LAM FACIAL PLASTICS

Hello Dr. Lam,
I have a few questions regarding silicone nose revision & cheeks sagging problem at a early age.
1. I previously had done a nose job, had a silicone implant. I want to know what if i decide to take out that implant by you, will my nose become sagging? (for example, let say you put full volume into a balloon, then you decide to take out some air, it's obvious that the balloon will not be as tight as before, so same applies to everything such as skin) So what really will happen if i decide to take out the implant??? I really dont wnat my nose to be sagging.

My most concern is that it kinda looks shinny, it's too high to my standard (i want a lower nose, asian looking), and i hate looking at it from bottom up, it looks unnatural. It looks like my tip is totally faked. But the thing is i have an ear cartridge piece in the tip. I probably wnat to keep the tip. Will it be possible to keep the tip and take out the silicone only?

My most concern that i had a nose job back then was to reduce the flare and to create the W shape, which i dont have it naturally (my was flat like a straight line). I probably will show you some pictures of how i want my nose to look like after revision.

2. i m about 22-23 yrs old, and i dont know why but i am born with very low cheeks, but wide face. Now my skin start to loosen up on my cheeks area and my eye bag area begin to loosen too. Is fat grafting + botox be one option for me. I believe i just need a tiny little bid of fat to fill up the volume.

3. How many days do i need to stay in Dallas for nose revision?
Thanks Dr Lam

1. I previously had done a nose job, had a silicone implant. I want to know what if i decide to take out that implant by you, will my nose become sagging? (for example, let say you put full volume into a balloon, then you decide to take out some air, it's obvious that the balloon will not be as tight as before, so same applies to everything such as skin) So what really will happen if i decide to take out the implant??? I really dont wnat my nose to be sagging.
IN MOST CASES BUT NOT ALL, THERE WILL NOT BE ANY SAGGING. IN FACT, THE NOSE TYPICALLY SHRINKS DOWN TO THE NEW SHAPE. THE NEGATIVES IS THAT IT COULD ACTUALLY SHRINK TO MUCH AND TURN THE NOSE UPWARD. IF YOU HAVE MORE OF A CARTILAGE TIP GRAFT AND NOT MUCH SILICONE THERE, THE CHANCES ARE MUCH LOWER. ALSO, ANY SILICONE ON TOP OF LOWER CARTILAGES IF THE SILICONE IS BIG CAN CAUSE PRESSURE CHANGES TO THE CARTILAGE TIP THAT CAN BE UNFAVORABLE. IN YOUR CASE SINCE THE TIP SOUNDS RELATIVELY FREE OF SILICONE, YOU ARE PROBABLY OKAY.

My most concern is that it kinda looks shinny, it's too high to my standard (i want a lower nose, asian looking), and i hate looking at it from bottom up, it looks unnatural. It looks like my tip is totally faked. But the thing is i have an ear cartridge piece in the tip. I probably wnat to keep the tip. Will it be possible to keep the tip and take out the silicone only?
ACTUALLY, IT IS FAR EASIER TO TAKE THE SILICONE AND LEAVE THE CARTILAGE. IT IS VERY HARD TO TAKE THE CARTILAGE OUT. I CAN TYPICALLY EVEN TAKE THE SILICONE OUT IN THE OFFICE WITHOUT PAIN BUT WHEN I HAVE TO TAKE CARTILAGE OUT, THAT IS A REAL SURGERY.
My most concern that i had a nose job back then was to reduce the flare and to create the W shape, which i dont have it naturally (my was flat like a straight line). I probably will show you some pictures of how i want my nose to look like after revision.

2. i m about 22-23 yrs old, and i dont know why but i am born with very low cheeks, but wide face. Now my skin start to loosen up on my cheeks area and my eye bag area begin to loosen too. Is fat grafting + botox be one option for me. I believe i just need a tiny little bid of fat to fill up the volume.
AT 22 AND BEING ASIAN YOU SHOULD NOT HAVE ANY CHEEK SAG. BOTOX IS SAFE. I ASSUME YOU MEAN FOR JAW REDUCTION? BECAUSE FOR WRINKLES, I ASSUME YOU SHOULD NOT HAVE ANY. FAT GRAFTING IN YOUR AGE GROUP IS PROBABLY A BIT UNSAFE AND I WOULD NOT RECOMMEND IT.

