LAM FACIAL PLASTICS

Hi Dr. Lam, I underwent my primary rhinoplasty over 2 years ago and would like to tweak my nose slightly. I have a silicone implant as well as ear cartilage used for tip projection.

I would like to have my tip further refined and have an osteotomy to further narrow my nose.

I am perfectly fine with the height of my bridge, so my question is do I have to have my implant taken out and replaced if I were to have an tiplasty and an osteotomy done..?

that is a tough question for many reasons:
1. sounds as if you are Asian perhaps. i typically do not do osteotomies on Asians because the bones are so flat and weak, you don't get much improvement. plus, it can destabilize the implant. third, over narrowing the bridge can make the tip fatter looking.
2. it is very hard to get much refinement on an Asian nose. oftentimes the degree of refinement able to be achieved with a ear cartilage is all that is possible shy of creating a problem with a silicone implant there in which too much sharp definition occurs that looks fake.

i know that is not an easy answer but what you are wanting most likely is not possible and carries risk just from what you are asking.
best,
sml