you, you have one freedom left, the freedom of attitude." i know that might sound defeatist but it is in a way liberating. i deal with a lot of fixes but the fix must start with the heart. you might not be ready to allow that to happen. give it time.

i always say that when we offer forgiveness for the past procedure we can gain strength of freedom from it. most individuals who have a poor outcome stew in their past, get deeper in it and never escape. you must work to free yourself. most individuals who have undergone an unpleasant experience say that a large part of their forgiveness is not toward the doctor but toward themselves for having chosen the physician in the first place. please offer yourself forgiveness.

here is a video to watch: http://lamfacialplastics.com/gallery2/v ... rgery.html

the books that have radically changed my life in no uncertain terms that i would recommend to help you have clarity of your choices are The 4 Agreements and The Power of Now. Actually, I write a blog every day http://www.lfp-blog.com on personal healing. I would recommend reading it. I use the blog to help me get better so that I can be in a better position to help you.

here is a summary of the books that have helped me:
http://lamfacialplastics.com/gallery2/v ... _.flv.html

best wishes,
sml

Good Morning Dr Iam,

I appreciate every word. I do remember the qoute from Frankl. This situation has taken alot out of me. I have been putting all me energy in getting past this I don't want this to rule the rest of my life and you are correct when you say that it is myself I cant seem to forgive. I guess it will have to be one day at a time for now and hopefully at some point i will be able to make peace with myself. Thank you again for your honesty and time.

Diana

My pleasure and honor to help.
Best,
SML

Hi Diana,

I have the same regrets as you. For my case, it's worse because I wanted alar base reduction. I did not like how my alar flare out too much but all I wanted was to take it in a little. I was thinking about 1-2mm on both sides. I love my hump/bridge and tip and did not want anything done to them. I thought my aquiline profile gave me character.

However, the surgeon I went to took off too much. He did not keep any flare (we said we would not bring it in too much) and narrowed the width by 3mm (from pictures, I think it's more as he lied about other things too). It seriously flattened my nostrils and when I smile, something is amiss. The surgeon is a "yes" man because, as I found out later, he is money hungry. He portrayed himself as a conservative, natural results surgeon and all the testimonials on the internet were moles of his. The results he gave me were anything but natural and conservative. He did not even tell me about the effects of alarplasty on the nose, such as the tip will look bigger, the nostrils will flatten not only horizontally but vertically ( we all think about the horizonal but no one thinks about the vertical!). He kept saying I do not have to worry about the scars and everything will settle in 2 months.

I wish I did more research. I thought I did and he was highly recommended by people of my ethnicity. Fake "word of mouth" is the worse form of advertising.

I don't know how I am going to get through this and the only thing that gets me through now is that no one noticed it at all. I feel like I am going through this emotional turmoil for nothing... there is no improvement, only "deprovement" as I perceive it. I wake up with anxiety attacks and miss my old alars.

But I am learning to forgive myself. It can be hard for someone who used to be stunning and, under the hands of a drastic surgeon and her own stupidity, became relegated to the girl who never get dates anymore.

I have sent pictures of my nose to a lot of prominent surgeons in reconstructive surgery. While they all say that my nose still looks attractive, still looks fine, I can't believe them. I can only see the weak alars, the bulbous tip, and the drastic hand of the surgeon I picked.

I do have an appointment with a nostril reconstruction surgeon who also does rhinoplasty. I am pretty sure he will say that I do not have to do anything to my nose. And I am learning to live with it by picking out the nice things about my nose now, like a more refined look or something. I don't know, just anything.

I just want Diana to know she's not alone in this. Alar base reductions cause a lot more trouble than they are worth. But it's such a common procedure in Asian countries so we do not think twice about it, until a bad result happens.

thanks for sharing tammy. that sounds as if you are going through very much. i am glad that i hear a glimmer of positivity and hope at the end of your comments. that is a beautiful thing. take it one day at a time.
best wishes,
sml

