shinangel Posted September 5, 2009 Share Posted September 5, 2009 Is there no follow-up???!!! Link to comment Share on other sites More sharing options...
asiangirl Posted September 6, 2009 Share Posted September 6, 2009 shinangel, out of curiosity i just took a look at dr. lansangan's page, and wow! i'm even more thankful that you mentioned him, because if i had seen his page, i would have been completely fooled. he has a numerous amount of very good "after" photos! whether photoshopped or not, i have to admit it looks like he is a very good surgeon. i have heard from both dr. carlos lasa, and dr. lorenzo. it was very surprising, because they actually e-mailed me back within 5 minutes of each other. dr. lorenzo seemed very kind in his e-mail, and i probably need to be kicked for this, but he scored some bonus points in my book since he included bible quotes at the end of his e-mail. (i must be a sucker, yes.) anyway, dr. lasa told me that he would not be able to e-mail me any photos of his work to protect the confidentiality of his patients and that i will have to fly out to the philippines for a consultation. right now, i'm leaning toward dr. lorenzo, but either way, i'd be spending $700 for a flight out to the philippines. Link to comment Share on other sites More sharing options...
asiangirl Posted September 6, 2009 Share Posted September 6, 2009 shinangel, out of curiosity i just took a look at dr. lansangan's page, and wow! i'm even more thankful that you mentioned him, because if i had seen his page, i would have been completely fooled. he has a numerous amount of very good "after" photos! whether photoshopped or not, i have to admit it looks like he is a very good surgeon. i have heard from both dr. carlos lasa, and dr. lorenzo. it was very surprising, because they actually e-mailed me back within 5 minutes of each other. dr. lorenzo seemed very kind in his e-mail, and i probably need to be kicked for this, but he scored some bonus points in my book since he included bible quotes at the end of his e-mail. (i must be a sucker, yes.) anyway, dr. lasa told me that he would not be able to e-mail me any photos of his work to protect the confidentiality of his patients and that i will have to fly out to the philippines for a consultation. right now, i'm leaning toward dr. lorenzo, but either way, i'd be spending $700 for a flight out to the philippines. Link to comment Share on other sites More sharing options...
asiangirl Posted September 6, 2009 Share Posted September 6, 2009 shinangel, i also just looked at your before and after photos. the after result actually doesn't look so bad. i can tell from studying it, though, that one nostril is smaller. i can totally understand what you mean when you say your implant shifted, too. i am vietnamese also, and your nose looks similar to mine. here are my before and after photos from my US surgeon. the two pictures on the left side (side B) are my before pictures, and the two pictures on the right side (side A) are my after pictures. i don't know what happened, but the implant kind of curves at the tip. i also don't think i needed that much height added onto my nose. it just looks very fake. i think when i do my revision, i will get the implant removed and just fix the tip combined with the alar reduction.http://asiangirl84.zooloo.com/uploads/photo/25513_20090906_CR-YeqH3yaxkQ.JPG Link to comment Share on other sites More sharing options...
sandy816 Posted September 7, 2009 Share Posted September 7, 2009 hello everyone found this on dr. lasangan(spelling?) site. "however there is growing evidence nowadays on the deposition of calcium crystals on a prolonged implant (red arrow). The crystals causes nasal bridge irregularity and in one study (Kim et.al) shows evidence to be pre-carcinogenic, suggesting to change the implant every 20 years similar to breast cohesive gel implants."http://www.shimmianmanila.com/side-effects-of-silicone-implant is this true? omg... also with gortex, i heard that the implant eventually shrinks. as much as 40 %.. is this true as well? thanks for any input! Link to comment Share on other sites More sharing options...
