LAM FACIAL PLASTICS

Dr. Lam,

Many say that Michael looks better now in his new picture than he has in years and I tend to agree as some of his pictures in the 90's were scarey.

The link to that picture is:
http://www.abcnews.go.com/Entertainment ... id=3838071

I was curious as to how someone makes that transformation. The obvious answer is plastic surgery but what specifically takes place surgically/cosmetically to acheive that result?

hi,
interesting question. given how bad his nose looked recently, there are not many options to make it look that good. here are 4 options that may have occurred:
1. Photoshop! the magazine could have simply morphed the image until it looked presentable both to them and to Michael. That, of course, is the most obvious and straightforward answer.
2. He had a standard revision nose but this is very hard given the fact the entire skin of his nose is shrunken down and to expand it back to accommodate a larger graft of some kind (there can't be much left except rib grafting) is not easy if not impossible. If the skin still had some elasticity, he could have had an extended spreader graft to bring his nose tip down and alar rim and alar batten grafts to support his collapsed sides of his nose.
3. Honestly, if I had a chance to rebuild his nose, I would take the entire skin off and rebuild it with a forehead flap as you see in my patients who have had cancer. Ideally, I would use some rib cartilage and ear cartilage to rebuild his nasal tip but blood supply could be compromised from so many surgeries and he may lose that blood supply to the graft over time. Fortunately, the forehead flap is well vascularized so that helps. He basically may have had this procedure done. Surprisingly, the forehead tissue provides an almost identical tissue and skin match for the nose.
4. He may have had the whole nose amputated and a nasal prostehsis affixed. This makes the most sense but psychologically can obviously be the most devastating. A nasal prosthesis affixed to the remaining nasal bone via magnets or clips would actually be the best way to look natural. You can look pretty close up to a nasal prosthesis and not tell that it is a fake nose. Now, we are not talking about the Groucho Marx special with cigar, glasses, and moustache included!