LAM FACIAL PLASTICS

hi dr. lam,

i'm an asian female who had I-shaped silicone implant with ear cartilage to the tip 6 months ago. i had the silicone implant in january, but left the ear cartilage in. the ear cartilage has always been kind of pointy on the left side of my nostril, even right after i had the surgery done. taking the silicone implant out didnt make a diffference.

i'm not sure what the ear cartilage graft is shaped like. is it a stick, or more of like a plate, or a "columnella strut"? as i'd said, when i touch my nasal tip, i feel a "point" on the left side. it is pretty pointy and i sometimes worry that it will eventually extrude. does this happen with ear cartilage grafts?

i've asked my surgeon about this, and he said that the graft will soften over time. however, it's been 6 months and i've not noticed any changes. in fact, it seems to be getting more pointy as my tip is deswelling.

thanks for reading.

i also have another question - do you do rib grafting? i'm thinking about a rhinoplasty revision in the future. removal of the silicone implant has left my bridge kind of "blobby" looking. can the scar tissue be surgically removed?

if i wish to augment my nose again in the future, would rib grafting be a good choice? i'd like to have a defined looking nasal bridge - is this possible with the scar tissue that had accumulated from the silicone implant? what about using goretex?

i'm an asian female who had I-shaped silicone implant with ear cartilage to the tip 6 months ago. i had the silicone implant in january, but left the ear cartilage in. the ear cartilage has always been kind of pointy on the left side of my nostril, even right after i had the surgery done. taking the silicone implant out didnt make a diffference.

i'm not sure what the ear cartilage graft is shaped like. is it a stick, or more of like a plate, or a "columnella strut"? as i'd said, when i touch my nasal tip, i feel a "point" on the left side. it is pretty pointy and i sometimes worry that it will eventually extrude. does this happen with ear cartilage grafts?
THE CARTILAGE GRAFT CAN BE SHAPED AND POSITIONED IN ANY NUMBER OF WAYS. THAT IS SOMETHING YOU NEED TO ASK YOUR SURGEON. FORTUNATELY, CARTILAGE AS FAR AS I EVER SEEN WON'T EVER EXTRUDE OUT OF THE NOSE LIKE A SILICONE IMPLANT COULD IN RARE CASES. IT CAN BECOME MORE VISIBLE OVER TIME BUT DOUBTFULLY EVER EXTRUDE.

i've asked my surgeon about this, and he said that the graft will soften over time. however, it's been 6 months and i've not noticed any changes. in fact, it seems to be getting more pointy as my tip is deswelling.
THE GRAFT CAN BECOME MORE VISIBLE OVER TIME AS THE AREA AROUND IT DESWELLS AS YOU ARE OBSERVING OR LESS VISIBLE IF THE GRAFT ABSORBS, WHICH IS NOT HIGHLY LIKELY BUT POSSIBLE.
thanks for reading.

i also have another question - do you do rib grafting? i'm thinking about a rhinoplasty revision in the future. removal of the silicone implant has left my bridge kind of "blobby" looking. can the scar tissue be surgically removed?
SCAR TISSUE CANNOT BE REMOVED BUT CAN BE PARTLY DISSOLVED. I USE 5-FU TO BRING DOWN ANY SURGICAL SCAR TISSUE NOT ALWAYS WITH ABSOLUTE SUCCESS. I USE SILICONE MICRO TO INJECT AROUND SCAR AS NEEDED AS WELL TO BRING DEPRESSED AREAS UP. I DO NOT LIKE RIB GRAFTING FOR A HOST OF REASONS. YOU CAN SEE A PREVIOUS FORUM POST JUST THIS PAST WEEK ON A DETAILED ANSWER. SUFFICE IT TO SAY, I THINK RIB GRAFTS SHOW UP OVER TIME (LIKE YOUR EAR GRAFT IS DOING), CAN WARP, ABSORB, AND ALSO SIMPLY ARE TOO HIGH AND STIFF FOR ASIAN NOSES.

if i wish to augment my nose again in the future, would rib grafting be a good choice? SEE ABOVE. i'd like to have a defined looking nasal bridge - is this possible with the scar tissue that had accumulated from the silicone implant? I WOULD NEED TO SEE YOUR SITUATION BUT GENERALLY SHOULD BE POSSIBLE. what about using goretex? I WOULD NEED TO SEE YOUR CASE. BUT GORE-TEX IS A GOOD MATERIAL.