foxycleopatra Posted September 7, 2009 Share Posted September 7, 2009 Hey guys, does anyone know if ALAR PLASTY can change the shape & positioning the nostrils (with respect to the tip) from the type on the leftmost girl to the type on the center....... Right now my nose tip & nostrils resemble those of the girl on the very left....but I really want the down-ward pointing tip of the girl in the center (Pan Chen, one of top 10 Super Girls '09, basically the Chinese version of "American Idol"). I've done a lot of facial analyses of photos (of people I consider attractive) and thought about what best fits my face....and it truly is that type of downward-pointing tip that works. But to go from the typical Asian tip/nostril (e.g. left-most girl) to the DOWNWARD-POINTING TIP of the girl in the middle.....is that where ALAR-PLASTY comes in?? Is there some way to reduce the size of those two little "tabs" on the left & right-hand side? Does it also involve adding extra cartilage to the tip to make it droop more? (that's sort of like Dr. Tseng's aesthetic, except more drooping than he adds....but I heard that he actually adds a layer of silicone to the columella area/bottom of tip to achieve that droopy look.....and that sounds really suspect to me in terms of long-term safety....can't risk artificial implants in the tip area, only bridge/top portion and all autologous cartilage for the tip portion). BTW here are more photos of the DOWNWARD-POINTING TIP on that girl I just had my rhino 2 weeks ago (I-shaped silicone, with ear cartilage for tip) and have been quietly (but impatiently) waiting for the results to show. For some reason I recovered extremely quickly and didn't experience excessive swelling (just a bit, more of asymmetric swelling from week 1 to week 2....that has since subsided). Well, in terms of the silicone implant selection & placement and bridge & side profile.....it's fantastic.....the bridge and side profile (and basically the nose MINUS the tip) turned out almost exactly the way I dreamed of. I'm soooo glad I went with the 5mm implant and didn't opt for a lower implant or conservative change. 5mm made the difference that I wanted; yes in some photos now I do look a tiny bit Eurasian (just a bit), but I have no complaints about that as I definitely look better post-op than pre-op. I'd probably opt for even higher, i.e. 6-7mm implant, with goretex if I have to get a full revision later on. HOWEVER, I still despise my tip and nostril positioning.....and think I'll have to get alar-plasty and/or possibly tip-plasty re-done later.....unless some miracle happens in the next 6 months, which I highly doubt. My family thinks I'm crazy though, as does my surgeon.....but I had a truly specific look in mind and don't want to settle for less. I love my bridge the way it is now and really want to avoid tampering with that for the time being (who knows, a revision could screw that part up), so I'm wondering if it's possible to get alar-plasty and/or tip-plasty revision while keeping the silicone implant intact (or do surgeons handling revisions insist on revising everything and replacing the implant)?. I just really regret not going full out and getting alar-plasty when I got my rhino......in retrospect it seems that changing the nostril shape from circular to oval (typical of Caucasian noses) and reducing the size of the nostrils (even just a small reduction in size) can make a drastic difference. Case in point is the Vietnamese girl's nose on Dr. Toriumi's website.....he modified the shape of her nostrils and it obviously affected the tip and projection. According to all the surgeons I'd consulted alar reduction was "not really necessary" for my case and it would be my prerogative whether to add that option......but to obtain a truly truly beautiful nose (not just an above-average nose) I think I needed to go all-out and not hold back. Link to comment Share on other sites More sharing options...
foxycleopatra Posted September 7, 2009 Share Posted September 7, 2009 That website has some truly horrific photos of silicone implants gone wrong.....but it seems that most are L-shaped implants which are prone to extrusion (not I-silicone ones with tons of cartilage underneath for the tip). When I email-consulted with Dr. Charles Lee and asked him about silicone implants and calcification, he wrote: "The modern silicone implants don't have the same problems such as calcification or translucency as before. Both gortex and silicone are very good, and the material is not as important as the shape of the implant. I will keep in mind your concerns; they both can be very permanent. With silicone, small holes can be placed so there is tissue ingrowth into the silicone implant; and if placed above the covering of the bone, there is not as much resorption of the underlying bone." Hopefully that info is reliable...... BTW I have to say that Shimmian Manila website's bottom ad photo (scroll to the bottom of that page) is pretty bad, if that's their standard of "beauty" or a beautiful nose..... .....I showed my surgeons this photo as an example of the bulbous nose tip that I definitely wanted to avoid. Link to comment Share on other sites More sharing options...
