Learn From My Mistakes! (My Septorhinoplasty/Revision Rhinoplasty Story) - Fleming Island, FL

I was initially hesitant to post here (even using...

I was initially hesitant to post here (even using an anonymous username), but I'm doing it for two reasons:

1) I sincerely hope others can learn something valuable from my posts and avoid some of the mistakes I made along the way

and

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.

MY ADVICE:

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 :-)

2 Weeks Post-Op and All's Well :-)

Had my 2 week post-op appointment today. Dr. P says everything looks good, and I am still very happy with how things are looking! He showed me some "nasal exercises" that he wants me to do to help prevent a bone callus forming on the upper third of my bridge where he rasped away the weird irregularities left from my primary op. Basically the exercises amount to using my two index fingers to tighten and press down the skin over the rasped area for 30 seconds at a time, 4 to 5 times a day. He said I should do these all the way up until my next scheduled follow-up (at 6 weeks post-op). When he first mentioned the "exercises" last week (saying I would be starting them this week), I had been a little nervous about possibly doing them wrong in some way and messing something up, but I was relieved to see that it seems pretty simple to do. I'm glad I didn't have my nasal bones broken during this op (that had already been done in my primary), though, because that would probably make me more worried about pressing too hard or something.

Other updates at this point:

--The incision under my nose seems to be healing well. The last little "dot" of a stitch end (in the middle of the "stair-step" incision) came out today when I showered. Dr. P says I don't need to apply any more antibiotic ointment to it and that the main thing is to make sure to apply sunblock to the area if I go out in the sun, particularly if I'm at the beach where there's more reflected light coming up from the water and sand. I asked him about various products recommended for minimizing scars, but he said that some of those haven't really been shown to be effective and really wouldn't be necessary anyway. He suggested just keeping the area moisturized would be sufficient.

--He noted again that I had very little swelling, and said that while my tip will look more refined as the months pass, I don't have to worry about things looking a lot different since I didn't swell up a lot to begin with. This was great news to me as I really like the way things look now and don't really need or want my nose to look significantly smaller! My "supratip" and tip areas do look more swollen in the mornings, and he said I can expect my nose as a whole to swell up and maybe even turn a little red with exercise during the first several months, but I don't feel at all self-conscious about being seen even in the morning. I think unless someone purposely focused their attention on my incision area (where the incision is still visible as a pink line), they would have no idea I had surgery!

--Even before my cast came off, I had noticed that from the "worm's eye" view, the opening to my right nostril seems slightly smaller and differently shaped than my left one and that my columnella doesn't appear _completely_ straight (just very slightly tilted or off-center, particularly in the upper half of it). However, I haven't compared what I see to the views from that angle that my doctor took before the surgery (I only have copies of one profile view and the frontal view), so I'm not sure if there was already some asymmetry there before. (I noticed that one of the docs in the Q & A section of Real Self answered a similar question with the reply that "The primary cause of asymmetry after rhinoplasty is asymmetry before rhinoplasty," since people tend to focus a lot more attention to every little detail in their noses after they have surgery and then end up noticing things they had never noticed before but that were always there to begin with!) I sent a preliminary email to my doc about this last week just to ask if such asymmetry could be due to irregular swelling. He said that, in general, yes, uneven swelling could be a possible cause and he also noted that he had done more work/"dissection" on one side than another (because he had considered doing a slight shave of my still mildly-deviated septum on one side until he determined that it shouldn't be done because my mucosal lining was already too thin there from my previous op). Then I asked him about it in person today, and he did say that sometimes the "worm's eye view" can end up being compromised a bit in order to fix other problems. That makes sense to me and I think that as long as the issue doesn't become more pronounced appearance-wise and as long as my breathing is still at least as good as it was before my revision, it won't bother me to have some unevenness there.

That was about it. He said I'm cleared to blow my nose regularly (he said I could blow gently at one week) and am also cleared for strenuous exercise. Next appointment will be at 6 weeks, and then the next at 3 months when he will take a first set of pictures.

All in all, I have been surprised at how great things are looking this early in my recovery. I just hope nothing changes for the worse over the next weeks and months! I had so much anxiety about this whole situation going back to the days right before my 1st op, so it's such a RELIEF to feel like over two years of anxiety and regret are finally behind me! I will update again at the 6 week mark (or before if something notable develops either positive or negative).

Nice experience today :-)

I was in an elevator today with the kind of overhead lighting that made my pre-revision nose look the very worst (the two visible lines and small bumps on the upper bridge created by my 1st op would create weird shadows with that kind of lighting, and my supratip area was so flattened that the lower part of my nose also looked really bad with odd shadow effects there too) and...to my delight, everything looked super smoothed out and had a very nice overall shape!! :-) Such a change for the better! I also don't have to cringe when going into public bathrooms anymore (another type of location that made my pre-revision nose looked pretty bad)...hooray! It really is so nice not to have to worry about significant changes in my appearance based on the lighting (before my revision, it sort of reminded me of that old Seinfeld episode about the girl that Jerry dated who was a "two-face," lol...)

