Revision Rhinoplasty, Septoplasty and Turbinate Reduction with Dr Gruber

I started off with a crooked nose that had a...

I started off with a crooked nose that had a severely deviated septum but normal tip cartilage. In 2009 I had surgery with a closed approach that involved trying to straighten out my nose and septum. This ended as a big fail as my septum reverted crooked and my tip and mid vault became collapsed in on the left hand side. The surgeons' response was to suggest permanent filler bio alcamid, and I never went back to see him again.

I had revision with a different surgeon in 2011 who proposed straightening the septum using the open approach and rebuilding the left side using ear cartilage. Initially it looked better but by 6 months my nose became warped and the grafts showed through, by 2 years post op I had very distressing graft mobility and inflammation that caused me to become depressed and suffer from insomnia, the onlay grafts were used as the surgeon abandoned spreader grafts because he couldn't do them and he just draped cartilage over my nose. My tip was very pinched and asymmetric. My septum was dislocated again and my nose looked far worse.

By this point any naivety or trust in a surgeon's assurance or confidence had gone. I researched extensively and became much more savvy. Previously I hadn't done any proper research or consulted with more than one surgeon. In addition I chose my surgeon for primary and first revision based on how local they were and didn't understand that skill level could vary so much.

For my second revision I consulted in person with 3 prominent surgeons in Europe and on-line with Dr Anil Shah. I was very worried about travelling from the UK to the US and didn't think that I could cope or afford the surgery but I knew of many successful Dr Gruber patients. After consulting with Dr Gruber via telephone consult I instantly felt that he was my surgeon, despite having not met him in person. I don't know why but it was a feeling that I didn't feel with any other surgeon that I consulted with. I travelled from the UK to San Francisco which is a long flight.

Dealing with his office was always a pleasure and they couldn't of been more helpful to me.

My operation lasted 4.5 hours and was extensive, the horrid mobile onlay grafts I had previously were removed. I had my internal and external valve and tip cartilages completely reconstructed and my septum had extensive work to straighten it. Ear and septal cartilage was used. My skin was lined with a blanket fascia graft.

Recovery was really, really tough and the journey home was very far from ideal. Now at 5 weeks I am recovering from an abscess that caused me to be hospitalised for 2 days and Dr Gruber has been incredibly concerned and supportive.

My results...... the redness from the inflamed grafts is gone and my skin although not perfect as it had been damaged has calmed down completely. No more angry red areas of inflammation. The shape is really amazing and symmetrical and my tip looks like it did originally before being butchered. It looks like a normal nose which considering what it like before is nothing short of a miracle. My insomnia and depression has gone. My family are so happy to have the old me back.

Doctor Gruber's age did concern me but not enough to not go ahead with my surgery and as soon as I met him, it was not an issue.

before revision with Dr Gruber

tip rebuilt after revision with Dr Gruber

front view - I have my smile back

another before revision

Thank you! Your whole nose just looks so much smoother it's hard to tell everything I'm seeing.
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hi there, I didn't need height but my bridge is wider due to dorsal spreader grafts.
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You look so pretty, your nose looks perfect! Did he add any height to your bridge?
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after showing straight septum in the midline

Nice results, thank you for sharing, it gives us hope. Have a great recovery
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Thank you very much. It's unbelievable that surgeons can do harm and see nothing wrong with the results.
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Thanks a lot. Hoping my recovery can start properly now my infection can heal.
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Post Op Complication

I seem to have very bad luck. I developed an infection that developed an abscess after having it drained with a needle a month ago, and a week ago and a month of antibiotics it made no difference.

I saw Mr Matti in London Harley Street, who I previously saw for two consultations and he remembered me. He diagnosed a suture granuloma, which under local anaesthetic he removed. He injected the local anaesthetic through my mouth into my nose, I had numbing creme up my nose so the only part that hurt was injecting into my mouth.

The swelling is immense on the right side of my nose and cheek and normal on the other side so I look very distorted, it's still numb today. The external lump on the skin may take a time to go down.
How are you today ? Did dr matti gave any helpful insight ?
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I have brought my appointment forward to tomorrow. I would rather take the graft out then continue with inflammation that I have now. I'll let you know how I get on x
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I hope your appointment goes well. Will taking the graft out majorly change the look of your nose?
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swollen nostril after removal of granuloma from infection

