College Student, Revision Surgery

I love swelling. I love the way it blankets the...

I love swelling. I love the way it blankets the nose in a sheath of ambiguity. Did I just waste a cool 15k? Will I finally look good enough? The lack of certainty is intriguing, like Schrödinger's cat (or Schrödinger's nose job if you will, the nose is simultaneously f*ck** up and beautiful). However, the swelling is only temporal. It fades and all the neurotic questions are finally answered. In the case of a good nose job, the concerns are no longer relevant and the nose at last is not the prima donna of the face. This is what a typical nose job should be. However, there are the not-so-seldom cases of Benjamin Button nose jobs. The healing of the nose seems to go in reverse, getting worse and more undefined daily. These are the nose jobs I have experienced.

My first procedure (see the review here :http://www.realself.com/review/united-states-rhinoplasty-residual-dorsal-hump) was botched. I was driven to find a relief to the psychological pain I was experiencing. I wanted to feel normal, human, and approachable. I initially chose my revision surgeon based on volume of reviews. He offered to get my insurance (UHC) involved in the breathing component. The other doctors I interviewed with didn't. So I chose his office. (There were definitely other assets this doctors seemed to have; however, involvement of insurance was the most significant).

The anatomical goals of the procedure were as follows:
-Straighten my profile (raising the middle/lower third and lowering the upper third)
-Widen the middle third (provide structure to my collapsed valves)
-Narrow the upper bridge (osteotomy)
-Narrow the tip (cephalic trimming and cartilage grafts)
-Straighten my septum (septoplasty)
The initial results were appreciable:
-The profile was markedly improved (like OMG, no more peanut nose!!!!!!!!!:D!!!!!!:DDD)
-The collapsed valve was successfully repaired (yay, no more impaired breathing!)
-The bridge was narrower
-The tip was narrower
However, there were caveats:
-The bridge was slanted
-The tip was asymmetric
Overall, I had a C-shaped deformity. After a few Belotero injections and waiting an entire year, I underwent a tertiary rhinoplasty. Currently (4-months post op), there has been improvement with the bridge: it is less slanted and more symmetric.
Disappointments:

General

-Benjamin Button nose syndrome
There is nothing more discouraging than seeing your nose change for the worst over time. If my current nose were my 1-month post-op nose, I'd like to think I'd be satisfied.
-Tip asymmetry/size
The doctor I went to did not agree to pursue tip-plasty in the tertiary surgery nor is he now. Therefore, I am actively seeking a skilled surgeon to perform a minor tip-plasty.

Private Practice Specific
-Poor estimation of surgery time. Both of my surgeries exceeded their quoted time.
-Difficulties scheduling a tertiary rhinoplasty.

Conclusions:

Even though there is hope to have a normal nose after a traumatic rhinoplasty, it is much more challenging to achieve it.

Don't sacrifice what you want for what is available. After my reconstructive surgery, I wanted improvement in both my tip and my bridge. My surgeon only offered improvement in my bridge. I now regret wasting my time (and his!) on a surgery that was bound to be unsuccessful.

Don't prematurely judge the success of a rhinoplasty. Often the swelling can mask refinement (or unresolved issues).

Hope this review was useful. Please feel free to PM me any questions about the surgeries!

*Note: The posted photos are in chronological order.

Elongate Tip and Correct Bridge Asymmetry

Surgery Info
---------------------
Cost: 5.7K
When: May 2016
Procedure Summary: DCF graft to left side of nose to address asymmetry issue and to the infratip lobule region.
Surgeon: Same
Duration: 3 hours
Possibly relevant events: Was offered a slightly longer procedure (4 hours) that would have emphasized tip grafts more from the same doctor. 7lb laptop fell on nose 11 days post op; however, no major fractures were identified.
Healing progress: The nose was objectively better (in terms of length and nostril visibility) in the early stages of the healing than it is now. I am seeking to change my nose (non-surgically or surgically depending on my resources).

Recent Surgery Photos

Nasal elongation is difficult apparently...
Lesson learned: If you need tip augmentation, don't opt for a simple infratip lobule graft.

Trying to Upload Photos (again)

I'm uploading these again just to show the progressive "undefine-ness" of the tip.

Hopefully, the photos highlight the importance of tip grafts. If you're in the case I was in before (having minor bridge issues accompanied with a short nose), it would be better to have your surgeon focus on elongating the tip rather than resolving the bridge issues.

In my personal experience, having a better tip (i.e. more defined due to swelling) is more important than having a slightly better bridge.

And therefore, I highly regret my recent surgery. I should have completely ignored the minor bridge issue. The result would have been better if the entire 3 hour procedure focused on my tip. At the end of the day, nothing bad happened, it was just wasted money and time that could have been better allocated.

