LAM FACIAL PLASTICS

Hi dr lam..

I can't stand the thought of getting a revision on my nose, especially when i don't think my nose is bad at all and the only reason why i woudl consider a revision is because I would like to add a tiny bit more height and to make my nose a little bit straighter.. in other words my nose is fine the way it is exept it has a slight curve in the middle of the bridge which i would like to straighten to make it look a little taller... For ur info I had a L silicone, and a septal cartilage graft to make my nose pointier.

My questions for u are:

1. Are there A LOT of risks involved in a revision if all i need is to switch implants with another one to make my nose taller and straighter?
2. Do L silicone have a higher rate of extrusion through the tip then a regular I silicone?
3. If I decide to go for silicone droplets, on top of my silicone to fix the slope, what happens if i one day for whatever reason need to take out my silicone? what happens to the silicone droplets since they're permanent?
4. What are the risks involved with micro droplets on top of silicone and how much can be added at a time? I need about 2 mm
5. can u create a tiny bit more columella with the droplets?

Can I do consultation and the surgery same day? And could u pm me the quotes per ml and let me know the mm equivalency?

Again I hate to put permanent things in my nose incase somethign goes wrong u can't really do anything about it. But I know u wouldn't recommend anything that u don't think is safe for me..

just pm'ed you pictures for u to view,

thanks for your time!

my responses are in all caps following your queries:

1. Are there A LOT of risks involved in a revision if all i need is to switch implants with another one to make my nose taller and straighter?

I AGREE IF WE CAN AVOID THAT, THAT WOULD BE BETTER. THERE IS ALWAYS RISK WITH REVISION PROCEDURES. NOT NECESSARILY VERY HIGH BUT VERY REAL. I ALWAYS THINK LESS IS MORE IF POSSIBLE.

2. Do L silicone have a higher rate of extrusion through the tip then a regular I silicone?

YES, BUT I HAVE SEEN THEM HOLD FOR 30 PLUS YEARS SO DON'T GET OVERLY CONCERNED ABOUT THAT. YOU SHOULD CONSULT WITH YOUR SURGEON REGARDING THAT MATTER. I ALWAYS DO NOT LIKE TO COMMENT ON SOMEONE ELSE'S WORK.

3. If I decide to go for silicone droplets, on top of my silicone to fix the slope, what happens if i one day for whatever reason need to take out my silicone? what happens to the silicone droplets since they're permanent?

USUALLY, THE SILICONE IS SO MINOR THAT THERE IS NO PROBLEM. HOWEVER, YOU THEORETICALLY MIGHT NEED MORE SILICONE TO BALANCE THE PREVIOUS WORK IF YOU UNDERGO AN IMPLANT REMOVAL OR REVISION.

4. What are the risks involved with micro droplets on top of silicone and how much can be added at a time? I need about 2 mm

SILICONE CAN ADD ABOUT 1 TO 2 MM IN GENERAL. THERE IS ALWAYS A RISK THAT INJECTING SILICONE ON TOP OF A SOLID SILICONE IMPLANT COULD LEAD TO AN INFECTION OF THE ORIGINAL IMPLANT. I HAVE NOT SEEN THAT BUT YOU ASK ABOUT A RISK.

5. can u create a tiny bit more columella with the droplets?

USUALLY, NOT WELL. SILICONE ONLY WORKS TO A LIMITED EXTENT IN THE TIP. IT IS BETTER FOR BRIDGE ELEVATION. HOWEVER, I HAVE PLACED IT IN THE TIP TO CORRECT RETRACTION OF THE SIDEWALLS OF THE NOSE.

Can I do consultation and the surgery same day? And could u pm me the quotes per ml and let me know the mm equivalency?

