LAM FACIAL PLASTICS

Dear Dr Lam,

I had asian rhinoplasty about a month+a week ago in Taipei. My doctor used Silicon I implant (.35mm) and septal and ear cartilage on me. My bridge now is so high and thick, ususally how long does it take for the bridge to settle down? Also is .35mm a big change in height? I feel like my face is completely shifted, my eyes are pulled too close together.

My biggest concern however is that my doc extended my nose, and now it feels pulled down. It creates a beaky effect when i smile, my doc says i should push my nose up so cartilage can be absorbed. But i when i feel the middle area in between my nostrils, its incredibly hard. Im scared it will stay this way. I really want a unpturned nose. How major of a procedure would it be to get my tip shortned to before? Please Help.

Hi,
I don't know obviously exactly what your surgeon did so it would be unfair of me to a certain extent to reply. That being said, I will try my best here. First of all, I assume 0.35 mm you mean 3.5 mm since 0.35 mm is very very thin. 3.5 mm is about what I would expect if you feel the bridge is too high. As far as how long it takes for a nose bridge height to settle, I would say in a couple of months most of the swelling is down but you have a little swelling that lasts about a year or more. Even with higher implants though I have not seen a "face shifted" or eyes pulled in.

As far as why your nose tip feels hard and is rotated downward, I don't know what part is causing that either a longer silicone implant or the cartilage. If the silicone is the problem, it is usually easy to remove in the office setting. If it is the cartilage, then that needs to be removed through revision surgery which is more involved.

I know that may not be an ideal answer but given the circumstances that is the best that I can do. I always recommend for you to go back to your surgeon and tell him/her about your concerns so that he/she can help you.

Best,
SML

Dr Lam,

Thanks for your reply. Yeah i meant 3.5mm, sorry. Would 3.5mm be considered a natrual change? Also the width is 1cm, i feel its too wide right now.

I called my Dr last night and he told me its the ear cartilage thats pulling my nose down. He told me to push my nose up constantly as ear cartilage will absorb. But im just confused because if he shaped the tip upwards it shouldnt matter how i push my nose right?

One more thing: he corrected the size of my nostrils as one was bigger than the other but now i feel the right side he made smaller, the tip is slanting towards the left. Could this be swelling? I told my doc about it but he doesnt seem to understand my concern. Can i send you my pic for a second opinion?

Dr Lam,

One more thing: ive been pushing my nose up alot the last 2 days and now the skin feels incredibly soft and thin near my tip area. When i touch the end of my tip lightly i can feel really hard sharp edges. Would this be the ear and septal cartilage? Is it possible for cartilage to protrude?

I am not certain if pushing your nose is a wise thing but again I don't know your situation. Usually nose cartilage like septum is much harder than auricular or ear cartilage. Please consult your surgeon or get a second opinion. I personally have never heard of pushing on your nose tip.

Dr Lam,

I will stop it for a day or two as i think its causing too much stress on my tip skin. I've heard different views regarding ear cartilage. My doc seemed sure that it will absorb over time. Have you had any experience with ear cartilage absorption? Also if i send my pictures to your email address could you take a look when you have time? I'd really appreciate it.

P.S thanks for your fast responses... my doctor takes so long to respond.

Sure, I will take a look at your photos but really can't make any promises as to helping you definitively. Only your surgeon really knows what he did. Ear cartilage can be absorbed but not necessarily. I just did a phone consultation with a woman who had a rhinoplasty using ear cartilage to rebuild her bridge 18 years ago and I (and she) can see the outline of the ear cartilage on the bridge of her nose. That is why I don't use ear cartilage to build bridges by the way. Also, that is why I don't believe one can say that all ear cartilage is resorbed. Otherwise, I would not use it to build noses.
Best,
SML

Dr Lam,

How bad would it be to get a revision 3 months after surgery? I think i want my tip shortened back to the way it was before. My doctor put a piece of cartilage in my columella to extend it... now i feel my nose is too beaky looking. I dont think it will receed to much in the final results.

I understand your concerns. 3 months is early in general. It usually can be more difficult going in there the first 3 to 6 months. I would really either talk with your surgeon or elicit a second opinion from someone local that has experience with rhinoplasty.

In general it is hard for me to help you via the Internet even if I view a photograph. If you were my patient and I saw something grossly wrong, I would go back in earlier than later. If I thought it was most likely due to swelling and just needed time, of course I would encourage you to wait.

If a graft is malpositioned and you are waiting for it to "resorb", I don't think that game plan is logical. A lot of grafts stay forever...that is the whole point of a graft.

Best,
SML

Dr Lam,

Would this be a fairly simple procdure? It should be better than my first nose surgery right? I'm a pretty slow healer, im hoping for a faster recovery with revision tiplasty.

Hi,
I have taken the time to review your photos that you kindly sent me. My honest opinion is that your nose looks good this early out from the surgery. With an open rhinoplasty technique you will naturally have a bit more swelling, which can take a year or so (or more) to resolve for the most part. Whether your bridge will get lower will be determined with time. I honestly would give it time and not rush to have a revision rhinoplasty. I appreciate your concerns and your fears, but I always encourage patients to talk with their surgeons about their concerns, especially since I am so far a way from you. If you are not happy at a year, I would be happy to consult with you regarding a revision procedure.
Best wishes,
SML

Dr Lam,

Thankyou for reviewing my pictures. What about the slant in my tip area though? I mean is that likely due to swelling, or misplaced cartilage in my tip? I dont think i can take a year of looking the way i do though. I feel so selfconcious about my appearance.

I can't promise you that the slant will or will not improve. I think time is the best option at this point. Honestly, my suggestion for you is try as much as you can not to obsess over a particular part of your nose. I certainly have seen bad and very bad nose jobs and I don't think yours is bad. I think now that you have become fixated on your "slant", you will not rest until your slant is gone. Try to take a break in thinking about your nose. I am sure that you are constantly in front of the mirror looking at your nose from every angle close up and obsessing with it. GIVE YOURSELF A BREAK! I honestly think if you try not to focus on your nose for a while you will actually not be so negative about it...as time goes by. If not, then a revision may be in order. Think positive! I think you will be okay.
best,
sml

Dear Dr Lam,

Thanks for your reassurance, i will try to be more positive. I'm just wondering though, since it takes a long time for my nose to deswell, if i get my tip revisioned would i be back at square one? Thats why i wanted to get a revision faster because i dont want to wait even longer. I'm pretty sure i want my nose back to its original length. Also im seeing little round circles on the skin of my nostrils, its very faint. Is that from the ear cartilage pushing against my skin?

1. I don't think your nose will be back to its original shape but I think that is okay. If you are talking about the length of it, that is hard for me to say.
2. I really can't answer your question about the little circles. That is something I usually don't see. Perhaps, again, you might be over-analyzing your nose. If you are talking about two small highlights that appear as circles that is something that is known as "tip defining points" that is considered an attractive feature in Caucasians but not so often found in thicker skinned Asians. The tip defining points represent the recurvature of the nasal tip cartilage seen through the skin, usually thicker/firmer cartilage seen through thinner skin. If you are seeing this, then most likely those defining points are being created by a tip graft. Again, I don't know what you are seeing so this is a hard question to answer.
best,
sml