1) I sincerely hope others can learn something valuable from my posts and avoid some of the mistakes I made along the way
2) I am grateful to have found an outstanding doctor for my 2nd surgery (Dr. David C. Pearson, Fleming Island, Florida), and so I am happy to do anything I can to further add to his already extremely positive reputation on this site (check out his other reviews to see what I mean).
I will have a lot of details to add to subsequent posts, but I'll start with the specifics asked for when you fill out the review form here:
MOTIVATION FOR MY PRIMARY SURGERY (A SEPTORHINOPLASTY): I am someone who never thought I would have even one rhinoplasty, let alone two! A few years ago, I initially sought out a consultation with an ENT doctor due to problems breathing through my nose at night. He recommended a septoplasty with turbinate reduction, but as he was also board certified in facial plastic and reconstructive surgery (in addition to his certification in Otolaryngology), he offered to take down my semi-prominent dorsal hump at the same time. (He also told me that he thought that having some elements of rhinoplasty would allow him to do additional things that could further improve my breathing.) Although I had always hated my profile (my nose had been broken as a child, and in addition to the dorsal hump, I had a noticeable bump high on one side of nose), I had never planned on getting a rhinoplasty. I was always pretty happy with how my original nose looked from a frontal view, and I was content to live with a less-than-attractive profile. But when the first doctor said he could fix the hump at the same time, make possible additional improvements to my breathing, and since most of my procedure was being covered by my insurance due to the breathing issues I was having, I stupidly agreed to the rhinoplasty component without thoroughly researching either rhinoplasty in general or my particular doctor. That turned out to be a considerable mistake! Luckily it didn't turn out as badly as it could have (though it was bad enough to cause me over two years of sadness and anxiety over the outcome) and now, one week out from from revision surgery, it appears that it at least turned out to be a correctable mistake. (I will write another post later with more details about my experience with the primary surgery and the doctor who performed it.)
MOTIVATION FOR REVISION RHINOPLASTY: While my primary surgery was not a complete disaster and even had some good results (my breathing, while not made perfect, was definitely improved), it left me with three significant problems:
1) Some strange-looking irregularities on the bridge of my nose that were especially noticeable in certain types of lighting (direct overhead lighting being the worse). This problem was also visible in a good number of pictures taken in the period between my two surgeries.
2) In addition, the mid-third of my nose was made noticeably wider by the spreader grafts used in my primary septorhinoplasty. Before the op, my doctor had never even mentioned that he might put in such grafts and that they had the potential to visibly widen my nose. I do think they have ended up improving my breathing (in combination with the septoplasty and turbinate reduction done at the same time), but the change in the frontal view of my nose (which I had always been happy with before and which I had not asked for any change to) was shocking to me and I quickly began to feel upset every time I looked in the mirror or at a picture of myself.
3) Even though I had not asked for any "tip work" and the first doctor didn't do any, somehow my tip ended up looking different anyway, just from the work that he did do*. I don't know if it was related to the way the spreader grafts changed my mid-third area or the work around the caudal end of the septum that was done (or some combination), but my tip ended up looking really flat in the middle and also noticeably wider than before the surgery.
*This is related to a very important point to contemplate about rhinoplasty--the various parts of the nose are interrelated in such a way that even though you might be focused on just "one thing" you don't like about your nose, sometimes changing that "one thing" will result in an unanticipated negative effect on some other aspect of your nose that you didn't previously have a problem with. Obviously, a top-notch surgeon should be able to anticipate this to some extent and can advise you or make adjustments on the spot during the surgery to take this into account, but in my experience, this is one of the riskiest elements of rhinoplasty and where I really feel I was "burned" by my first surgery and surgeon. Consider whether you might be creating problems you never had before by trying to fix whatever you feel your initial problem(s) is(are). If you feel your initial problem is severe enough, you might feel the risk is worth it, but if not, you may decide that "the devil you know is better than the devil you don't."
So, after MUCH agonizing (and A LOT of research), I decided to get a revision rhinoplasty. I'm only one week post-op at this point, so I'll be making updates as I go through the entire healing process (which I know might take even longer than a year since this is my 2nd surgery). I'll also be posting more about what happened in the period leading up to and following my primary surgery. For now, I'll end this already long post with a few bits of advice for anyone considering rhinoplasty. Obviously, I can only base my advice on my experience, so of course I would encourage anyone considering it to read widely (yet carefully) on this site to get a number of different perspectives.
