LAM FACIAL PLASTICS

Hi Dr Lam,
I'm male asian and had a 2-3mm soft-grade silicone implant with ear cartilage at the tip.It's a closed rhinoplasty that's why the bridge starts higher. I understand that u said the shiny looking appearance is inevitable and irreversible. May I know if the extent of the shiny appearance depends on the size of the implant? Will it get shinier as we age or it'll just stop becoming shinier at one point? Should that bother any of us at all eg. a sign of extrusion? Should skin thinning at the bridge causing shiny-looking appearance be a concern much?

When u said silicone shrinkage, does it lead to extrusion or other problems?

I understand the final results will only show after 6 months to a year.
When compared a patient 1 month post-op VS 3-month postop, what are the changes that will be observed? Will the height of the bridge go down by 1-2mm and then another 1-2mm reduction the following 3 months? Basically it will keep reducing in height by 1-2 mm every 3 months even though it feels solid and wouldn't change much? True?

I understand u mentioned if a patient doesn't like the silicone implant, he should get it removed ASAP to avoid scar tissue and capsule formations.
Will it be too hasty to consider a removal because I don't like the height of my bridge 2 months post-op (a bit high for my liking)? Or should I wait a full 3 months before deciding? My point is, if I consider to remove after 3 months, will some capsule be retained to maintain the projection of the nose? say maybe 1/2 the height of the nose with silicone implant?

Thanks in advance Dr Lam

ANSWERS IN ALL CAPS:
Hi Dr Lam,
I'm male asian and had a 2-3mm soft-grade silicone implant with ear cartilage at the tip.It's a closed rhinoplasty that's why the bridge starts higher. I understand that u said the shiny looking appearance is inevitable and irreversible. May I know if the extent of the shiny appearance depends on the size of the implant? Will it get shinier as we age or it'll just stop becoming shinier at one point? Should that bother any of us at all eg. a sign of extrusion? Should skin thinning at the bridge causing shiny-looking appearance be a concern much? DON'T WORRY. NOT EVERYONE GETS THIS. JUST HOPE FOR THE BEST.

When u said silicone shrinkage, does it lead to extrusion or other problems? NOT ALWAYS.

I understand the final results will only show after 6 months to a year.
When compared a patient 1 month post-op VS 3-month postop, what are the changes that will be observed? Will the height of the bridge go down by 1-2mm and then another 1-2mm reduction the following 3 months? Basically it will keep reducing in height by 1-2 mm every 3 months even though it feels solid and wouldn't change much? True? YOU PROBABLY HAVE MOST OF YOUR RESULT SET ALREADY NOW.

I understand u mentioned if a patient doesn't like the silicone implant, he should get it removed ASAP to avoid scar tissue and capsule formations.
Will it be too hasty to consider a removal because I don't like the height of my bridge 2 months post-op (a bit high for my liking)? Or should I wait a full 3 months before deciding? My point is, if I consider to remove after 3 months, will some capsule be retained to maintain the projection of the nose? say maybe 1/2 the height of the nose with silicone implant? HARD FOR ME TO SAY BUT 3 MONTHS PROBABLY WON'T HAVE MUCH MORE NEGATIVE IMPACT. YES, SOME CAPSULE MAY HAVE FORMED BY 3 MONTHS MEANING YES SOME PROJECTION MAY BE PRESERVED. HONESTLY, I DO NOT KNOW WHEN THAT CAPSULE IS FORMED EXACTLY.

Thanks in advance Dr Lam

Hi Dr Lam,

Thanks for the reply. I'd like to know if upon removal of my silicone implant at postop 3 months, will the capsule formed inside the nose dissolve over time (years later) and my nose will revert back to my original nose? or will it become even worse with the height of my nose lower than my original nose due to damage done to the underlying cartilage and tissue?

What will happen to the cartilage at the tip of my nose? Since it's a closed rhinoplasty, the surgeon only used the silicone to fix the position of the cartilage at the tip. With the removal of the silicone at 3 month postop, wouldn't the cartilage collapse at the tip without a proper support? Or will it actually mesh with the tissue of the tip of my nose and make the tip look bulbous and wider than usual?

If I decide to go ahead with the removal, when will it be safe for me to do a filler injection? Dr Lam, have u heard of bio-alcamid? I know that it's not FDA-approved. Is it safe to inject 1ml at the bridge? I have heard that the risks that come with Bio-alcamid in the long run are very significant eg, infection, difficulty removing it, tendency to shift to other undesired places. Is that true?

Would you just recommend the FDA-approved Restylane and Radiesse?


