Asian Rhinoplasty FAQs
How is Asian rhinoplasty different from other types of rhinoplasty?
The goal of Asian rhinoplasty is generally the opposite of Western rhinoplasty. Whereas rhinoplasty for the Caucasian is typically intended to reduce a nose that is too large, Asian rhinoplasty is designed to augment and increase the size of the nose. Even nasal tip refinement techniques that work well for the Caucasian nose simply will not work in the majority of Asian patients and also lead to problems. The Asian nose tends to have much thicker skin, weaker cartilages, a lower nasal bridge, and wider, flared nostrils. In some Asian noses that exhibit qualities similar to the Occidental nose, Dr. Lam employs a combination of techniques (Western and Eastern) to achieve the ideal results.
What method does Dr. Lam use for enhancing the Asian nose?
The most important element in any rhinoplasty is achieving harmony. Harmony means that the relative size of the bridge of the nose, the tip of nose, the sides of the nose, as well as the entire face are all in proportion to one another. The absolute size of each part of the nose is not as important as how each part of the nose relates to the other. For example, if you believe that your nasal tip looks too big, part of the reason is that your bridge may be too small. Balancing the bridge and the tip can help achieve a more harmonious and thereby create a more attractive looking nose. Dr. Lam performs all of his rhinoplasty in his own surgery center under general anesthesia. He uses a technique known as open rhinoplasty in the majority of his cases in which a tiny, inverted v-shaped incision is made between the nostrils in a part of the nose known as the columella. This incision has healed uniformly in all races, including African-Americans. The only external incisions that heal more slowly are the ones that are found on the outside of the nostrils to reduce their size and shape. This type of nostril reduction is discussed below. There are two methods by which Dr. Lam can augment a nasal bridge. He can either use your own tissues or Gore-Tex. For the nasal tip, Dr. Lam always uses your own natural cartilages. If you prefer to use your own natural tissues he takes fascia (lining of the temporalis muscle) from the temple area using an incision inside the hair-bearing area to harvest the fascia to wrap finely diced cartilage taken from your ear cartilage to build up your nasal bridge. If you prefer Gore-Tex, unlike a solid silicone implant, Gore-Tex cannot be seen through the skin in certain lighting and tends not to shrink-wrap like silicone does that would leave an artificial look to the nose. Also, because it is softer, it does not feel hard like a silicone implant does. Gore-Tex is lighter in weight and tends not to shift downward like silicone can. The major advantage of using your own tissues over Gore-Tex is that some individuals prefer to use their own tissue over a “foreign material”. The major advantage of Gore-Tex over fascia-wrapped cartilage is cost savings. Dr. Lam can discuss with you the pros and cons of each method more in detail during your personal consultation. For your nasal tip, Dr. Lam always uses cartilage, typically from the inside of your nose, known as your septum, to raise, shape and support your nasal tip, but at times may also need to use ear cartilage. The natural question is if he removes cartilage from your ear will you miss it? The simple answer is no. It is taken just in the area called the concha near the ear canal from an incision behind the ear, so you will not miss it and your incision should be well-hidden. He believes that this combination provides the most natural results that are possible both in terms of how your nose looks and how it feels.
Will Dr. Lam make my nose too high and fake looking?
No, the older style silicone implants, especially the harder ones, not only looked unnatural but felt unnatural. Many surgeons in Asia and the United States have made nose bridges for the Asian too high and unnatural. Dr. Lam has a different set of aesthetic rules he follows when designing the Asian nose bridge than standard Caucasian measurements. Using digital imaging can help establish what your goals are in terms of tip and bridge shape and height.
Does Dr. Lam perform silicone implants?
He did in the past. However, he has found that even the softest silicone implants are still too heavy and too hard to permit the most natural looking results. Having lectured at major meetings on Asian rhinoplasty, he has discussed this issue with numerous other respected colleagues and they have come to the same conclusions as Dr. Lam. At times silicone implants can work well, but Dr. Lam does not want to take a chance that it will not. He simply does not use silicone anymore.
I have a silicone implant, and I want it removed. Can Dr. Lam perform that procedure for me?
Yes. Actually, silicone implants are extremely easy to put in and to remove. Removal of a silicone implant typically only requires 2 to 3 minutes under local anesthesia. In most cases, Dr. Lam charges only a modest cost to have your silicone implant removed. However, it is not always safe to remove the implant as the nose could shrink upward after removal. Dr. Lam will have to evaluate you personally to determine your candidacy for removal or whether a simultaneous rhinoplasty would not need to be performed, which would be a more expensive endeavor.
