I had a rhinoplasty in 2006 and really regretted it. I was in my early 20s and unhappy with my life and wanted to do something to make me feel empowered, so I got a cheap nose job--big mistake. It looked OK in profile, but you really noticed the pinched tip when I'd smile and in photos. I was determined to get it fixed and eventually saved up the money and did the research to pick my surgeon, and this time I was determined to go to the very best I could find. I had formal consults with three plastic surgeons in NYC who said they had extensive experience with revision rhinoplasties: Dr. Philip Miller, Dr. Steven Pearlman, and Dr. Norman Pastorek and also had an informal consult/conversation with Dr. Jaimie DeRosa of Boston who studied under Dr. Dean Toriumi, a very well known revision rhinoplasty specialist in Chicago. I also asked a classmate of mine from high school who is a dual trained ENT-facial plastic surgeon who she recommended for revisions in NYC. Both she and Dr. DeRosa said without reservation that Dr. Norman Pastorek is the best (my friend also recommended Dr. Miller).
My consult with Dr. Pearlman was OK, it felt a bit rushed and not as polished. I had it in 2011.
My consult with Dr. Miller was very thorough, I was impressed with his consultation process, the photos that were taken and his listening and recording of what I wanted; he did an OK job conveying what his plan would be for me. I was a little concerned that some of his before-and-after revision pictures were too conservative or not my idea of a good revision. My consult with Dr. Miller was in 2015.
Soon after, I had my consultation with Dr. Pastorek. I had not heard of him until my plastic surgeon friend mentioned his name, he had not come up in my google and other searches which is interesting given how well-known he is in the Plastic Surgeon community (perhaps he is too established for google ads and paid search engine optimization)? I immediately liked his manner and the way he communicated his surgical plan which pinpointed all the things I wanted fixed. I loved the fact that he does the surgery under light IV sedation and local anesthesia. His price was a few thousand more than the other doctors, and that was something I considered, however my greatest concern was really his age. He seemed very agile and sharp for his age, however I am a doctor myself and know first hand that many physicians get a little complacent when they have 40+ years of experience under their belts and get lax on staying on top of the best research and techniques. They figure that if it's worked for them for 30-40 years there's no need to change anything, even when better, safer methods have been developed. For that reason, part of me was leaning towards Dr. Miller since he was in the sweet spot of being young enough to perhaps be more cutting-edge but old enough to have extensive experience.
Anyway, almost 2 years later, I had finally saved enough money to pay for this procedure and found a time in my work schedule where I could take two weeks off from work to recover. I contacted Dr. Pastorek's office and Dr. Miller's office to make follow-up consults. Of course, since more than a year had passed since my initial consultations, both said I had to pay the consult fee again, I suppose that's understandable. I was put off when Dr. Miller's office asked for a credit card number to hold my follow up consultation appointment, I happened to not have my wallet on me at the time, but I thought that was kind of insulting since I had seen him before for a consult and paid the fee without a problem. After my second consult with Dr. Pastorek, though, there was no doubt that he would be my surgeon.
Updated on 30 Jun 2017:
Day 0
So the day of surgery I went the hospital and checked in an hour and a half before my scheduled time. The nurses reviewed my medical history, did chemistry, and the anesthesiologist came in to meet me and review medical history as well. He said he would give me versed to sedate me and fentanyl for pain, the versed is a short acting anesthetic which also gives you retrograde amnesia, which means I'd forget most of the procedure. Dr. Pastorek used lidocaine locally on my nose as well (this is the same local anesthetic dentists use when doing dental procedures). I really liked that I was not given general anesthesia, I think it helped my recovery be much easier, didn't have to worry about nausea, etc. The surgery took under 2 hours and I woke up feeling great. The pain was starting to kick in and I could feel the area where the sutures were tugging at my tissue by the time I got home an hour later so I took some of the pain meds (percocet), put ice on my eyes and cheeks and slept elevated. When I woke up the evening of my surgery, my eyes had developed bruising, which was expected. I had little "wicks" in my nose, like packing but not as bad, that Dr. Pastorek told me to keep in all night until the day after surgery. He called me that night (I always think it's so sweet when surgeons check on their patients the night of the surgery, he had also called me the night before) and said everything had gone really well and that he had been able to accomplish all of our goals, so that was very reassuring. The packing made it SO HARD to sleep comfortably, I hardly slept all night. I kept waking up every ten minutes because my throat was PARCHED from mouth breathing while sleeping. I was also bleeding slightly so I had to keep the gauze taped under my nose. At 6AM I finally took the "wicks" out of my nostrils and although it was stuffy, at least I could breathe through my nose, so I took my meds and immediately went back to sleep and could finally find rest.
