Septorhinoplasty with Rib Graft - Beverly Hills, CA

(I am from the UK and decided to go abroad for this procedure. I don't feel comfortable sharing my photos online at this time but I hope that my experience proves particularly useful for those who are considering going abroad for surgery but also useful for those who are considering rhinoplasty.)

Background
I previously had fillers to augment my nose and I was pleased with the look, and so I decided I wanted to take a more permanent option. I had consulted with some surgeons in Harley Street in London but they all said they did not have much experience with augmentation rhinoplasties, so I decided to go abroad to find a surgeon who had such experience and whose 'style' I liked.

Prior to surgery, I had to have blood tests done and medical approval from my GP. I did not mind doing this but I did have some trouble trying to get these done:
- I managed to find a clinic in London that did 'pre-surgery blood tests' which were all the ones that were requested. Be wary of the price though because this can vary ~£100 between providers!
- I thought because my GP surgery has my medical records, I could get the approval done through booking an NHS appointment. However, when I did turn up, I got told to book a private checkup for £100! I am not sure if this is up to the GP's discretion though.

Pre-Op Appointment and Surgery
I met with Dr Yoo and the team the day prior to surgery (I had a Skype consultation beforehand in April) where we went through the morphs and and an examination of the nose. What surprised me was that he said I needed a septoplasty, which none of the other doctors I consulted with pointed out but I was pleased because I had an opportunity to improve my breathing as well.

My surgery was scheduled for 8am on 16th June. The surgery itself lasted about 6 hours, and I came in at 7am and went back at 4pm. I did not feel nervous at all going into surgery as I felt I was in good hands thanks for the kindness of the staff.

The week following the operation was more pleasant than I had expected - I just took the time to recuperate indoors. A few comments:

Medications
After a couple of days it became easier to get into the aftercare routine. I don't think that I experienced any significant side effects from the medications.

Discomfort
I had no pain from my nose at all. My fascia incision and my rib were a bit sore, and I did struggle moving about with the rib incision for a couple of days but Extra-Strength Tylenol was sufficient for this. After 2 days most of this had gone. I was a bit hot on the face for the first two days but the nurse on the day of surgery had provided me with an ice eye mask which really helped.
At times, the breathing was congested and I had a lot of nasal drainage (but I am not sure if this is mainly because of my internal splints which were for the septoplasty) so it was useful for me to have lots of gauze to make moustache dressings.

Bruising
By about day 3 I had slight bruising and swelling under the eyes. But this was hardly noticeable, and analogous to dark circles and I think the swelling dissipated about two days afterwards.

Facial range of motion
Soon after the surgery, it was difficult to make any facial expressions at all, due to sensation in the columellar incision and the fascia incision. The fascia incision in particular gave me some difficulty in brushing my teeth and opening my mouth to eat food. Day-by-day I am able to gain more movement, so am able to brush more of my teeth, take larger bites of food, etc.

Cast removal
I got my cast removed on day 6. The medical assistant cleaned me up first and then Dr Yoo himself did the stitch and cast removal. I was a bit worried about the stitch removal, but it wasn't painful at all. The sensation of the internal splints was not painful either, but a bit strange. They were bigger than I had expected!
Even though I am obviously swollen, I am super happy with my result so far, especially the profile, which has a more refined tip and a higher radix, which is what I asked for. After the removal of the internal splints, the congestion is gone and I would go as far to say I can already breathe better than I did pre-surgery which is an enormous bonus for me.

My two week post-op appointment was actually at 12 days, since I was leaving earlier. I think I actually developed a minor infection in the preceding weekend, since my columella was getting quite red and noticeable from the Saturday. I was worried and decided to contact one of the medical assistants on Sunday. Since it was the weekend, I was concerned that I would not be able to get a prompt response but I got a response in an hour and a prescription for Mupirocin which I was able to pick up on that day (thank goodness for 24 hour pharmacies!). I would say from my experience though not to throw away any medications you might think you no longer need, since I was asked to use Mupirocin/Bactroban prior to surgery as well.

