Rhinoplasty, or nose job, describes a procedure to alter the shape of the nose principally for cosmetic purposes but it can also be for functional reasons too, i.e., for breathing. Dr. Lam has extensive experience in both functional and cosmetic improvement of the nose. Since the nose is a respiratory organ, Dr. Lam also strives to enhance breathing if it should be impaired and to avoid problems with breathing that can arise after poor rhinoplasty. Dr. Lam has a broad experience in both primary (not previously operated on) and revision (secondary or more) rhinoplasty. He has performed many reconstructive rhinoplasties for cancer operations of the nose and has intimate knowledge of both the inside and the outside of the nose. He also specializes in ethnic rhinoplasty for Middle Eastern, Hispanic, Asian, African-American and other ethnicities. Dr. Lam’s recovery following his rhinoplasty is typically short (approximately a week), relatively pain free, and does not involve extensive swelling or bruising in most cases.
- Dr. Lam maintains dual board certification in both otolaryngology-head and neck surgery (ear, nose, and throat) and facial plastic surgery, so he is as concerned about your breathing as well as your cosmetic desires for your nose. He uses very advanced techniques that preserve the architecture of the nose so that not only will the nose look natural and attractive but should remain that way as time progresses. Many over aggressive (destructive) rhinoplasties look good initially and then over time progressively collapse. Dr. Lam has followed his results over 15 years and has maintained excellent cosmetic results over that time period.
- Dr. Lam is very careful for the male patient to maintain a strong nasal profile and a nose tip that is appropriate for a man. Too often rhinoplasty for the male patient has relied on techniques intended for a woman in which the nose is over reduced and the tip is over refined, losing or compromising the masculine quality of the nose.
- Dr. Lam practices ethnically sensitive rhinoplasty that looks natural for various ethnicities. For example, over narrowing an African-American nose does not look natural. Over elevating the nasal bridge for an Asian does not look natural; and, conversely, over reducing the nasal bridge for a Middle Eastern patient looks unnatural. He artistically balances ethnicity, gender, facial features, and your desires to accomplish the best results for you. Further, with thick-skinned ethnicities over reduction of the cartilage of the nasal tip under thick skin can actually promote scar tissue to develop under the skin and thereby make the nose appear even larger. Having extensive experience with all ethnicities, Dr. Lam understands how to avoid this problem.
- There are certain stigmata of bad rhinoplasties that Dr. Lam absolutely must avoid for you that you may not even notice are bad outcomes (because you may not have as much sensitivity to fake results as Dr. Lam’s trained eye). A scooped nose (concave nose) that was popular in the 1980s is unnatural, and Dr. Lam always says “God never created a scooped nose, only man does that.” A nasal tip that has lost the natural dome highlights (two distinct light reflexes that bounce off the skin) is also very unnatural and has been known as a pinched nasal tip. The overturned nasal tip is also unnatural and unattractive. The slit-like nostrils that lose the nasal sill (the part that attaches the nostril to the upper lip) is a telltale sign of bad rhinoplasty. Dr. Lam avoids all the bad techniques that lead to these types of outcomes.
- Balanced rhinoplasty is very important. Balance means that each part of the nose: nasal bridge (dorsum), nasal tip, and nasal sides (alae) are in harmony. For example, if the nasal bridge is over reduced, the nasal tip can then look too large in relative proportion. Based on the natural cartilage structure of the nasal tip, Dr. Lam can only reduce the nasal tip so much. Accordingly, that may limit how much he should reduce your nasal bridge. Similarly, making the alae (sides of the nose) too small can also make the nasal tip appear too large. A balanced approach is critical to create a harmonious outcome.
- Dr. Lam uses 3D Vectra imaging preoperatively to show you how your nose would appear after a rhinoplasty. Although imaging does not provide you a perfect reproduction of your nose after a procedure, it gives you a very accurate portrait of what is possible and provides a platform for discussion and dialogue with Dr. Lam.
What is the nature of the procedure and recovery process?
If you are 18 years or older, Dr. Lam performs your rhinoplasty in his accredited surgical facility under general anesthesia with hand-selected board-certified physician anesthesiologists who have been with him at least a decade if not longer. If you are under 18 years of age, he will perform your procedure a few blocks away at the Texas Health Presbyterian Hospital based on state regulations and guidelines. The procedure typically lasts about 2 to 3 hours but could last slightly longer. You will go home the same day but you need to have a companion drive you home. During that week, you will have a nasal splint on top of your nose that you must keep dry by avoiding showering (you can tub bathe your body or wash your hair in the sink.) If Dr. Lam lowered your bridge, you will have small packs inside your nose for one night that you remove yourself. These packs stabilize the nasal bone but can be painlessly removed at your home the following morning. These are completely different from the painful, long nasal packs of yesteryear. You can even breathe around these tiny packs, and, as mentioned, they only stay one night. Your nose may drip clear to blood-tinged fluid for the first few days. This nasal drip represents your nose not working properly but the cilia in the nose will start to function properly again in a few days and this will stop very quickly. Nasal tip dressings that Dr. Lam provides for you will make this easy for you to tolerate. Typically, Dr. Lam’s rhinoplasties have very little pain following a procedure and very little bruising. He has not seen a lot of swelling, pain, or bruising after his rhinoplasties because he is an efficient and gentle surgeon using very tiny instruments to perform his procedures.
