The Rhinoplasty Expert

This is variable depending if you are doing a primary (first time) or revision (multiple time) rhinoplasty since the latter is technically more involved. Dr. Lam charges a very fair price for the level of quality of his work. We do not publish pricing on the internet but would be happy to answer your question regarding the price of his rhinoplasty should you email or call us at the office.

This is a hard one to answer but generally after one week is usually safe. The nasal bones are relatively set then and the tip has begun to create improved scar tissue to hold all the tissues together. However, if someone is a violent sleeper who tosses and turns, then possibly two weeks would be better to ensure no risk of changes to the nasal bones. You can ask Dr. Lam what would be applicable for you.

Rhinoplasty takes between 3 to 4 hours and possibly longer for revision rhinoplasty cases. Dr. Lam undertakes a very sophisticated rhinoplasty procedure that takes time to perform correctly, but he does not take an inordinate amount of time to perform the procedure and he is a very gentle surgeon, meaning typically you should have a much shorter recovery time than elsewhere.

This is variable depending on a lot of factors. Generally speaking, the major swelling and possible bruising should be resolved in the first 7 to 10 days. However, there could be residual bruising that lingers even though most times Dr. Lam does not significantly bruise most of his patients. With a revision rhinoplasty there can be more persistent swelling even for several months where the nuances of the result are not entirely obvious initially. Usually after a week Dr. Lam allows you to return to exercise so long as there is no risk of contact sports (which should be withheld for 3 months), swimming or dirty water exposure (which should be withheld for 4-6 weeks) other than showering (which can start after the splint comes off at a week). Most individuals look socially acceptable by 7-14 days and most patients take only a week off from work. In terms of major social events, perhaps 2 to 3 weeks would be safer.

Dr. Lam does not take insurance. However, if you have a functional or reconstructive component he is happy to give you his records to submit for possible insurance coverage but almost all of his rhinoplasties are mainly cosmetic in nature, which insurance would not cover. He fixes the functional component as part of the procedure without additional payment.

Yes and no. It all depends on what you value in life. But the nose is the central part of your face and a great rhinoplasty can be life changing and confidence boosting. As Dr. Lam always says, “A great rhinoplasty goes undetected but only enhances the beauty of your eyes.” An unattractive nose is something that draws unwanted attention, whereas a beautiful nose disappears allowing a viewer to concentrate on the beauty or handsomeness of the face.

Generally, that is unlikely if you follow the instructions given by Dr. Lam and his staff. Only under extreme trauma would nasal bones be reset or the tip seriously hurt. Nevertheless, the precautionary measures outlined in Dr. Lam’s postoperative instructions should be followed to minimize this risk.

There will be a component that will fade in days to weeks and a portion that will last months to even years. The problem with liquid rhinoplasty is that it oftentimes builds up scar tissue under the skin leading to a potentially more difficult rhinoplasty, so Dr. Lam suggests to avoid liquid rhinoplasty or to minimize the times you undergo this procedure if you are seriously considering surgical rhinoplasty. Further, liquid rhinoplasty does not work tremendously well in the nasal tip but mainly on the nasal bridge and lacks the predictability and longevity along with the superior results compared with surgical rhinoplasty. Nevertheless, Dr. Lam performs safe and aesthetically pleasing liquid rhinoplasty quite often and will help guide you on your aesthetic goals, options, and desired results.

Generally speaking, there is not a lot of pain following Dr. Lam’s rhinoplasty procedure. This is oftentimes surprising to most individuals because rhinoplasty is considered very painful elsewhere. The number 1 reason Dr. Lam believes his noses do not hurt is that he does not use the large packing in the nose that is very uncomfortable used in other clinics. In addition, he uses very small instruments and is very delicate in how he addresses a nose, so patients do very well with minimal discomfort in most cases. The only exception is that if ear cartilage must be harvested, the ear is typically sore, especially when you sleep on that side for the first couple of weeks. Dr. Lam uses a long-lasting anesthetic that knocks down the discomfort significantly during the most sensitive part of the first few days if he must harvest ear cartilage.

