Rhinoplasty with Dr. Grigoryants

Hello all, I've been a member here on RealSelf...

Hello all,

I've been a member here on RealSelf for a couple of years now and am overwhelmed by the amount of feedback and support you all offer each other. This is the first time I have considered posting anything to the website because I consider myself an extremely private person. However, with my upcoming surgery date looming closer and closer, I find myself constantly checking the website seeking reassurance about my decision (this website and your reviews are the reason I picked my surgeon!), pictures and reviews of procedures I do and do not like, as well as the many tips and tricks my fellow patients have been kind enough to share. And then it occurred to me, how selfish am I to keep this huge life event to myself when I have learned so much from you all.

So here I am. I am exactly one week away from my surgery as I am writing this and nervous as all hell. For those of you still making this decision (it's a big one!) or have already scheduled and are looking for insight or support, here's a little about me and my situation:

WHY: My story is similar to most so I won't belabor the topic. I have, what I consider, a large nose with a dorsal hump and bulbous tip. I have wanted and otherwise known I would get a rhinoplasty since I was about 13 because of the deep insecurities I feel toward my nose. I'm sure you all understand when I say that even on my best day, I never feel 100% because of my nose. No one has ever teased me about the size of my nose or suggested I get the procedure. To the contrary, in fact, most people in my life strongly oppose me getting it done or have taken some convincing. Now that my family understands that it is not a superficial insecurity that I will grow out of (I'm 23 years old), I am moving forward with their support.

WHO (surgeon): I have chosen to go with Dr. Grigoryants because of the amazing feedback I have seen here on RealSelf. Although I still have my concerns and not all of his work is 'perfect', I also realize that perfection is an impossible standard whether its given by God or paid for.

WHEN: my pre/op appointment is Tuesday, November 15th and my procedure will be Wednesday, November 16th at 9:30am.



I am currently in the process of gathering my post/op supplies as well as compiling a list of questions and photos for Dr. G. If you have any suggestions or questions for me, please fire away! :)

(Pictures to come)

Pre op - Day 5

Hi everyone,

I'm sorry it has taken me a few days to update my review since the surgery (it's been quite the whirlwind), but I finally feel up to reviewing the process so far.

Pre-Op:
My pre-op appointment was November 15th at 5:30pm. I arrived a few minutes early, filled out some paperwork and was seen shortly after. I started the appointment with one of the girls from the front desk (who are all very sweet to answer questions), who described a little about what the surgery day will be like, what to expect, etc. My actually meeting with Dr. G took place afterward and only lasted a few minutes. Despite my best efforts to come prepared with lots of questions and pictures, he pretty much told me exactly what I wanted, took a few pictures and said goodbye.

My mom and I went to the pharmacy afterward to fill my prescriptions (I was given one for antibiotics, one for pain and one for nausea), as well as buy any last minute supplies. I could hardly sleep this night because I was so nervous and excited!

Surgery, DAY 1:
I was told to arrive at the hospital by 8am, but we got there about 30 minutes early because I was nervous about the LA traffic. I filled out paperwork at the front desk for about 20 minutes and was brought back to the nurses station at about 8am to get ready for surgery. My nurse, Erry, was very sweet and brought me back to a bed behind a curtain to change into my surgery gown. She went over more questions and paperwork and then went about trying to get my IV in. For whatever reason this is always a struggle whenever I get blood drawn so it took a few tries, but I'm fine with needles and wasn't too bothered by it. At around 9:30 they wheeled me into the pre-op area where I waited to meet with Dr. G and the anesthesiologist. Both meetings were brief; Dr. G quickly explained what he would be doing to my nose and I asked my mom to take a picture of his finger morph so I would have an idea of what to expect. The anesthesiologist was very nice and smiley, which instantly put me at ease. He let me ask all of my crazy medical soap opera questions about being unable to move but feel everything during surgery, gave me something to relax and explained what would happened after surgery as I came out of anesthesia. My mom was able to stay with me until they took me away for surgery. I remember them wheeling me into the operating theater and then sliding from my bed to the surgery table and then nothing after that.

