LAM FACIAL PLASTICS

Dr Lam,
I'm very impressed with how diligent, honest/realistic, and informative you are with answering these questions! I'm kicking myself because I should've seen you to get my nose done. I believe in subtle, smart plastic surgery like you do. Most likely, I will come to you for a revision.

I ended up getting a silicone implant, with ear cartilage in the columella in Sept 08. The bridge looks a bit too high (and fake). Also, the implant is slightly, but noticeably crooked.

1. I heard that one of the major disadvantages of using GoreTex (to build up the nose bridge) is that it is difficult to remove if the results are unsatisfactory. What are the options if a patient wants to remove or adjust the GoreTex?

2. While one of the advantages of silicone is that it is easy to remove, I believe it is limiting in that it tends to look fake and it can lay crooked if the underlying bone does not give the silicone a flat and perfectly straight foundation to sit on. Is this a correct assumption?

3. Can a silicone implant push down on the lower lateral cartilages and cause the cartilage to poke into the nostril space? If so, is that dangerous? can the cartilage extrude?

4. For now, I think I'd like to get GoreTex for revision surgery with you. What would you do with the ear cartilage in the columella? How long should I wait until I can get revision rhinoplasty? Will it be a difficult surgery? How long would recovery be? (as I will have to fly to TX)

Sorry for the multiple questions... but I trust your opinions.
Thank you very much! And I look forward for your reply!!!

1. I heard that one of the major disadvantages of using GoreTex (to build up the nose bridge) is that it is difficult to remove if the results are unsatisfactory. What are the options if a patient wants to remove or adjust the GoreTex?
yes, it is hard to remove but i can do it. gentle technique will help get it out.

2. While one of the advantages of silicone is that it is easy to remove, I believe it is limiting in that it tends to look fake and it can lay crooked if the underlying bone does not give the silicone a flat and perfectly straight foundation to sit on. Is this a correct assumption?
yes, you are right.

3. Can a silicone implant push down on the lower lateral cartilages and cause the cartilage to poke into the nostril space? If so, is that dangerous? can the cartilage extrude?
yes to all. however, i don't want you to worry. these are uncommon events.

4. For now, I think I'd like to get GoreTex for revision surgery with you. What would you do with the ear cartilage in the columella? How long should I wait until I can get revision rhinoplasty? Will it be a difficult surgery? How long would recovery be? (as I will have to fly to TX)
oftentimes, just removal of the silicone can lead to a result that is just high enough. i may save you the big expense for revision work. however, a revision might be necessary. in general, if the main problem is the bridge is too high, you might consider just removing it. if we do that, you could possibly fly back out the same day. if a formal revision is needed, i would need to take sutures out at a week. i don't look at it as difficult surgery in that i am comfortable with it but i never know what i will find when i go in there so it can be theoretically difficult. recovery is typically not too bad with either case. a revision nose could lead to a few weeks of swelling but since i am making your nose smaller i hope the swelling won't be that noticeable into the second week.