Finally, a normal looking nose! - Chicago, IL

I had my initial rhinoplasty in 2001 when I was...

I had my initial rhinoplasty in 2001 when I was 23, and while it was an improvement over the old nose, I was never 100% satisfied with it -- the doctor left a hanging columnella and slightly over-rotated tip. In addition, the nose seems still a bit too projected for my (small) face. So after much research and time, I am finally taking the plunge and getting a revision done by Dr. Anil Shah next week! I met with several doctors and his suggestions and imaging best matched what I originally wanted my nose to look like. Updates and photos forthcoming...

I had my surgery yesterday! More details below. I...

I had my surgery yesterday! More details below. I also posted some "before" pics and the photshopped version of expected results from the doctor's office. The "before" one is not terrible, but all plastic surgeons I've visited agree that it looks too "done" and not natural. Note columella hang and alar retraction from first rhino. Also not visible are turbinate reductions in my initial rhino that didn't much improve my (pretty bad) sinus problems, as well as some deviation in the septum that causes the right side to be somewhat obstructed for airflow.

My pre- (one week before) and post-op vitamin routine has been 500mg of vitamin C and 50mg of zinc once a day. I think that has really helped the bruising, my first rhino I had two black eyes for two weeks! Anyway, detailed surgery reviews are below.

Week before surgery
One of the nurses called to review pre- and post-op instructions. So far the staff have been very friendly and informative, despite it being clearly an extremely busy office. I had one more in-person meeting with the doctor four days before surgery to review the surgical notes from my first rhino and to make sure we were on the same page about expectations and outcome. I do not want any surprises this time! It was a brief but good meeting and I felt confident that he could give me the results I was hoping for.


Day of surgery
We arrived very early in the a.m. and I was the only patient in the surgery center during the whole procedure. My nurse (Rommel) was fantastic. He had such a positive attitude and friendly disposition, really important for a nervous patient! Dr. Shah arrived on time, we went over everything once more, they started the IV for antibiotics, and another nurse walked me to the OR. The OR got me a bit scared, plus it was *freezing* but I could see Dr. Shah had posted my photos with his notes on them right next to the operating table, which I really appreciated. A nurse put warming wraps on my legs and the anesthesiologist gave me the stuff. I recall shivering and wondering when it would kick in, and then woke up to Rommel's smiling face preparing me for the recovery room. The heated blanket was amazing! Meanwhile Dr. Shah had visited my boyfriend in the waiting room to tell him that everything went well. I stayed in recovery for about 2 hours, during which the nurses fed me applesauce, juice, and a pain pill even though the pain was minor--mostly sinus pressure and a dull headache. I wanted to talk to Dr. Shah again before leaving, but we had to wait a while for him because he was already in the clinic seeing other patients. However, when he arrived, he seemed very positive, and said everything went smoothly. There had been a chance of having to use ear or rib cartilage but he said he didn't need to do that, and just used septal cartilage for the tip graft. I was VERY pleased to hear that. Also he mentioned there was a lot of scar tissue from the previous rhino, which he removed. So then they wheeled me out, we took a cab to the hotel, and I slept on and off most of the day. My boyfriend was very diligent about doing the 20-min on, 20-min off ice routine. We also had to change my gauze "moustache" a few times because there was a small but steady blood drip. I ate some frozen yogurt (Pinkberry!), chicken broth, and a Naked smoothie. Also took the pain meds every 4 hours, although nose pain was minimal. My throat did hurt a lot though, both from mouth breathing and the breathing tube they used during surgery.

Day 2
I woke up with no nose pain but a very sore throat and some body aches. It's essential to keep cold water and straws around for the throat, and Aquaphor for dry lips. I decided not to take any Vicodin because while being bandaged up is obviously uncomfortable, nothing really hurt. Pain was maybe a 3 on a scale of 10. Both Rommel from Gold Coast and Mia from Dr. Shah's office called me in the morning to get updates on how I was doing. Since there had been no nausea, minimal pain, and only a bit of bruising (under the right eye), they seemed very pleased about the progress. We drove home (90 minute drive) in the afternoon, and I did take a Vicodin for the car ride, assuming it would be unpleasant. Riding in the car was actually fine at first, but towards the last 30 min or so, all the bumps were making me headachy, nauseated, and generally feeling bad. We made it back home and iced me right away, which helped a lot. We've been doing the frozen pea method, which works great. There's been a reasonable amount of bloody mucus in my throat that I've needed to cough up today, but draining on the "mustache" has slowed. It seems to drip more after I've been walking around. Nose pain level is still very low, a happy surprise! Bruising aready changed from purple this morning to more reddish in the evening. Had lentil soup and watermelon chunks for dinner; trying not to eat anything too chewy. Honestly I am just thrilled that I can finally drink coffee again tomorrow :)

More updates to come...