I was told that after surgery I would wake up to them clearing out my throat and asking me how I'm doing, but I don't remember any of that, just waking up to a throbbing pain and nausea. They gave me something for the nausea and then took me back to the post-op area where my mom was waiting. I waited there for another hour before they would release me and the nurse helped me into my sweatpants, zip up sweatshirt and slippers. They put me in a wheel chair and escorted me out to our car where we only made it halfway across the parking lot before I was hit with nausea and dizziness. We waited about 20 minutes until I was sure I wouldn't pass out and then made the 30 minute drive home. I slept for most of the first day, drank water and nutrition shakes and felt nauseous from my meds.

DAY 2:
Admittedly, after reading about how smooth so many people's recoveries were, I was a little bit surprised at the amount of pain I was in. The pain meds they gave me took the edge off but made me really nauseous, so it was a constant battle to balance the two. The pain meds also made me really sleepy so most of the second day was spent sleeping for 3-4 hours, waking up for 45 minutes, repeat. I drank a lot of ensure (highly recommend, they were cooling on my throat and full of protein and vitamins when I wasn't feeling up to real food), water and had some noodle soup and a few bites of jello. I can't taste much with my nose all stuffed up and haven't had much of an appetite anyway.

DAY 3:
Still very bruised and feeling a lot of pain. I'm surprised at the amount of pain I've been in after reading so many reviews about "uncomfortable" recoveries. It just goes to show that everyone heals differently! I switched to tylenol today because the nausea was worse than the pain, but I noticed I had a much harder time sleeping because of it. The doctor said its ok to eat normal foods again after day 2, but I just haven't had much of an appetite so still sticking mostly to soups, jello, ensure drinks, and microwavable dinners with soft turkey and gravy. I also discovered today that my uvula may have been damaged during the surgery. Immediately after the procedure on Wednesday I could feel a fleshy lump at the back of my sinuses that when I pulled on it (like when trying to withdraw mucus), felt "wrong". The nurse had told me it was probably a blood clot and to leave it alone, but for the past few days the inability to clear my sinuses has gathered mucus in my throat that makes it difficult to breath. After doing a little internet research and inspecting the back of my throat, my uvula appears stretched out and the bottom half is a white/gray color. I emailed Dr. G about it and he said that this sometimes happens, nothing to do about it which was actually helpful in that it made me feel comfortable enough to withdraw some of the mucus from the back of my throat and I could breath much better. After being on tylenol all day I woke up in the middle of the night in pretty horrible pain and switched back to the pain killers.

DAY 4:
The bruising around my eyes continues to decrease and has become increasingly yellow, less purple. The skin under my eyes, which was pretty swollen for the first couple of days, has a funny texture, kind of saggy as the swelling decreases. I also woke up this morning with really heavy cheeks toward the bottom of my face. They felt like they were full of liquid. I switched on and off between tylenol and pain killers throughout the day, but the biggest discomfort is proving to be my throat/uvula. It's very raw and stretched out and although it used to feel better to drink cool liquids to sooth it, now it feels a bit like squeezing lemon juice into an open cut. I had a bit more energy today and spent more time awake than I had for the past few days. Me and my mom take little strolls arm and arm around our hotel floor to help prevent blood clots and to get out and stretch my legs. I'm really not bothered by being seen with my bruising, swelling, facial bandage and generally un-washed state of being. I'm really nervous about my family and close friends seeing me, but don't mind the stares from strangers. I'm getting a little more movement in my face and can now raise my cheeks into a little smile, wiggle my nose from side to side (which I try not to do!) and generally move my upper lip a lot more.

