Rhinoplasty FAQs – (Rhinoplasty Frequently Asked Questions).
- Does Dr. Lam specialize in rhinoplasty?
Dr. Lam’s entire training and a large part of his clinical practice are dedicated to every aspect of nasal enhancement and nasal correction from aesthetic rhinoplasty, revision rhinoplasty, complex nasal airway correction, ethnic rhinoplasty, traumatic nose reconstruction, and reconstruction of a partially or totally absent nose from skin cancer. As the nose is first and foremost a functional organ, a specialized surgeon who understands the intricacy of both the internal and external anatomy is mandatory to achieve a great aesthetic outcome that preserves or enhances the airway and breathing.
- What is Dr. Lam’s preferred technique for rhinoplasty?
There are two major approaches to rhinoplasty: closed and open. Dr. Lam prefers open rhinoplasty that employs a small inverted-v incision in the area between the nostrils known as the columella. This 2-mm incision line heals extremely quickly and seamlessly and is barely or not even perceptible under close inspection, even in ethnic and African-American skin types.The reason for Dr. Lam’s approach is the unparalleled access and visualization of both the nasal tip and the entire framework of the nose, permitting him to achieve excellent precision that may not always be possible with the closed approach, which is essentially a blind technique. As superior rhinoplasty depends on accuracy of millimeters and fractions of millimeters, Dr. Lam believes that open rhinoplasty permits the most accurate ability to achieve optimal results. Although this method does require an additional 30 minutes of operative time, Dr. Lam truly considers that the extra time and effort are worth it for his patients.
- What kind of anesthesia does Dr. Lam use for rhinoplasty?
There are three types of anesthesia levels that are possible for cosmetic procedures: local anesthesia, sedation, and general anesthesia. (Local anesthesia refers to no sedation, just injection of a fluid anesthetic into the tissues to numb them. Sedation usually refers to an intravenous method of making you sleepy in conjunction with local anesthesia. General anesthesia requires a breathing tube for the procedure.) Dr. Lam prefers general anesthesia in almost all of his rhinoplasties for several reasons. As rhinoplasty requires a level of precision of millimeters and fractions of millimeters, Dr. Lam uses general anesthesia so your movements during the procedure do not compromise the success of your outcome. Second, a little bleeding in the throat that occurs during the procedure will not make you cough or worse unfavorably enter your lungs. For these two reasons, Dr. Lam believes that general anesthesia is ideal for rhinoplasty. Most of Dr. Lam’s rhinoplasties only require about one and a half hours to complete. Occasionally, for difficult revision rhinoplasty (corrective nose surgery), he may take up to 3 hours to complete the work. Even with general anesthesia, you will rest and recover in the privacy of Dr. Lam’s surgery center for about an hour before your discharge home. As rhinoplasty is a relatively short procedure, all surgeries are entirely outpatient, that is do not require hospitalization.
- How does Dr. Lam perform ethnic rhinoplasty?
Dr. Lam is very sensitive about all types of so-called “ethnic rhinoplasty” including Hispanic, Asian, African-American, and Middle Eastern. Each type of rhinoplasty requires a very good understanding in the differences in the anatomy of the nose as well as the aesthetic expectations for each individual patient.Some ethnic rhinoplasty involves reduction of a nose that is simply too large for the ideal harmony of the face. This kind of nose is most often encountered in the Middle-Eastern patient. At times to achieve the ideal result, chin augmentation may be necessary to provide overall balance to the face. Digital imaging is particularly important to establish with each patient how much the nose should be reduced to achieve the desired effect. In most women of Middle Eastern descent, nose reduction would most likely benefit from reduction of the nose until a more feminized contour is established. In some men who want to maintain their ethnicity or more masculine profile, a more conservative profile reduction may be indicated. Again, digital imaging technology provides the most accurate method of communication between you and Dr. Lam to ensure that your objectives are mutual and aligned.At times, the nose may be too small for the face and require augmentation of its size. This type of anatomy is frequently encountered in the Asian and African-American noses. In these cases, Dr. Lam typically uses a material known as Gore-Tex for the bridge of the nose and cartilage grafts for the tip of the nose. Gore-Tex implants permit a seamlessly smooth result along the bridge without the problems that have been encountered with silicone implants in the past, e.g., visibility through the skin, falling down the nose, and shrink wrapping around the implant. Dr. Lam believes that there is simply not enough cartilage in the ear and the nose to achieve a smooth bridge result without this kind of soft implant. Although rib grafting is an alternative method, rib grafting requires a chest incision but more importantly, can make the upper and middle nose too stiff and unnatural feeling. In addition, rib grafts over time can begin to warp and shift over a period of 10 to 15 years.The Hispanic nose is also very different and may have some Caucasian and Oriental features owing to the melting pot known as the Mestizo nose. The Mestizo race refers to the amalgam of Caucasian features (from the Spaniards and Portuguese who settled into Central and South America), African-American features (from the slaves that circulated throughout the Caribbean basin in the past) and Oriental features (from the indigenous Indian/Native American populations who originated in Central and South America). For these reasons, the goals, methods, and results will vary based on the confluence of the possible presence of these different races.The African-American nose is oftentimes characterized by a broad and flat nasal bridge, larger nostrils and a broader and flatter nasal tip. Cultural and ethnic sensitivity is always paramount when deciding what would be ideal attributes for each individual patient. At times the larger African nose may be suitable for some men but may be less so in the African-American female population, as it may serve to masculinize the face. A careful discussion about your anatomy and desires will help Dr. Lam truly understand what would be the best techniques for you. Although some African Americans desire reduction of larger nostrils, Dr. Lam always judges the entire nose as a unit and as part of the face to determine the effect of overall harmony in his decision-making process. For example, if the bridge is relatively small, the tip of the nose can be made to be more in balance with augmentation of the nasal bridge. With the rise of intermarriage between the races, many individuals may exhibit a combination of many of these attributes that require a very personalized evaluation and consultation with Dr. Lam to determine which method and/or methods would be most suitable in your case. Part of the evaluation involves carefully touching your nose to feel the skin and cartilage thickness so that Dr. Lam can determine the best techniques for you.