3. How many days do i need to stay in Dallas for nose revision?
IF IT IS AN IMPLANT REMOVAL ONLY, YOU CAN TYPICALLY LEAVE THAT DAY OR THE NEXT. IF IT IS A FORMAL REVISION PROCEDURE, I NEED TO TAKE THE SUTURES OUT AT A WEEK.
best,
sml

Hi Dr Lam
Have you seen any nose implant case using silicone that is not so bad looking?
Please describe

Will aging cause the silicone shine more and makes it look worse?

Do you think removing the silicone of the nose and leave the cartilige is a good idea?
Or
Do you think removing the silicone and put in gortex and still leave the cartitige in?

Regarding #2
I really believe my face / cheek area is sagging. Is there a way i can show you pictures
I watched one of your you tube videos regarding cheeks implant on asian, so what do you really recommend asian that seek just a tiny little bid of lift or height on cheek? I agreed that seeing in person will help a lot. Please give advices.

Is there a way i can show you some pictures but not show it to anybody on the forum (perfer not even your receptions)? Please and thank you

Thanks Dr Lam
have a good day.

Will aging cause the silicone shine more and makes it look worse?
Sometimes yes but usually the shine is more evident early and is maintained. Any nose can undergo ongoing slight degrees of shrinking and shrink wrapping over time. That is not to frighten you but to be honest. I think however most of the shrink wrapping after a silicone is more apparent in the first 1 to 2 years.

Do you think removing the silicone of the nose and leave the cartilige is a good idea?
Or
Do you think removing the silicone and put in gortex and still leave the cartitige in?
If it is too high, then removing the silicone can get the nose at about the right height because the previous encapsulation of the implant (i.e., scar tissue) can keep the height halfway between fully augmented with the implant and without (in most cases). cartilage removal is very very difficult. it needs to be done as an open surgical procedure. even then, i wind up usually shaving the cartilage down because it becomes integrated with the tissues. i think if the implant is too high, most oftentimes removal of the silicone implant is a good first start with the slight risks of further shrink wrapping and cartilage distortion from the implant putting pressure on the cartilage what i consider a minor but possible risk. sometimes that can be managed with some liquid silicone. sometimes that needs to be managed with a formal revision rhinoplasty.

Regarding #2
I really believe my face / cheek area is sagging. Is there a way i can show you pictures
I watched one of your you tube videos regarding cheeks implant on asian, so what do you really recommend asian that seek just a tiny little bid of lift or height on cheek? I agreed that seeing in person will help a lot. Please give advices.
i do not believe in midface lifts, and they don't work well on asians anyway. cheek implants can help but i would have to see your situation. i can look at your photos but really this forum is just meant to give you general concepts.
Is there a way i can show you some pictures but not show it to anybody on the forum (perfer not even your receptions)? Please and thank you
as above but you can send me a private message here.

HI Dr Lam,
to be honest, have you seen at least one or a few cases of silicone implants that are not so bad on asian?

I remember you once said you cant even take the look of your own work before regarding silicone implant on nose. Would you be further discuss this issue?

would you say after taking out the implant, the nose is still half the height of the orginal nose? And after there is no more L-shaped support silicone in the nose, will the tip with the cartitage tip down towards the mouth?

Do you think if i lower the nose, my face wont seem sagging anymore? But then my cheeks are naturally low. Would adding a tiny litte bid of fat help to balance the hollow area?

Regarding eyes, when aging comes, the eye area is the first signs to show aging. So what could be done to prevent that or slow down the aging a bit interms of plastic surgery?

Thanks

to be honest, have you seen at least one or a few cases of silicone implants that are not so bad on asian?
YES, I HAVE. IT IS NOT ALWAYS BAD. THERE IS JUST A HIGHER CHANCE OF IT NOT LOOKING GOOD SO I HAVE STOPPED DOING IT.