My nose is a reddish color after my silicone implant. Can Dr. Lam fix that problem?
Removal of the implant may or may not help with this condition. This peculiar result that occasionally occurs with a silicone implant is why Dr. Lam now does not use silicone implants anymore. Laser therapy may help to reduce the red color. After an evaluation with Dr. Lam, he can help guide you as to whether removal of the implant, laser therapy, or both may be recommended in your case.
Does Dr. Lam perform rib grafting to the nose?
Generally, no. He has performed rib grafts to reconstruct noses and ears and has published his method on nasal rib grafting in the prestigious journal, Plastic & Reconstructive Surgery. However, he prefers not to use rib grafts in most cases for nose enhancement for three reasons. No matter how small the chest incision is to remove the rib, there is still a visible scar. Second, rib grafts are very hard and do not feel natural. The nose is divided into three parts: the upper third of the nose is hard and fixed, the middle third of the nose is semi-mobile, and the bottom third of the nose is very mobile. The rib graft that occupies the upper two-thirds of the nose tends to be very rigid in the way it feels and looks, which is unnatural. Finally, some studies have shown that rib grafts can warp and change shape over a period of months to years. For all of these reasons, rib grafting is not Dr. Lam’s preferred method for Asian rhinoplasty.
Does Dr. Lam just perform cartilage grafts to the entire nose?
Generally, no. He does not like native cartilage for the bridge of the nose for several reasons. First, the Asian nose lacks sufficient cartilage to build the bridge of the nose smoothly. Using ear cartilage for the nose bridge may lead to a bumpy and unsmooth result. Dr. Lam has had to perform extensive revision procedures in many patients who have had these kinds of grafts. Dr. Lam specifically reserves cartilage grafts for the nasal tip. Interestingly, even the way that he grafts the nasal tip with cartilage is very different for the Asian versus the Caucasian.
How does Dr. Lam narrow a nose that is too wide?
Dr. Lam first of all needs to establish how every part of your nose works together, so-called harmony (discussed in a previous question.) In many instances, raising the nasal bridge and the nasal tip can re-establish harmony so that you do not need to reduce the sides of the nose. Dr. Lam has developed many of these original ideas in his definitive textbook, Cosmetic Surgery of the Asian Face. If Dr. Lam believes that reduction of the sides of your nose is appropriate in your case, he will discuss with you the various methods he has to reduce the width of the nose. It is important to remember that the incision on the sides of the nose for nostril reduction will most likely be somewhat visible even for several months following the procedure. This incision takes longer to completely heal. If you look at over-reduced noses like Michael Jackson’s, you will notice that the sides of the nose after reduction reveal two major attributes that appear unnatural: the shape of the nostril flare has been straightened, which looks unnatural, and the nostril looks cut off where it attaches to the face. Dr. Lam uses a specialized technique to avoid both of these problems, which he will discuss with you in detail during your consultation.
How does Dr. Lam correct a deficient premaxilla (the area under the nose at the point where the nose joins the lip)?
The premaxilla is the bony area right below the nose, where the central nose meets the upper lip. This area is at times deficient in the Asian nose. A deficient premaxilla can lead to a gummy smile, i.e., too much gum showing when you smile. In the past, Dr. Lam used larger silicone implants to correct this deficiency. However, some patients can actually feel this implant when they smile or move their mouth. For these reasons, Dr. Lam prefers your own cartilage instead.
What kind of anesthesia does Dr. Lam prefer for Asian 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.
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. Of note, Dr. Lam does not accept any kind of insurance.
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 kind of recovery is involved with the procedure?
Recovery after rhinoplasty is very mild and quick. The extensive bruising that you may have seen on television shows like Extreme Makeover simply have 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 makes the fact that they had surgery more obvious 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 more patients are comfortable being seen. 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 the minor amount of 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 small 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.
What if I still what my nose higher after the procedure?
Dr. Lam sees you throughout the year following rhinoplasty. If you should desire some minor modifications to your nasal bridge, Dr. Lam can easily raise your bridge slightly using micro-droplets of silicone at no extra charge. Surprisingly, silicone micro-droplets are very safe compared with a solid silicone implant. Dr. Lam will discuss with you about these options during the time of your consultation.