Days 3-6 Nothing too major happening on these...

Days 3-6

Nothing too major happening on these days; pain has been mostly nonexistent except for some stinging/tenderness around the stitches after cleaning with saline solution. The upper lip area feels kind of stiff, and I'm trying not to smile or laugh much, but that can be hard! I've been off the Vicodin except for taking a half-pill on day 3. I'm going to be honest, one of the main reasons for going off Vicodin asap is that the combo of that and antibiotic makes it basically impossible to go "number two"...yeah I said it. ANYWAY so the bruising has improved significantly (now mostly greenish), but my face did still look and feel a bit swollen days 3 and 4. Inside it still feels swollen. I finally put contact lenses in on day 4 and also stopped icing. The past two days my nose has been pretty itchy around the stitches, and I'm getting a lot of tingling sensations on the tip (this should mean the nerves are healing in the tip graft). It also alternates from constantly dripping clear mucous (I had to make another moustache) in the morning to feeling more dry and open in the evening. The doctor's office said all this was normal. They have been really fantastic, calling every day to check on my progress. Overall recovery is going smoothly; day 4 was when I pretty clearly started to feel more like myself again and am feeling better every day.

Cast comes off tomorrow!!

So the cast is gone. Everything around my nose...

So the cast is gone. Everything around my nose area still feels pretty stiff and swollen, and there's some very light bruising. Stitch removal was easy but did make my eyes water a bit because of stinging. The doctor noted that this day is often hard for patients because they want to see big changes but the nose is still very much in the early stages of healing. Since I had a revision rhinoplasty, septoplasty, and tip graft, plus turbinate reduction and removal of interior scar tissue, he said that the trickiness of all that meant it would probably be a month before I would really "love my nose". First impressions do not inspire tremendous love just yet...the front view looks cute, it seems just a bit shorter, thankfully the columella issue is fixed so my nostrils finally look normal (hooray!) and are not the first thing you see, but it's also clearly very wide and swollen. All good. The profile view I'm a bit more worried about, since it looks a bit too projected (like it was before) except with the nicely lowered alar rim. However, I think he said that it can get 50% smaller after the swelling reduces (!?) and that it is 10 times more swollen on the inside than the outside, which is a lot! So I will be a good patient and have patience. :)

Day 10 I posted some new photos. It was so...

Day 10

I posted some new photos. It was so swollen and drippy and sore on cast removal day that I couldn't bear to take any pics. Swelling has subsided only the tiniest bit--- basically it feels like there is an alien appendage on my face. :) Obviously still quite a ways to go with healing. Forgot to mention that I am doing Type 2 taping at night, which seems to help with swelling. Ever so slowly I'm regaining sensation in the tip area, but smiling still feels weird. Overall the nose shape is looking ok, and I'm very pleased with the columella/alar retraction fixes...but the whole thing also looks/feels pretty big yet so I'm hoping to see it get a bit smaller & more refined as time goes on.

Week 3 Had my 3rd week appointment with Dr....

Week 3

Had my 3rd week appointment with Dr. Shah yesterday. He seemed like he was in a good mood and said that everything was healing well. One gets the impression that he gets a lot of complaints about the healing process, though, because he really emphasized how long swelling can last, etc. All of us at RealSelf should know this by now, right? I am trying to be pretty relaxed about it but it was helpful to listen to him spend some time talking about the recovery timeline and its somewhat protracted course for revisions and more complex procedures. This experience has been very different than my first rhinoplasty, and of course the first one was long enough ago that I don't remember as many details. For anyone else considering a revision (or even a first-timer), it's so important to keep in mind that each experience is different and the recovery process is highly variable, depending on the doctor, the complexity of the procedure, open vs closed rhinoplasty, and other individual differences. I try to remind myself of these when reading about other experiences and thinking about my own healing process.