At the appointment, my tape was removed, Dr Yoo checked on the incisions and cut some of the remaining sutures I had. He also gave me an injection to reduce swelling on the tip, which I didn't have to pay for.

Thoughts on progress
The infection looks like it has cleared up a lot and the majority of the redness on the tip and columella has gone, but I still have a red mark from the incision on the columella. I am not so bothered about it since this obviously takes some time to clear up.

The shape of my nose seems to be changing every day but I think the swelling is improving with time and taping. For the first few days, the tip did get noticeably rounder but it is starting to sharpen up again. From the frontal view, my nose is still very swollen but the profile still looks great. The tip is a little bit upturned but I think it is kind of cute and not too piggish.

I had to take a long-haul flight back (~10 hours), but since I decided to tape my nose for the whole flight (it was an overnight one anyway), sit in a seat with extra leg room, and wear the decompression socks from surgery (the nurse actually recommended this to me) I don't think it affected the swelling too much.

-LOTS of distilled water to clean incisions and to wash your hair
-Extra gauze
-Extra cotton buds/Q-tips
-Cotton pads. I was a bit cautious about wetting my cast so I used these to wash my face.
-Lip balm
-Straws and small spoons helped me to eat during the first few days
-Lozenges. The position of the tube for anaesthesia made my throat extremely sore for the first few days after surgery.
-A travel pillow
-Lots of button-up tops and pyjamas (not just for the day of surgery)
-A hat
-Non-wired/sports bras. I did not realise this and did not end up packing any (oops) but you cannot wear underwire bras for 3 weeks post-surgery if you are having a rib graft.

I also found it useful to make a note of the nearest pharmacies and supermarkets to where I am staying just in case I needed to top up anything and bought a UK pay-as-you-go sim and an add on which enabled me to use the phone plan (and particularly data) at no extra cost to use whilst I was abroad.

The swelling is still going down, but I can see the general shape of my nose which I am happy with. There were a few dents that I could feel but it disappeared as the swelling changed. The one thing I did notice was a bit of redness on the upper third of my nose but it was just redness (no swelling or pain) so I assume that this is the growth of blood vessels, since most of my augmentation grafts were in the radix. The side profile is great, but the front still is noticeably swollen to me. However, I have gone out and met a few friends and nobody has seemed to have noticed!

The scar on my scalp and rib have healed up completely and I don't feel much sensation from my temporalis fascia any more. However, I am feeling the rib a little bit when I do certain exercises, so I feel that I have to progress with my exercise a bit more slowly than usual.

As requested I have provided a picture. I apologise that it is small but I hope you can see the changes, all of which I did ask for - namely a higher radix and more projected tip. I think my new nose harmonises well with my other facial features as well.

Wow I can't believe it's been that long already.

Thinking about my overall recovery experience since undergoing rhinoplasty, I would say swelling, tip rotation and rib sensation changed most drastically in the first three months. Looking back at the photos, I was extremely swollen and the result is a lot more natural now (especially around the radix area), and my rib is pretty much back to normal.

I had asked for a 'moderate' result and I actually think I look drastically different, and I think that's because the tip has projected a lot more. That is not necessarily a bad thing since my nose was not straight previously and quite flat, but it's something that has surprised me. I also feel that when you go through an experience like rhinoplasty, one tends to get a lot more fixated on it, whilst it actually might not be noticeable for anyone else, so that's something to be cautious about. It's not perfect, since a small dent has formed around the start of the nose tip and the more sebaceous part of the nose, but in a way it looks a bit less artificial and you can't really anticipate these kind of things. I am guilty of asking friends and family 'oh what do you think of xyz?' when they can't see it / have not noticed it until I pointed it out. Nonetheless I am super happy with the result and I don't regret doing it.