DAY 5:
I still wake up a few times throughout the night because of the aching in my face and pain in my throat. I take a couple of tylenol, drink some water and then try to go back to sleep. The swelling has gone down in my cheeks a little today and the bruising continues to improve. The skin around and under my cast is starting to itch a lot more and I am feeling a more constant burning sensation throughout my sinuses. I have been wearing my glasses over my splint for the past few days. The doctor said its alright to wear them over the cast because I can't see more than a few inches in front of my face without them, but they do apply more pressure to my nose which makes it uncomfortable, so I take them off when I can which has caused a bit of eye strain as well. Both of my nostrils are still draining, but one side continues to bleed bright red (this started up again after I began cleaning it day 3 when I think I put the moist gauze a little too far up my nostril, so beware). I'm not too worried about it but I'll see if Dr. G has any concerns when I go in for my post-op appointment. I can't wait to get my cast removed on Tuesday (two days from now)!!! Partially because I'm eager to see the results, but also just because I'm starting to get my energy back and am just ready to get home (I'm from out of state).

Sorry for the delay and subsequent long post! I'll be posting pictures and another update as soon as I get my cast off. Let me know if you have any questions!

Trouble uploading photos?

The site is not accepting my photos... They are in jpeg format and within the size limit. Any ideas?

Before Photos

Finally got some photos to upload!

Cast off!

Hey all!

I got my cast off today and after working myself up in nerves all week and preparing myself for the worst.. I could not be more pleased!!!! The front is definitely upturned and wide due to swelling, but honestly I'm so happy with the improvement, I will be ok with it no matter how much swelling goes down. Even though my surgery was a week ago, I really felt like I got my new nose today. I only managed to get one photo in (sorry, I hadn't had a chance to wash my hair yet), but I had a super busy day getting ready for my flight home tomorrow! I'll try to post more soon and I'll be sure to keep you all updated!


On a side note:
While I was cleaning some of the thick, dried mucus around the inside of my nostrils, I accidentally grabbed a stitch and, thinking it was nose hair, ripped it out. O_O it gushed blood for a minute but then stopped. I emailed Dr. G about it but haven't heard back. Then later I noticed a mushy, fleshy blob on the inner wall of the same nostril that I thought might have been a booger, but bled when I touched it. I'm really concerned... Please let me know if you have any insight!!!!!

Day 12 Update

Hi everyone! Sorry for the delay. The truth is, I haven't gone anywhere or done much since my surgery and the last few days have pretty much been the same in terms of recovery. Since I got my cast off I have been rinsing once a day with saline and cleaning it with tissue, pretty aggressively.... I can get air through both nostrils now but I still pretty much sleep with my mouth open (and sitting up) so I still wake up with a sore throat and dry lips. My nose is pretty sore in the morning so I usually take two Tylenol after waking up. I stopped taping last night because removing the tape is really difficult and uncomfortable and I feel like it's too rough. Also breaking out pretty badly from the tape. I plan on calling his office tomorrow to make sure this is ok, although he did tell me that taping will not affect the final results and it's just to reduce the amount of swelling that develops over night.

Update on the ripped stitch:
I stopped by his office before I left for the airport and he looked at it and said it should be fine, just leave it alone lol. He cauterized the incision to prevent further bleeding. The lump is still there and despite him looking at it still concerns me. I emailed him again and he said it's just swelling.

Here are some pictures from various angles. Today was my first day wearing makeup since the surgery but I took the photo before I did any contouring to my nose. I can tel it's still quite swollen in the lower half, but it was easy to slim down with makeup. The most uncomfortable part about my appearance now is actually just the swelling/stiffness in my upper lip! My cuspids bow is kind of pulled up and tight, like a who from whoville. And I can't really smile with teeth. I'm loving my nose but feel that my face still looks 'weird' just because of the stiffness of my upper lip, which also appears quite long.

Let me know if you have any specific questions and I'll try to update again soon!

