Open Rhinoplasty Scheduled for December 15. Netherlands, NL

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Tomorrow I will undergo an open, full rhinoplasty....

Tomorrow I will undergo an open, full rhinoplasty. This to make the nose smaller, remove a dorsal hump, correcting the septum and refining the tip. Of course a little anxious, but I have full confidence in my surgeon! I will update my experience as soon as the surgery is finished and I feel good enough to do it.

Update 1 day post op

Hi all, yesterday at 8am I had my surgery until 10:30am. Very friendly medical staff, although only brief explanations of what was going to happen. So just lay back, oxygen mask on and I was gone within a few seconds. After I woke up really fast at 11:00 and there was no nausea or throwing up at all. Only a little disoriented. Then the surgeon came and told me the surgery was a little more complex than he thought, that my nose must have been broken in the past. But fortunately, he managed to fix it all and showed me already some first pictures on his smart phone. Then I returned home right after.

At home I was fully prepared for the swelling and bruises, but until now it is only very minimal purpleness under my eyes and my face feels a little puffy and stiff. I must say I started to take Arnica pills and ananas 2 days before and am still taking them. Also I have pain medication and I don't feel pain at all. I don't feel the splints in my nose, I have only the discomfort of not being able to breath through my mouth. The very worst part for me so far was last night..pffff no chance of sleeping because I had my head lifted 45 degrees as was recommended. I really can't sleep on my back, so the night was horrible. Also a very very dry mouth. But so far, it's all worth it!

Tomorrow I have an appointment, then the splints will be taken out. Hope that will be a relief!

Internal splints are out!

After another rough night of hardly any sleep and a painful throat, today the internal tampons/splints or whatever these things are called were removed. Finally some air! I heard and read horrible stories before about this, but the removal does not hurt. It only feels terrible when they are pulled out, and I really got tears in my eyes. After I had to relax a few minutes before I was able to walk out again.

The swelling and bruising is still minimal, only purple stripes under my eyes. I really believe it is the Arnica, or the gentle techniques of my surgeon. I will upload some photos later today.

The stitches also are healing well, so I can continue recovery with a good feeling.

Still going well

Today is the 3rd day after surgery and luckily I'm feeling well. No real pain and swelling is sagging to the cheeks. Here are some more before and after pictures. Please let the final result be good! All of us, including me, take such a big risk with this treatment because the result is shown to everybody!

Cast off tomorrow

My surgery was last monday so this is the 6th day after. The nights are much better now since I can breathe through my nose again. It is still a bit blocked though but of course this is normal. I still sleep on 2 pillows and on my back to get rid of the swelling as fast as possible. Sometimes I wake up suddenly and catch myself rubbing my nose, ouch!

Bruising is almost totally gone.
Tomorrow the cast and stitches between the nostrils will be removed. I am looking forward to that very much, although I know I will see a very swollen nose. I feel under the cast my nose is healing, which itches a lot. So time to get rid of that damm thing.

At the moment I am worrying a bit about the stiffness of the face, especially in the upper lip. I can't smile, like I injected botox. When I try to smile, no upper teeth are shown. Fortunately, I read on Realself that this will resolve over time. It has to do with the work that has been done on the base of the nose and the depressor muscle that was cut.

I am taking it very easy these days, taking a lot of rest, don't do anything that raises my blood pressure. As they say, time heals all wounds, so I will wait. Luckily I have two more weeks of holiday.

Next update will be without the cast!

Feeling a bit like Rudolph

Last monday finally it was cast off day! Well I must say I prepared for some swelling to occur, but I freaked out when they showed me in the mirror. My nose is swollen from the bridge to the tip, no contours can be seen at all. It looks plastic and shiny, like a doll's nose. It also feels like a statue on my face, hard and stiff. That's why I felt a bit sad when I arrived home; I don't recognize myself, of course, because also this is the first time I don't see the nose I was used to for 33 years. I underestimated this part of the rhinoplasty phase and to see this swelling is the worst in the procedure for me so far. That is why I am not confortable enough already to place any photo's on RS. But I am sure I will do soon when at least some of the swelling is gone. The swelling is not that unusual since almost all possible work at a nose was done in my case.

Today I also called the clinique and asked if taping is necessary. The surgeon did not mention anything about this and I forgot to ask. The answer was that the best thing I can do now is cleaning the nose with the saline. The first week I did not do this because getting salt water from a glass into your nose is not so easy. Last monday they finally gave me syringes so then I started right away. So my advice to any of you: clean the nose as soon as the internal packing is out!

So I will clean my nose some more days and hope at least the majority of the swelling will be gone in a few days.

By the way: the profile of my new nose underneath is very very nice so of course that is most important in the long-term! I am sure the doctor did a very good job.

Swelling is going down

Every day I look in the mirror I see a more natural nose, which means I am happier every day. The swelling is certainly decreasing. I am, just like you all, very impatient and would really like to see the final result within a few weeks :D. However, I have to wait but I am very glad to see how my nose is healing. That the tip is round and bulbous at this stage is what I was expecting and it really doesn't bother me at the moment.

