Reflections and Advice from a 35 Year-old Male. Munich, DE

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Why is someone from the UK going to Switzerland,...

Why is someone from the UK going to Switzerland, via Munich, for a second rhinoplasty 17 years after the first one? Let me take you on my journey and hopefully along the way I can offer some words of wisdom...

I've always been bothered with a "big nose" and back in 1998 I travelled to New York to be operated on by a surgeon who was feted by the US media. This guy had been on all the TV chat shows, had performed operations on celebrities and presented himself as the world’s greatest surgeon. In a pre-internet era, it was as close a guarantee of a top surgeon as I could find. How wrong I was. In later years I read he’d settled more than 30 malpractice lawsuits and one of his patients died following an operation! Lesson number one: don’t chose a surgeon based on their media profile — TV stations and magazines have neither the expertise nor the time to assess a surgeon’s work.

I was lucky. I came out with a smaller, more aesthetically appealing nose (see attached photo showing my nose pre-1998 opt and how it is now). It wasn't a perfect result — I was left with a saddle nose, a bulbous tip and excessive nostril show — but the surgeon claimed these were impossible to fix due to the thickness of my nasal skin, and the second opinion of another surgeon seemed to confirm this. It’s only lately, many years later, that I’ve decided to explore whether there's someone out there who can fix the problems with the lower half of my nose.

So how did I find a surgeon I could trust? The mistake most people make is limiting their options to their local surgeon. He or she may well be great, but in a procedure that relies so much on artistry you’re massively reducing the odds of finding the best person for the job. My problem with the UK, however, is that I find it impossible to separate the good surgeons from the bad ones — this was the case in 1998 and I still find it to be the case now. You either have those who do a lot of NHS work and don’t really specialise in aesthetic rhinoplasty — the ones who invariably tell you there’s nothing wrong with your nose — or you have the ‘flashy’ surgeons in London’s famous Harley Street with their very slick marketing and astronomically high prices to match. The latter are often hailed as “the best” and quoted extensively by the media — but given my past experience, you’ll understand my distrust of celebrity surgeons!

But why Munich? Well, I recently had a very positive experience with the German healthcare system for an entirely unrelated medical procedure, which had been botched when I had it done in the UK, but was treated brilliantly in Munich. As I occasionally go back to visit the city for check-ups it seemed like a good place to look for a rhinoplasty surgeon. German cosmetic surgery doesn’t appear to be as flashy or as expensive as London’s Harley Street and it’s actually better regulated that UK cosmetic surgery. So I did a simple Google search for rhinoplasty surgeons in Munich and Dr Thomas Hundt was one of the first names that came up. A few facts stood out for me on his website:

He’s performed more than 4,000 rhinoplasty operations, at a rate of more than 370 per year.
He has a specialisation in difficult revision rhinoplasty.
He uses a gentle, closed surgical technique with no visible scars.
And he has an emphasis on “safety over beauty”.

Experience is hugely important. It’s the old adage: practice makes perfect. Sure, you don’t want a surgeon who's overworked, but you certainly want one who does rhinoplasties all the time and has done so for a good few years. Every nose is unique, but if you have thousands of operations under your belt, chances are that you’ve seen just about everything.

The consultation cost me €100, which is pretty inexpensive by UK standards (my local surgeon, who doesn’t even specialise in rhinoplasty, charges three times that amount!). Dr Hundt proposed to augment the bridge of my nose with a substance called “Fascia Lata”, de-project the the tip of the nose by reducing the alar cartilages, and lift the columella a little bit to offset my drooping tip. Because the procedure would widen my already wide nose, the base would be narrowed with “wedge incisions” (basically cutting out skin to tighten the nostril rims).

I felt confident he knew what he was talking about, but I also appreciated his honesty when I pressed him. He admitted he couldn’t guarantee to match the computer simulation and that it would be a difficult procedure, but the result would, at the very least, be “better” and he would do anything which might risk damaging my nose (“safety over beauty” once again). One problem some people have with Dr Hundt is that he’s not the most talkative of surgeons, but after my experience with a brash New York surgeon 17 years ago, I much preferred dealing with a more reserved character this time round. I saw Dr Hundt for two follow-up consultations and he didn’t even charge me for them. That again left a good impression.

So far, so good, but I wasn’t ready to put my complete trust in him until I read some testimonials on the internet. They were glowing. “Dream result”, “outstanding doctor”, “an artist”, “one of the best and brightest doctors in his field”. And the comments were backed-up with impressive before and after photographs. Of course, there was the odd unhappy former patient, but often they would fail to explain why or they simply had unrealistic expectations. The most re-assuring part, given the reputation of my previous surgeon, was that no-one seemed to have had a completely botched operation. That was good enough for me! The operation date was duly set and I'll report back on my experiences in the operating theatre in my next post!