GENERALLY, THAT IS A BAD IDEA WHEN IT COMES TO NOSES. AT LEAST A PHONE CONSULTATION IS BETTER. IF IT IS JUST FOR SILICONE DROPLETS THEN THAT WOULD BE MORE FEASIBLE. HOWEVER, HERE IS THE TRUTH AFTER ALL OF YOUR QUESTIONS. I REVIEWED YOUR PHOTOS AND WOULD BE HONEST AND SAY YOUR NASAL HEIGHT IS ABOUT RIGHT FOR YOUR FACE AND NASAL TIP. I DON'T REALLY THINK IT NEEDS TO GO MUCH HIGHER. THE OTHER ISSUE IS THAT IF YOU RAISE THE BRIDGE TOO HIGH THE TIP WILL START TO LOOK TOO SMALL. EVERYTHING SHOULD BE IN BALANCE. ALTHOUGH ALICIA KEYS IS BEAUTIFUL SHE IS NOT YOUR ETHNICITY AND HAS DIFFERENT FACIAL FEATURES SO I WOULD NOT JUST USE HER NOSE AS A MODEL. THE COST OF SILICONE DROPLETS IS 700 PER ROUND. USUALLY YOU NEED 1 TO 2. IT IS NOT CHARGED AS AN AMOUNT BUT AS A SESSION BASED ON SAFETY PARAMETERS.

Again I hate to put permanent things in my nose incase somethign goes wrong u can't really do anything about it. But I know u wouldn't recommend anything that u don't think is safe for me..

I WOULD ONLY PERFORM SAFE PROCEDURES AFTER APPROPRIATE CONSULTATION REGARDING RISKS, BENEFITS, AND LIMITATIONS.

best,
sml

I had 4mm put in my nose and i think the middle of my nose is curved inwards too much and that's why i wanted to straighten out my nose which will make it look a little higher but the main thing is to have my nose straighter by adding height in the middle to even it out.. If I add 1 or 2 mm how would this affect the tip? U mean the nostrils would be pulled closer together and the tip woudl be pointier?

ALso, within what timeframe would my silicone implant be infected by the silicone droplets? or is this indefinite? if so, how would u go about correcting this?

Actually, what you are asking then is rather reasonable, i.e., just to straighten the bend out a bit in the center of your nose. I thought you were looking for a lot more height to the bridge. It should not affect your tip. Either way, nothing pulls the tip. What I meant was the size of the tip becomes relatively smaller compared with a larger bridge, and therefore appears smaller. A little in the center is okay.

Infection is pretty darn rare with injection but always possible. If it happens, it will happen almost immediately within a few days. But don't panic about this. It is very unlikely. I am very sterile when I do this.
best,
sml

Even though it is rare, there is a possibility.. what woudl u do if it does get infected within days..? Can u remove the substance together with the implant? And let's say my implant gets infected.. when I remove it can i replace it with another implant at the same time same day or do u have to wait?

Another quesiton about infection.. if ur implant gets infected for no reason does that mean ur body cannot handle implants or should u give it another try with a new implant? and is there a way to prevent/stop an infection once it happens with anti-biotics? if so will the infection go away most of the time or is there only a 50/50 chance? And last.. what are some early symptoms of infection? I tried to look it up but it doesn't say it anywhere..

If I'm gonna go with the silicone droplets i'll probably want 1mm on the entire bridge to increase the total heiht by 1mm, then add another layer of 1mm in the middle (that becomes 2mm in total in the middle to fix the bend), will this make a noticable difference in height and can this be done in 1 visit?

Thanks

MY RESPONSES ARE IN ALL CAPS:
Even though it is rare, there is a possibility.. what woudl u do if it does get infected within days..? YOU WOULD HAVE TO REMOVE THE IMPLANT. Can u remove the substance together with the implant? NO, THE SUBSTANCE DOES NOT GET INFECTED. THE SOLID IMPLANT DOES. And let's say my implant gets infected.. when I remove it can i replace it with another implant at the same time same day or do u have to wait? NO, BECAUSE THE AREA IS INFECTED. YOU WOULD HAVE TO WAIT A FEW MONTHS.

