THE BEGINNING What I now know: (1) This will take a while. Be ready for a 3+ year journey end to end. How long have you wanted to have this surgery? Probably a lot longer. Be patient. (2) Do your research but beware of the horror stories and fake news. NO surgeon has a perfect track record because many ‘bad’ outcomes can be as much about a patient’s mismanaged expectations as it could be about inadequate surgery results. Many top surgeons have dissatisfied patients, and more people write negative reviews than satisfied clients who write positive ones. I also discovered that the least visible surgeons on Realself are often the most respected in their field. (3) Have clearly in mind what you want to do - but also, be open to what the (experienced) surgeon’s advice is on what’s needed or is not realistically possible. (4) Research a reputable consultant who can manage the surgery yes, but most importantly find someone you’re comfortable with/feel listened to by. (5) Identify 2 full weeks off work/activity in the months ahead of you (and 2 further weeks beyond, where you won’t be on a sun holiday) and try to match surgeon’s availability with that to book in surgery. I booked for my surgery 7 months in advance. (6) Get properly prepared for surgery. The first week of surgery 95% of patients will need help at home. You’re going to be WIPED OUT from the gen anesthetic and in real discomfort. (7) Deeply accept that your nose won’t reveal itself for up to a year (in my personal experience, I’m going to warmly welcome it at around the 2 years mark!). Swelling fluctuates, rhinitis abounds, you feel great one day, the next morning you feel like Rudolf. It will come. Patient in every sense of the word is your mantra. Updated on 3 Oct 2020: BUDGET PLANNING (note UK experience) CONSULTATION COSTS - For every FIRST appt you usually pay the consultant in the UK £250. This cost includes every follow up appt you may wish to have before surgery, during which you’d get morphs done, and this single cost is recouped against the final surgery bill. Over the course of 2 years I met with 5 surgeons, paying £1250, £1000 of which I won’t get back. That’s what’s involved here. Be financially prepared. SURGERY COSTS - (note BEVERLY HILLS prices are extortionate, LONDON costs for me were far cheaper) For the SURGERY work in the UK your approx. budget is £4,500-£6,500. Each consultant charges slightly differently and it depends on the extent of the ‘work’ involved to reach your goal results. My consultant charged £4,500 as I had no bone work required. Then you need to add the costs for an ANAESTHETIST where you approx. budget £750-1000. All surgeons engage a specialist anaesthetist as you’re under general anaesthetic for the surgery and the Anaesthetist will always charge direct. You then have your HOSPITAL STAY with approx. budget £2000-£3000. All London consultants will perform your surgery in a private hospital with a day patient and/or overnight patient option and this includes your surgical theatre use, private recovery room, nursing staff etc. I paid £2,500 and stayed at the London Clinic. The Weymouth Hospital is another one often used, and usually slightly cheaper. Then you go home to heal and in your immediate first days you need a RECOVERY KIT at approx. £250. I needed everything from cotton buds, tissues, support pillow wedge (you can’t sleep lying flat for over a week, and need to sleep supported and more upright), comfort food, saline nose sprays, tons of paracetamol and ibuprofen, blender to puree food/make smoothies etc. So, TOTAL BUDGET PLANNING (London prices - variable depending on extent of work involved and not including consultation billing). £7,500 - £10,750. Updated on 3 Oct 2020: My journey began in Beverly Hills. I am London based but have work commitments in LA. I was persuaded, as so many are, that the best were to be found there. Incorrect. There are top surgeons all over the world. In Beverly Hills, all you’re guaranteed are the highest prices. DR GREG MUELLER – known via a work connection, specialises in necklifts. I asked for a recommendation for a reputable rhinoplasty surgeon in Beverly Hills? He put me in touch with DR ANDREW FRANKEL.DR ANDREW FRANKEL – you can dive down a rabbit hole of horror stories about Frankel online. I fully believe that the trauma of these patients’ personal experiences is real. You can also find a lot of positive commentary. So I found it hard to judge. Frankel is a prime example of where surgery can be seen as a godsend or a curse for some. It certainly added to my caution and fear throughout this process. What I personally found is that Frankel’s team were communicative, supportive, and he was affable and very confident. He created morphs for me which became my benchmark of expectation. I met for a third and final consultation, to commit to surgery. He sensed my anxiety and instructed me to ‘let go’. I felt pressure to move forward, and before I knew it my gut was off. So I pulled out. Nothing more sinister than this took place. I believe he would have done a good job to be honest. I just don’t think I was psychologically ready yet. Down the line, a consultant later commented on the fact that the original photo he took of me, let alone his morphs, looked very 'touched up' the lighting was so good. He advised that based on that I might have ended up facing a disappointing result, based on mismanaged expectations. Knowing now what I do, I completely agree. I remember saying to Frankel ‘if I looked like I do in this first photo you took, all the time, I wouldn’t be considering getting a nose job!’