Hi Tammy,

Thank you so much for sharing your story with me. I like you wake up every day with anxiety attacks. I have been put on medication because my heart is racing 24 hrs a day due to the anxiety. No one can possibly understand me. I feel so violated. I have also lost so much weight I don't know what to do. I used to be so full of life and laughter and now I just hope I can make it through the day without braking down. I'm a single mom, my daughter graduates high school this year and I try to be strong for her. I still can't get to the point where I can forgive myself for what I let happen to my face. Like you, I was always told I was beautiful and now I feel like I'm hard to look at, like the pieces don't fit right together. It will be three months April 15 since I made the worst mistake of my life. Like you I am trying to take it one day at a time but I can tell you that every last minute is a struggle for me. How long has it been since your procedure? Does it get better with time? The are still days where I obsess over finding someone who can reverse this but the feedback is never positive. Now I wish I had my whole nose back bump and all I wish I could of known then that it was my nose that gave me character please keep me posted it helps to know that I'm not alone you are the first person I feel can relate to what I'm going through.

i hope you have a chance to read my daily blogs: http://lfp-blog.com/ they have personally helped me overcome a lot as well. hope you continue to do better.
best,
sml

Good Morning Dr. Lam

I have read your blog but unfortunately I don't think I'm ready to hear all those wonderful things. The peace you speak of is something I had. I always considered it my greatest gift. In the most troubled times it was that that got me through. Strangers would smile at me and say I looked so bright it spilled over on their mood. I miss that more than anything the light heartedness I carried within. I still can't get myself to go around my friends only family which Im sure is exhausted with dealing with my situation. I guess I'm still on phase one, accepting that there is no going back that I trusted the wrong doctor and that it is ultimately all my fault. I still can't forgive myself my daughter wanted to take a picture with me yesterday and I just couldn't do it. I hated myself for that. I'm sorry to rant on I guess I'm just venting. Thank you for taking the time to listen to a complete stranger. You will be rewarded for your kindness. I have found more comfort from you words than you know. God bless you always.

Diana

don't worry diana. take it one day at a time. when the time is right, you will know it. try to read the Power of Now. it is a great book to help get you there. also, excuses begone! by wayne dyer.
best,
sml

Dear Dr. Lam,

I dont know if I'm overstepping bounderies here but, I wanted to ask you a question, no need to answer if it is to personal. You mentioned that posts on your blog and the books you have read have helped you get through alot in your life, have you ever gotten a bad cosmetic procedure? If so is there a point where you learn to accept it an become yourself again? I feel like I have gone from anxiety 24 hours a day to depression. My daughter told me today that she would be leaving to San Francisco for college, 3 months ago I would have been devistate because she was moving away so far yet excited for her. But I was almost glad to hear she was leaving so she wouldnt have to deal with me always depressed. I dont know how to shake this off. This is why I ask the question because I want to know if you have been through what I am going through and if you can be as fulfilled and peaceful after the experience then I can somehow hold on to that and know I can get there too. Again no need to answer if the question is to personal I understand.

Diana

no, i haven't but i deal with people who have all the time. further, i deal with my own personal issues that we all deal with. i am working with a woman who has stage 4 pancreatic cancer who was supposed to have been dead last year. however, through meditation and peace, she has now had her tumor shrink from 6.5 cm to 2.5 cm. her tumor markers have gone down from 7,500 to 288. that will put life in perspective. if this woman, catherine, with whom i work every week can be healed, then anyone can. as contrast, my cousin who was angry and negative about his stage 4 pancreatic cancer died within 2 months of his diagnosis and his tumor started out smaller than catherine's. we all can learn to heal if we permit the healing. we all can also hurt ourselves by our attitude if we want. attitude is about the only freedom we have,as Viktor Frankl said. obviously, my disclaimer here is that i am not a licensed psychologist. you must seek a psychologist for proper counseling. i am here just to share stories of healing if we are open to them. change will occur if you allow it and not force it.
namaste,
sml

I understand. And it try so hard ever second of the day but the fact that I have to start everyday by looking at myself in the mirror and know that I did this to myself makes it to much to bare. I'm not like this because of an illness or an accident which would have been Gods will, I'm like this because I had a weak moment of vanity I was already beautiful what was I looking to improve a small bump on my nose which you could only see in profile! I let someone cut my face open just for that? and worst of all he did more than what he was supposed to I need your advise. I know I'm an emotional wreck right now so my judgment is not clear. You said that alar base reduction was extremely hard to reverse. I have an appointment with a doctor who says he would have to see me in person in order to evaluate the possibility of improving my situation. Is this wishful thinking at my end? Or is it possible to better the procedure to a small extent even if it does not end up the same as before. A small improvement will mean a great deal to me. Please advise. Thank you.