LAM FACIAL PLASTICS

Dear Dr. Lam,

I've had an L- shaped silicone nose implant put in when I was 17, and that was 27 years ago! Needless to say, I need to take the silicone out because I can see the skin is thinning out at the tip. I would prefer not to have any implant at all, but after so many years with silicone, would my nose look deformed without a replacement? Do you suggest replacing the silicone with goretex for the bridge and septum cartilage for the tip? Thank you.

this is a tough situation. if you have had it that long and it is actually creating tension on the skin tip itself then the implant is quite large and probably causing thinning not just of the skin above but of the tissue below on the cartilage itself. i would almost definitely say there would be some level of cartilage impairment and even bone erosion. accordingly, my opinion is that it would be much safer to do a formal revision rhinoplasty removing the implant and looking at what damage lies below. a gore-tex implant to the bridge with cartilage AND fascia from the temporalis to thicken the skin probably would be required because the cartilage graft probably would be visible afterward. you might then need a few drops of silicone if there is any residual skin envelope deformity that remains down the road like several months to a year later. hope that makes sense.

Dr. lam, thank you for the quick reply! Will you be able to tell during consultation how bad my situation is?

yes and no. i cannot see underneath the skin to see what is happening with your cartilages and bone until i open the nose and look there. however, if the skin is being tented out and thinned it gives me an idea already that the implant is relatively large and causing pressure changes to the surrounding tissue and probably has done a similar thing to the underlying cartilage and bone structures.

Dear Dr. lam,

I was lucky enough to secure a consultation appt for this coming Friday with you. I really need to take care of this asap because i'm really feeling the pressure of the implant the past few days. Is it even remotely possible for you to perform a revision asap as within the next week or two?

i think a revision is not only possible but necessary given what you are describing to me. i will see you friday. if things worsen in the short run, let me know and i will try to see you faster but i can't promise you that.
s.

Dr. lam,

After you remove the implant, will you do the revision immediately or do i have to wait for the nose to heal first? Sorry if I'm being annoying by asking too many questions.

immediately