The splint comes off at a week and all sutures (stitches) dissolve over a week or two. You will be able to return to work in most cases after the first week. The tiny stitches that remain are typically hard to see to the casual observer. At night you will have to tape the nose between 1 to 3 months. Taping the nose will help reduce swelling, minimize swelling that may occur in the morning, reduce the risk of scar tissue under the skin’s surface, and speed up the result of seeing the refinement to the nasal tip. Depending on your skin thickness Dr. Lam will instruct you how long to tape the nose at night. For the first few days after the splint comes off, you should wear the tape if you are resting at home. Otherwise, just wear the tape at night. If you miss one or two nights of taping that is not a big deal. Dr. Lam will provide you with the tape and show you how to do it. He has an instructional video on YouTube and on his website if you forget (just search “how to tape a nose after rhinoplasty Dr. Lam”).
Can I wear glasses after a rhinoplasty?
If your nose bridge was worked on, then the answer is no for a period of about 6 to 8 weeks. However, Dr. Lam will provide you with a flesh-colored, very comfortable headband at no extra charge, which allows you to support your eyeglasses or sunglasses on your nose bridge without creating damage to your rhinoplasty. If you begin to wear your glasses again after the first 2 months and you see some skin indentation beginning to occur, you should wait another two weeks and try again. Contacts are acceptable any time from the very first day of surgery forward.
When can I work out after my procedure?
Contact sports should be avoided for 3 months. Swimming should be avoided for 6 weeks. You can begin to work out when the splint comes off (at a week) but please use your judgment about how you feel so that you don’t fall down or bump your nose. For example, if you run outdoors, Dr. Lam is concerned that you may fall and hurt your nose even though the likelihood is low. Take it slowly and go for a casual walk and then bring yourself back up to full speed in a gradual fashion, listening to your body all the while.
Does Dr. Lam make any external incisions on my nose?
Yes, the columellar incision (an inverted V-shape in the skin between your nostrils) is very tiny and should heal to the point of imperceptibility. He uses dissolvable sutures that are very hard to see even at a week following the procedure. He has found that dissolvable sutures actually heal tremendously better than removable sutures. Dr. Lam prefers to perform an “open rhinoplasty” in the majority of his rhinoplasties because it offers him unparalleled view of the nasal architecture and thereby permits very precise changes to the nose rather than working in a blind pocket. Second, it permits him to have structural cartilage grafting in which the grafts are fixed in place rather than blindly tucked into pockets. This allows for much more predictable outcomes in his rhinoplasty results. The sides of the nose (nostrils) called the alae (ala, singular) can also be reduced with external incisions. The key is that Dr. Lam uses very precisely controlled incisions that are well hidden and retain the natural curve of the nostril rim. However, these incisions can require more work postoperatively with dermabrasion and possible scar dissolver injections at times to ensure optimal outcomes.
For Asian rhinoplasty, what techniques does he have to raise my bridge?
In the past, Dr. Lam used “one-piece” silicone implants that extended down from the nasal bridge to the nasal tip. However, these implants, albeit easy to insert, raised the nose bridge too much, made the nasal tip appear unnatural (too pointy), and had occasional problems of infection and extrusion. It has been well over a decade since Dr. Lam performed his last silicone nasal implant. (Interestingly, silicone is a wonderful material for chin augmentation.) Dr. Lam always performs a so-called “two-piece” augmentation: one for the nasal bridge and one for the nasal tip. For the nasal tip, Dr. Lam always uses one’s own cartilage, usually from the septum of the nose. For the nasal bridge, Dr. Lam has two methods to augment it. First is Gore-Tex. Gore-Tex provides a simple and natural augmentation to the nasal bridge. Unlike silicone that shrink wraps excessively and over elevates the nasal bridge, Gore-Tex is very natural in appearance. Alternatively, Dr. Lam uses fascia (the lining of the muscle from one’s temple) to wrap both ear cartilages that are in turn finely diced and placed into the fascia “burrito”, which is then inserted into the nose. The ear cartilages are harvested from the concha (the bowl near the ear canal) from behind, so this cartilage will never be missed and there will not be a visible incision in front of the ear. Behind the ear, the incision also heals very well. This technique allows what is known as an “all-natural” augmentation in which no foreign material is used. Dr. Lam can discuss with you the pros and cons of each method more precisely as it relates to your situation. In general, he does not use rib cartilage for Asian rhinoplasty because the nose is too stiff and too high. However, he has used rib cartilage for Asian revision surgery in which insufficient cartilage is present in the septum and in the ears.
Can Dr. Lam perform an injectable rhinoplasty?
Yes. Dr. Lam uses micro cannulas that are very safe to virtually eliminate the risk of tissue compromise or necrosis that can occur with aggressive needle injection of products into the nose. Injectable rhinoplasty can work well as an expedient and less expensive alternative to surgical rhinoplasty in patients who desire a slightly elevated nasal bridge but not much tip modification or for someone who would like to mask a small nasal hump (larger humps are very hard to mask with injectable rhinoplasty). Dr. Lam uses exclusively hyaluronic acid, which is temporary, but performed repeatedly over time can be semi-permanent. It can last upwards of a year if not longer with a little loss initially even after the first few weeks. In general, Dr. Lam does not like to perform injectable rhinoplasty in patients who are seriously considering surgical rhinoplasty, as it can develop scar tissue under the skin making rhinoplasty less ideal.
How often does Dr. Lam want to see me after a rhinoplasty?
You will see Dr. Lam one week after your rhinoplasty then at a month, 3 months, 6 months, one year, and then yearly thereafter. If you are coming from out-of-town, then you will only see Dr. Lam one week after your procedure. Thereafter, Dr. Lam recommends to come in a few months later only if you can to check on your results but this visit and subsequent visits are not mandatory and do not follow any strict timetable. The reason Dr. Lam follows patients yearly is to observe small changes that occur over many years, some favorable and others that would benefit from some office-based injections. Dr. Lam would like to make small adjustments in the office as needed at no charge to ensure that your rhinoplasty will age well over your lifetime.
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