LAM FACIAL PLASTICS

Hi Dr. Lam,

I am considering non-surgical rhinoplasty prior to undergoing surgical rhinoplasty, but would like to know of any possible complications. I read somewhere that it's fine as long as it's Restylene and not Radiesse. I was also thinking of more permanent fillers as well. Part of the reasons I am considering the non-surgical approach is because it allows me to oversee the procedure while it is being performed. I am concerned I may not like the outcome of my surgical procedure, although I would rather prefer traditional rhinoplasty just because I don't like the idea of chemicals being injected in me unless maybe it's a permanent filler. I would rather prefer a solid material implanted if that makes any sense. What are your thoughts on non-surgical rhinoplasty and chin augmentation. How accurate are the computer-generated before and after photos to the actual results achieved post-surgery? Also what are revision conditions or requirements and any costs for revision?

Also I am considering some facial shaping as well (buccal fat removal, jaw-line reduction, and possible chin implant). In what order would you recommend the procedures be performed? Should I undergo face-shaping prior to rhinoplasty? I am considering jaw-line shaving to avoid chemical injections, but am really afraid of any possible complications. Also is it possible to preserve my buccal fat if in case I may need it in the future to avoid fillers? Kinda weird question I know...lol.

I understand you don't perform buccal fat removal and jawline shaving, but just wanted to get your thoughts on the procedures. I also read about radiofrequency waves in masseter reduction, but don't think it's that prevalent in treatment and only has like 10-30% reduction in appearance with a 30% average. How can I tell if it's bone, fat, or muscle that is making me look chubby? I tried biting down, but can't tell.lol

Also, is it common for someone to want to get these many procedures done? Is there something wrong with me? lol. All I know is I want to achieve a slimmer facial appearance which has bothered me for the longest time. The rhinoplasty was more of an afterthought.

1. i really almost always advise not to do injectables of any kind if someone is seriously contemplating rhinoplasty. even though restylane is the only thing that i would do pre-surgery, i would still prefer not to do it if someone is going to contemplate rhinoplasty. why? don't have a concrete reason except i rather have an untouched nose before rhinoplasty. there can always be increased complications due to blood supply, etc.
2. i am not going to comment on procedures that i do not do.
3. i think combination procedures in general can be fine so that one can go through one recovery period but you must talk to your doctor about the safety of the proposed combined procedures based on your health, type of procedure, length, etc. i should not comment.
4. as far as your psychology goes, the best way to determine if you are a proper candidate is to make sure you do not have body dysmorphic disorder (BDD). buy Katherine Phillips' The Broken Mirror. If you do not fit that picture then after a discussion with your surgeon, you are most likely (but not definitively) psychologically fit to have multiple procedures.
best,
sml

Hi Dr. Lam,

Would you happen to have additional before and after rhinoplasty photos representing more aggressive surgeries? The ones on the site are pretty subtle, and I would like to see some more if you have any. I am afraid I would not experience a noticeable difference post-surgery. Also, what are the general policies for revision? I've never undergone any past surgeries before as well as an out-of-state patient so it would be nice to know. Also, in which order should I undergo surgery when considering face-shaping and rhinoplasty or should it matter? Thank you.

aggressive surgeries always look terrible IMHO. asian before and afters should not be that noticeable when looking at them. when i had dramatic before and afters with silicone implants, they looked great in photos and they looked frightening in real life. if they don't match your desires, you should find a surgeon who is more aggressive. if a revision is necessary, i generally do not charge. i would have to see it case by case. hopefully that helps.
best,
sml

Thank you for the rhino advice. It hadn't occurred to me that some surgeries looked better in photos than in real-life, but yeah that is definitely something to consider as I would like a natural look, but was just concerned I might not see much difference or worse look like I underwent rhino.

My skin is prone to developing keloids and I was wondering if that would affect the healing process if I were to consider to undergo any facial plastic surgery. Also, do you perform keloid removal? I have one between my chest and neck that's visible when I wear some tops that I try to cover with necklaces which over time I've learned to accept and doesn't seem to both me much except that occasionally people might think it's a love bite.lol

I have received steroid injections in the past and it has helped, but over time it went back to being elevated and seems to have actually gotten bigger. I heard there are laser techniques available for treatment of keloids nowadays. Also, if you harvest cartilage from my ear for the tip of the nose in rhinoplasty what are the chances I will develop a keloid on my ear after surgery?

1. keloids do not occur on the face. you can have an ugly hypertrophic scar but it is very unlikely to get a keloid on the face. now on the ear, scalp, and neck, they are more common.
2. if you are a first time rhinoplasty, then it is unlikely that i will need ear cartilage. i usually only need ear cartilage in someone who has had a previous rhino. as far as keloid risk in that case, it is possible especially considering that it would be on your ear.
3. i do not remove keloids from the body in general but do in the neck. you should just watch my video on keloids with radiation therapy. it is in my video log section currently.