LAM FACIAL PLASTICS

Hi Dr Lam

I had an awful overly-aggressive "hump reduction" rhino 3 years ago. My thick skin never shrunk down around the nose - it looked unrefined, flat and broad on my face. Of course, my breathing also suffered. My original nose was longer, refined and more pointy. Frontally, it was narrow and elegant, all I needed was a finesse hump reduction to improve the profile.

In order to restore height, it was suggested that I try restylane to build up the bridge again. I was told to test it out for a while before deciding whether to have revision rhino done. It worked to an extent, although never provided good support to the nasal skin (still looked flat and broad, but an improvement all the same).

For some reason, after having it refilled 4 times in 2 years, I've recently developed an infection 2 months after the last refill. My nose is swollen, hot, tender, and slightly red in the parts that contain the restylane. I've been on strong antiobiotics with no luck. I want to get it dissolved asap (if that's the best thing to do?). The infection has been active around 3 weeks.

My main question is, once the filler has been dissolved, is an infection likely to resolve and does the swelling ever go away? I've now read terrible things that other prominent rhino plastic surgeons have said regarding fillers in nose causing permanent damage to the skin envelope. I'm terrified that I've possible ruined my nose due to restylane use, even though this infection is a one-off, short term thing. I never had any issue before. My doctor has been doing Asian noses with restylane for years.

In your experience, are problems like this common? If the infection subsides after dissolving the filler and taking antiobiotics, can someone like me embark on a revision rhinoplasty in the future to correct my breathing and structural appearance?

Thanks in advance for any thoughts on this topic.

obviously, i can't answer your situation specifically since i cannot dispense medical advice here. however, speaking in general, here are my thoughts:
1. if there is an infection to the nose where the restylane is then it is most likely due to the product, which should be dissolved right away.
2. in general, if someone is desirous of a revision rhinoplasty, i prefer not to put any injectable product, restylane or otherwise, because my feeling is that the skin envelope can be compromised, which it already is from an original rhino.
3. if the person truly just wants to try it on so to speak and really is contemplating most likely not having a rhino in the future, i go with restylane. even if they are considering rhino but not seriously, i will consider restylane. if they are seriously considering rhino, i won't do anything.
4. i do not use other injectables at all if they are considering a revision rhino. however, if they really are done with revision rhino needs and really have just a shrunk down appearance or small residual hump that i can manage with a permanent filler then i go with silicone micro droplets. sometimes noses can actually look better after silicone than a formal revision rhinoplasty because the problem is in the shrunk down skin and not in the architecture. your case does not sound that way.
best,
sml

Thanks Dr Lam. Your points were most interesting.
Hopefully, people can become more educated and informed via blogs like this, so they don't make the same mistake I did.
All the best!

thanks. hope all goes well for you.
best,
sml