Typically, Dr. Lam will see you approximately one week after the surgery. He asks that you take a warm/hot shower the morning of seeing him at a week postop so that the splint will be more easily removed or will come off. Please bring your splint to the appointment if you are intending to wear glasses for the reasons explained in the recovery section. At the one-week postoperative appointment, he will help you remove your splint if it has not already fallen off, take photographs to record your progress, and show you how to tape your nose to reduce swelling. He will also check your nose for proper healing and look inside your nose to make sure there are no excessive clotting or other issues. If you ever run out of tape for the nose, he would be happy to provide you more or send you more if you do not live close by.
In most cases, it is advisable to tape your nose at night for the first postoperative month. Taping the nose while you sleep will remove the swelling that may occur when you wake up, which would help avoid social embarrassment but also help the nose heal better. Typically, this recurrent swelling diminishes after the first few weeks and is related to lymphatic obstruction (your body not clearing the swelling) as your body heals. In ethnic noses with thick skin, Dr. Lam may advise you to tape your nose at night for the first 2 to 3 months if residual swelling is persistent.
If you live in town, Dr. Lam will typically have you return approximately at 1 month postoperatively for evaluation, at 3 months postoperatively, 6 months, 1 year, then annually thereafter. If you live out-of-town or are traveling from very far away, Dr. Lam will see you when you are available or you can send photos every few months for him to evaluate your progress for the first year. If you are happy with your nose and your progress, there is no need to send in photographs. However, Dr. Lam always likes to hear of your progress. For more details about what you need to know if you are from out of town, please see the section for out-of-town patients.
With rhinoplasty, over weeks, months, and years, there will be changes that can occur, some good and some not so good. On the good side, noses become progressively more refined, especially for thicker, more ethnic skin, that can take up to a year or longer for refinement. This is especially the case in revision rhinoplasty, where the nose may look even slightly swollen for a few months and the “final” result may not even be apparent for a year or more. That being said, noses continue to change over many years. The great thing is that Dr. Lam’s technique for nose surgery today truly preserves nasal function and shape in ways that older methods simply did not. With older techniques noses started to collapse after a few months to a few years but Dr. Lam uses the techniques explained in this website (Rhinoplasty of the Nasal Tip, Rhinoplasty of the Nasal Bridge, Functional Rhinoplasty) that help preserve and enhance the nose. Nevertheless, at times Dr. Lam may see over time some small changes in the nose that may be less than perfect and may benefit from in-office treatments, performed in a few minutes at no charge. For example, if the nasal tip remains slightly too full at a month or two, he may inject a combination of 5-fluorouracial and dilute steroid that help shrink scar tissue under the skin. If a slight deviation is evident in the nasal bridge, he may need to inject a few drops of permanent micro silicone to smooth the nose bridge out. These are a couple of examples that may benefit from Dr. Lam’s assessment and intervention.
With all follow up, Dr. Lam is always open to seeing you with any questions, concerns, or comments. If you feel something may need attention, it is far better to reach out to Dr. Lam and his staff than to ignore the situation and worry that you are troubling the staff with any of your questions. In very rare cases, Dr. Lam must return to the OR to make minor adjustments to your nose. If it is under light nurse sedation for minor rasping, for example, Dr. Lam will not charge you for this intervention. However, if it requires deeper sedation, Dr. Lam will only charge you a modest facility charge to cover expenses but will not charge you surgical fees. Again, this is very unlikely. In over 20 years of performing rhinoplasty Dr. Lam has only had to return to the OR very seldomly.