Recent MD Sought Revision Rhinoplasty After Goretex Reaction and Failed Correction - Ellicott City, MD

I am two weeks post-op and healing wonderfully from my revision surgery with Dr. Le . I am a medical doctor and a bit of a perfectionist; and with some insight into important characteristics of a surgeon well beyond bedside manner, I spent a long time looking for the one who would correct my nose both functionally and aesthetically and minimize the risks of another failure. I know it's early in the recovery process, but I do feel like I made the right decision with Dr. Le (ie. that he is among the very best, if not it) and hope to share my experience with other patients who are facing this difficult decision.

I. MY PREVIOUS SURGERIES and LESSONS:

1, minor chisel: My plastic surgery nightmare began with a highly naive decision I made when I was 20, 7 years ago, and decided to have a small bump "filed down" by an ENT during a sinus surgery. I asked him about a feared outcome called flat roof deformity and whether I needed osteotomites to avoid it, and he said no, it would be fine. Then, he chopped up my bridge, leaving it flat. He meanwhile took out all my septal cartilage for "breathing reasons," lacking the foresight that I might need that cartilage to fix his mistake.
Lesson one for patients: DO NOT TAKE PLASTIC SURGERY LIGHTLY, or think that anything like this is quick and easy. Changing a structure on your face in highly complex and requires meticulous effort.
Lesson two for patients: DO NOT think that a surgeon is any good at cosmetic (even "simple") procedures just because he went to a top medical school and residency program, especially if he lacks cosmetic expertise.

2, primary official cosmetic: I had a proper rhinoplasty four years ago, at age 23. The results were good, my bridge was corrected, my facial balance fixed. The surgery required osteotomies to bring the bones together and the use of a goretex implant to restore my height. I also had some medpore inserted in my side wall, which had a chunk missing from Doc 1, and into my septum as well. Unfortunately, I had a lot of swelling that wouldn't resolve and 2 years later (age 25), it became evident that my body was rejecting the goretex, had formed a large seroma around it. I had the goretex removed in the office but the seroma remained. My nose still looked good with my face, but it was very swollen and there were fluid pockets that had to be removed to avoid impending damage / infection.
Lesson 3 for patients: AVOID foreign objects if at all possible, especially (I believe) if you have eczema, autoimmune disease or an otherwise hyper vigilant immune system.

3, correction post seroma ("revision" 1): I entered into the OR with my same cosmetic surgeon in order to remove the seroma / scar tissues and correct the structure without the goretex (NO SPECIFIC PLAN). Because the missing goretex left a cleft in my nasal bones, he ended up performing additional osteotomies to make everything "fit together." He also (and I didn't know this until recently), took out the medpore that had been supporting my left nasal bone and my septum. Afterwards, I was shocked by how different my nose looked -- most of my bridge was gone. Over time, due to the instability on the left side, my nose and septum also twisted over to the right. I also had an inverted V deformity from collapsed sides and could barely breathe through my nasal passages. Aesthetically, this particular surgery was very traumatic for me, as people kept telling me they didn't recognize me; I felt like my face was drastically changed and I hated it.
Lesson 4 for patients: Even if you trust your previous surgeon, DO NOT enter surgery unless the surgeon has a plan and you know it. Do not allow a surgeon to keep removing structures from your nose without a plan for replacing them.

II. SELECTING A REVISION SURGEON

As may be expected from the reader, I was pretty neurotic about my nose after this -- seeing a different face every time I looked in the mirror but at the same time uncertain over whether things could be restored. I spent a lot of time researching surgeons and was additionally overwhelmed by all the contradicting information available on the internet and all the contradictory suggestions made by surgeons about how to fix the issues.

I originally was very interested in Dr. Le for a variety of reasons:
1) He does revisions all the time.
2) He had great reviews online, with barely any negative.

