LAM FACIAL PLASTICS

Hi there, Dr. Lam,
I got my first ever rhinoplasty 2 years and 2 months ago (Oct 2008). All the surgeon did was insert a silicone L-shaped implant in and he said that would create a narrowing effect to my nose. It shifted to the right pretty quickly (maybe it wasn't even equal in the first place), but the shift became more noticeable over time.

I had the silicone L-shaped implant taken out 1 month ago because of this and because I just wanted a narrower nose. So I got an alar base reduction and some tip work with ear cartilage. The surgeon also replaced the silicone with ear cartilage wrapped in fascia from my scalp. I'm not quite sure why he didn't use septal cartilage. I heard that was the best material...if I only had a silicone implant put in the first time, shouldn't I have enough cartilage left from my septum?

The only thing I liked after the first surgery was done was the nice definition on my bridge, even from front view. From what I remember the first surgeon said he gave me the "2nd longest, but the one with the most projection" or something like that for the size of the implant from a catalog.

Right now, I am 1 month post-op but I do not see any definition at all. The transition between my nasal bone and the ear cartilage dorsal graft seems too obtuse and there is no distinguishable edges especially at front view. Also, my nose is crooked and skewed. Do you think there will be more definition over time or am I stuck with a blob for my nose? I went to a rhinoplasty specialist for this, that is why I am so disappointed that my results look nothing like what his before & afters look like so far.

I am concerned about lack of support and that maybe it is not just as simple as swelling and healing that is causing it to look this way. Also, I think the part of where the bridge meets the nasal base has something of what I describe as "loose skin" on the sides that is making my nose look even rounder and lacking definition.

It is really funny because my surgeon sounded very satisfied right after surgery and he said that I will have a beautiful nose. He also claimed that all areas of my nose will become more defined with time. I have yet to see any "beauty" in my nose right now.

Thank you.

hi,
in the early phases of healing especially a revision nose it is not uncommon to have swelling to the point of dissatisfaction even in the first few months. you might ask your surgeon about taping the nose, which i use to expedite swelling and to minimize scar formation. however, i never directly give advice to a patient early on in the healing process. you must ask your physician. i do not know why he did not use septum. i prefer it when i have it available over ear cartilage especially for the tip. the septum is a tricky thing to harvest if you are not a rhinoplasty specialist but it sounds as if you went to someone who does that so i have no idea. i am sure he had a good reason.
best,
sml

Hi Dr. Lam,
It has been a while since surgery....like 1 month and 1 week or so and I've noticed that the ear cartilage on my bridge does not blend in very well with my own natural nasal bone. The ear cartilage seems too thin in depth and narrow in width on my wider nasal bone. I don't believe I noticed this with the silicone inside. Also, my bridge is still crooked. The doctor still insists on "pushing" it to get it into place. I know you do not give advice to patients of other surgeons...but do you have any insight at all of whether this manipulation is a good idea?

I have communicated with my surgeon a lot but he is still blaming my situations on swelling and I don't know if I should trust that anymore...

At this point my nose is still:
1) Crooked
2) Huge and wide ball tip - too much space between nostrils
3) Very round-looking
4) Soft in some places and hard in others (it is hard on the left side of the base to be exact)
5) I still see no frontal definition on the bridge nor the base

The doctor says that I apparently still have a long way to go...and the nose I have now is not what he envisioned on the operating table (then again...no one is ever going to envision a crooked nose!)

i am not too certain whether you can push an implant into place especially cartilage after 5 weeks. that sounds tough to do but most of the complaints IN GENERAL but without specific regard to your situation since i did not do the surgery and you are right i try not to make commentary on someone else's early work, many of things you mentioned could improve especially if the nose looks too big or the nose feels different. sorry that i cannot help more.
best,
sml