The only real problems I'm having are excessive runny nose in the mornings and when I take walks, and increased numbness & discomfort during walks (haven't been cycling or doing heavier exercise yet). This is pretty frustrating because I can't blow my nose or sniffle too vigorously, but Dr Shah suggested regular irrigation with saline solution. I've sneezed several times and it seems fine if a little uncomfortable, and I try to let the sneeze come out through my mouth, if that makes sense. Tip sensation has improved but has a ways to go, and he doesn't want to do kenalog injections yet. Also, on a couple of days I taped a little too firmly and got a minuscule bump where the tape was. I've been told that all of this is normal and will disappear... sooner than later I hope!


Finally...before I start nitpicking about swelling, tips, perfection, and so on (as will surely happen in the coming weeks/months), I'd like to note that the result so far is natural enough that it's almost too easy to forget how bad it looked before. Look at those photos. My original rhinoplasty was BAD. Even at this early stage in the healing process, I can say with confidence that Dr Shah took my hack-jobbed nose and made it look normal. For that alone I am so thankful and happy.

One month down. Do things get worse before they...

One month down. Do things get worse before they get better? Is it just me or did my nose look better a couple weeks ago? I am definitely in the worrying stage now! It's difficult to notice drastic changes from the past two weeks, mainly because it seems that the size shifts almost daily. I also think that starting up regular exercise has meant that the nose will swell right after working out. Still taping diligently every night (would love any tips on how to make the morning tape removal routine less painful, though!) Taping seems to be working, or at least is better than the alternative...the couple of times I forgot to tape, it seemed much bigger the next day. That said, right now I'm feeling kind of frustrated with the 3/4 view, which is why I included photos of that angle. To me it still looks too projected and dare I say witchy, similar to the way it was before. I worry that Dr. Shah was too conservative. I want the result to be a small, delicate, feminine nose. But of course, there was complex grafting so presumably that area will take the longest to shrink. My skin is pretty fair and thin, so it's unlikely that kenalog injections will be an option to speed that up. However, coming back here and reviewing the post-op timelines of others is helpful. I'm also starting to consider whether another procedure (a chin implant) will benefit and make me feel better about my profile. Right now, though, life is busy enough that there are other things to worry about first. :) Otherwise, and happily, breathing has been much better, tenderness has decreased overall, and numbness is almost all gone.

Hard to believe it's already been two months. I...

Hard to believe it's already been two months. I decided to have a little fun with anonymizing photos and gave myself purple "hair". :) FINALLY, the late summer allergies have subsided so that I don't wake up sneezing 20 times. Swelling is slowly going down. From some angles my nose looks great! From others...it seems a bit projected (especially the oblique view). The tip is still hard though so hopefully that means it will get a bit more refined. I meet with the doctor later this month... and some feedback from him should help with the occasional "worry days" (like the last update). Recently it seems that a small bump on the bridge has been revealed; not sure if this is compensatory swelling from where that area was made smaller, but it does feel more like bone than swollen tissue. I'm not super worried about this, though--if it doesn't disappear, I suspect the doctor can rasp it down without much difficulty.
Chicago Facial Plastic Surgeon

I chose Dr. Shah after years of debate on whether it would be worth it to get a revision, and finally meeting with 3 facial plastic surgeons in various cities. Although Dr. Shah is young, his training in facial plastics, co-authors and mentors, number of publications, and comprehensive website as well as the detailed reviews on realself convinced me that he would be the best choice given my location and needs. Also, his photoshopped version of the expected outcome was the closest to the photoshopped picture I'd made myself and brought in. This made me confident of two important things: that my expectations were reasonable and that he felt capable of fulfilling them. All this said, it's clear he is at a prime stage of his career and trying very hard to keep building his name by taking in a lot of patients. The office can be very busy, and speaking with him sometimes feels a bit rushed, but other times is more relaxed and informative. It's clear that he has a lot of knowledge and takes his work seriously. The staff has been excellent and very quick to respond to questions. I'm still healing, but so far have been happy.