. So the learnings here became – (1) TRUST YOUR GUT (2) morphs are excellent to help you refine your goals and reach a shared understanding, but must be considered as a guide only, no ‘perfect’ surgery exists. I went back to London and did some digging there.CHARLES EAST – very pleasant, warm and welcoming. Faffed a bit too much on his newly purchased iPad to scramble some morphs for me in record time, the result of which I didn’t feel were a natural look. I ultimately didn’t ‘connect’ with him. I later learned that my chosen surgeon rates Charles East very highly. Don’t be put off by my review. I just didn’t get ‘comfortable’ in that first consultation is all.LUCION ION – waited 8 months for this disastrous consultation! See my review on this site.SANDEEP PAUN – great guy. I really liked his gentle, non-pressurising approach. We worked through two different sets of morphs, adjusting my goals, and he was clear in explaining what would be easy or challenging, and what I’d need to consider. I saw him twice and was ready to commit to surgery with him in fact. Updated on 3 Oct 2020: THEN I DID A ‘TRIAL RUN’. Something which surprises a lot of people – at this point I still felt psychologically unsure, so I embarked on a "trial run" in my mind by getting temporary rhinoplasty via filler. I did this with DR JAMES MULLEN at Medicetics in London. I LOVED what I achieved from this process, even though the filler didn’t actually bring about my chosen results. Filler allowed me to understand what it would really feel like to have my nose change permanently, and for the better. I saw ‘in the real world’ the problem areas for me, and potential solutions. I had filler in my nose for 3 months and then had it dissolved. The experience gave me total confidence for the first time to move forward with surgery. Just as I was about to commit to Dr Paun’s surgery, a happenchance conversation with Dr Mullen had him recommend a new surgeon to me for a second opinion, someone I’d never even heard of. In the end, he became the surgeon I moved forward with. Life’s meandering path takes you where you need to be. Updated on 3 Oct 2020: With Mr HESHAM SALEH everything clicked. He was excellent in his manner and approach - calm, a confident appreciation of my goals, he managed my expectations with honesty. He was very understanding of my anxieties as a 'first timer'. The morphs he produced were the most ‘natural’ of all I’d had done. And that was very specifically what I wanted. He spent a ton of time with me. He ran late in his day’s appointments because of it. He sometimes does that I later heard. And every patient doesn’t care to have to wait, because it means he’s fully in the moment with you in each conversation, taking more time if needed. I really appreciated that. It definitely was timing too. 2 full years of research and preparation brought me to the point of committing to moving forward. Hesham Saleh is uber qualfied. Sitting on countless boards for ethics and skilled practice. I believe he's capable of achieving any results (i.e. more striking, dramatic if preferred) but he's also known to be able to achieve subtle, natural, complementary results. I absolutely wanted someone to be cautious in the changes I wanted to make. He fully respected and delivered that. Updated on 3 Oct 2020: I lead the treatment plan. I wanted an incredibly subtle, almost imperceptible change. Whereas some men and women wish to have significant change, I didn't want a single person that I knew to notice that I'd had it done. In hindsight I know that a large part of that was driven by fear. Fear of irreversible change I didn’t like, especially so prominently on my face. Fear of judgement. So I erred on the side of enormous caution. And I insisted such caution be applied in my surgery. As a result, my nose adjustment is so subtle, some might even argue that what I've had done wasn't even worth the money! But it HAS made all the difference to me. I specifically explored consultants whose track record showed an ability to be closer to natural and imperfect, than artificial and perfect. I COULD have gone further. I might look even better today if I had. But I’m ok with where I’ve got to. Just know what you really want and try not to let fear dictate too much in the process. Updated on 3 Oct 2020: Swelling fluctuates, rhinitis abounds, you feel great one day, the next morning you feel like Rudolf. Food is a factor, alcohol has an impact, as does the weather, monthly cycle, stress factors, lack of exercise... all seem to influence the size of my nose! I have seen my ‘final’ nose on the occasional no-swelling day, and so I know I’m excited when it exists more permanently. I’m patiently waiting. Updated on 3 Oct 2020: The 'ONE YEAR' mark isn't something you should fixate yourself with. Even without bone work, I'm still healing. I know this because I've seen my 'nose' without the swelling on the very occasional no-swelling day, and so I have a clear comparison now. And what I have found SO interesting in this process is how important lifestyle, health, good nutrition is. The days when I've welcomed my non-swollen nose are usually after a week of very healthy eating, plenty of exercise, water, no alcohol. So I know what I need to do to encourage the healing. Pretty straightforward stuff. Updated on 3 Oct 2020: My best guess is 18-24 months for me to meet, finally and permanently, my new nose. I'm ok with that. It's been a very long journey. I'd do it again (though I'd be a lot more brave, not procrastinate so long, and be slightly more assertive with myself in being clear with what I wanted perhaps... but life is a learning curve!)
