Male rhinoplasty with subtle change to slightly bulbous/drooping nose (using graft) with small hump (osteotomies)

I met with Dr. Bustillo on April 28, 2021, to discuss my concerns that the tip of my nose was a little curved and looked a little swollen on each side of the nostrils. I had my surgery in May of 2019, so by now the swelling on my nose had resolved and this would be the final product.

Dr. Bustillo explained that my nose is not at the center of my face, but rather a little off center. He said there is surgery available to actually break and dislocate the nose from the cranium and reposition it. The dangers of that include cerebrospinal fluid leak, which doesn’t sound appealing. My concern is not the actual position of my nose but just the tip since it’s turned to one side quite a bit. Also, if I knew that the surgery to remove my nose from my cranium was the "best" option for the best results I would have done it from the start. I guess that option was not discussed because the doctor figured the curvature would be fixed with a regular rhinoplasty... I assume.

He offered another solution which includes a minor surgery to remove the natural nasal strips located on each nostril. He said that will make the nose look thinner and might correct the appearance of the curvature. Before resulting to that procedure, he wants to try steroid shots, which I took my first course that day. It has been over two years since my rhinoplasty so my ENT said he’s not sure the steroids will work to correct issues since all the scar tissue is now surrounding the nose and it is all healed.

I have to follow-up with Dr. Bustillo in a couple of weeks to see if there has been any progress from the steroid injections, and get another round of steroids. I really do hope the steroids work because I am not interested in surgery, but if I must I will do it to achieve a better result.

Honestly, I would like my nose tip to be a little higher, my nose tip to be more centered, and my nostrils to look a little less round, but we all dream of things we can't have, huh?

I am currently 14-months post-op and the swelling on my nose is completely gone. The question many of you have asked, “Am I happy with the results?” The answer is, “Sort of.” I will explain why the answer is not a definite “YES!” I had to have another three or four consults with Dr. Bustillo post-op because my recovery was a little slow and I did face some minor complications.
First of all, within the first month of surgery I had Pseudomonas aeruginosa, which is NOT Dr. Bustillo’s fault. To be clear, the CDC website states this bacteria is spread at hospitals. Although Dr. Bustillo has his own facility to do surgical procedures (which is gorgeous and spotless), I used an outpatient hospital facility (Baptist Health South Florida) because my septoplasty was performed by a certified ENT/reconstructive surgeon, which my health insurance covered the septoplasty.
Secondly, the tip of my nose still doesn’t have full sensation. Until recently I felt discomfort (slight pain) if I pressed down on it slightly while washing my face or touching it. For that reason Dr. Bustillo had me return to his office to continue the follow-up on the healing. During one of the visits he injected my nose with some sort of solution which is supposed to help the healing and swelling. I would tell you the name but I cannot remember for the life of me right now. I wouldn’t say the injections were the most enjoyable thing in the world, so if you have to do it just suck it up and do it because it is supposed to help with healing and swelling.
Lastly, now that I am 14-months post-op I went to my ENT for my year follow-up, which had to be 14-months later because of the COVID19 situation. He told me the inside of my nose was all healed up and looked good. I asked him to give me his honest opinion of my nose and he said it looked great. I asked him if he thought it was a little crooked and he said he wasn’t going to lie to me, and that it is in fact ever-so-slightly a little to the side. He said if it absolutely bothered me to discuss it with the plastic surgeon and to wait a couple more months to see if there was any residual swelling, but it would be unlikely. With that in mind I followed-up with two other facial plastic surgeons who had the same opinion of the curved tip.
Also, on my left side there seems to be a little bump, like a raised area. Could be scar tissue but highly unlikely that it is swelling. When I am facing forward you can totally see the tip is off to one side and when I smile you can see it a whole lot more. I still have another follow-up with Dr. Bustillo in August to see how the healing is going, and I will absolutely be discussing a touchup because this nose cost me almost $9,000 (cosmetic portion). I don’t expect perfection but I also don’t feel completely satisfied, and if other doctors see the issue and believe it is fixable I would trust Dr. Bustillo to fix it because who better would correct their own work since he knows what the inside of my nose looks like.
I have included pictures and will let you know what I hear back in August. Send me more questions, comments, or concern and I will answer them for you.
-Jesse

I am currently 54 days post-opt and the results are changing daily. It's like my nose is a character in Alice in Wonderland. Somedays I wake up and it is swollen, somedays it's just chubby, and somedays it looks thin but swells after an hour or so. The tip of my nose is numb and feels tender/hard to the touch. When I shave my face it feels uncomfortable to pull down on my lower lip because it moves the tip, so I have to be extra careful to avoid that discomfort.
According to my doctor's rhinoplasty manual, "At 1 month, approximately 70% of the swelling is gone, at 6 months 85%, and at 1 year 100%." Since I am just a couple of days shy of two months at this point I think the swelling on the bridge has resolved, but my tip is still swollen because the definition is not totally there. In order to see the progress I limit my mirror time and I take a couple of selfies once a week to see if I notice the changes in pictures.
As you can see from the picture (left to right) the tip of my nose was very high (upturned) six days post-opt (May 28th), which I expected and knew would change. About two weeks later, on June 11th, the tip dropped a good amount and I figured it would stay at that height, which I loved how it looked. On June 20th, I took some more selfies and I noticed it dropped even more. DO NOT GET ME WRONG: It did not drop into a polly beak or became droopy, but it just wasn't at the height I thought it was going to stay at.
My ENT, which I see every two weeks since I did have a septorhinoplasty, said my nose will probably drop a tiny bit more as the swelling resolves. He said since I do have a graft in the tip of my nose I should end up with a 90 degree angle once it is healed. Keep in mind that my ENT practices facial plastic and reconstructive surgery. Male rhinoplasty patients usually end up having a nose with an angle of 90 to 95 degrees and female patients end up with a higher/upturned nose.
For me, the tip is bulbous still and I know that it is mostly swelling, or at least I keep telling myself that because I don't want to have a second rhinoplasty. I have to go see my plastic surgeon in August and will ask him some more questions, but like most doctors his response will be, "You're swollen and have to wait until you heal." I just hope that when I do heal and reach that 12-month (1-year) mark I am happy with my result and end up with a good defined pointy tip.