I chose Dr. Le as my surgeon for another set of reasons:
1) He explained every opinion in a way that was scientifically logical to me.
2) He spent hours consulting with me, when I had seen other surgeons for 15 minutes.
3) He was not eager to take me to surgery as other surgeons had been, never pushed me but instead suggested that I delay as much as possible to let the tissues heal. I knew he wouldn't agree to my case unless he was confident that he could improve things to my liking.
4) He is super meticulous in his planning and I knew he would be in his surgery. I knew he had very long surgeries compared to other doctors, but I knew from our consult that compared to some other doctors, he wants to get every aspect of the nose perfect to the very last mm and will try his hardest to accomplish this.
5) It was clear from my meetings that Dr. Le and his staff would never spend any time censoring reviews online -- some other surgeons have been accused of false reviews and deleting real reviews, which also worried me in my paranoid state while choosing a surgeon. Dr. Le is a very no-nonsense guy. He barely even puts any pictures on his website but will spend time with you viewing and explaining pictures of past patients who had similar cases.

Why I ALMOST DID NOT choose Dr. Le:
1) I wanted Dr. Le to look at my old pictures and then tell me how to restore my nose. However, he would not look at my pictures at the first visit and insisted we talk through my nose detail-by-detail, followed by the simulations. I'm not a fan of the simulations because they're usually kind of unattractive, mug shot-like pictures, so it was really hard for me to use them to select goals. It was also really hard for me to be in charge of selecting the changes versus just showing old pictures, as I'm not a very detail-oriented person and wanted more of his input. However, he has particular methods by which he does things and this is it. Whether or not it jives with every personality, it helps him achieve the best, most consistent results.
2) The cost of the consults is per half hour, and they add up. What's more, Dr. Le does tend to talk a lot and uses a lot of analogies which you may or may not find helpful. At first, this was also agitating but in the end it was worth it. He tries to really connect with his patients and takes time on his consults -- in order to do this, of course he has to charge hourly, but he still must be losing a lot of money by not rushing through consults and into the OR.
3- Dr. Le doesn't sugar coat things. He sets your expectations fairly low (though his are much higher) so that you're prepared for margins of error. This was frustrating because I wanted a surgeon to tell me that everything would be exactly perfect in the end -- but that's not realistic in medicine and surgery.
4- He pushes back in order to make sure that the cosmetic and functional goals are worth the risk of the surgery to the patient, and this is because he cares about his patients. HOWEVER, this may come off as condescending (which I do not tolerate well) and personal at times.

((In summary, I didn't pick Dr. Le because of his warm and fuzzy personality. I picked him because his personality traits, if anything, only reinforced the characteristics that make him a meticulous and consistent surgeon that cares intensely about every surgical case.))


III. MY SURGERY, RECOVERY AND RESULTS (SO FAR)

While we had originally planned for about 8 hours of surgery, mine lasted almost 10.5 hours. Yet, somehow I came out of surgery with no bruising and way less swelling than I had after my previous 2 hour surgeries (literally outside my cast I looked normal). He used rib cartilage through a small incision (can be covered with a small bandaid).

Some changes that Dr. Le made were: reverse osteotomies to correct side wall collapse (also corrected a jagged previous break), untwisted my nose and restored my tip cartilages to their original positions, rebuilt by left side wall with rib grafts, rebuilt my bridge and restored my radix height with rib grafts; masked some soft tissue loss with grafts; straightened and reinforced my septum; used grafts to lower columella, which had become tucked up during prior twisting.

Right after the surgery, I already could breath better through my nose. Recovery wasn't bad, though I did have some rib tenderness and limitations on movement.

At 1 week post pop, my nose was still swollen so it looked a little funny, but I could tell that everything was straight and symmetric. At this time, the swelling has gone down quite a bit (won't resolve completely for at least a year) and I am amazed by how much my nose has been restored. I actually have my old face back and am thrilled to move on from this.

Honestly, I think that every reputable plastic surgeon has good results among the variety. My bet would be on Dr. Le for the most consistent successful results. If you're looking for precision, he will stay in the OR until every detail is optimized. I would suggest Dr. Le to anyone considering rhinoplasty and most certainly for patients undergoing revisions.

I received requests for pictures before and after. It is still early, however, so there is a fair amount of swelling.