Successful operation

So I had my operation today at a private Swiss clinic about 100km from Zurich. (I should explain that while Dr Hundt is based in Munich, he offers patients the option of having the operation done in Switzerland where medical services are tax-exempt. It means you save more than €1,000 compared with treatment in Munich where taxation is 19%.)

On arrival I had to hand over 2,000 Swiss Francs to cover the clinic’s costs (including the anaesthetist’s fee, overnight stay in a private room and nursing costs). Annoyingly, they do not accept direct bank transfer or credit card payments and that’s a lot of cash to carry around. Still, the staff were very friendly and I was soon shown to my private room where I was left to deposit my belongings and lock my valuables in a drawer.

After a short wait, a friendly anaesthetist came in to explain how the general anaesthetic would be administered, making sure I was aware of all the complications and risks associated with surgery. Techniques have really improved since my last operation and I was glad to hear the anaesthesia and all the other drugs are fed to you intravenously — in other words, there’s no horrible ‘laughing gas’ suffocating you through a mask, just a supply of oxygen.

Weirdly, I wasn’t really nervous. That’s probably, in part, because I spent months researching my surgeon and I feel secure that I’m in good hands. But it’s also down to the fact that I’ve been through this procedure before and know what to expect. In fact, the only horrible part I recall from my previous operation was taking a pill which made me feel extremely nauseous. This time there was no such pill, so I had nothing to fear!

I changed into the supplied compression stockings, underwear and white surgical gown. I was asked to lie on my bed and then they wheeled me along the corridor and down the lift to a room adjacent to the operating theatre. It was here that I met with the anaesthetist again (this time in his mask and surgical gown) and his two assistants. It’s then that it all becomes very real. Various electrodes were placed on my skin and an injection was made in my forearm to attach the tube they administer the anaesthesia through. The prick was not painful at all. An oxygen mask was then held a few centimetres away from my mouth and nose and I breathed in the air as normal. The last thing I recall is saying to the anaesthetist “I feel really relaxed” — and the next moment I was completely out! I don’t know why, but I was expecting it to take longer and for it to happen more gradually. But trust me on this: there’s no pain or uncomfortableness. In fact, it was a mildly pleasurable experience! You really have nothing to worry about.

I woke up some time later in what they call the 'intermediate care' room. It’s like an intensive care ward but not as critical! My first memory is of a nurse asking how I was feeling. “I feel great actually,” was my reply. I think I was still high on the effects of the pain medication! I was amazed that I was able to breath freely without any congestion in my nose, though that would soon change. After a while the nurse asked if I was ready to return to my room and they wheeled me back.

I don’t recall much of this period: all sense of time escapes you and because you’re so tried and groggy it’s difficult to recall if you’ve been sleeping and for how long. Of course, my immediate thought was: how did the operation go? It's pretty impossible to tell looking in the mirror because of the plastic splint over your nose. The nurse told me it had gone well, which comforted me at the time, but on reflection I suppose she would say that!

A couple of hours later, Dr Hundt appeared in my room and confirmed that it had been a successful operation. The good news is that he'd managed to reduce the size of the nasal bone without having to break it, and there was no need to harvest cartilage from my ear because he’d found enough excess cartilage in my septum.

There was no actual pain after the operation, just the throbbing sensation of a pressurised force on the nose. The worst part, by far, is that you develop what seems like the worst head cold you've ever had. A huge amount of mucus is produced in your nasal passages, which are already constricted because of the inflammation. It's mixed up with lots of blood and all you want to do is sniff it out, but you can't because the pressure would cause internal damage. You’re not meant to sneeze either, but sometimes you can’t avoid it and simply do your best to make it more of a cough than a sneeze. To catch any dripping the nurses place a 'moustache dressing' under your nose, which is tied round the back of your head to hold it in place. That, along with the blockage you feel in your head, means you simply can’t be bothered doing anything other than lying back and feeling sorry for yourself! I couldn’t even be bothered watching TV and found more comfort in listening to the radio.

Having not eaten since the previous night, I very much looked forward to my evening meal at 5.30pm. I’d ordered parsley soup, a meatloaf with new potatoes and veg, and a tasty ice cream and fig dessert. It was pretty good though a bit difficult to eat with the bandage under my nose! My only complaint is that they provided no snacks during the night. I might have been recovering after a operation, but my appetite certainly hadn't been affected!

If you look at the attached picture you'll see that the majority of the swelling is visible at the top of my nose, above the top of the splint. A small amount of bruising has also appeared round the eyes, but nothing too severe.

The day after surgery

I barely slept all night, yet it all seemed to pass reasonably quickly, perhaps because the nurses popped in every hour to take my blood pressure, change my 'moustache dressing' and apply some ointment round the nostril rims. They also kept asking if I had any pain, but thankfully I haven't, helped no doubt by the ibuprofen and paracetamol/codeine tablets I'm taking.