I couldn't post a whole face photo as I looked awful. I went into a bit of a dark place since last Thursday due to the awful swelling . Fast forward to Tuesday and my lopsided swelling has gone done a lot. Enough that I don't look noticeably distorted. I emailed Dr Gruber upset at the weekend and he emailed Mr Matti who personally phoned me but I missed his call. I saw him today and he was very reassuring and said that the red lump externally will go down but it may take months for resolution. He said he couldn't see a stitch when he excised the lump and really doesn't not think there is one there. He does not anticipate taking the graft out. Everything feels very distorted to me, I can feel the outline of the graft and the whole area is red. Hope time can be a great healer for me. The photo shows how swollen my nostril was.
How are things progressing? Is it getting better? I hope your swelling is going down.
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Swelling has come down loads, internally still have an external lump and sort of divot. I can't assess the damage until the inflammation has gone down. Feeling positive today.
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What an ordeal :(
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Healing from post op complication - 3 weeks after excision of granuloma

My nostril swelling has come down a lot. I was unbelievably distorted due to the asymmetrical swelling. Thank you to all the people who were supportive and gave great practical advice. It was much appreciated. Externally there is inflammation around the graft but Mr Matti is sure that it will come down. I have seen him twice and am due to see him in two weeks as the area still has not healed up completely. This is a bit worrying as he said if it still hasn't healed he may have to do something, what? I have no idea. He is liaising with Dr Gruber and keeping him informed.

another posing photo

This is a flattering photo of me. Some days I can looks so rough. Also I am having a problem with my skin including redness and spots over my cheeks, nose and forehead and I am afraid it is rosacea. I am 35 next week and the whole nose saga has been going on since I turned 31. I hope that I can not lose any more of my life to being sad about my nose. So I am sharing a nice picture for my self esteem.

forgot to attach photo to above update

How many surgeries have you had? As of right now, are you happy with your nose? I've had three surgeries and my nose is awful. I can only take photos from one side, etc. so depressing.
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This was my third surgery too. I think no matter how my nose turns out I would be extremely reluctant to undergo a further surgery. Some people can come out of 3 surgeries with flawless skin. Be careful about having a further surgery as things can always be worse. I would recommend Dr Gruber as he is a very good surgeon. 
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Did you meet with the ENT? If you did how did it go?
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Flying back to San Francisco on Thursday, Dr Gruber is going to surgically explore what's causing infection/inflammation

I don't feel I can prolong the inevitable. I have to be opened up to find out what's causing this as it's something internal i.e. stitch, graft infected. I don't really want anyone else but my own surgeon messing about in there and although I have now got a nice NHS ENT consultant on my case I can't keep being told to keep taking antibiotics. I stopped taking them for 2 days as I thought they were useless - big mistake my nose has really flared up and pain really increased. I will update on Thursday and let you know how I get on.

I'll be thinking of you next week!

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Thank you x  
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I'm so sorry that this is happening to you . I really hope dr gruber can resolve what ever it is that's causing this . I'm wondering if the crawling feeling is throbbing . Like that pulsating feeling when you hade a tooth ache or bad head ache ?
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painful inflamed cartilage graft

I hope this area will end up healing well.
Did you see Dr Gruber? I hope he was able to help!!!
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Good luck with Dr Gruber... I hope he can figure out what is causing this and fix it for you!!! U deserve the nose you dreamed of.
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I am glad to hear you are going back to Dr. Gruber even though it is a hassle to travel that far I am sure. I think he will go the extra mile for you and make sure everything is on the right track before you go home again. I will be thinking of you. I know how stressful it is and I hope it is all sorted out again soon. Take good care of yourself.
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Back from San Fran, yet another removal of a second lump by Gruber

I flew out last Thursday and saw Dr Gruber the same day. He removed the lump, which he said was like a cyst, the day before a doctor had called it a boil and when Mr Matti removed a previous growth he diagnosed that as a pyogenic granuloma. He didn't think there was an active infection until he injected directly with local anaesthetic and he said it sunk in which showed there was fluid behind the growth which was why it was so painful! A culture was taken (cost $400). I had no swelling like I had with previous excision at all and my nose was not distorted so I felt comfortable going out.

He said that being on antibiotics for the past 6 weeks was a bad idea. This was prescribed by the original ENT who discharged me from his care while I had an abscess/growth. I left Gruber's office and had saw a voicemail from the UK telling me to call re. results of swab taken in the ER a week and a half previously. I called on Friday and it showed a pseudomonas infection. Well I've been on antibiotics that treat staph and strep, not pseudomonas. I stopped taking the antibiotics. I am so annoyed. I have had a previous culture but it was when the area was dry so no blood or yellow discharge. Three ER visits - first time with 3 days in hospital on IV, three trips to London to see Mr Matti (including traumatic lump removal) and 4 appointments with ENT and last one with a new consultant who was much better and finally all the way back to the US and another surgical excision and culture which showed pseudomonas and a yeast infection. Dr Gruber prescribed two types of creme and the hospital want me to pick up a prescription for the correct antibiotic but Dr Gruber said I do not need an antibiotic.