I'm still a little concerned about a small difference in my right nostril...even before the cast came off, I noticed that it is now slightly smaller and a little differently shaped than the left one, and since then I've noticed that it pulls inward more with breathing (both visibly and in terms of how it feels) noticeably more than the left one does. It also sometimes feels less "open" in its upper corner where the septum is, almost like there's something obstructing it or stuck in that area or like it's slightly "pinched," and there's a little indentation on that side of the tip that isn't there on the left side. So I hope to ask Dr. P about that at my next visit in about 2 weeks. (I say hope, because it is a pretty minor thing and I don't want to come off as too nit-picky or like I'm being critical of his work--I absolutely trust his skill and what he did in my op 100%, but I know that even with a great surgeon, some effects of surgery and/or healing are not always completely predictable.) Assuming that what I'm noticing doesn't become more pronounced over time, I'm really not worried about the "worm's eye" view of my nostrils or even the small indentation/asymmetry on one side (my husband said no one would notice it unless I pointed it out, since he didn't notice it until I directed his attention to it, even though of course he's looked closely and carefully at my nose at several points since my cast came off) . My only concern would be I started to feel like my breathing was significantly compromised on that side (like if the nostril opening starts to collapse more with breathing and/or its overall shape becomes more narrowed). So I would like to get his opinion on whether he thinks it might get worse with time or not.

But the main purpose of this post was to report something that really put a smile on my face, so that is what I want to emphasize! :-)

Six Weeks Post-Op (and things are still good!)

Had my 6-week post-op visit this week. Dr. P says everything looks fine inside and lifted the remaining restrictions I had (I can now wear sunglasses--previously he had approved only regular glasses that have nose pads; I can sleep on my stomach if I want, etc.). I did the "nasal exercises" for the last four weeks and he said they can now be stopped. (He also pointed out that there's no hard evidence that they help at all in the first place, but they can't hurt during that period, so he tends to recommend them just in case.)

I asked him about the slight asymmetry in my nostrils (including the small "dent" or "notch" in the "soft triangle" area on one side) and he saw it , but he said that it could still change over time, so it's too early to make any definitive assessments (which I anticipated it would be). But, on the positive side, he said that it's not likely to change _a lot_ in either direction (worse or better), so that helped to ease my mind about something really pronounced developing. (Right now, the unevenness is so minor, that if even it just changed a little for the better, that might be enough to eliminate the issue completely.) Also on the positive side, he mentioned at least two possible types of minor, in-office "tweaks" that he could do to address whatever issue may remain at 6 months to a year (things to make the nostrils appear more even from the front view and/or to "fill in" the little notch/dent on one side). I'll just have to wait and see and actually, the issue is so minor now that as long as it doesn't get worse, I think I might opt to just leave it as it is and not even get any "tweaks."

All in all, I felt really good after this visit. Sometimes I can let my anxieties about what might develop in the future run rampant (probably reading too many "horror stories" on RS), and Dr. P definitely put my mind at ease. I really do have complete trust in everything he did (and didn't) do in my surgery, and I fully trust his responses to all my post-op concerns and questions. This is such a huge difference from my post-op visits after my 1st op, when I lost more and more trust in my doc with each visit!

So, I imagine my next update will be in early September, when I go for my 3 month post-op appointment and he will take my first set of "after" pics. But I'll try to check back here now and again before then in case anyone has any questions for me.

Three Month Update (a little late)

I had my three-month appointment a couple of weeks ago. Nothing much to report. Overall, I am still happy with my result as it is definitely a significant improvement.

I do still seem to see a slight unevenness/asymmetry in the tip (with the shape being a little different on one side and the nostril on that side seeming to appear a little higher than the other one), but I think Dr. P thinks it's still too soon to really evaluate that (he said I still have some swelling). If what I see now is still apparent at 1 year, I will see what he thinks and if he would recommend any little "adjustment" (using a filler, I'm guessing), but assuming that what I'm noticing doesn't get any worse, even if he thinks he can improve it, I might decide to just leave things as they are as it seems very minor right now and I still feel extra cautious/conservative about doing anything further (I just don't want to risk any unintended consequences--my experience with that from my first surgery made a lasting impact on my attitude toward all of this!).

He did take a first set of post-op photos (though not the complete set of all the different views, as he said it would be better to wait until more swelling dissipates to take the "oblique" views), but I haven't seen them yet, so I'll need to email him to ask him for a copy. I am very curious to compare them to my pre-op photos, since even though I've had photos taken of me since June, you can't really get the same sense of comparison unless you're comparing very similar shots in terms of distance, lighting, etc.

My next update won't be until January, but I'll try to check into my account here every now and again before then in case anyone has any questions about my op/results and/or Dr. P.
Jacksonville Facial Plastic Surgeon

I am so grateful to have found Dr. Pearson. In researching my revision rhinoplasty, I met with a total of 5 different surgeons and Dr. Pearson clearly stood out as the best choice. He has excellent training and experience, and, so far, I have been happy with every stage of my interactions with him (from multiple initial consultations and the final pre-op appointment to the day of surgery and my initial post-op appointments). I'm still very early in my healing, but I'm already very happy about my initial results and am optimistic that the final results will also be excellent. Due to my bad experience with my primary surgery (with a different doctor), I'm sure I haven't been the easiest patient at times, but Dr. Pearson has been very reassuring. Dr. Pearson specializes in facial plastic surgery only and is passionate about rhinoplasty/revision rhinoplasty. You can tell that he enjoys the challenge of understanding a patient's individual situation (nose anatomy, any past surgeries, etc.) and formulating a customized plan to address the patient's concerns. While some doctors seem to just be merely "doing a job" when you meet with them, Dr. Pearson is different. He's sort of like one of those auto enthusiasts who love working on cars in their spare time (to make them both perform better and look better), except that his passion is for improving noses! :-) He takes time to fully answer all your questions and I never felt "rushed through" any of my appointments (this seems to be a rarity in healthcare today). Furthermore, his answers always inspire trust and confidence. He pays attention to the details and is dedicated to working with his rhinoplasty patients to make sure that they understand every stage of the process. He also listens carefully to the patient's goals and clearly communicates his plans for how to achieve those goals. I have also found his office staff to be friendly and helpful.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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