The most alarming development has been the bruising. Initially, right after the operation, I thought I'd gotten away with it, but over the past 24 hours the black and blue patches have spread right round my eyes and in lines down my upper cheeks like tears. It's so bad the nurses kept commenting on it. The worst of it is on my eye-lids, which feel really tight, especially when I try to blink and close my eyes. It'll pass, of course, but I worry that it will prolong the amount of time I have to hide myself from public view.

After breakfast was served in bed at 7.30, the anaesthetist popped in to see me. It was good to get the prognosis of a senior medic again. He explained that my bruising was perfectly normal, especially in cases of revision rhinoplasty where the operation is often longer, exposing the face to extended trauma. However, I was surprised to learn that my operation had lasted 90 minutes (I'd been expecting something closer to 60), but I guess that just underlines how challenging revision operations can be. It’s like an archeological dig where they have to scrape away all the scar tissue from the previous operation just to uncover what cartilage is actually there!

It's a pity I had to leave the clinic this morning — I could have done with another night there to be honest. I'm just glad I'm not flying home today. The bruising is not appropriate for public viewing and I still feel too groggy and tired to be getting on a flight, especially with all the dribbling mucus and blood emanating from my nose!

The clinic arranged for a driver to take me to a local apartment I've rented for the next week. When your intention is to avoid venturing outside and coming into contact with people, it's a far better option than being cooped-up in a hotel room for a week. You have more room to move around, a kitchen where you can store and prepare food, and there are no interruptions from cleaners. I've even arranged for a home delivery of supplies from the local supermarket. My intention is to lock myself away for the next seven days and enjoy being lazy!

First night "at home"

Had my first half-decent sleep since the operation, mainly lying on my back with extra pillows propping my head up. For some reason my hand would occasionally bang against the nose splint, instantly waking me up each time. No idea what my hand was trying to do as I slept — perhaps I was subconsciously trying to remove the splint in my sleep?

With a continuing head cold I couldn’t be bothered doing anything so spent all day lying on the sofa watching YouTube videos. Struggled with the amount of mucus blocking my nose, though the colour changed to a paler red, suggesting blood-tinged mucus rather than an actual nosebleed. Just before bedtime both my nasal airways cleared for the first time and the head cold began to lift — a hint of light at the end of the tunnel!

Recovery days 2 – 7

Woke-up on day 2 with a clearer head and nose, but still a bit of sneezing and I also developed a nose bleed. Was quite concerned about this at first, but it eventually went away. Good news is that my bruising went from black to a more acceptable red/yellow shade.

Day 3 saw a real change for the better. I got a decent sleep and my nasal passageways were a lot more clear. Amazing how much this changes your mood. I even ventured out to the local shop with my shades on (to hide the bruising). Got a couple of looks but nothing prolonged. Nose splint feels a bit looser — maybe the swelling is going down a bit?

As for days 4–7, things got increasingly better. Nose was often still bunged-up but I increasingly felt I had more energy. Bruising on the cheeks became a very faint yellow, it's just round the eyelids it's taking longer to fade from the darker blue/red. I can see how some people could return to work by day 7, though I think you'd need a bit of make-up to hide the excess bruising.

Delighted with the result!

My surgeon removed my splint and dressing today — and I'm delighted to say I'm really pleased with the result!

Dr Hundt has successfully achieved what he said he would: the hollowed-out part in the middle has been built-up again with 'fascia lata'; the nostril show has been reduced; the columella and tip have been slightly lifted; and the tip also de-projected a very conservative amount. I left the surgery with a spring in my step, not just because I'm happy with the result (which I am), but just out of sheer relief! The biggest worry with a revision rhinoplasty is that things are made worse, or that in fixing one problem another is introduced. That's not been the case for me and I think I've now got the nose I always wanted.

A couple of people who commented on my earlier posts warned me against making my nose "too small", but I don't think that's actually what's happened. Dr Hundt discovered that my previous surgeon hadn't touched the cartilage in my septum, so he was able to harvest this (rather than resort to using ear cartilage) to reconstruct the parts of my nose where cartilage had been (inadvisably) removed. That's why my tip and nostril rims didn't look right — the previous surgeon had stripped away a lot of my internal foundations. What Dr Hundt has done is build that back-up and reverse the damage.

So the result is not necessarily a nose that's substantially "smaller", but one which has a more refined and homogenous shape because the underlying framework has been fixed. Sure, it's not a perfect match with the simulation — it was never going to be, but it's pretty close and may get closer still as the swelling goes down and my thick skin retracts a little. But, in any case, I'm not really bothered about that. The main thing is that it looks good!

I will leave it a few months until I'm confident enough to get a final verdict, but initial results are good!
Dr Thomas Hundt

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