I remember you once said you cant even take the look of your own work before regarding silicone implant on nose. Would you be further discuss this issue?
WELL, I AM JUST HONEST THAT I DON'T LIKE THE PREVALENT SHRINK WRAPPING THAT CAN OCCUR WITH EVEN THE THINNEST SILICONE IMPLANTS. PERHAPS I AM BEING TOO HARSH ON MYSELF BUT I AM WORKING ON GETTING AS NATURAL A RESULT AS POSSIBLE. SILICONE JUST LEADS TO A MUCH HIGHER CHANCE THAT I WILL NOT ACCOMPLISH THAT GOAL.

would you say after taking out the implant, the nose is still half the height of the orginal nose? YES, IN MOST CASES THAT IS RIGHT. And after there is no more L-shaped support silicone in the nose, will the tip with the cartitage tip down towards the mouth? PROBABLY NOT. I HAVE NOT SEEN THAT. IN FACT, IF THE SILICONE IMPLANT WAS MASSIVE IN THE TIP AND WAS SITTING THERE FOR A LONG TIME LIKE A FEW YEARS, THE NOSE CAN MORE LIKELY SHRINK UPWARDS AND ROTATE TOO HIGH. THAT IS EXTREMELY RARE BUT POSSIBLE. ALSO THE SILICONE CAN CAUSE PRESSURE ISSUES ON THE NASAL TIP CARTILAGE AND CAUSE DISTORTION IF YOU ARE USING A L-SHAPED STRUT AND IT IS VERY LARGE.

Do you think if i lower the nose, my face wont seem sagging anymore? THE NOSE AND THE FACE HAVE NOT MUCH TO DO WITH EACH OTHER FROM A SAGGING PERSPECTIVE. But then my cheeks are naturally low. Would adding a tiny litte bid of fat help to balance the hollow area? ADDING FAT TO A CHEEK CAN BE VERY REJUVENATIVE IN THE RIGHT PERSON. I WOULD NEED TO DO A CONSULTATION WITH YOU TO SEE IF YOU ARE A CANDIDATE.

Regarding eyes, when aging comes, the eye area is the first signs to show aging. So what could be done to prevent that or slow down the aging a bit interms of plastic surgery?
TO PREVENT WOULD ENTAIL BOTOX, GOOD SKIN CARE, GOOD DIET, EXERCISE, AVOIDING SUN (BIG ONE), AVOIDING SMOKING, AND STAYING HYDRATED AND SLEEPING RIGHT WHILE MINIMIZING STRESS. BOTOX IS CRITICAL. TO MANAGE THE EYES SURGICALLY TO RESTORE YOUTH, YOU PROBABLY KNOW THAT I AM OPPOSED TO TRADITIONAL CUTTING EYELID SURGERY EXCEPT IN TWO CASES:
1. CREATING A CREASE FOR AN ASIAN FOR THE SAKE OF A CREASE OR IN COMBINATION FOR REJUVENATION.
2. FOR REJUVENATION, ALMOST ALWAYS WITH FAT. IN MOST CASES WHEN I DO FAT TRANSFER I DON'T EVEN NEED THE CUTTING AT ALL IN ABOUT 80% OF CASES. AND WHEN I DO, IT IS VERY VERY MINOR.

Hi Dr. Lam

I spoke to you last year, and shortly after had surgery with a very good doctor over seas, however, I changed my mind about plastic surgery, I can't stand adding things to my face, and now that I have a nose implant that's 3.5 mm and a chin implant that's 4 mm, I feel extremely fake...

I found out that the answers to my problems were not plastic surgery, and don't know who else to turn to, to ask these questions so once again I'm coming back to you since you always seem to know much more,

What you told asianbeauty was that removing an implant will still leave you with half of the height for the rest of your life, in which case I would keep 1.75 mm height if i remove 3.5 nose implant? I've had this L-Shaped implant for 14 months.

I just received a chin implant 2 months ago and think it doesn't suit my face very well, however, it's medpor and I heard that's hard to remove. In the case of chin implants, do you also keep half of the chin implant height or protrusion, so in my case, that would be 2mm of chin projection if I remove the 4 mm implant?

I have read that once you have a chin implant, if you for some reason change ur mind, u should always switch it out for a smaller one or a different shape instead of removing it, since I've read many people reporting irregularities on the chin skin after it healed and that's because the chin pocket and scarring made it uneven when it shrunk back.

I also read somewhere on your board that having a winged implant instead of a button implant is more permanent? Why so? I currently have a winged implant that gave me a squarer chin, 4mm projection and a little more length to my face, It did however change my face so drastically that I wish to have it fixed.

Also, I only had a nose implant for a little over a year, and a chin implant for 2 months, is this enough time for scar to form so I can keep half of the height for both parts?