Thanks again Dr Lam for your help

Thanks for the reply. I'd like to know if upon removal of my silicone implant at postop 3 months, will the capsule formed inside the nose dissolve over time (years later) and my nose will revert back to my original nose? NO. or will it become even worse with the height of my nose lower than my original nose due to damage done to the underlying cartilage and tissue? I DON'T KNOW WHEN DAMAGE OCCURS. PROBABLY NOT AS EARLY AS 3 MONTHS BUT I AM NOT 100% CERTAIN. TYPICALLY WHEN I SEE THE CRUSHING OF THE CARTILAGE IS AFTER YEARS OF HAVING AN IMPLANT.

What will happen to the cartilage at the tip of my nose? IT WILL STAY THERE IN PLACE. Since it's a closed rhinoplasty, the surgeon only used the silicone to fix the position of the cartilage at the tip. With the removal of the silicone at 3 month postop, wouldn't the cartilage collapse at the tip without a proper support? NO, IT STAYS PUT TYPICALLY. Or will it actually mesh with the tissue of the tip of my nose and make the tip look bulbous and wider than usual? I DON'T KNOW SINCE I DON'T KNOW HOW MUCH OR HOW IT WAS POSITIONED. IT COULD LOOK FINE OR NOT GOOD. I SIMPLY CAN'T ANSWER THAT WITHOUT HAVING PERFORMED YOUR PROCEDURE MYSELF.

If I decide to go ahead with the removal, when will it be safe for me to do a filler injection? Dr Lam, have u heard of bio-alcamid? I know that it's not FDA-approved. Is it safe to inject 1ml at the bridge? I have heard that the risks that come with Bio-alcamid in the long run are very significant eg, infection, difficulty removing it, tendency to shift to other undesired places. Is that true?

Would you just recommend the FDA-approved Restylane and Radiesse?


Thanks again Dr Lam for your help

Hi Dr Lam,

What if I choose to take the silicone implant out at week 10 postop, will the cartilage at the tip stay put?
How long will the swelling of the nose last? 2 weeks?

I understand that the skin of the nose must have stretched to an extent with the silicone and cartilage implanted. What happens to the extra stretched skin then? Will it get firmer again? Or will it just look like a blob even if the silicone's height used was 2-3mm?

Thanks so much again for your help Dr Lam...I really appreciate it.

again, i can only guestimate since i am not your surgeon. in general, the cartilage won't move because the scar tissue will hold it in place. swelling is different for every person depending on who takes it out, how it was taken out, how big the implant is, and just generally how you heal or perceive your healing. in general when i remove implants, the recovery is less than 2 weeks. the skin tends to shrink over the new architecture so i would not necessarily be too worried that the skin won't accommodate the newer smaller structure with the implant gone. firmer? hard to say. should not typically look like a blob though.

Hi Dr Lam,

Just wanted to know if the damage caused by the 2-3mm silicone implant to the underlying cartilage and tissue happens to all patients or not? Say if i want to harvest the nasal cartilage to reshape my nose a few years down the road, will it be possible? Will the nasal cartilage stay intact or crushed?
Is it relatively difficult to remove a 2-3mm silicone?
Thanks very much.

damage does not occur to all people with nasal silicone implants but it does proportionately increase with the size of the implant especially if there is an L configuration and the time that it has been there.

in rare cases, the silicone implant can become calcified making implant removal difficult but in my hands still doable even as an office procedure but i sweat a little bit more. with calcification, there is a higher risk of damage to the overlying skin but i am pretty careful to avoid this in the vast majority of individuals with calcification, and again calcification is rare fortunately.

typically, if there is damage and the nose looks flatten it is not wise to wait a few years to reconstruct it because over a period of a few months the nasal skin starts to contract around the implant and can alter the nasal tip shape pushing it up. if that happens you need a full revision procedure done within a few months to salvage the nose.

sorry to give you all the scary stuff but in general the removal is relatively easy in my hands and you hopefully will not need anything further.

Hi Dr Lam,
I have seen results of people with postop 1 year to be compared with postop 2 years (same person), the height of the nose (eg tip, bridge) reduces a bit more? Is this actually a sign of underlying cartilage damage? cos I cant imagine it's still de-swelling.
I'm planning to wait a bit longer (maybe 6 months) for the capsule to form a bit more before considering removal (if i still want to at that time) so as to preserve the height/shape a bit more. Wonder if that's a ridiculous idea at all?

Thanks Dr Lam.

i don't know why there is a drop. could be just skin scar contracture and loss of further swelling. in general, you do increase risk with silicone implants if you wait maybe past a year or so, as i think capsules form already within a few months. those are my thoughts at least.
best,
s.