Great revision result! - Beirut, LB

I booked my primary procedure with a well-known LA...

I booked my primary procedure with a well-known LA surgeon who visits the Gulf region and has excellent before/afters (and charges extremely high fees)

I went into the original surgery seeking a reduction and a reshaping. My nose wasn't huge but was too big for my face, I also had a small dorsal bump, a bulbous tip and an overhanging collumella, plus a deviated septum. I requested a reduction in projection and refinement of the bridge and tip.

You always hear "if you hate the shape when the cast comes off, then chances are you won't be happy". At the first cast removal, my reaction was unimpressed but held my judgement while I waited for the swelling to go down. By 3 months, the shape had settled - and I wasn't happy; after 6 months I saw no further improvements. The result was not terrible, but it was far from good and especially disappointing given the price paid. The surgeon also dismissed all my concerns, constantly saying it was a great result. The twisted tip was brushed away with the excuse that I had an "exceptionally asymmetric face" (which isn't true). The excess supratip fullness was "swelling" - but it never resolved even after steroid injections - the tip was also hard as a rock with more tissue on one side than the other.The projection hadn't been reduced at all and I was told that reducing was not possible and would widen the nose. (Which is a bit ridiculous given tons of other patients get a reduction in projection)

The final result had various issues including
- over reduced bridge
- under reduced tip resulting in too such supratip and columellar volume as well as too much projection
- convex shape to the tip, very unflattering in photographs and worse when smiling
- visible twisting and asymmetry of the tip (nostril height asymmetry was present before original op, but after the tip was both twisted and off center)
- breathing difficulties
- rock hard tip

I consulted a variety of surgeons for revisions. I had 3 options - either simple fillers to the bridge to balance out the tip, complete reconstruction including grafts to the bridge and alar rims, or simple reduction of the tip. I chose the latter as it was the simplest surgery and shortest recovery (and I am hoping the result holds up over time)

I had a closed rhinoplasty done under local anaesthetic in Beirut, Lebanon. I would have preferred an open operation but my surgeon prefers to do closed rhinos to reduce swelling and scar tissue. Having it done under local was not particularly pleasant as my body is somewhat impervious to both sedatives and local anaesthetics so after the first 15 minutes the sedative had worn off and close to the end of the procedure my nose was starting to wake up - ouch! You can, of course, still feel all the pressure and scraping of the tissue even when you can't feel the pain. My surgeon removed a lot of scar tissue left from the previous op and discovered that my septum was broken!! However, apart from IV paracetamol immediately after the surgery, I did not require painkillers aside from panadol a couple of times a day

I was extremely swollen around the eyes for 4 days post-op - even more so than the primary op. The tip swelling has quickly reduced and by 1 week I was presentable - but the internal healing inside the nose has been problematic. I still have 4 or 5 stitches inside the nose that have not dissolved at 10 days post op and I really feel like these stitches are actually preventing proper healing of the internal wounds, as the skin is trying to heal over and around the stitches. The tip nose is still tender and sore inside and out and there are lumps all around the stitches as well as the wounds not looking like they're completely closed. I also got a small area of skin necrosis on the tip of the nose which is healing fine but will probably leave a small pitted scar that will require subscision or fraxel treatment

Visually the result is looking pretty good. It was not possible to completely correct the asymmetry but the projection and shape are much improved. I am hoping over time the roundness of the tip will reduced and it will become more pointy and refined. My ideal nose is one with a supratip break and I am not sure this will emerge but even so, at the moment I am happy. I might get some fillers to widen the bridge at the 3 month mark.

Please PM me if you'd like to know more about my surgery or my surgeons

Some more pics

Some more pictures to show how my nose ended up twisted and off-center after the primary op. Although I had a slight asymmetry of the nostrils, the tip was straight. After the primary op, the surgeon claimed the tip twisting was due to my 'asymmetric face'.
We didn't correct the tip in the revision it would have required a much more extensive surgery. I might try to camouflage it with filler at a later state

Swelling going down quickly

I guess my doctor was right about the swelling going down more quickly after a closed op. Here is the profile at 13 days

Stitches still annoying!

One of my stitches got infected, making it really sore and tender. I had my friend who is a doc give me an ointment; it's now a lot better. The interior of the nose is much improved but one stitch is still really causing issues and interfering with the healing. I wish I could get it removed! Can't wait til it falls out so my poor nose can heal inside :(

Most of the tip swelling seems to have resolved which is quite amazing after only 4 weeks

I have a small red mark and a pit on the tip where I had skin necrosis :( Will deal with it when it's more healed with filler and laser as necessary!