The area around the bottom of the nose and upper lip bothers me the most. There is much stiffness and this part feels a bit heavy, especially when turning my head to the side. To support the tip a graft was placed and this is, next to the swelling, the cause for the stiffness. My smile is still messed up, but slowly I can see more of my upper teeth every day. My surgeon said that it would take 3 weeks for the smile to return, so I have to be more patient. Next monday I have to start working again and it bothers me that not being able to smile obstructs me in my daily interaction with other people.

Nose is still a bit stuffed, so at night I still have to breath through my mouth mostly. Tomorrow I go back to the clinique to have some remaining sutures removed.

Patience patience

I am one month post op and the swelling is subsiding slowly. Last monday I had a check up with my doctor and he mentioned the swelling on my bridge going down very nicely. It was not a planned check up so soon, but I have problems with a dissolvable suture inside not wanting to dissolve.. However, it is getting better every week and my smile is returning slowly as swelling in the columella area is going away. There is still stiffness because of the grafting that was done. My smile is now normal for 75%. I think my tip is a bit upturned, guess because of the swelling. It will come down I hope in the next weeks. So I guess I have to be more patient, how hard is that!

Time flies when healing

Two weeks ago I was already 3 months out. Last Monday I had my final checkup with my surgeon. Both him and me are very satisfied with the result! He asked me to give the result a rating somewhere in between 0-10. At the moment I think it's a 7-8; I really like my new nose better than the old humped one, but I am not totally happy with my tip since it is more bulbous/round than before. This is obvious from the front view. However at 3 months we expect swelling to still play a role here. My tip is still hard and stiff. He did not talk about steroid injections and I didn't bring it up either. I have faith in time!

Furthermore I still notice extra swelling in the morning when my nose is more puffy than the evening before. My smile now is 90% normal; my upper lip still doesn't exactly elevate as high as before surgery. Since this is a little worse in the morning I expect it to be still swelling that is not entirely gone yet. Also I can still feel a tiny bit of stiffness in the columella where the strut was placed. My surgeon confirmed that it will take some additional time for my smile to return to normal, but eventually it will. Well let's hope so! Unbelievable how much time it takes to completely heal from rhinoplasty. Of course I know that it can take a full year though.

Happy healing to you all!

Waiting for the tip to decrease in size

A little update since I am past the 4 months mark. In the last month the stiffness/hardness in the tip decreased a bit, very very slowly. I can 'wiggle' it a bit more but the tip is still hard as a rock. Also in the columella area there is still some swelling, what is probably the reason for my upper lip not moving up totally yet. However it is only me noticing, especially when comparing photos.

I keep wondering why there are so few people that notice my nose has changed, which is actually a good thing. For me it is a huge change, especially in profile. There are people that asked me if I gained weight, probably (I hope) because of the swollen tip ;-).

Now we are in spring season I am being very careful exposing my nose to the sun, scared of the hyperpigmentation which means getting permanent dark spots after a sunburn. That would be a dramatic surprise after drinking a beer at a local bar on a sunny terrace. Fortunately I don't think this is an issue anymore, since most surgeons on here advise max. 3 months or less to stay out of the sun (which my surgeon confirms).

When I see my swollen tip I read Q&A on RealSelf again and again, just to assure myself I should wait until 1 year has passed (of course I already knew lol). Do you recognize?

Six months have passed

Recently I passed the 6 month mark. Compared to my 5 months PO update things haven't really changed. Looks like swelling has become my best friend: it is there when I wake up and it is still there when I go to bed. My nose is still extra swollen in the mornings and when the weather's hot. My upper lip hangs lower when I wake up, then at the time I go to bed (when it's almost normal as it used to be). But of course, I was prepared for the swelling to linger this long. I am very happy with the results so far, as long as my tip will end up as slim as it was before surgery (my surgeon even improved the tip with the open approach!). Also I want my smile 100% the same as before when all swelling is out. But the thing is, I can't be sure about that yet. Also I know I shouldn't strive for perfection, but hey, I have still hope as I have 6 more months to go!

Good thing also is that my nose becomes more flexible every month. The first weeks after surgery I couldn't move my nose at all (it looked and felt like a doll's nose), but now it is only the tip that is still hard. My nose looks more natural now. The first months there was a lot of skin peeling off like a had a constant sunburn, which was very annoying. I think this stopped at about 4 months.

So with regard to the healing, I am half way there and still happy with my decision so far! Can't wait for the final result and the tip to define itself. Good luck to you all!

Is this the final result?

I started my adventure almost one year ago. So it is time to post a small update. I my opinion my nose hasn't changed much since my last post in June. I am still happy with my improved profile - no hump and big nose anymore - but my front is much wider than I expected it to be. Later I found out this is due to the deprojection and all the grafts my surgeon put in my tip for support. Also the spreader grafts contribute to this. I really don't understand why surgeons don't tell these consequences before. Also he didn't prepare me for loss of my smile for 3 months after surgery, but let's not discuss this for now. Although my surgeon tells me that my wider nose suits my face better, I preferred my smaller nose tip. I asked him to make my nose smaller, not fatter! Or is this what he meant when he said: expect an improvement, but not a perfect nose! Still I don't see much definition in my tip (not even the grafts), which probably has to do with my skin being thicker because of the deprojection.

