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 : 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.


-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.


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'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)


Again, this is just a way for me to vent.

So why are surgeons so against tip bossae?

Honestly it doesn't look that bad and I'd much rather have it than a short nose...

Also why do surgeons shorten noses if the patient patient has a masculine-esque face?
It's kind of a poor surgical idea that results in the patient having to pay more money.

Most importantly why can surgeons charge for their mistakes?
It's not like the patient is the one that underestimated the cartilage graft.

Anyway...yeah fuck plastic surgery. It's like gambling and the house always wins (well in this case the aesthetics company, but I think the point is clear).

So I think I found I way to afford the surgery with my conservative AF surgeon: clinical trials. I know technically this should be private information... but my face changes so much that I highly doubt anyone can recognize me from this website.

It's kind of poetic in a very twisted manner: I'm getting PAID for a medical professional to mess with my body so that I can PAY a medical professional to mess with my body. LOL. Gotta love that economics.


My last surgery of 5.7k was probably the worst decision I've made with that much money.

After my SECOND surgery with conservative AF surgeon, I interviewed with other doctors to see what their opinion of my nose was. Nearly all of them said my nose was too short. But due to being in a low social economic household and a college student, I couldn't afford any of them. It sucked. So I chose a procedure with my original surgeon to smooth out the bridge (AGAIN!, cause he is conservative AF and the second surgery did accomplish what it was suppose to). Currently, my bridge still has a dorsal hump...WHAT THE LITERAL FUCK. How can money and surgery be so useless. I really wish my surgeon could have communicated better with what was being done, or just had not been so conservative AF with the grafts.

I hate how there are so fucking many other things I want to be doing with my life other than having surgery. Like, seriously, why the fuck are surgeons so fucking conservative.

And there's nothing I can do besides pay the same conservative AF surgeon to operate on my nose again hoping that this time he actually puts an adequate amount of cartilage in my nose.

But FUCK, holy FUCK, I don't have the mental strength to get from now until May with such a shitty, short ass nose that he left me with.

I mean like, I think I would still be equally mad if I had spent say only 10k with him rather than 19k with him because either way I'd still be living with a shitty nose.

But seriously looking at the finances of it, damn, I don't care if this surgeon is the best in CO or even in the four corner states. For the total amount I've spent (and going to eventually spend on this mother f*er) it would have been better to have paid for a surgeon who was more expensive but more likely to have done a better job. And I sincerely do believe there are better surgeons (Dean Tourimi, Paul Nassif, a few down in Florida like Bustillo and Davis). I mean I cannot obviously say their objective skill level is greater because ranking surgeons is not an exact science, but just by pure metrics of annual rhinoplasties, I'd assume I could have gotten a better result.

I guess I didn't realize how much my primary surgeon royally fucked my nose over. Seriously he fucked my life is such a profound and painful manner, you could say I lost my virginity to my primary doctor. And he is still practicing rhinoplasty. How the fuck is that legal?!!?? Such of a shitty surgeon who is uneducated can still ruin people's lives. How the fuck is that possible???

I have like no words. I know having a mental breakdown on a public website probably isn't the best thing to do in life.

But it's fucking...inexplicably debilitating and frustrating to continuously have the dream of normal ass nose crushed by shitty, conservative AF surgeries.

I don't understand how surgeons cannot estimate the amount of cartilage they're going to be using a head of time...Like seriously it's just a proportionality problem.

If you know how long the patient's nose is in real life (like say..pfff..4 cm) and the ideal length being 4.5 cm, then why can't a graft of .5 cm be used? I know there's elasticity of the skin and tip bossae (which isn't that big of an issue anyways...), but still knowing the patients surgical history and skin type should help the surgeon predicate how elastic the skin is ahead of time.

It just seems like doctors should be able to predict better results...I seriously don't understand this shit. I don't want to understand it. I'm never going to be a medical professional, but why, like why the fuck do doctors shorten noses??? If you see a patient with a masculine AF jawline, how about just not fucking with their nasal length/projection?

This sucks...bitching about it isn't helping...fuck. 5-6 months of this hell. Great.


So I really need to stop using RS during finals.

Rationally, what I'm dealing with isn't that bad. Is it sub-optimal? Yes.

Can I live with it? Yes.

Did my surgeon do what was expected of a surgeon (weighing risks against benefits)? Yes.

I think I'm freaking out about things independent of the surgery and using my normal (yet unattractive nose) as a scapegoat.

It's gonna be fine.

The reason my bridge is dented is because my laptop fell on it...if I have another surgery and protect my nose during the healing stages everything should heal well.

My surgeon couldn't add sufficient amount of cartilage to the tip because he was using an endonasal approach and wanted to be on the side of caution ( he couldn't be as confident as preferred when doing open tip work).

If I have another tip surgery, sure still having a short nose is a risk, but at least it would be better and that's all that can be expected.

It's unrealistic to expected optimal results.


Is going under the knife for the fourth time the right decision?

I'm only 21 years old but I utterly hate my nose again. I can't imagine living the rest of my life with a dorsally asymmetric/ tip asymmetric and most importantly short nose (Again, why doctors??? Why do you shorten noses? I literally look like I'm about ready to climb back into my mother's **** due to the immature look a short nose gives.)

Most people my age have experienced so much more socially in their life than I have and I think it's ignorant to not blame my nose.