Hi, Dr. Lam. So I've been considering getting the 5-FU injections because my nose looks really fat and wide. I am not sure how much is it is due to scar tissue or swelling. I have some questions about getting these injections to remove scar tissue:

-How long should I wait after rhinoplasty to get them? I had my silicone implant inserted in October and removed in January. Could there still be a lot of swelling left and I should wait to see if it'll get better at the 6 month mark?

-What are the potential complications of 5-FU injections? Can it dissolve scar tissue unevenly and cause my nose to look uneven? Is there a risk that I will make things worse?

-As I'd mentioned, I have an ear cartilage graft remaining on my nose. I already feel like my nose is a bit overprojected at the moment because of the ear cartilage graft. If the injections bring the scar tissue down, my nose may look even more overprojected. Would it be wise to plan on getting the injections to first bring the scar tissue down, and a revision to remove the ear cartilage/correct the overprojection if necessary?

-How exactly do these injections work? How long would I have to wait to see results from the injection, and will it interfere with a rhinoplasty revision in the future if I decide to get one?

Thanks again!

-How long should I wait after rhinoplasty to get them? THERE IS NO PERFECT TIME. AT LEAST A COUPLE OF MONTHS. AFTER THAT IT DOES NOT MATTER AS MUCH. I had my silicone implant inserted in October and removed in January. Could there still be a lot of swelling left and I should wait to see if it'll get better at the 6 month mark? YES, THERE CAN BE SOME. IF IT IS REMOVED IN A FEW MINUTES IN THE OFFICE AS I DO, THERE TYPICALLY IS NOT THAT MUCH SWELLING. IF THE SURGEON TOOK A LONG TIME TO GET IT OUT OR SOMETHING, THEN THERE THEORETICALLY COULD BE MORE. OBVIOUSLY, I DID NOT REMOVE IT SO I DON'T KNOW.

-What are the potential complications of 5-FU injections? Can it dissolve scar tissue unevenly and cause my nose to look uneven? Is there a risk that I will make things worse?
GENERALLY, IT IS PRETTY SAFE. THERE CAN BE PIGMENTATION CHANGES BUT I HAVE ONLY SEEN THAT WHEN I INJECT IT VERY SUPERFICIALLY INTO THE DERMIS WHICH I DON'T DO WITH 5-FU. OBVIOUSLY, UNEVENNESS IS A THEORETICAL POSSIBILITY. I HAVE NOT SEEN THAT. THE MAJOR RISK IS THAT IT DOES VERY LITTLE OR NOTHING.

-As I'd mentioned, I have an ear cartilage graft remaining on my nose. I already feel like my nose is a bit overprojected at the moment because of the ear cartilage graft. If the injections bring the scar tissue down, my nose may look even more overprojected. Would it be wise to plan on getting the injections to first bring the scar tissue down, and a revision to remove the ear cartilage/correct the overprojection if necessary?
YES, THIS COULD BE A PROBLEM. IF YOU ARE TRYING TO BRING THE BRIDGE DOWN, YOUR NOSE TIP WILL MOST LIKELY LOOK EVEN BIGGER. THE LAST QUESTIONS REQUIRE A CONSULTATION. IT IS HARD FOR ME TO PERSONALIZE ALL OF THIS UNTIL I SEE YOU IN PERSON. IF YOU NEED TO REMOVE THE EAR CARTILAGE THEN YOU NEED TO REMOVE THE EAR CARTILAGE. THE 5-FU I WOULD NOT DO IF WE ARE PLANNING A FORMAL REVISION BECAUSE IT COULD LEAD TO MORE TISSUE DISTORTION DURING THE PROCEDURE.

-How exactly do these injections work? How long would I have to wait to see results from the injection, and will it interfere with a rhinoplasty revision in the future if I decide to get one?
5-FU SLOWS DOWN CELLULAR TURNOVER SO IT BRINGS SCAR TISSUE DOWN THAT WAY. TYPICALLY, YOU WOULD SEE SOME SLIGHT CHANGES AFTER A WEEK TO A MONTH. OFTENTIMES IT TAKES 2 TO 3 X TO START SEEING SOME FAVORABLE IMPROVEMENT IF YOU WILL GET IT. REMEMBER YOUR SCAR MAY NOT RESPOND. NOT EVERY SCAR DOES. AS FAR AS THE LAST QUESTION, IT COULD SO I WOULD NOT NECESSARILY DO IT IF WE ARE PLANNING TO GO TOWARD A FORMAL REVISION. AGAIN, THAT WOULD REQUIRE A CONSULTATION.