Another quesiton about infection.. if ur implant gets infected for no reason does that mean ur body cannot handle implants or should u give it another try with a new implant? NO, IT IS RANDOM. and is there a way to prevent/stop an infection once it happens with anti-biotics? USUALLY NOT. IT NEEDS TO BE REMOVED. if so will the infection go away most of the time or is there only a 50/50 chance? And last.. what are some early symptoms of infection? REDNESS, TENDERNESS, SWELLING. I tried to look it up but it doesn't say it anywhere..

If I'm gonna go with the silicone droplets i'll probably want 1mm on the entire bridge to increase the total heiht by 1mm, then add another layer of 1mm in the middle (that becomes 2mm in total in the middle to fix the bend), will this make a noticable difference in height and can this be done in 1 visit? POSSIBLY. EVERYONE'S PERCEPTION IS DIFFERENT. IT MAY TAKE TWO ROUNDS.

Hi dr.Lam, i just emailed my doctor and he advised against getting a revision if 'm already satisfied with my results, and i am i just want a little bit more height in the middle of my nose so going through a whole revision just to straighten up my nose seems too much and too risky so I am very interested in the silicone injections but before i go furhter into that i want to ask u a few more questions...

1. Normally without the implant the silicone droplets would be between ur skin and bone right? But with my implant the silicoen droplets would be on top of the implant and under the skin?

2. If an implant infection does occur and it gets removed.. how would the nose shape look like with the silicone liquid? would my bridge have irregularities?

3. If the silicone liquid inside if your nose itself gets infected how would u go about removing liquid silicone if it's already permanently attached to ur skin?

I feel like I really want to correct that bend just to get a straighter nose but don't want to completely mess up my nose just because i'm greedy

my answers are in all caps:

1. Normally without the implant the silicone droplets would be between ur skin and bone right? But with my implant the silicoen droplets would be on top of the implant and under the skin?

CORRECT.

2. If an implant infection does occur and it gets removed.. how would the nose shape look like with the silicone liquid? would my bridge have irregularities?

USUALLY NOT, AS I HAVE REMOVED VARIOUS IMPLANTS AFTER INJECTING SILICONE AND HAVE NOT SEEN THAT. HOWEVER, YOU COULD HAVE A SLIGHT RAISE IN THE CENTRAL REGION REQUIRING A FEW DROPS TO BALANCE IT OUT BETTER.

3. If the silicone liquid inside if your nose itself gets infected how would u go about removing liquid silicone if it's already permanently attached to ur skin?

SIMPLY PUT, YOU CANNOT. SOMEHOW LIQUID SILICONE HAS AN INCREDIBLE RESILIENCE TO INFECTION. IN THE "OLD DAYS", 1960S AND BEYOND, SILICONE WAS DRAWN UP FROM A BUCKET AND INJECTED WITHOUT PROPER STERILE TECHNIQUE AND STILL THERE WERE NO INFECTIONS, AT LEAST IN COMMUNICATION WITH MULTIPLE PHYSICIANS WITH WHOM I HAVE WORKED AND WHO HAVE DONE IT FOR THAT LONG A TIME. DON'T WORRY: I USE ONLY SILIKON 1000 FROM ALCON LABS AND I CAN SHOW EACH BOTTLE THAT I PURCHASE FROM THEM. PLUS, I AM SUPER CLEAN WHILE DOING THE INJECTION.

REMEMBER THERE ARE A LOT OF PRODUCTS OUT THERE THAT SIMPLY MASQUERADE AS A PURE SILICONE FILLER. THERE ARE ALSO REALLY BAD INJECTORS WHO DO SILICONE BUT DON'T DO IT RIGHT. I FIX BAD "SILICONE" LIPS ALMOST EVERY WEEK. SAD TO SAY.

BOTTOM LINE: YOU HAVE TO MAKE A SAFE CHOICE FOR YOURSELF. I AM NOT HERE TO CONVINCE YOU EITHER WAY.

best,
sml

Dr Lam,

Are you able to inject silicone drops into the tip as well to raise the height or only the bridge?

really only the bridge. the tip just does not move forward with silicone.