Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam, I've seen your consultation video and was impressed with your clear explanation on rhinoplasty as well as your passion for your work.
I'm a Caucasian who has had a tip rhinoplasty 3 years ago but I now can see a slight lump on both side of the nose where the surgeon cut the cartilage between the nasal bone and the upper cartilage. I've been to see another surgeon but he told me it would only get worse if he tried to fix it and best if I left it alone... is he right? or can you help?

John

If it is a slight depression then silicone is the easiest and best way to correct it. If it is a slight lump, then I would have to see it. Sometimes even then, I can avoid surgery by filling around the defect to improve it. I would have to look and feel the area. Hopefully, I can entirely avoid a revision nose surgery. If you fly in for the procedure, you can typically fly right back out later that day. I would need some time to photograph, consent, numb, and perform the procedure. That would take about an hour. I could not guarantee even after you fly in that you are a candidate. Also, I might need another treatment for you to make it perfect. If we use silicone, that would be a month between treatments if you needed a second round. Hopefully, I can avoid another surgery for you.
best,
sml

Yes, of course I can see how filling the lumpy area would balance the imperfection and iron out the lump without surgery. This would indeed be the ideal solution for those who wish to avoid a revision rhinoplasty and I do appreciate the fact that you need to see and feel my nose to have an accurate assessment of my situation.
But since I'm willing to have a revision and keen to correct rather than hide the problem... would that be possible? The lamps on the laterals of my nose seem to be cartilage scaring that's developed a crust. Would open surgery and then using a laser on the scar tissue correct it?

Regards

Again, seeing you would help. This is why in general I hate cartilage grafts anywhere along the bridge. First, they oftentimes will show up as a lump after several months but most likely after several years as the skin begins to shrink wrap down over it. Also, the lump is really hard to physically remove. The cartilage grafts become stuck to everything around it.

If you look at my before and after gallery on corrective rhinoplasty, the second girl you see had a "lump" from a motor vehicle accident. I did an open rhinoplasty and found the knuckled cartilage, shaved it down, waited 3 months then cleaned up the area further with 2 to 3 rounds of micro silicone. Sometimes, even the best surgical efforts will not be perfect and require the finesse of some microsilicone drops. I think any physical graft on the bridge of the nose is very unpredictable over the long run.

By seeing you, I would have to see what would be the best method. I have also seen btw (even in my own hands) a bony callous develop high on the bridge where the actual nasal bone is following rhinoplasty. This phenomenon is most likely due to an abnormal periosteal (bone lining) reaction. This condition can be typically managed by subcising the bump several times with a needle and injecting 5-FU to minimize its recurrence. This condition feels like a hard little bump but it only occurs in the upper 1/3 of the nose bridge and does not require surgery to correct.
best,
sml

Thank you for your time and patience answering my questions. I wish there were more people like you here in England.
So, for now I'm going to leave my nose alone and see whether with time the scar tissue will improve.

Best Regards

J.

thank you for the kind words. believe it or not, i appreciate all kind sentiments expressed. i wish you the best and hope that i don't need to help you.
cheers,
sml