The most tangible lesson I've learned from my 4 years of university have not been in the classroom, but rather in the months following a surgery. The anticipation and excitement, yada, yada, swelling goes bye-bye...then the ultimate disappointment. (I've been threw this multiple times before.) But the few moments of FUCK yes! I spent money the price of

-8 Macbook pros or
-1 2017 Toyota Corollas (#notProductPlacement),
-1 years tuition,
-Average GDP in rural towns,
-1 Dean Tourimi rhinos,
-2 Andres Bustillo rhinos,
-3 1/3 years rent in Boulder,
-10 beat up 150K miles cars,
-or a bunch load of concert/food/ski trips...

And that money was worth it on my nose!!! But that disposition is soooo temporal. However, life during that time is 100x better (not scientifically measured). And I hate being aware of that. Knowing the grass IS greener on the other side and...I might not ever be able to afford the other side.

The next surgery (if my surgeon consents to it). Should be approximately 3.8k for 2 hours in the OR.

However, would the added risk of that surgery be worth the little improvement?

Also, how much improvement can be expected from a surgeon who has a track record of being extremely conservative as mine?

If I knew for sure my surgery were successful and my surgeon were able to add adequate amount of cartilage to ALL left regions of my tip that need it, then yes! I could say for sure the surgery would be worth it.

But that's not the case. Surgery is probabilistic...

The only way to reduce the uncertainty of attaining the desired results is to increase the financial burden...which in turn pushes my "life goals" timeline outwards.

The thing is that for high profile surgeons, I'm fairly confident that I won't be able to afford them until I'm 30 years old.

So fingers-crossed I can get the permission, no the honor, the privilege of f*cking over my finances by 4k to roll the metaphorical dice, pull the surgical slot machine again and possibly get a decent nose that 90% *(obviously not an exact statistic) of the population gets for free...

Regretting Regret

So, not sure if this is just me talking to a wall, but I'd thought I'd make an update saying I have a lot of emotions. Like the whole rainbow of emotions raging through my mind in a given week. So...yeah I'm not going to take this whole RealSelf blogging thing seriously, cause I literally don't think I'm mentally capable of it. I don't want to damage my doctor's reputation or lead people to harm's way.
That being said, today I feel like my surgeon is nothing short of a genius. I came to him with fundamentally a facial deformity. My tip was deformed and MAJORLY deprojected when I came to him. What I'm experiencing right now is for the most part my primary surgeon's fault. My primary surgeon took so much of my cartilage. I just never realized how much until now. Pretty much every revision surgery I've had has had an element of augmentation to recover the damage he did. So, I'm mad at him, my primary surgeon, or at my parents for letting me make a bad decision, or at myself for not realizing a 17-year-old knows nothing about the world. Either way, I'm emotional right now, but I'm so happy my nose is better today than it was three years ago. I've come a long way in terms of looking not only more normal, but more feminine and honestly more like my old self. So for anybody looking into my revision surgeon, he's not a miracle worker, like at all. There likely is someone else out there that can do a better job, maybe even for less money. But know that at least my surgeon did a good job and I did not get "conned" my money. Surgery is f*cking hard...but so it accepting less than desired results.

Oversharing is a silent addicition

Okay, I'm just going to write as a coping mechanism. Damn, I still can't believe surgeons can profit on their mistakes. Like, my nasal length is seriously getting worse every day and there's like nothing I can do about. I'm going to have to use CareCredit just to afford another one with this surgeon. I just can't believe how fucking bipolar he is...Literally one day he says he won't do a tip plasty and the surgery will only cost 4k (tentatively) and then the next time I see him he says he's willing to do a tip plasty that costs 8k...WTF, how can I finance surgeries if there's no predictability? Just an FYI, I'm referring to my previous (3rd) surgery with him. Maybe if I weren't a college student then I wouldn't be so pissed about this...but it's like I'm a fucking college student. I need to not look deformed, I need to be able to go through interviews and focus on my life. This is like one of the most critical time periods of my life and I have to go through it with such of a short nose...Like damn, I wish I would have known a head of time how conservative he was. But there was no Before and Afters with results as bad as mine are...I wish my anger were actually useful and could help me work through this time period, but all I do is get super depressed. Like, it's just not fair. I have to cope with a minor tip deformity while my peers are able to enjoy they're lives, get great jobs, have a social life, and I'm stuck again in the exact same situation I was fundamentally when I came to my surgeon. Sure he kind of helped, but it's like helping an obese person lose 25 lbs. Technically, that person improved, but it didn't make that big of a difference because they're still overweight.

More thoughts

Again, this is not an actual review...I just have a lot of thoughts about this industry. I'll post pics someday so that there's objective material here. But, anyway...that's why I don't rate surgeons: it's hard to determine if I've been "wronged" by surgery or the surgeon...or both. I know that the cosmetic surgery industry is relatively a young medical field. Also, obviously there's not much funding that goes into perfecting it...unlike other scientific fields. It's pretty much just learning via an individual doc's private practice. There are academic journals and such, but it's not like there are government grants to further the understanding of aesthetics. And I think that leads to a very stagnant field. Either way, I still have my fingers crossed that someday my nose can by properly lengthened and that doctors will have the proper intuition to not shorten a girl's nose if she doesn't have the facial features for it.
Denver Facial Plastic Surgeon

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