Incredible Experience- Large Bulbous Nose with Thick Skin

I am so happy with my closed rhinoplasty. I shopped around for months until I met a surgeon I was comfortable with- De, Maloney struck the right balance between honesty and setting expectations and hope for what could be done with my skin and bone structure.

I had a consult and pre-op appointment. We’d used imaging to generate my goals and while I never expected such a good outcome, I was so pleased that we were clearly on the same page.

Day of surgery was very comfortable- we chatted again, the center took incredible care of me, and I woke feeling a little groggy but joined a work call at 3 PM (surgery 745).

The recovery period was more annoying than painful. My mouth was SO dry a biotene was a life saver and I was congested. But I never had pain that required more than ibuprofen or Tylenol.

My bruising was not significant, but I had significant swelling, especially in the nasal tip. My goal was to address my bulbous nasal tip but I was otherwise happy with my nose and did not want an “overdone/Barbie nose”.

I spent months and months researching and knew that especially with my skin type I should expect months before I had my final result. The day of my cast removal I was thrilled it looked a little better than before and waited patiently.

All I can say is time is your friend after rhinoplasty. I still wake up with a swollen tip (this is much better at the end of the day) but my nose is SO much better than it was before. I am so, so happy with the result, and every week it gets better. I expect a more final result in the next 2 months, but even if nothing improves from today I am very happy.

I look in the mirror and feel like the me I should have been- no one has said they noticed anything (though I’ve had a few double takes and “you look great/different though I can’t put my finger on it”). It just a better me, which is exactly what I asked for.

I cannot recommend Dr. Maloney enough, for his professionalism, surgical technique, personal follow up, and courteous staff. I am very grateful and would do it again in a heartbeat.

I've been reading this forum and others for months, and so I decided to give back by telling my story. I hope it helps others as others have helped me.

I've wanted a rhinoplasty since I was a teenager when it was clear that my large bulbous nose was not appealing to myself or to others. I waited many years, first before of financial reasons, and then later because I didn't have a time when I could take 2 weeks off, then came 2 kids....and before I knew it, I was 37 years old, still disliking the appearance of my nose.

My husband and friends all insist I am beautiful (which I appreciate) but when I look in the mirror, I just don't feel like my nose fits my body. And so I started meeting plastic surgeons. I chose to meet only with surgeons trained in both plastic surgery and ENT and picked 3 based on reviews, before and after photos and location to where I live. Because each consult costs $100-200 and most people don't have the resources to do an unlimited number of consults, I hope these impressions will help:

Surgeon #1- Kalos/ Dr. Stong. I picked this surgeon primarily based on before and after photos and because the practice is close to where I live (Buckhead/Brookhaven area). He also had some pretty good reviews. I was informed that the consult ($200) would be on zoom only before our appointment, and given COVID and the move to virtual everything, I thought this would be fine. Dr. Stong was pleasant and kind. He suggested an open reductive rhinoplasty, making my nose shorter, and promised I would have "a cute dainty curve and upward tilting nasal tip, a perfect nose"- but I didn't want any of those things. When I asked questions about my skin thickness and the feasibility of getting the results I wanted, he kept saying "look at my before and after photos, they speak for themselves, you won't find a better surgeon in Atlanta". I thought when looking at his before and after photos, if he can do this for someone, surely he could achieve my goals, but I didn't end the consult this way. It turns out the virtual approach did not work for me. There were no computer generated images to help communication, he never felt my nose or saw me in person unless I agreed to surgery at which point I would get an opportunity to meet him at pre-op visit. Again, the staff was upfront about this appointment and what to expect, it just did not work for me. If you think images help you communicate your desires and expectations, I would not recommend this practice be one of your consults unless they change their current practice.

Surgeon #2, Dr. Thomas Walker- I met with him largely because of incredible reviews, though I must admit I thought many of his before and after photos looked almost indistinguishable. This was a completely different experience. Dr. Walker's team took many photos and he did a nasal scope and informed that I have a deviated septum (which I hadn't known before). He was patient, kind, felt my nose and we had long, long discussions about my skin type, which he described as thick and quite challenging to work with. He set expectations that I should not expect my final result for 1-1.5 years given prolonged swelling. He recommended an open rhinoplasty and discussed potentially needing cartilage grafts of the ear or even the rib while still highlighting the limitations of my skin. Even if we did these pretty invasive procedures he was not certain what impact it would make and if I would achieve my ultimate goal. I was so, so grateful for his honest opinion, and I trusted him. However, I was not willing to consent to a potential rib graft for a first rhinoplasty and I did not love the rendered photo he provided. While I'm certain he would have worked with me further, the 2 consults were so incredibly different I decided to seek out 1 more opinion. I decided if I was not comfortable with the third consult, I would wait another year or two and revisit a rhinoplasty.

Surgeon #3- Dr. Brian Maloney. The Maloney center was farthest from me, with excellent reviews and before and after photos I loved. My hesitation was that Dr. Maloney said he largely performed closed rhinoplasties on his website, which I had been told now by 2 surgeons was "antiquated" and an inferior approach. That said, I made an appointment and I'm glad I did. Like Dr. Walker's office, many photos were taken, and extensive details of the proposed surgery were given. Dr. Maloney recommended a closed approach- which he has extensive experience performing and said for my desired changes this was acceptable. As we discussed my hopes, he listened and rendered the images in real time. The final product was exactly what I was envisioning. He felt my skin was more in the medium thickness range, and that what I was hoping to achieve, a more defined nasal tip, was absolutely feasible. I felt at ease and reassured after our consult, but why would people feel so differently about the open versus closed approach?

I decided to go to the literature and pulled papers-- I could find no evidence that one approach is clearly superior. I am in medicine as well, and so it's not so hard for me to believe that there are differences in dogma/ training over time. However, if someone can achieve the results I desire in a less invasive approach, shouldn't I be thrilled? Dr. Maloney was also realistic- I wouldn't have perfect symmetry as I congenitally have some asymmetry, the results could be imperfect, we would have to see what extent of change was appreciable after the surgery (though he feels confident there will be improvement), etc.

So, at the end of the day- I decided! My surgery is on Monday. We'll see how things go. I'm hopeful things go well and I have a positive outcome

Fingers Crossed!