foxycleopatra Posted September 7, 2009 Share Posted September 7, 2009 Ok that photo didn't show up, but here's the comparison of the different nose tips......the girl on the left vs. the girl in the center (photo 1), and then girl on the left vs. girl on the right (photo 2). Link to comment Share on other sites More sharing options...
shinangel Posted September 7, 2009 Share Posted September 7, 2009 Hey, asiangirl! I looked at your pics, and your nose was iniatially already quite high, I must say. I agree with you that it didn't need to be augmented that much. What kind of implant did you get? Link to comment Share on other sites More sharing options...
cottoncandy77 Posted September 7, 2009 Share Posted September 7, 2009 Thanks shinangel. Since im very unlucky i think i will buy some insurance XD Anyhow. Im hearing so many things about implants and how badly and frequently extrusion happens. Now im thining seconds about getting an implant. I probably only want to get ear cartilage graft then. What do you guys think? I have a very small bridge but i just really hate my tip and dont mind a higher bridge but im scared of extrusion. Im very very unlucky when it comes to operations. Link to comment Share on other sites More sharing options...
knkk Posted September 7, 2009 Share Posted September 7, 2009 Unfortunately, all man-made implant materials have their downsides. What you said about gore-tex is true (as far as what I've read) and so is the calcification of silicone. Although, as foxycleopatra said, I've recently read something that says that modern silicone supposedly doesn't have this problem with calcification. Personally, I'd like to believe it to be true but I'd need more convincing. I think rhinoplasty using any sort of materials let it be synthetic or natural e.g. ear cartilage or rib will perhaps give long-term result but not permanent-last-a-lifetime sort of result since each material pose its own disadvantages. But then again, I could be really really wrong. I've only made my comment based on my own research. Link to comment Share on other sites More sharing options...
cersepn Posted September 7, 2009 Share Posted September 7, 2009 I haven't posted here in a long time but felt the need to seeing the amount of potentially false info spread, not by posters here but gasp, doctors. First and foremost, you have to realize that doctors will always say things to support what they've been consistently doing for a looong time. Not only that, it makes _alot_ more sense to use a rhinoplasty method that is cost-effective and easy (both for the surgeon and patient). What am i driving at? Simply put, silicon/gortex may not always be the best material for rhinoplasty. But obviously, your doctor who's been handling foreign implants his entire medical career isn't going to tell you that. And because potential problems that might occur with rhinoplasty usually tend to surface only after a couple of years, it is much more difficult for the patient to go back to the doc and complain about it - after all, people expect a nose job to last a long time. They might even think it's just their luck that the implant deviated/extruded on its own, since the doc, who is usually the only source of info, told them right from the start that silicon is 100% safe with very low complications. I might come off sounding totally anti-foreign implant, and i don't deny that. Yea, this is the asian nose job thread, but ever wonder why silicon/gortex is almost never used in caucasians (not that the majority of them needs a higher nose bridge, but for certain odd cases with no bridge) yet used in asians with moderate success? It is cos asians have much thicker nose skin. Think about that further -- the silicon bridge is exerting a tent pole effect (your nasal skin being the tent; implant being the pole). And the only reason why asians tolerate implants better is cos the skin is thicker so as to withstand that pressure. Isn't that scary? This is the exact reason why almost all good doctors still using silicon as their primary material use septal/ear cartilage together with the implant, to not only add definition to the tip, but prevent that tent-pole effect. The problems with using silicon are intrinsic to the material itself - there is no way around it by superior rhinoplasty skill. Just do a search on "silicon calcification" and you'll find plenty of supporting evidence. The implant does not, and will never, integrate itself as part of your body; it is always a foreign part. I have a lot more to say but am quite tired now. Hope you guys understand where i'm coming from. I just hope that for everyone contemplating a rhino, your first rhinoplasty will be your last Link to comment Share on other sites More sharing options...