My upper lip still hangs a bit lower than before surgery, and again I have to accept this is permanent. From the research I have done on RS this could be caused by the depressor septi muscle that has been cut, but my surgeon still says this will improve over time.
But what is bothering me the most is that I still have a lot of morning swelling, making my nose 1,5 times as big as in the evening. This is stable since June as well, I don't really notice an improvement of this symptom over the last months. My surgeon says this is still normal healing and thinks my result is too good to inject steroids. I really really hope that after 6 more months or so this swelling is all gone and I don't have permanent lymph damage or something like that.

So to conclude: I can't say that I regret my decision until now, but there are really some negative side effects of rhinoplasty I didn't expect and my surgeon didn't tell me about. I still hope for a bit improvement in de coming months, especially with the swelling. So in my experience, I tell to all people that are planning a rhinoplasty: be prepared for the side-effects. Personally I underestimated these. As our famous soccer player Cruijf in the Netherlands said: every advantage has his disadvantage!

Is this really the final result?

I am almost 1,5 years post op now. I am happy with my profile now. The hump is gone and from these angles my nose is smaller in size. However, what still bothers me is the front view. When I planned surgery I never wanted a bigger, wider, bulbous tip. Well that is what happened. It was very swollen and big right after surgery, but I expected it to shrink a lot the coming months. Afterwards I can say that after 4 months PO, my nose did not change so much anymore. I also still have swelling in reaction to laying down, heat etc. I am afraid this will never go away anymore as my nose isn't capable enough now to drain the edema. I read a lot on the internet and I think some steroid injections will help break down the scar tissues and settle my tip. My surgeon doesn't think so. He says when my nose (which he thinks is nice now) is still bothering me, the consequences of the kenalog might upset me even more.

Last week I saw a Belgian surgeon (Hoeyberghs) who performs 15 rhinoplasties a week. However he always performs closed rhinoplasties. When I showed him my problems with my tip, he said this is the typical effect of an open rhinoplasty. Because the tissues were lifted from the bone and cartilage, scar tissue will form as soon as the skin is reattached. Also the nose tip will never be as refined (bound to the cartilage) as before surgery. That's why he never performs open rhinoplasty and other surgeons shouldn't do them as well, in his opinion. When I asked him about steroid injections he said no because of the dents that might develop. He also advised me to leave my nose as it is and not seek revision surgery because if will make it worse. Don't end up like Michael Jackson, who should have stopped after his 2nd rhino, he said.

Well, so of course I am still thinking about a 3rd opinion, especially about the steroid injections. I have read a lot of experiences from people with the same tip problems where it actually helped. Or maybe just let it go, which is difficult :-).

Scar tissue

A few weeks ago I had another (guess it was my final) consult with my surgeon and his assistant. I told him my worries about the fact that I still have so much swelling, especially in the morning. His reaction was that everyone has some face swelling in the morning, and that it can become more apparent after surgery because of the scar tissue. When I asked him about steroids (again) he said he is anti-steroids because of the negative side effects/risks. He said if he gave me steroid injections it will get worse and he did not want to end up in court. So he could not do anything anymore, and emphasized me not to seek further revision surgery because "he had seen so many examples where people ended up worse and came back to him to have it repaired".

Well, I have my own ideas about this. The new shape of my nose I can accept and be satisfied with, but the swelling which restrains my smile the first hours of the day is problematic for me. I am looking for other solutions first, like ultrasound therapy, to treat the scar tissue. Hopefully it helps. Revision surgery to remove scar tissue and rebuild the cartilage in the (supra)tip is also still an option for me, but not now because I will have multiple consultations first.

Merry holidays!

Steroid shot

Last Tuesday I had a consult with another surgeon to analyze the swelling I still have in the morning. He confirmed my surgeon did a great job and the result is very good, given the fact that my old nose was overprojected and full of bend cartilage. The swelling/edema in the tip is most likely caused by the fact that the nose has been operated and now the blood vessels have more trouble controlling the natural edema (caused by lying down for example). He said it is likely that this will still improve over the years. He could not do anything for me at this point and he strongly advised against any revision (same as my own surgeon). I asked if a steroid shot would help and after some hesitation he gave me one low dosed. Finally, because I am trying to get one for months, at least to be sure that it doesn't help.

Now I am awaiting the effect. For me it is time now, 2 years after the surgery, to accept my new nose as it is including the morning/heat edema. I will try now to focus on other things then my own and other people's noses ;-). Easy to say, but let's do it!
Dr. Maarten Fechner

Maarten Fechner is one of the best, if not the best, plastic surgeon for corrections of the nose in The Netherlands. Even his colleagues recommend him in case their family or friends need surgery. He is very experienced and friendly. Also he operates on the more difficult noses, for example that have been broken several times.

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