1) Do some deep, honest reflection on whether you are really prepared to accept all the possible risks of having rhinoplasty. Unfortunately, I did not realize soon enough that it is not something to be taken lightly. An honest surgeon will tell you up front that rhinoplasty is considered to be the most technically challenging form of cosmetic surgery (your doctor should mention something about this at your first appointment--if he doesn't, I would consider that a "red flag"). You can see from the doctors' answers area of Real Self that the revision rate is anywhere from at least 5 to 15% percent, and even choosing an excellent doc for your primary surgery is no guarantee you won't end up having to consider a 2nd surgery (whether for breathing issues or cosmetic reasons). While docs will say that a number of revisions are actually "minor" in nature, it's still a 2nd surgery, with all of its related risks. And it's possible that a mistake or "unanticipated consequence" from a first surgery will end up being uncorrectable. I'll have to see how I feel at the end of my revision healing, but even if my nose ends up looking overall "better" than my original nose (before my 1st surgery), I'm not sure whether I will say that all the mental anguish and emotional upset I went through along the way was worth it. That may be because I was not someone who had spent years hating my nose and contemplating rhinoplasty. Overall, I had lived with my adult nose for decades and didn't have that much problem with it, so I feel it was stupid of me to sort of "add on" a rhinoplasty component to my planned septoplasty when I had always been basically happy with the frontal view of my nose (the view that is most important to me). BEFORE my 1st surgery, even though I had a somewhat large, beak-like nose from the profile view, I liked what I saw in the mirror from the front and in most pictures taken of me from the front, and I had _never_ felt an overall sense of "ugliness" due to my nose. However, AFTER my primary septorhino, I quickly _came_ to feel "ugly" due to the three problematic outcomes I listed above. It's really hard to look in the mirror and feel that the face you've known all your adult life has been changed for the worse and to not know for sure whether or not you will be stuck with that worse change.
On the other hand, if you are someone who has never felt comfortable with your appearance (from any angle) due to your nose, your situation would be different. Rhinoplasty is still not something for _anyone_ to take lightly or rush into IMHO, but at the very least I would recommend that people only consider it if they feel that their appearance issues with their noses are "severe," rather than just "moderate" or relatively small.
2) If you do decide to seriously consider rhinoplasty, take the time to thoroughly research potential surgeons and have initial consultations with _several_ doctors (really, the more the better, within reason, of course...and the more doctors you meet with, the easier it will be to tell which one (if any) would be right for you. Many docs offer free consultations, but even if you have to pay for all of them, the peace of mind would be worth it in my view. When it comes down to the morning of your surgery and you're being prepped for the OR, you will need to know in your heart that you picked someone you can truly have confidence in. In my own case, I didn't realize until too late that my first surgeon, even though board certified in both Otolaryngology and Facial Plastic and Reconstructive Surgery, was not skilled in performing rhinoplasties, and, as a consequence, after my 1st rhino, one of the problem areas on my nose was so unnatural in appearance that my revision surgeon found its cause to be inexplicable (even when he had the complete set of op notes and diagrams from the first surgery to refer to). You need to find a doctor who focuses on rhinoplasty, not just one who is certified to do them.
3) If at all possible, try to bring someone close to you to all of your rhinoplasty consultations and major appointments. If you're like me, sometimes it's easy to get lost in all the Q & A and the details (even if you try to take notes during the appointments), and it's invaluable to have someone else who can help you reflect on what you've learned at each appointment and even help to fill things in if you can't remember something that was discussed. And even though it's your opinion of your surgeon that ultimately counts the most, it's very reassuring when a second person can express confidence in your chosen doctor based on what they've observed at your appointments.
4) Don't be afraid to have multiple consultations with the same doc before making your final decision to book the surgery. Don't be afraid to ask _a lot_ of questions (bring them in written form to your appointments to make sure you don't forget some of them)! If the doc seems impatient or otherwise unwilling to go beyond a few general questions into more depth as your consultations progress, find another surgeon! If a doc isn't willing to patiently address all of your concerns, do you really want that person operating on your face?!
5) Ask your doctor to explain ALL the risks and potential complications of rhinoplasty (and of general anesthesia surgery generally) at your FIRST consultation. If his response seems brief, he's not being completely up front with you. Early on in your consultation process, ask to see an advance copy of the consent forms you will have to sign right before surgery. Ask questions about what you find in these documents. Don't allow yourself to be "baited" with attractive-looking simulation pictures months before the surgery and then end up feeling pressured to go through with it because you're only learning the details about all of the potential risks shortly before your scheduled surgery.
If the initial set of of simulation "morph" images doesn't closely match what you had in mind for your outcome, don't be afraid to ask the doc to produce a 2nd (or even third) set of images. Some doctors have a particular "aesthetic" they lean towards, and this may not be the same as what you are comfortable with. Any good doctor should be willing to deviate from what they might independently consider as "most attractive" in order to be able to create what the patient has in mind (assuming what you have in mind can realistically be achieved by that doctor given your particular anatomy and previous surgical history, of course).
6) Never let yourself feel pressured or "rushed" into booking your surgery (for any reason). In my own case, I had already met my insurance deductible earlier in the year I had my primary septorhinoplasty, and because most of my surgery was going to be covered by insurance (due to the breathing issues aspect), I let myself feel pressured by the fact if I waited until the next calendar year, my surgery would've cost considerably more (since the deductible would reset in January). If I had not rushed to get my surgery in by the end of the year, I would've had more time to research the rhinoplasty elements and perhaps I would've just gotten the septoplasty/turbinate reduction. Paying more for the surgery I _did_ need for my breathing would have been worth it if it meant that I would have avoided the unnecessary (cosmetic-only) parts of the surgery and/or at least chosen a better surgeon.
Whew! I wrote more than I had planned...hope at least it's helpful to somebody :-)