LAM FACIAL PLASTICS

Hi Dr. Lam,
I have noticed that your Asian rhinoplasty results tend to be on the conservative side. Are you willing to perform more dramatic changes on a patient such as considerable dorsal augmentation and/or nostril narrowing if the patient desired it, despite it being against your own personal aesthetic preferences?

To be honest, no. Let me explain why. When I see my patients, they look remarkably better than any photo that I take. When I used to do "conservative" silicone augmentation, the silicone would almost always raise the nose too high. My before and after photographs (which I have since removed) looked tremendous but in real life my patients looked terrible. What I have seen in my experience is that when a before and after looks significant but "natural", the individual in real life looks extreme. I use the parameters for nasal augmentation that maintain a natural profile with the radix (top of the nose) starting somewhere at the midpoint of the pupil from a profile view. When it starts higher, it can look okay on a photo but in real life the person looks like he/she is carrying a popsicle stick in their nose.

Narrowing the nasal base is fraught with problems in the majority of cases. First, as mentioned in previous responses, if I reduce the sides of the nose and the central tip is the problem, I will make your tip look significantly worse. You may think you want it but in fact it will look terrible for you. A lot of things you think you want, you really should not have. Also, cutting the sides of the nose can lead to very prolonged scarring that in most cases really never goes away no matter how you cut it. I tend to reduce the sides of the nose rarely but occasionally I will perform what is known as a nasal sill reduction which is reducing the inside part of the nostril to reduce the nostril width but will not take the roundness out of the outer nostril. Sometimes, the alar-base reduction is indicated and favorable and that depends on balance with the central nasal tip width. Everything is about balance: tip to sides, tip to bridge, etc.

I know that I am probably less than 1% of surgeons who will not do anything for a patient simply because the patient wants it. I have a strong aesthetic and in my opinion it is for the better. Most Asian noses only require about 1 to 3 mm elevation to get the right look. When you start hitting 5 mm or God forbid 7 to 10 mm, you have the wrong surgeon all together. I am not all things to all people. I have a defined aesthetic sensibility that in my opinion is for the better in the majority of cases (but not always). It is not that I have no room to listen to what you want. Of course, if it makes sense, then we can go for that. I do talk about different options for tip definition but if you want a bridge that starts at the top of your eye, you might find another surgeon more to your liking. I find that I stare across the room at these individuals who think they look good but to me and to many other Asians they look unequivocally fake. Usually Caucasians can't tell that the individual looks fake because they don't see the race that way. Other Asians will probably stare but not say anything like me. Sorry, it is the truth, especially considering that I have evolved my practice from 5 to 7 mm augs to 1 to 3 mm augs and I could not even look my patient in the eyes with the higher augs. I actually asked to remove most of these augmentations because I literally felt ill looking at my work. That should never be the case for a surgeon. I must be proud of what I deliver and it should look imperceptibly seamless to 99% or greater of people not 50%.
best,
sml