- Does insurance cover any part of the cost for my rhinoplasty?
Dr. Lam does not accept insurance of any kind.
- Does Dr. Lam do corrective work in rhinoplasty (also known as revision rhinoplasty)?
Given Dr. Lam’s extensive work with aesthetic and functional restoration of the nose, he regularly performs revision rhinoplasty. Revision work occupies a large part of Dr. Lam’s clinical nose practice, involving complex cosmetic and airway problems or a combination of both. During a consultation, he can establish with you what exactly are your concerns regarding your previous rhinoplasty work as well as any related breathing problems. If your nose is largely cosmetic reconstruction due to prior rhinoplasty, Dr. Lam does not submit this kind of case to the insurance company and you will be expected to pay for this procedure as an elective cosmetic operation. However, if your nose was broken or damaged from prior accident and even if you have undergone prior rhinoplasty to correct this procedure, Dr. Lam may elect to submit this kind of surgery based on your individual case. A consultation with Dr. Lam will help establish your eligibility.
- What kind of pain and discomfort should I expect after rhinoplasty?
Surprisingly, there really is little to no discomfort with rhinoplasty. Most patients report having no discomfort at all. The worst experience that patients have reported in the past is packing the nose or putting so-called splints in the nose for a night or for several days, which can be very uncomfortable. Dr. Lam does not use any packing at all so your experience is very pleasant.
- What is the recovery for rhinoplasty?
Recovery after rhinoplasty is very mild and quick. The extensive bruising that you may have seen on television shows like Extreme Makeover simply has not been observed in Dr. Lam’s patients. Most patients have little to no bruising, and swelling is very mild in most cases. The rare bruising that is encountered can be easily diminished within 48 hours with Dr. Lam’s specialized laser therapy that he can undertake when the splint is removed at 7 days if necessary at no additional charge.
For the first week, you will need to wear a flesh-colored plastic splint on your nose in almost all cases except when only the tip of the nose is worked on. Even with tip-plasty work, Dr. Lam still prefers to tape the nose for the week to minimize swelling and to ensure uniform and even healing. You will be asked to keep your nose relatively dry during showering (like tub baths and leaning your head back in a sink or in the shower) to lessen the chance that the splint becomes wet and falls off before the week is over.
You will also be given all your care instructions and care kit without extra charge that will involve typically placing a small “moustache” dressing under the nose to catch mild nasal dripping for 1 to 3 days. When the small amount of dripping stops, you can remove the tiny dressing under the nose.
At the end of the week following surgery when you come in to see Dr. Lam, it is advised that you take a good, warm shower for at least 5 minutes in duration in order to soften the hold of the splint on your nose or encourage the splint to completely fall off by the time that you arrive at Dr. Lam’s office. Dr. Lam at that point will remove the external nose sutures and remind you of any pertinent care instructions.
Most patients take one week off from work or school since they will be sporting a splint that week, which obviously makes the fact that they had surgery more conspicuous to the casual observer. Surprisingly, after the splint is removed the cosmetic improvement can already be clearly seen. Even though there is still lingering swelling, most patients feel very comfortable to re-enter the public eye. By the end of the second week, a large percentage of the swelling has subsided to the point that even a greater percentage of patients are truly comfortable being seen in public. As mentioned, however, most patients find that a week off from work is sufficient.
Remember that rhinoplasty takes at least a year and beyond for all of the remaining swelling to completely resolve. Dr. Lam will walk you through photographically the minor degree of changes that occur after rhinoplasty 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. These minor changes are typically imperceptible to the casual observer but you will probably notice the minor improvements as each week passes.
Although you may return to light physical exercise, you should not engage in more vigorous activity for 2 weeks total following your surgery. Contact sports should be deferred for a minimum of 6 months to lessen the chance of an unfavorable injury to your enhanced nose.
- Does Mederma (onion extract), Strivectin, or Vitamin E oil work to help improve the appearance of my incision?
Dr. Lam does not believe that any of these remedies work to help a scar mature well. In fact, rigorous scientific studies that have involved blinded, prospective, randomized, split scar analysis (in other words, good and controlled scientific research) have indicated that these treatments provide no improvement at all in an incision or scar. In fact, Vitamin E oil has been shown actually to worsen wound healing in some cases. In the past, Dr. Lam used Vitamin E oil to help with wound healing. However, with recent evidence to the contrary, he no longer believes that any of these topical ointments do any good to help with scar healing.
If you have Rhinoplasty Questions please Ask Dr. Lam in the Rhinoplasty Forum.