Day 1 I felt OK, pain was very manageable, just iced with frozen peas in a ziploc as much as I could and took it easy, listening to podcasts since I wanted to be able to close my eyes and ice and doze off as I felt. My eye swelling was pretty bad, I looked like the Beast from Beauty and the Beast because my eyes and area in between my eyes and cheeks were swollen to a bit of a squint. Slept well during the night, again on the couch, elevated. The little dribbling of bleeding mostly stopped by this day. I felt well enough to go up to the roof deck of my apartment building and get some fresh air. I wore a ball cap just in case anyone saw me, but no one really did.
Day 2 - This was the day the doctor and nurse said my swelling would be the worst, but I felt like it had actually started to go down compared to Day 1 post-op. Pain came and went, I iced some more throughout the day, mostly read, watched TV, and did light housework. I feel like the Vitamin C and Arnica are helping. I also am avoiding salt and drinking lots of water and eating lots of healthy fruits and veggies. Of course my nose is covered with the splint, but I can see the columella that was raised, so I'm really happy about that. Also, my nostrils look more symmetric.
Updated on 30 Jun 2017:
Day 2 - This was the day the doctor and nurse said my swelling would be the worst, but I felt like it had actually started to go down compared to Day 1 post-op. Pain came and went, I iced some more throughout the day, mostly read, watched TV, and did light housework. I feel like the Vitamin C and Arnica are helping. I also am avoiding salt and drinking lots of water and eating lots of healthy fruits and veggies. Of course my nose is covered with the splint, but I can see the columella that was raised, so I'm really happy about that. Also, my nostrils look more symmetric.
Updated on 30 Jun 2017:
Day 1 I felt OK, pain was very manageable, just iced with frozen peas in a ziploc as much as I could and took it easy, listening to podcasts since I wanted to be able to close my eyes and ice and doze off as I felt. My eye swelling was pretty bad, I looked like the Beast from Beauty and the Beast because my eyes and area in between my eyes and cheeks were swollen to a bit of a squint. Slept well during the night, again on the couch, elevated. The little dribbling of bleeding mostly stopped by this day. I felt well enough to go up to the roof deck of my apartment building and get some fresh air. I wore a ball cap just in case anyone saw me, but no one really did.
Updated on 12 Dec 2018:
Hi all, so I am updating my review. It has been a year and a half since my revision rhinoplasty with Dr. Pastorek and overall I am generally satisfied with the improvement. The change was very conservative and subtle but I do feel like my nose tip is less pinched. My nostril symmetry is improved but not completely symmetric, I did need to have some filler placed by the surgeon to even out the edges of the nostrils a couple months after the surgery. The surgery was very costly but the recovery was amazing as it was closed. To be frank, I am relieved that my nose looks definitely better and not worse, since in doing my research in revision rhinoplasties I saw some cases where people had two or three revisions, and I'm just glad that at this point I can live with my nose as it is and don't cringe in disgust every time I see it in a photo. That's a win, right?! So, all in all, I feel like my nose looks significantly less "fake" and "done" even though I don't "love" my nose, and I given that I know how difficult a surgery this is, I am genuinely extremely happy to put my nose hatred in the past and move on with my life.