Will try and post some more pics soon

4 weeks!

So, the annoying stitch came out a couple of days ago and since then, everything has been much more comfortably and the inside of the nose was finally able to heal.

The result is looking good. There hasn't been a huuuge change but the swelling has visibly gone down between week 2 and week 4. The resulting profile is super cute, I'm hoping the tip will get pointier and less rounded, even if it doesn't then the result is still great

As I declined a graft during the revision, I now have to decide whether to get filler in the over-reduced bridge. It will balance the tip, but I will lose some of the turned up look

Love my new nose

Swelling continues to resolve - I love my new nose!!! It photographs wonderfully too. My before pics don't actually show how bad my nose was before revision - at rest it wasn't disastrous but the tiniest hint of a smile and the angle would change and the entire tip was very peak like and turned down. Every time I got photographed I was tipping my nose up and not smiling, desperately trying to find an angle at which it looked ok. No more :)
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Really cute!
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Your revision looks good.
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Thank you for sharing the details. It proves it takes a few, or even more than a few consultations to decide what surgeon to go with. I have wanted to get my nose done since I was 13 years old. I also had a deviated septum and had asked the doctor if he would reshape my nose because I have a pretty good size nose and extra large nostrils. He said, if I had my nose made smaller, than it would be defeating the purpose of taking care of the deviated septum. I was only 20 at the time, and have wished that I went for more opinions. It took a long time to recover from having the deviated septum procedure done, so therefore I have not yet become brave to do it all over again. But, now I am wiser. I am happy that you didn't listen to your first surgeon and did not stop until you were satisfied. Take care.
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Yes, it's definitely important to get a 2nd, 3rd, 4th opinion!! I wish I had done more research and gone with my primary surgeon...probably would have gone with Dr Jaffer Khan or Dr Hossam Foda or Dr Gabriel Saab. There are some great rhinoplasty docs in the Middle East. In the end for the revision I went with Dr Saab as he does many many rhinoplasties. Dr Khan declined to operate and suggested fillers. Dr Rezi said it would be an uncomplicated excess cartilage trim but I didn't like that his afters had no supratip break. FWIW, the revision was a much easier recover and most of the swelling is gone after only 4 weeks. I did have the septum repaired but no bone work in the bridge. The initial swelling was massive but the healing has been much quicker overall
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You really went through a lot. You should be so good to yourself for having such persistency. You never settled. And you look fantastic!! I am much older....53 Ahhh!! I even still want to have it done, but I am just not sure if I swing the cost of the procedure. Maybe, I'll get brave enough like you have been, and just find a way. You take care.
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There are great surgeons in Lebanon and the cost is usually just $2000-$3000. Flight it depends on where in the US you fly from. Hotels are not expensive and some places are hospital/hotels even. Most of the docs are trained in the US, France or Canada Ironically when I mentioned to my primary doc that I was considering jaw surgery for my massive overbite with an Italian surgeon, he warned me not to see any docs that weren't American or US trained. When my Lebanese revision surgeon, Dr Saab, fixed the mess from the fancy US trained LA-based American surgeon. Of course, the best rhinoplasty docs are in Tehran!!!!
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Wow! What an awesome post. And thank you, I will look into how much it would cost to fly to Lebanon. Thank you for the suggestion; much appreciation. Also, that doctor had no right to say such a thing to you. I wouldn't think it would matter in what country you get your education, but I'm thinking it is the integrity of the school in which one attends. Providing excellence in education, passionate profs for their students, and the schools ambition to see that their students succeed. The US are such proud people. They are taught to be. If I could be frank about your jaw line....to me it looks beautiful already. But I do understand how many, many of us feel about our facial features. I guess, we just want to look our best. There's nothing wrong with that.
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Hi bst53grl. If you're not happy about your nose you should do it. But please research your surgeon. Good luck.
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Lovely - looking great !
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Looking great
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Your nose looks great! Thank you for sharing your experience. Happy for you!
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Thanks! I'm much happier with it now. Just hope it holds up over time...!!
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You got a cute nose now. Congrats!
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I think your results are great. I feel like I have a similar nose to yours. Are you Lebanese? I'm hoping to get my columella tucked and my nostrils taken in as my nose is too big for my face. I'm sure your nose will improve everyday!
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Thanks! It looks great on the outside...wish I could say the same for the inside! No, I'm not Lebanese - I'm mixed white/middle eastern. I'm not sure it's possible to reduce the width of the nostrils, though!
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Nostril width can be reduced with an alar reduction: http://www.realself.com/question/Rhinoplasty-alar-base-reduction-definition
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Please post update photos! :)
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