I went into the original surgery seeking a reduction and a reshaping. My nose wasn't huge but was too big for my face, I also had a small dorsal bump, a bulbous tip and an overhanging collumella, plus a deviated septum. I requested a reduction in projection and refinement of the bridge and tip.
You always hear "if you hate the shape when the cast comes off, then chances are you won't be happy". At the first cast removal, my reaction was unimpressed but held my judgement while I waited for the swelling to go down. By 3 months, the shape had settled - and I wasn't happy; after 6 months I saw no further improvements. The result was not terrible, but it was far from good and especially disappointing given the price paid. The surgeon also dismissed all my concerns, constantly saying it was a great result. The twisted tip was brushed away with the excuse that I had an "exceptionally asymmetric face" (which isn't true). The excess supratip fullness was "swelling" - but it never resolved even after steroid injections - the tip was also hard as a rock with more tissue on one side than the other.The projection hadn't been reduced at all and I was told that reducing was not possible and would widen the nose. (Which is a bit ridiculous given tons of other patients get a reduction in projection)
The final result had various issues including
- over reduced bridge
- under reduced tip resulting in too such supratip and columellar volume as well as too much projection
- convex shape to the tip, very unflattering in photographs and worse when smiling
- visible twisting and asymmetry of the tip (nostril height asymmetry was present before original op, but after the tip was both twisted and off center)
- breathing difficulties
- rock hard tip
I consulted a variety of surgeons for revisions. I had 3 options - either simple fillers to the bridge to balance out the tip, complete reconstruction including grafts to the bridge and alar rims, or simple reduction of the tip. I chose the latter as it was the simplest surgery and shortest recovery (and I am hoping the result holds up over time)
I had a closed rhinoplasty done under local anaesthetic in Beirut, Lebanon. I would have preferred an open operation but my surgeon prefers to do closed rhinos to reduce swelling and scar tissue. Having it done under local was not particularly pleasant as my body is somewhat impervious to both sedatives and local anaesthetics so after the first 15 minutes the sedative had worn off and close to the end of the procedure my nose was starting to wake up - ouch! You can, of course, still feel all the pressure and scraping of the tissue even when you can't feel the pain. My surgeon removed a lot of scar tissue left from the previous op and discovered that my septum was broken!! However, apart from IV paracetamol immediately after the surgery, I did not require painkillers aside from panadol a couple of times a day
I was extremely swollen around the eyes for 4 days post-op - even more so than the primary op. The tip swelling has quickly reduced and by 1 week I was presentable - but the internal healing inside the nose has been problematic. I still have 4 or 5 stitches inside the nose that have not dissolved at 10 days post op and I really feel like these stitches are actually preventing proper healing of the internal wounds, as the skin is trying to heal over and around the stitches. The tip nose is still tender and sore inside and out and there are lumps all around the stitches as well as the wounds not looking like they're completely closed. I also got a small area of skin necrosis on the tip of the nose which is healing fine but will probably leave a small pitted scar that will require subscision or fraxel treatment
Visually the result is looking pretty good. It was not possible to completely correct the asymmetry but the projection and shape are much improved. I am hoping over time the roundness of the tip will reduced and it will become more pointy and refined. My ideal nose is one with a supratip break and I am not sure this will emerge but even so, at the moment I am happy. I might get some fillers to widen the bridge at the 3 month mark.
Please PM me if you'd like to know more about my surgery or my surgeons