Generally speaking, you should wait 6 weeks before wearing glasses following rhinoplasty. However, Dr. Lam typically will give you the splint you used during the first postoperative week so that you can easily wear prescription or sunglasses on the bridge using the splint to protect the nose. He also has a specialized headband that you can wear with a hook to hold your eyeglasses if you prefer. After 6 weeks he encourages you to make sure that there is no visible dent and if there is you would need to wear the splint on for 1-2 more weeks until you no longer see any indentation while wearing your eyeglasses.

Typically, you can gently blow your nose after a week. Prior to that time, you should only be using nasal saline sprays to gently clean the nose. However, after a week, you cannot firmly grab the nose with a tissue and blow. It would be a very gentle blowing or better yet you should continue to just use saline drops to clean the nose and wait for at least two weeks. You should consider no aggressive nose blowing for one month.

Yes. There should not be any issue with eating after a rhinoplasty. However, you may have some nausea for the first 24 hours or slightly beyond that period of time and should wait until it passes before you begin eating. You should try to start with liquids and progress to larger meals as you feel up to it.

The most important thing to reduce swelling after rhinoplasty is choosing the right surgeon. Dr. Lam is an expert at rhinoplasty, so his gentle hand and efficient method truly minimize swelling compared with other places. That being said, the tape and splint further help reduce swelling after surgery. The things you can do to reduce swelling is avoid all workouts/exercises for a week and after that to only exercise moderately without a lot of Valsalva (bearing down like when having a bowel movement) or upside-down movements (like downward-facing dog in yoga) to minimize swelling. If you see any uptick in swelling from any activities, then you should consider refraining from those activities for an additional week. Further, a really good anti-inflammatory diet would be helpful minimizing salt intake, processed/fast foods, gluten, while optimizing nutrition from healthy green juices and vegetables. Also, taping your nose at night for the first 1-2 months, as Dr. Lam shows you, can help you reduce swelling on your nose when you wake up and result in a better long-term outcome with less scar tissue in the subcutaneous tissues (under the skin).

Generally, you should refrain from all exercises and workouts for a week. As mentioned above, you should minimize Valsalva (bearing down like when having a bowel movement) or upside-down movements (like downward-facing dog in yoga) thereafter until you see that those activities do not lead to swelling. You can lift weights though and workout after the first week so long as you do not risk traumatic injury from overaggressive working out or contact sports for 3 months. You should avoid swimming for 4 to 6 weeks.

Most likely, you will be able to breathe immediately after the procedure even if you had breathing problems before surgery, as Dr. Lam corrected your nasal breathing issues. However, if a clot forms in your nose and there is dried blood there, then you may have a stuffy nose for the first week after surgery. Also, nasal tissues can swell and also lead to engorgement and difficulty breathing. However, Dr. Lam does not use large packing in the nose so you should be able to breathe from the very beginning if you do not have any dried blood or excessive swelling in the nose. He does use a small piece of cotton to stabilize the nasal bones if he does osteotomies (bone breaking), but you should easily be able to breathe around it. In fact, even with this tiny piece of cotton, you will probably breathe better than before surgery if you had a prior problem with breathing before surgery.

Your smile is typically not affected following rhinoplasty. However, if Dr. Lam performed a chin implant at the same time, sometimes you will feel as if your smile is slightly not as full or natural for the first 7-10 days because he has to place the implant under the mentalis muscle, which takes time to re-heal.

That is all relative depending on your expectations and whether you had a revision or primary rhinoplasty. With a revision rhinoplasty, you can have swelling that is mild or moderate, lasting even weeks and slightly for months. With a primary rhinoplasty, oftentimes most major swelling is down after 7-10 days. Nevertheless, there could be residual bruising for 7 to 14 days but rarely longer. Also, there is still minor swelling that can last weeks if not months. That being said usually, you are generally socially presentable in 7-14 days in most cases.