Well my nose has calmed down, still over all red and have the external lump but the pain immediately improved upon removal of lump and drainage. I have external inflammation but inside seems to be healing, but I can't say 100% that it's going. I am going to take antibiotics as I can't take any chances with this. My poor daughters have had me out of action for months due to op and infection, when I think about this it absolutely breaks my heart.

Dr Gruber said that everything will settle and the inflamed side and redness will all subside. He double checked the cavity where the infection was to see that it hadn't filled up with a special tool.

One other thing which I have found difficult is that being outside when my nose tip is very cold and red at the tip. I find this stressful and worrying. I hope this improves.

Thanks for all the messages of support. I will update in a month or so and hope to say everything is healing well.
How are you doing?
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How are you? Has the infection subsided yet?
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I feeling very unwell and in continuous pain. I've been on 3 different antibiotics for 3 months and I was on antibiotics for a 6 weeks before my op. No improvement, things are actually worse.
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Infection has finally gone and nasal membrane healing

After I came back from the lump removal with Dr Gruber a few days later more necrotic stuff came out of the excised area. It took 6 weeks of the correct antibiotic to halt the infection. The lining of my nose was really damaged and painful and I had burning and stinging as there was exposed areas. I finally feel so much better and things internally are healing. Externally there is still a lump and then a dent but it's smoothed out to a small degree and the skin is red but I can cover this with make up. Hopefully with time it will smooth out more.

My skin was clear before my revision and after a few weeks after revision coinciding with infection my skin became really bad. Acne/rosacea all over my face and nose. Been on meds for a week and it's more or less completely cleared up.

My advice would be for anyone who has a post op infection get the infected fluid tested to identify the bacteria to make sure you get the right antibiotics straight away.
Thank you for updating. I'm glad your skin is finally clear and good advice on getting fluids tested to show what kind of infection you have, I know from personal experience the right antibiotics can make a huge difference. Do you have any frontals that you wouldn't mind sharing? And all in all would you say you are happy at least with the look of your nose?
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Not feeling very happy with my front view. I'll pm you.
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If you would mind I would like to see the front view too! That's what I'm most unhappy with from my revision.
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What is going on? pain back, inflammation back too!

I am miserable again, pressure feeling on bridge which has been there since start of revision but got worse and severe redness and inflammation come back on strong. I look hideous. Whatever happens with future healing I am going to have a scarred, red lump on the side of my nose. I would do anything to live without constant pain. It is debilitating.

inside painful nostril

Other nostril feels great, very normal even with alar rim graft. This nostril is inflamed and painful.
I'm very sorry for all you've been through :(
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Thanks. I have terrible down days and the days I feel better. Pain and inflammation fluctuate as well. I am feeling better today x
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Hopefully the pain is temporary and much better days ahead.
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I had a consult with a surgeon to examine my painful alar area, possible reaction to suture

I saw a nice surgeon who examined me and read my op report. I don't have any exposed cartilage which is a relief. He was a little critical of some of the sutures used and said that that he wouldn't of used them. Some absorbable sutures can hang around a long time, they dissolve a lot in the first few weeks then remnants remain for months. I have a lot of vicryl and pds sutures and pds can last 200 days. Also vicryl can cause infection and inflammation.

He said it could be some dead cartilage or a stitch still hanging around, stitches can harbour bacteria and as they are not living tissue bacteria on the suture or dead cartilage will not be treated with antibiotics. Its a waiting game and to leave it and see if it heals, I may develop an abscess again in the future. There is a lot of redness on the side where I had a batten graft and I think thats a reaction to the sutures.
Any updates to the healing progress of your nose?
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Hope you're feeling better and sorry to hear about what you're going through. I have been strongly considering Gruber but this worries me. Do you think he was sloppy with his work? You can pm me if you like.
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I hope you heal better and I'm really sorry for this suffering. Please keep us posted.
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Things finally settling.

In the lasts week I haven't had any pain it's as though my healing has had a turbo boost. Still have barely covered edge of cartilage in nostril but the external lump has smoothed out.
Had a lot going on so not kept up to date with my progress. Will do a proper update in the next few days.
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Besides the awful infection I do have to say your nose looks amazing!!
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Thank you. X
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