LAM FACIAL PLASTICS

My questions are highlighted in blue.

Hi Dr. Lam,
I had a revision rhino in November 2011 to take out my too-bulky silicone (L-shaped) implant that I had for 3 years and 1 month. It was crooked, shiny, the tip was so so hard, and unnatural.

I had it done by a renowned revision specialist. He put ear cartilage (wrapped in fascia) on my bridge and did some tip work with cartilage. I also had a very minor alar base reduction. Heck, I don't even notice a difference besides the fact that the scars were there from it.

So right now it has been 1 year and 3 months. My bridge is still crooked just like the silicone implant was (but now it curves a bit now though since the cartilage is softer and not rigid). It is also BUMPY. The surgeon tried to alleviate this issue 1-3 months after my surgery by telling be to push the cartilage to center it on the bridge. This obviously did not work. So could my nasal bones have had an uneven plane in the first place? If so, how come the 2 surgeons I had never noticed and did anything about it? Before I had any surgery, you could not tell that I had any kind of crooked bridge, but now you can.

Also, why is my nose still wide, round, bulbous after my 2 surgeries? Well then again..the first doctor didn't really do anything besides add the implant to my nose. He told me that the appearance of a taller nose will make my nose look slimmer already. The second doctor promised me a feminine, much narrower nose/pointier nose and I didn't get what I wanted. I trusted him so much!

Is it really that hard to make this kind of nose (I unfortunately sort-of have this actress, Ariel Lin's downturned-ish "V" nose and I think that's her weakness):


Into this kind of nose (Song Hye Kyo's best feature):


Or actually...any typical "gentle and sharp" Asian female or any typical Caucasian female's nose would work for my face (I am half-Asian, half-White with a very unfortunate nose that does not fit my face at all and I regard it as my definite weakness). I love/can live with my other features and will not have any surgery besides on my nose unless I get in an accident or something.

Yes I still hate my nose that much. The big reason is that it does not go with my other features. I have big "western-looking" eyes and small Asian-ish lips. The proportion isn't right because my nose is equal to/wider than the width of my small lips. I believe that if I had a narrower nose, it would definitely bring out my eyes. Right now my pretty eyes (probably my best feature) is hidden behind my weird, ugly nose that's too wide for my face. I specifically repeated this to my surgeons and I do not know why it didn't happen- is it impossible to achieve?

This is my nose:

I hate the wide "V" shape between my nostrils (how far apart my nostrils are) the most and the big tip. The wideness is the problem. I think I am pretty much okay with the height, except maybe the radix could be a tad filled in. It's just the width that I REALLY hate.

Also, could I still have swelling at this point or scar tissue? Again it has been 1 year and 3 months. When I squeeze my nose, it feels very squishy/spongy and makes a squishy noise as if there is liquid inside. I did not have kenalog injections and don't know if I should've.

More details: I have had 2 surgeries so far, first one closed and second one open rhino. The surgeons I spoke with all said I had thick skin.

Please do not tell me to talk to my surgeon. He is already ignoring me so I'm moving on.

But what can I do now? I really don't want any more surgery, but I still do want a nose that suits me. I think I'm going to give it one more shot though in a few years. I've been squeezing my nose hoping it would get narrower..if there is still swelling. My surgeon told me to do this "lymphatic massage" several months back when he still talked to me. It isn't really working. My nose tip is still round and huge. The nostrils are too far apart. It is now LESS-DEFINED than before with the silicone. Looks shapeless to me and lacks support. TO SUMMARIZE MY NOSE HAS ALWAYS AND STILL RUINS MY OTHERWISE PRETTY FACE. My whole nose just looks like a big fat triangle instead of straight. Could the skin of my nose still need more redraping/shrink-wrapping since the silicone implant I had removed was much bigger than the cartilage is now? So it has to fill-in the hollow spaces?

