So happy and grateful. It looks beautiful.

Provider Review

• 17 May 2018

*My Methodology for Choosing Dr. Grigoryants* I spent a lot of time picking the the right doctor for me. Here’s how I arrived at this decision. Location came first. Although I live in San Francisco, I chose LA for my surgery, because I suspect that this is where the best of the best plastic surgeons practice. Since LA is home to so many people who need to look beautiful in order to make a living, it makes sense that the highest concentration of talented, experienced plastic surgeons would be in LA. Next, I went through all the LA surgeons and bookmarked the ones with the most striking “before/after” pictures, in my subjective aesthetic view. Of those doctors, I looked for the most encouraging good-to-bad review ratio, across both Yelp and RealSelf. Dr. Grigoryants had both the most beautiful before-and-after photos *and* the best reviews across the board: 4.5 stars based on ‎108 reviews on Yelp, and 4.5 stars based on 364 RealSelf reviews at time of writing. (Thanks, RealSelfers, for helping me take the plunge - your reviews were invaluable!) Then, I went through all the 1-star reviews on both sites to see if there were any real horror stories in terms of the doctor’s behavior and integrity. Unlike some other doctors’ reviews, I didn’t find anything that was a deal-breaker for me. Complications and bad results do inevitably happen, and it’s important to know how your doctor responds. I also evaluated the 1 and 2-star reviews based on articulateness and whether or not they sounded like they were written by a crazy person. Finally, I asked myself the question: “how bad is this doctor’s WORST before-and-after photo?” There were other doctors who did really stunning work, except that when they did a bad job, it was REALLY disfigured. Whereas with Dr. Grigoryants, his least impressive “after” photo (and I had to work hard to find one) was still a nose that I personally could live with. The final thing that made me settle on Dr. Grigoryants is the fact that he’s co-authored several peer-reviewed academic papers on rhinoplasty (there’s a list in the “about” section on his website). This showed me that he knows this practice better than most, and that he cares about advancing the state of the art. *Working With Dr. Grigoryants* I found the process highly collaborative, and very satisfying. The final result was a combination of my aesthetic preferences and that of Dr. Grigoryants. Some of the ideas for how to improve the nose came from me, and some came from him. For example, it was my desire to trim away some excess cartilage that made my nose look bulbous. But it was Dr. Grigoryants’ idea to deproject the tip and decrease the size of the nostrils. I wasn’t even thinking that it was something I needed - but I’m grateful that I listened to him and let him make these changes, because the result is beautiful. My impression is that this is not a doctor you micromanage. I could be wrong, but I don’t think this is the kind of doctor who wants/needs a PowerPoint presentation of specific, obsessive nose specifications. My impression is that Dr. Grigoryants does want to know your preferences (I remember him asking me whether I wanted him to raise the tip, what kind of slope I wanted), but I got the sense that he works best with some creative freedom, because I think that, for him, this is art as well as a science. For example, right before surgery, we were discussing whether or not I wanted a supratip break. I said - “use your aesthetic judgement - I trust you! Yolo.” And I’m glad I did, because it turned out awesome. So my advice is: if you have strong convictions about certain aesthetic decisions, voice them, and in the areas where you are less certain or agnostic, defer to the doctor. But, do make sure you always understand the decisions he’s making and make sure you can visualize them. Ask clarifying questions if you’re confused. In reading his reviews, I saw that quite a few reviewers reported that they felt rushed during their exchanges with him. I confess that I felt that way, too. But - I’ve noticed that this feeling comes up with all doctors who are at the top of their field (due to a rare eye condition, I‘ve undergone 15 surgeries and have a *lot* of previous experience dealing with many doctors, including one world-renowned expert). Doctors who are superstars - they’re busy people, they have huge wait-lists, they appear on television, they make a lot of money, a bad review doesn’t hurt their bottom line, and they can dismiss a patient for any reason whatsoever. All of that can make a person - especially women, who are socialized to please others - feel meek in an appointment, embarrassed to ask questions, afraid that if she asks one more question, the doctor will think that she’s demanding, needy, obsessive, a pain in the ass. All I can say is: work through your fears and speak up. Be respectful, thank the doctor as you go through your concerns, and don’t leave the appointment with unanswered questions. I find that making a list of questions beforehand helps. Doing basic research also helps. If you’re getting this expensive, intense procedure done, you owe it to yourself AND your doc to know words and phrases like “columella”, “dorsal hump”, and “supratip”. Before you walk into the appointment. I don’t think Dr. Grigoryants does anything especially to make his patients feel rushed. In our appointment, he seemed to actually enjoy the conversation. He’s a super-nerd when it comes to noses, and it seemed to me that he enjoyed sharing his esoteric knowledge. Unlike many doctors, Gr. Grigoryants doesn’t use morphs. I found this refreshing. We talked about it, and agreed that morphs often tell lies and create unrealistic expectations. When other doctors sent me morphs while I was still shopping around, I often found them unflattering or too cookie-cutter generic. Dr. G’s lack of reliance on morphs as a selling tool demonstrated a certain confidence and honesty that I liked. I actually compared my real “after” photos from Dr. Grigoryants to the idealized morphs I got from other doctors, and found my real actual results to be more beautiful than those morphs. I’m sure other doctors and patients find them useful, but I’m glad morphs weren’t part of our conversation. One final thing that made me really appreciate this doctor: he chose honesty over up-selling me on other procedures. Twice, I asked him for his opinions on two other surgeries - a neck lift and a Permalip - that I thought maybe I needed. Re: the neck lift, he was straight-up like “you don’t need that. You have nothing to worry about.” With the Permalip, he was like, “your current lips look good already, I’m not sure if it’s worth it for you.” I feel like another doctor who was less thoughtful would say “sure, whatever you want” and take my money. I appreciated the integrity of the push-back. *My Surgery* I had my first rhinoplasty when I was very young, and over the years, I grew dissatisfied with the result. I felt that the nose was lumpy, misshapen, bulbous, and difficult to photograph in a cute way. The goal of this rhinoplasty was to fix those issues, mostly so that I'd be happier when I look in the mirror, have more fun taking selfies, and feel more confident. We didn’t touch the bone, only the cartilage. The hospital staff and office staff were lovely. Recovery was annoying but manageable. And so far, I’m absolutely in love with the results. It’s perfect. The nose reminds me of the nymphs and mermaids in a John Waterhouse painting. It's only been 8 days since the surgery, but I am so, so, so happy. I'll update with my results in one year, if I remember. *Random Bits of Advice* - Save your last pain pill for the morning that the splint/stitches get removed, it’s an unpleasant feeling - Tell your friends not to make jokes during your week of recovery - I snort-laughed a few hours after surgery and spent the rest of the week agonizing over whether I’d ruined my $12k nose job over some middle-school dick jokes - You may be tempted to email the doctor with basic questions. My advice is to save the emailing for really important stuff, and to call the office for reassurance instead. Examples of questions I’ve called the office with: “how long will I sound like I have a cold post-surgery? (2-4 weeks)” “will the tip drop a bit as I continue healing? (don’t worry, yes, it will)” - You nose will look awesome immediately after the splint comes off, but will swell up after that. So get some good selfies as soon as the splint comes off, and don’t be sad as the swelling sets in. Remember that it’s temporary - If you have the means, don’t skimp on a nice hotel with room service, if you’re from out of town. Give yourself the comfort to really heal. - Do this surgery for you, not to please anyone else. And be in a good place when you do it. - Do lots of self-care, and work to have a healthy and happy opinion of your good looks going into the operation. You are beautiful already. Do this because you want it - not because you need it. - Good luck!