Dr. Lam uses a “caudal septal extension graft” that holds the nasal tip to the septum so that it is precisely positioned and does not drop. In the old days, which the majority of surgeons still perform, a free-floating piece of cartilage called a “columellar strut” was used and the nose had to be overcorrected by a few millimeters in anticipation for it to drop after a week or several weeks. The problem with this older technique is the unpredictable nature of the ultimate nasal-tip position. Sometimes it does not fall enough and other times it drops too much. Dr. Lam does not like the imprecision that this method has on the nasal-tip position, so he has abandoned it now for many years.

Usually, the nose tip will feel numb for the first 4-6 weeks and the tip will become progressively more sensate, i.e., you can feel it more, after this time. That numbness could last longer, but in most cases any temporary numbness should be resolved around that time.

Scars are permanent but should be almost invisible to the naked eye after it heals. Typically, Dr. Lam’s incisions are only noticed if you stare underneath the nose a few inches away and you are trying to find the scar. Even then it can be very hard to detect. He does not use any straight lines meaning your brain will have a very hard time finding when it heals. The scar typically becomes much less obvious after a month or so but can be very hard to detect after a few months with ultimate healing after 6-12 months of time.

Dr. Lam uses stitches inside the nose to hold the sculpted tissues where they need to belong. The outside stitches to close incisions will be between the nostrils and sometimes along and around the nostril depending on what type of rhinoplasty he is trying to perform. Please visit the other parts of the website that describe the nature and positions of his incisions to understand that better. All stitches (or sutures in medical speak) used are dissolvable. Dr. Lam does not believe in using permanent sutures inside the nose because not only are they unnecessary but they risk an infection showing up even years after surgery, which would be otherwise difficult to correct.

The two nasal bones that are broken are on either side of the midline. Dr. Lam typically will perform osteotomies (bone breaking) medially (near the midline) and laterally (where the nose meets the cheek) on both sides of the face for a total of 4 osteotomies. With a very crooked nose, he may need 1 to 2 more osteotomies known as intermediate osteotomies to further straighten a broken bone or a deviated nasal bridge.

First and foremost, the candidate who is the least ideal for rhinoplasty is someone who is psychologically not suited for rhinoplasty. That person may have unrealistic expectations of the surgical result or expect that the nose will someone change one’s life in a way that is not possible. For example, some individuals may think that the only reason they are not finding a spouse is due to their nose and if they cannot find one after the rhinoplasty then they may blame themselves or the surgeon for a failed procedure when that is most likely not the case. A good saying is that motivation for rhinoplasty really should come from “inside” and not “outside”. In other words, individuals who are seeking rhinoplasty should be wanting it because they think it would be a good procedure for them rather than somehow to change outside circumstances in their life, e.g., spouse, job, etc. Also, a small percentage of individuals who seek rhinoplasty may suffer from body dysmorphic disorder (BDD), which is an over obsession with a body part in disproportion to the problem at hand so much so that they cannot go out in public or engage in social/professional life. It is important that if you are experiencing any of these issues that you seek guidance from a psychologist or psychiatrist before even contemplating having a rhinoplasty. Besides psychological issues, Dr. Lam always emphasizes that some anatomy is harder to achieve excellent results. Usually very thick skin and weaker cartilages are not as ideal for rhinoplasty. However, this combination is oftentimes found in ethnic noses, which Dr. Lam specializes in, so he oftentimes can still attain very good results with the right expectations and the right technique. During a formal consultation with Dr. Lam he can give you better advice as to your suitability for rhinoplasty so that he can adjust your expectations for the results of the procedure.

As mentioned above, Dr. Lam does not use large packs in the nose but at times very small cotton pieces that despite how small they are may still lead to some temporary bleeding upon removal. If that is the case, some Afrin spray will help stop it or simply just waiting a few minutes. Wearing the cotton “drip pads” taped to the bottom of the nose after removal of the cotton piece can catch any of the blood from soiling your clothing.