Thank you so much. Please kindly reply.

hi,
let me answer your questions broadly here. it is impossible to get exact replicas of other noses. part of the problem is that we can only alter our nose shape to a certain degree. we cannot radically change it. second, we are tied down by our native skin thickness. thick skin prevents the fine contours under the skin to show up.

there is a great story of ira tresley from the 1950s who would have 10 people fly in from everywhere for his rhinoplasty work. he would refuse 8 of 10 people because they did not have the right balance of anatomy for an excellent outcome.

as far as whether your nose will continue to shrink, the answer is most likely yes. noses continue to slightly shrink for 10 to 20 years following a procedure. sometimes to the point that it does not look good but you can have favorable and unfavorable changes over the next many years to come.

i think the problem with narrowing your ala further is that the your tip will look bigger seeing your photos. that will make you look more bulbous. if you cannot reduce the tip further (which i am saying you cannot), then i would be highly cautious to make the ala smaller too.

sometimes leaving things better off alone is the better option in my opinion. i wish i could have an easy answer but the best answer sometimes is not trying for something unattainable.
best,
s.

Hi Dr. Lam,
I actually do not want something "exactly" like Song Hye Kyo's nose, but just something feminine-looking and sharp. I know that I have to be realistic. But my nose hasn't changed very much from my birth nose after the surgeries. I have also noticed that I have something called a synechium on the right side of my nose, inside the nostrils. That makes my right nostril look smaller compared to my left. I have been told that this is scar tissue. I first noticed this after my first surgery, but my doctors did not mention it at all so I ignored it. Could that mean that I could have more scar tissue and swelling inside my nose? My nose just looks so chronically swollen to me, especially at the tip.

Also, should I get Kenalog injections? Will it still be effective now that it has been 1 year 3 months after my revision surgery? Can I get this from another surgeon closer to me? My original surgeon offered that to me several months ago when I was still living in my home state. But I was so concerned with the complications from injecting these steroids. However, I do have thick skin at the tip that feels really squishy to the touch, like there is a layer of fat beneath it covering up the tip cartilage. But the skin on my bridge is thin compared to the skin on my tip. I have heard that Kenalog can cause cartilage to reabsorb though so I am really cautious about that.

Here is a photo courtesy of Dr. Denenberg of what a synechium looks like..mine is very similar to this (this is the only pic of it I can find!):


Thank you.

hi,
this forum really is not to give you medical advice, which is near impossible if not frankly impossible to give. it is meant to direct principles of care that i subscribe to in general not specifically. with that in mind,
1. synechia are very rare and not easily treated. they tend to recur unless stented long enough that the raw tissues do not merge again. how long? hard to say. doubtful that is impacting your tip.
2. in general, i am not a fan of steroids, as they can cause some tissue atrophy. i personally prefer 5FU ,which is like a steroid but in my opinion safer. i think steroids work pretty well for scar (as 5fu does) even late in a rhinoplasty. in that case, taping the nose afterward helps. noses can still be slightly swollen at a year.
best,
s.

Just a regular poster here, but I'd like to add that I think Smilebaby's nose (@8 mos and later) look very pretty to me, as they are.

Nord wrote:Just a regular poster here, but I'd like to add that I think Smilebaby's nose (@8 mos and later) look very pretty to me, as they are.

Thanks Nord. I was never expecting that. But are you serious?

My nose looks the worst when it is seen together with the rest of my facial features. Alone, it is a "meh" nose. But when put together with my other rather good-looking features, it sticks out like a sore thumb and throws off my facial harmony dramatically! Ughhhhh.

dr. lam wrote:hi,
this forum really is not to give you medical advice, which is near impossible if not frankly impossible to give. it is meant to direct principles of care that i subscribe to in general not specifically. with that in mind,
1. synechia are very rare and not easily treated. they tend to recur unless stented long enough that the raw tissues do not merge again. how long? hard to say. doubtful that is impacting your tip.
2. in general, i am not a fan of steroids, as they can cause some tissue atrophy. i personally prefer 5FU ,which is like a steroid but in my opinion safer. i think steroids work pretty well for scar (as 5fu does) even late in a rhinoplasty. in that case, taping the nose afterward helps. noses can still be slightly swollen at a year.
best,
s.

I understand and thank you. Where can I get this 5fu administered? What is the full name of this? How is it safer than Kenalog? This is the first time I've heard of 5fu, but I've heard of Kenalog many times. Thank you.

yes, unfortunately, most people do not use 5FU (5-flourouracil) because they do not know about it or how to use it. I like it to reduce scar better than kenalog because it does not have the risk of dermal atrophy. however, if you can't find anyone that uses it, just use very very dilute kenalog and you should be ok.