john1 Posted September 7, 2009 Share Posted September 7, 2009 a couple points so readers get the FULL information. first, i think you need to differentiate between an L-shaped and I-shaped silicone implant. most surgeons these days use an I-shaped implant on the bridge and cartilage on the tip. so the "pole" is cartilage not silicone. silicone is on the bridge where there is not nearly as much pressure so to speak. as for the calcification and lack of permanancy, i would agree with those points tho i do not know very much about that. second, it would be helpful if you were to discuss the alternatives to man-made implants. cartilage has its downsides as well and there are just not many surgeons who use cartilage on asian noses. ear cartilage is likely not permanent either as it has a tendancy to warp. and if it warps its very difficult to correct. so if you want to risk having a permanently bumping bridge then ear is for you. as for rib it can warp too and is also difficult to correct, there are only 2 rib surgeons that i know of. i have heard DISASTER stories about toriumi and there are basically no patient testimonials about shahs results. so though it is undeniable man-made implants have their downsides, cartilage implants have theirs too and are also not necessarily permanent and have the added risk of being very difficult to correct if something goes wrong down the line. Link to comment Share on other sites More sharing options...
john1 Posted September 7, 2009 Share Posted September 7, 2009 to add further, the REAL reason caucasians dont use silicone/goretex is because they have sufficient SEPTAL cartilage that can be used. plus as you mentioned, caucasians usually want to reduce their bridge, not add to it! septal is the best to use but unfortunately asians have too little. for my surgery, the first thing the doctor checked was septal but i didnt have enuf for my tip let alone for the bridge. so i had to go with silicone. its that simple. no conspiracy there. Link to comment Share on other sites More sharing options...
cersepn Posted September 8, 2009 Share Posted September 8, 2009 john1: Ear cartilage is never, ever used for the bridge; it is only used for tip work. The structure is such that it can't warp - it's kinda like minced meat lol. "most surgeons these days use an I-shaped implant on the bridge and cartilage on the tip. so the "pole" is cartilage not silicone. silicone is on the bridge where there is not nearly as much pressure" <- Honestly, if you've read medical literature (i had the privilege, courtesy of college's subscription!), most silicon work out there is still L-shaped silicon. And seriously, no. The real world, especially in places like thailand, still uses a lot of implant only, without any added cartilage. Though the better docs like dr lee do use the implant + cartilage approach, it is still not widely adopted. "silicone is on the bridge where there is not nearly as much pressure so to speak."<- Yea, you're right. I missed out this part. In fact, it's precisely cos the implant is on the bridge that makes things even more dangerous. The bridge CAN be quite mobile. I have friends with silicon noses and it can move. The reason why the silicon implant can stay rather stationary without wobbling about is cos right before the insertion of the implant, the doc is supposed to scrape the inner lining (periosteum of the nose) to remove some tissue, so after the implant is put in, scar tissue will grow back around the area and help to keep the implant in place <- That's the really layman explanation of it; the actual article was a lot more technical and i can't remember the exact words used but the intended meaning is there. Rib can warp, but the occurence is very low in the hands of a skilled surgeon. Warping happens when the cartilage is trimmed/augmented into an unnatural shape or cut against the natural 'grain' of the cartilage. I think you missed my point about caucasians + foreign implants. What i was trying to put across is that the same foreign implant in an asian can hold up relatively well compared to caucasians -only- because of the nasal skin type. I really wish i could put up some of the rhino medical articles here but i can't; my college has some way of preventing the articles from being saved. Doctors have in time past tried to use silicon for rebuilding caucasian noses in time past and the results were terrible, with extrusion occuring very soon post-surgery. For the rare caucasian without a tall and strong nose, why would he/she have septal cartilage to work with when they don't even have good nose bridge/definition. Obviously they won't. Again, i'm only talking about caucasians without a caucasian nose. I understand that you came from having a silicon rhino done so maybe that's why you feel more compelled to 'speak up' for that method. I'm not saying -everyone- who has silicon/gortex done is definitely gonna get complications, but the risks are real. Yes, it's sad that not many doctors in the west are not well-versed with rib/autologous rhino; but in korea/taiwan, the trend is increasingly towards rib/autologous. Which i think, is a good thing. Link to comment Share on other sites More sharing options...
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