5 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
4 out of 5 stars Wait times
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Comments (21)

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Hi elfgirl, I'm just wondering how you're liking your nose lately and if anything's changed?
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Hi, do you have pictures of your columella stitching. Dr. Shah got rid of my hanging columella too, but I think mine looks a bit odd. I definitely have asymmetrical nostrils now.
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Your nose looks good so far! It is definitely a big improvement, appearance wise. I hope you don't have to have anything rasped down though. Is your breathing still good? How are you feeling?
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Thanks! I am pretty happy with it, although there are some minor issues. The bump is definitely still there, and it seems pretty clear that it's not just swelling. I hope that can be dealt with easily. The tip still feels firm but everything else seems as it should. I haven't spent a ton of time thinking about my nose for the past couple of months, so that's probably a good sign!
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I'm sorry about the bump. Yes, it can be taken care of in the office (I had it done) and the recovery is pretty quick. It sounds like overall, though, things are going well and that is so exciting. It looks great!
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I looked at your pics again, and I think your chin is really cute! If your doc says you've still got swelling, then I bet each month your nose will get a teeny bit smaller! It's really an elegant looking nose right now though, and I think it suits you beautifully !!
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Your nose does look a thousand time better than your original. It's wonderful that the nostrils and columella are gone! Does it take longer for swelling to go down if you have thin skin? (Just curious, my skin is also thin, and my revision is in 5 weeks.) Like you, I also have chin issues, but mine is too large! I want a feminine, much smaller nose, but I know if the doc makes it too small, my chin will look HUGE. In all cases, the size of the chin definitely effects the appearance of the nose. Good luck down the road, and keep us posted!
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Hi-- I hope your rhinoplasty went well! I think the issue with thin skin is that swelling goes down more quickly but imperfections can be more visible, so doctors need to be extra careful. I totally agree with you about the chin issues. Haven't made any decisions about that yet myself, but still thinking...
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How do you feel now? Any news about the bump?
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Just saw this. I understand your anxiety. Hang in there. I think it will change a lot more over time. And I can't get any kenalog injections either, my skin is way too thin. I look at photos and sometimes it's hard to tell how big a change (improvement) there is. And I know for you it's worse since you had a revision. PM me if you want to - I don't check this site that much, but from time to time. And yes, I had the sinus/tear duct surgery.
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Your nose looks awesome!!! It took me like 3 years to see my final results from the first surgery. It could be that way for you too.
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Thanks so much for the support :) I think my doctor is great, but it's terribly difficult to be patient, especially the second time around when you REALLY want everything to go right. Scary to think that swelling could last 3 years though! I just read your story, did you end up getting a revision? Obvs I'm still in the waiting stage but regardless would definitely recommend Dr Shah.
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Glad to see things are going ok for you so far. I am sure the tip will be more how you want as the swelling goes down. Re Dr. Shah, you can always call and see if he's running behind if you don't want to sit and wait (and wait!) for your appointment :). I hope things turn out well for you.
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Thanks, very good tip about the calling ahead, I will definitely do that next time! Hope you are doing well... did you get your tear duct issue resolved?
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Thank you! :D I am definitely happy with the shape but it's still not that much smaller than it was originally...although it's clearly improved since last week. Even knowing that this is super early in the healing process, I had to click on the "worth it" button, if only because the main issues (alar/columella) seem to have been fixed so well. Hopefully all other weird little bumps/swellings/etc will be just a matter of waiting and/or minor tweaks.
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Loved that last little part of your most recent update. So true that it's easy to kinda lose sight of the big picture sometimes. Rhinoplasty recovery can be hard at times, but at least we can be glad that those old noses of ours are now long gone. Yay for our new "Worth It" noses! :p
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Your nose looks great! Now to wait for that damn swelling to go down over time. In my case, the swelling initially made my nose look probably twice the size than it is now... talk about freaky. Haha, it gets better every day, though!
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Hello again! Haha, so I just looked at your story. Didn't even see it posted originally, but I'm glad you commented on my page so that I could read about your experience as well. :) So glad that your recovery has been off to a good start so far. You'll be getting your cast off before you know it! I hope you keep us updated and I'm looking forward to seeing your results soon enough!
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Hey, thanks for reading my story! I love reading about everyone's experiences here, it has helped so much with questions and what to expect and general confidence. Just taking it one day at a time now but have got my fingers crossed for good things next week. Also it's great to see how your swelling reduced so much in a matter of weeks; your 2-month is going to look even better!
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I feel the same way - so glad that this site exists! I knew to expect swelling but I feel like I had it to an extreme... so I hoped that those pictures would help people see how much it can vary from one person to another. Hopefully you'll be lucky in that regard :) I forgot to say before that I think we had the same nurse, too! Loved him.
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Very exciting! Please keep us updated on your progress.

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