Thanks so much,
Miss08

1. as far as the nose, i think you will retain half of your augmentation. can't promise you exactly but that is the case with silicone in most cases. remember there is always a risk with pressure changes on the tip after 14 months with the silicone. we can fix that either with silicone micro droplets in minor cases or a full revision rhino if need be. hopefully, you don't have that issue.
2. medpor is very very very hard to remove. 2 months out it might be easier than 1 year out. i have never had to remove it. i have removed gore-tex which is hard but doable and silicone. medpor is truly very difficult. i would say if you were going to remove it, remove it sooner than later. what you say about irregularities, etc. can be true. this is why i simply don't use medpor. i don't have an answer that i can reliably tell you regarding the safety or removing the medpor. just being honest.
best,
sml

Thanks Dr. Lam

If I were to remove the chin implant, would i still retain some projection from the encapsulation of the medpor? and if I were to wait till summer ot remove it (Just for travel/break convenience) would it still be safe to remove it?
And what chin implant material do you personally recommend that will last a long time with the least complications?

Also, what do you mean by the nose tip having pressure after 14 months of having an L silicone in it? I had septum cartilage layers on top of the L implant part on the tip so between the skin and the tip there;s septum cartilage, and I did not get that much tip projection from the surgery, only a bit. So if I were to move the nose implant of 3.5 mm, what are the possible complications, having my nose tip turn up..? If so, what are the chances? There should be no other complications with removing implant right?

I am learning to appreciate my own beauty, and it is especially hard being asian in america where your facial features are not accepted as beauty, but surgery was not the answer as it only made me weaker by trying to imitate them. I travelled to Asia and went to several countries to learn about the different cultures and have learned so much about the human values, that, when I was in bed healing from these surgeries, it just struck me, why am I doing this to myself? If I was the only person living, I would be content with who I am and what I look like.

Sorry for the long speech, and although I'm a poor student and considering removing these implants when it cost me a fortune to put them in, I think it was worth the experience and lesson that's worth more than money can buy.

I do want to thank doctors like you who at least appreciate the natural beauty, and a more natural approach to things. My doctor is great, I just wish he would have told me that I would have such different face, and I don't mean surgically different only, but almost 100% ethnically different.

If I were to remove the chin implant, would i still retain some projection from the encapsulation of the medpor? HARD TO SAY AS I HAVE NOT REMOVED MEDPOR BEFORE. and if I were to wait till summer ot remove it (Just for travel/break convenience) would it still be safe to remove it? AGAIN, JUST TRYING TO BE HONEST HERE. I DON'T KNOW.
And what chin implant material do you personally recommend that will last a long time with the least complications? I HAVE MOVED TO SILICONE CHIN IMPLANTS BECAUSE THEY ARE EASILY REMOVABLE BUT STAY IN PLACE. INTERESTINGLY, I DON'T LIKE SILICONE IMPLANTS FOR NOSES BUT LOVE THEM FOR CHEEKS AND CHINS.

Also, what do you mean by the nose tip having pressure after 14 months of having an L silicone in it? I had septum cartilage layers on top of the L implant part on the tip so between the skin and the tip there;s septum cartilage, and I did not get that much tip projection from the surgery, only a bit. So if I were to move the nose implant of 3.5 mm, what are the possible complications, having my nose tip turn up..? If so, what are the chances? There should be no other complications with removing implant right? IF YOU HAVE CARTILAGE IN THE TIP, THAT WON'T COME OUT WITH THE IMPLANT BECAUSE CARTILAGE IS PRETTY STUCK IN THERE UNLESS I FORMALLY OPEN THE NOSE. IN GENERAL, THAT IS NOT WHAT WE ARE TRYING FOR. IF YOU HAVE CARTILAGE THERE THEN I WOULD SAY THE CHANCE OF TIP ROTATION, ETC. WHICH IS ALREADY LOW CHANCE SHOULD BE MUCH LOWER. HOWEVER, YOU COULD VISIBLY THEN SEE THE CARTILAGE IMPLANT'S EDGES. THAT BEING SAID, IF IT IS MINOR, LIQUID SILICONE CAN HELP TO SOFTEN ANY VISIBLE EDGES DOWN THE ROAD BUT IT SHOULD NOT BE USED IF WE ARE EVER PLANNING A REVISION IN THE FUTURE BECAUSE IT WILL MAKE THE REVISION MUCH HARDER AND LESS SAFE.