LAM FACIAL PLASTICS

Hi Dr. Lam,

I hope you could kindly advise my concerns here and would very much appreciated. I am an Asian Chinese who has a short/upturned with nostrils showing/flat bridge nose. And I am seriously set to do Rhinoplasty but am not sure yet what I should go for in term of whether or not to use Gore-tex to stack my bridge instead of using RIB?

I did Silicon twice before and was removed due to infection and according to the Doctor, my nose is too short to hold the implant even though he has shaved down quite fair bit to make it shorter.

My question;

1) I am not sure should I/is it necessary to break my nosal bone to create my nose bridge or i should just stack with Gore-tex (am aware abt the cons) OR don touch my nose bridge at all? I am afraid of the overly high straight bridge down to tip. But I would want to have a depression (ski slope) between forehead and the starting point of the bridge (which start center part of pupils.

2) Lengthening my nose and to have define tip is my priority/concerns. Will this help my nostrils to be showing lesser? So if not using RIB, can septum enough to lengthen? If not enough will ear cartilage be able to? (since ear cartilage is soft). And What about the TIP area? Is order not to have the too pointy look, is it true that ear cartilage can cover the underlying tip to have the round but sharp tip?

3) And since I am a relatively small nose.. Is alar base resection necessary for me?

Please advise if you would to fix my nose, what would you recommend to best suit my feature in a natural looking way. Thanks in advance and hope to hear from you soon.

Rdg,
Linsay

1) I am not sure should I/is it necessary to break my nosal bone to create my nose bridge or i should just stack with Gore-tex (am aware abt the cons) OR don touch my nose bridge at all? I am afraid of the overly high straight bridge down to tip. But I would want to have a depression (ski slope) between forehead and the starting point of the bridge (which start center part of pupils.
I almost never break bones for Asians. no point to do it. gore-tex can work well for small bridge elevations. i do not like rib for the bridge. it is too strong, hard, and big. does not look natural.
i have to see your nose to see better what you are talking about.
2) Lengthening my nose and to have define tip is my priority/concerns. Will this help my nostrils to be showing lesser? So if not using RIB, can septum enough to lengthen? If not enough will ear cartilage be able to? (since ear cartilage is soft). And What about the TIP area? Is order not to have the too pointy look, is it true that ear cartilage can cover the underlying tip to have the round but sharp tip?
to lengthen your nose, i may have to use rib but i have to see how contracted it is. the tip should not use rib but septal and ear cartilage. no goretex there. it should not look pointy with my technique.

3) And since I am a relatively small nose.. Is alar base resection necessary for me?
not always. sometimes that makes things worse. i only do alar base resections in less than 5% of my asian noses.

Dr Lam,

Thanks for your reply. But Sorry, I don quite understand your reply on my question 2.

You replied: to lengthen your nose, i may have to use rib but i have to see how contracted it is. the tip should not use rib but septal and ear cartilage. no goretex there. it should not look pointy with my technique.

ME: You mentioned RIB is not advisable for the bridge cos it is too hard and strong, not natural. You mentioned to lengthen my nose, you may use rib? So does that mean in order to lengthen for my case, I have to use RIB on my bridge in order to lengthen?

I am thinking not to break my nasal bone, not using Gore-tex, meaning will not touch on the bridge part but just to modify the tip area by lengthen and shape the tip to more define look.
So can it done by just using Septum and ear cartilage to lengthen?

Thanks.

You replied: to lengthen your nose, i may have to use rib but i have to see how contracted it is. the tip should not use rib but septal and ear cartilage. no goretex there. it should not look pointy with my technique.

ME: You mentioned RIB is not advisable for the bridge cos it is too hard and strong, not natural. You mentioned to lengthen my nose, you may use rib? So does that mean in order to lengthen for my case, I have to use RIB on my bridge in order to lengthen?
THE RIB WOULD ONLY BE IF YOUR NOSE WERE TRULY CONTRACTED THEN I WOULD USE THE RIB AS AN EXTENDED SPREADER GRAFT. IF IT IS NOT VERY CONTRACTED UPWARD, THEN SEPTAL AND EAR CARTILAGE ARE SUFFICIENT TO PULL THE NOSE DOWNWARD. HOWEVER, AS A GRAFT ON THE BRIDGE, I DON'T LIKE IT BECAUSE IT IS TOO VISIBLE, TOO STIFF, AND TOO THICK IN MOST CASES FOR ASIAN NOSES.
I am thinking not to break my nasal bone, not using Gore-tex, meaning will not touch on the bridge part but just to modify the tip area by lengthen and shape the tip to more define look.
So can it done by just using Septum and ear cartilage to lengthen?
YES, IT CAN. WE DO NOT NEED TO DO THE BRIDGE BUT I HAVE TO SEE YOU TO HELP MAKE A LOGICAL PLAN FORWARD.