Botox Post-Op Day 15

I may have done something stupid today. I had botox injected into my forehead and between my eyebrows as it was my regularly scheduled appointment time. I didn't really think about my rhinoplasty as I have read that swelling that obscures forehead lines are the only contraindications for getting botox after rhinoplasty. However, after she injected the botox between my eyebrows, she pressed the palm of her hand firmly down on my forehead and slightly on the upper bridge of my nose, between my eyebrows. It didn't hurt, but I could feel the pressure in the upper part of my bridge and quickly mentioned that I had had surgery, but it was too late at that point. I have become very nervous about this pressure and generally the amount of pressure I use when cleansing the skin on my nose or applying makeup. Even though Dr. G said this was fine and it doesn't hurt, it also doesn't feel 'right' and I'm afraid I might be disrupting my results. I've also already had a few 'bumps' that include hitting my nose when sneezing into my hand and my cat bopping me on the tip of the nose with her head.

I have emailed Dr. G and am waiting for a response regarding the botox. Please let me know if you have any insight!!!!

3+ Weeks Update

Hi everyone! A little over three weeks now so I thought I'd update. My nose is starting to feel a lot more like a nose and less like a foreign object adhered to my face. I can now do most things like put on makeup, wash my face, clean my nose, and even lightly bonk it both out discomfort. I've tested out implementing saltier foods into my diet and even had a few cocktails the other night at a Christmas party and found that for me, it really hasn't made a different in swelling. The swelling in the upper half of my nose feels almost gone and I can really feel the bones underneath now. The lower half of my nose and tip are still really swollen but overall much less wide than before. From the profile I noticed the swelling on my upper bridge going down while the top remains pretty swollen, making it go from a straight shape to a slightly more sloped shape. I like them both. My nostrils are sill asymmetrical and tend to change direction from day to day. None of this bothers me. I have every confidence that these small imperfections will even out over time, but i would be happy with my decision if my final results were what I have today.

I've included some more pictures from this week. We just got snow!

Finger Morph Comparison

Hi all,

Someone mentioned it might be useful to see a comparison of the 'finger morph' that Dr. G does during the consultation and right before surgery to get an idea of how accurate his expectations are. Personally, I'm quite impressed with how similarly the results compare to his estimated profile. Keep in mind the following: 1) the finger morph picture was taken quite quickly immediately before my surgery and was 'approximately' what it would looked like. 2) these photos are all taken at different times and therefore may be at slightly different angles. I tried to re-orient them so that my forehead was at about the same slope and my eyebrows and lips lined up to give you guys the most accurate comparison of the size and angle.

Let me know if you have any other questions or requests and I hope this helps!

Photo Update

Not much to update. No major day-to-day changes, but it's feeling more and more like a 'real' nose all the time. Let me know if anyone has any specific things they would like me to update on about the healing process.

Photo Update.

It's been a while since I've updated anything because there haven't been many dramatic changes- just subtle refining. The profile has stayed pretty much the same but the front is still thinning down. There's also still some unevenness in my nostrils that I'm pretty sure will resolve as the swelling goes down. My post-op check up is in April so I'll be sure to update with the doctor's comments.

I tried to include a couple from the same angle where I am smiling/not smiling so you can see how the nose changes from the side when I smile. At first I thought the tip was still dropping when I smiled like it used to, but I actually think it's just an illusion. As I smile, my lips and nostrils raise, making it appear as if my tip is lower.

I'll try to post again if anyone is still interested in future pictures.
Los Angeles Plastic Surgeon

My interaction with Dr. Grigoryants during my consultation (I flew in-state to see him) was brief. He had a very no-frill straight-forward attitude. Although it wasn't particularly inviting, I don't mind this. What's most important to me is that my surgeon will perform well, not hold my hand. My consultation lasted all of 5 minutes, which I had read about beforehand and was determined to drag out, but it truly just wasn't necessary. Before I even began to rattle of my rehearsed list of concerns, he looked at me and said "Oh, yes, I can give you a better nose" and proceeded to describe everything that troubled me. Abrupt, but efficient.

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