TLDR: spend money on your tip NOT on minor bridge issues.

F Surgery

So this update is more of a personal rambling than an update, but other people may find it relatable. This may be a weird, unhealthy, melodramatic train of thought, but it's genuine (if that's a thing of value).

I have to go under the knife again to look "normal"...I hate being in this situation in life. I hate the fact I got to experience a normal social life and then had that stolen, ripped, "nonconsensually" taken (pretty sure there's not a fitting verb here) when the swelling went down. I hate living this repetitive narrative of Flowers for Algernon over and over again: yay, I finally look awesome and I'm socially competent and not a socially anxious adult........oh sh*t, oh sh*t. Nope, nevermind that was just the illusion of edema. F*ck I'm going to have to go pay thousands of dollars again to feel the way everyone else does...f*ck the inability for doctors to predict outcomes, f*ck my inability to afford the best of the best. Just f*ck having something as ridiculous as too little cartilage in my left infra-tip lobule effect my life this much.

I think that is what I miss most about having an awesome, nondistracting nose: the mental real estate. I was finally not consumed with self hating thoughts because of my f*cking nose. I was still frustrated with other things in my life (mostly things that involved other people), but not my face. I could leave my place in like 15 minutes not worrying about my f*cking nose. Do you know how great that felt? F*cking awesome. So that's I suppose why I want a 5th surgery (a 5th goddamn surgery).
See this emotional reaction...it's not minor, I guess it's the only thing rhinoplasty has given me proportional to the price I've paid. That feeling of progressive unattractive and unsocialability that comes as a poorly structured nose is revealed is hard to grasp for others (even surgeons). I feel that facial plastic surgeons often downplay the effects of a bad or even sub-par surgery. The worst effects in their mind(again, as I perceive it), is you don't get f*cked that night...yeah umm... there's a Pandora's box of terrible social, psychological consequences worse than having your sexuality suppressed.
Anyway, those are just my unabridged thoughts from an insomniac state as I attempt to engineer a plan to make a 5th surgery feasible. Take any opinions expressed as seriously as you think resonate with what you've experienced.

Why is revision surgery so difficult? And expensive?

Another rambling post cause I know RS doesn't update the revision rhino feed unless you post photos:

So I want to post my pics just to show the difference in my swollen nose and my current nose, but then again that wouldn't solve anything. A few people may comment on how it may have looked better with swelling but looks okay now or something totally different. But it really wouldn't matter. I would have to wake up the next morning, have to cope with my nostril show and weird ass bridge like every other day. So what are my means of changing my nose???? Like none right now. I'm 6 months post op and most surgeons won't touch a nose until its at least a year post op. I could theoretically consult with other surgeons and get their advice, but fuck, that wouldn't help speed up the time. I am literally powerless. Fuck. I'm a senior in college trying to bring my academic A-game, but damn is that hard when your nose looks so shitty and look worse than all your peers. Just fuck this in my life....fuck it's really just a game of economics. Can I afford the appearance I want? I wish I would have known about credit cards 6 months ago. It might have prevented the emotional distress I'm in now. Or not. Honestly, my surgeon seems so conservative that an extra hour in the OR might not have lead to a longer nose. Conversely, he may have added too much cartilage in my tip and I'd have tip visibility. But I honestly think that having cartilage show in your tip would be easier to deal with. Also, fuck surgeons who don't respond to emails quickly...just really? If a patient wants to inquire about something as simple as "Can I have filler in my nose?" it should not take over 3 weeks to respond, or in my case not respond at all. Which did not at all help my decision making process when I didn't know what the surgeon was willing to do. Fuck this, I need money...that literally solves this fucking facial conundrum. But fuck being in a position where as a 21 year old I need to have a fifth nasal surgery. I really wish I could have found a doctor that could have knocked my revision nasal surgery out in one go around. I should have looked harder around LA or gone to Miami. I honestly don't think CO has that great of revision surgeons for the degree of improvement I needed. In regards to the finances of it, I've spent soooo much with this one surgeon that it would have been better to have opted for a surgeon originally that was more expensive (especially back when I had the support of my parents).

TL;DR: I have a shitty nose again, I need money, I don't have money, fuck not understanding the importance of choosing a surgeon whose skill is proportional to the amount of work you need done.
Also, I'm a 21 year old, unsocial college student, so I'm not trying to make a statement about my surgeon. Who could be the best in CO (or maybe not). All I know is the price I paid and the result I got. I've seen other people who've gotten better results for less money and the opposite too... so just hopefully someday I can post by before and after for my surgeon (with the price) and that can help someone else out there make a better decision than I did. (Whether that means to go with my surgeon or not)
Denver Facial Plastic Surgeon

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