Experiences as an unsuccessful revision patient. I hope this helps anyone going into rhinoplasty or a revision themselves.

Research the list of services provided--debulking, hump removal, placement of a certain graft of implant--and then read those over with the surgeon, the night before surgery, and bring them the morning of.

Do not be rushed. I would strongly advise sitting quietly in front of a mirror with a notepad even before surgery so you can make a note of what you hope to see one the procedure is over. Make sure you and your surgeon are on the same page, again and again and again.

There's a certain level of presumption in doctors and their ability to see what you do that comes with going through something you want desperately that is also scary.

I have a deviated, bulky nose after a bad surgery, after many consults, and after emailing other patients who themselves could not fully warn me for a surgeon that did not use his judgment and would not listen to me. My rhino is and was too complex, and I wasn't just lackadaisical in that last consult, I should not have chosen him. I should have gone to someone that would act as an ENT and as someone treating the nose functionally, as well as aesthetically; and I should have gone to someone interested in feeling my nose and seeing the problems with the entire nose, while explaining what is a confusing, frightening process, instead of relying on me to tell him what to do. It also takes surgeons' good judgment to envision how a nose will turn out, with or without imaging--you are moving entire circulatory systems and planes of the nose.

This cannot be rushed, because if you get it wrong the first time, who knows what will happen to you aesthetically, medically, and psychologically. You need to choose someone you can trust for the long haul, who actually cares about making his patients happy and leaves a patient with something attractive that allows you to breath easily and without pain.

This is what I recommend to patients thinking about rhinoplasty:


a) I would also select surgeons to consult by Googling "(your nose problem) rhinoplasty (your geographic location)" to see who comes up. Acquaint yourself with patients who have the sort of problem nose you have and see what is done for them, grafts used (for many flat, wide-nosed patients, something in the columella and a support graft or custom-fitted implant; for those with more cartilage or natural bony structure, your issue will be finding someone to carefully work with or the cartilage you have). Acquaint yourself with nasal anatomy, because those are the terms your surgeon is thinking in that you might not be.


b) take a list of problems to your surgeon to EVERY consult--e.g., hump, breathing problem or a sense the nose is pulling in an uncomfortable way (pinpoint exactly where the discomfort is--I thought my breathing problem was caused by a deviated septum and it was actually a twisted valve in the side of my bridge, on the upper corner), septal twisting. You will need this record up to the morning of surgery. I would frankly go to an ENT before surgery if you have breathing issues--not a surgeon alone.

c) Ask each surgeon what he can do or likes to do in your case. Don't like the answer (e.g., he recommends rib cartilage and you aren't comfortable)? Ask if he can use septal cartilage. Ask how he will harvest it for surgery and the pain that comes with that process, or pain after the harvesting of ear cartilage.

He says he likes open rhino? Ask if he can do a closed option, but be aware he might be more comfortable with open rhinoplasty because one can see the whole nose and defat a bulky nose more easily. You can get a good outcome simply bulky cartilage or trimming and suturing boxy cartilage in closed rhinoplasty instead of adding material.

Make your surgeon put your fingers on your nose to see where the sides are, the underside, feel your cheeks and teeth. If you have a particularly painful or tight place on the nose, like a valve near the eye, ask. Ask about tip rotation, if you want to be able to smile without the nose spreading, but also be aware an overly rotated nose can cause a "piggy tip". (Google "feminine" or "masculine nasal rotation") for images.


Ask about the placement of a graft/implant (e.g., a Medpor graft in a cushion of ear cartilage) and removal method of a chosen graft or implant if there is a problem, or if it's misplaced. Ask to see pictures of other patients. Bring pictures of your nose or noses like yours to discuss issues. Look in a mirror, as well, as you point to places you have breathing tightness and exactly where/what you wish you could change about your nose.

For a bulky nose, for example, or a round, wide one, a surgeon should: debulk your nose (or tip, depends where the worst bulk is), narrow without compromising breathing, and then possibly elevate it (look that up) to make it smaller. This is what actresses do. In order to keep the tip elevated, they may rotate the lower cartilages (flipping the skin around a natural hinge in the nose) or use a columellar graft or strut.

If he suggests ANY cartilage source, graft, strut, or implant, ask how he will use it to achieve your goals--not just make a bridge straighter, but "refined", and angled in a way you like--and then do research at home yourself, and against any list of services he provides. You must get every procedure done in rhinoplasty in writing so you aren't surprised. Implants can extrude if not placed in a proper cartilage source, like conchal/ear cartilage. Rib cartilage warps, is hard to harvest, and heavy in the nose. If your septal cartilage is harvested excessively--such as in bridge creation--it can be unpleasant and cause the nose to deviate.

Do your research and challenge a surgeon on risks.


Take notes, a list of your concerns, and check them off as you voice them, (this is important-you want to make sure you cover everything) and their answers to each point (including about portions of the nose you want to preserve, like existing angle your tip falls, or a bony bridge) from each consult and date them. It is up to you to make sure your surgeon hears you, as well.


c) Ask about post-op care for swelling (kenalog injections, Medrol dose pack, pain and infection treatment) nasal packing-which can drive some people crazy- cast used, specific type of structure used (shape, size, placement in your nose) for nasal support IF NEEDED, and risks for each. Go home and research the "risks" yourself--e.g., of a silastic dorsal implant when it's suggested to be used in your bridge. Take down notes of the grafts or strut types (probably a main structure graft--including your own bone or cartilage--then a graft to go in the columella). You must ask, because surgeons may not remember everything. If you don't know how to communicate effectively, you will find out after surgery and be unhappy.

You may not WANT a columellar strut graft. Ask about it, then ask about risks. (Google it--if it's put in incorrectly, it can twist and hurt the nose).

Ask about whether your surgeon will support if you if you have a hanging columella, serious breathing problems (some breathing problems are normal due to internal swelling, but I'd say if you're still breathing out of only 1 nostril at 8 weeks post op, something is wrong), infections or other complications.

ASK FOR A REVISION POLICY. If they don't have one, leave. That simple. Don't stay with someone that is not willing to revise their own work if they do something wrong or excessive, or leave a problem unaddressed.

Every last thing--surgeons' solutions to your problem, their willingness to hear what you are not comfortable with, like removal of a "hump" on a bridge you want left alone, and their envisioned post op care for not just the week after surgery, but the whole year--must be written down and reviewed BEFORE SURGERY. Long before surgery.

d) You must go back to your surgeon before you deposit a down payment or anything else, and take notes at this final consult before you start the payment process. If you do not do this, you may be in trouble. Miscommunication is a big part of what can go wrong, and if something does, you are stuck until your surgeon decides to fix something for you. They might feel no legal obligation to help you once they've been paid. Assume everything can go wrong, which is to say, your surgeon will ignore a request to debulk a tip AND alter a hump unless you clarify what they plan to do. LOOK AT YOUR FEE LIST, AND ASK WHAT IT COVERS--after the first consult you pay. You can go to as many consults as you like to figure out if your surgeon listened to you, and has the same plan as you. Ask for imaging, ask for pictures of patients.

Don't just go by something vague like "bridge revision" on a bill if you want scar tissue removed or nasal tip debulking--make sure your surgeon will do it and get that in writing.

Do not let a surgeon surprise you or decide to do you a favor and remove a "hump" you had no issue with on your bridge.

e) You must bring your list of problems and surgeon's recommendations to the morning of surgery and sit down plus in front of a mirror to go over it. DO NOT LET HER RUSH YOU. Your body for the next six months to a year will be changed, and if something goes wrong, who knows if a surgeon will help fix it? You are the customer. You have the authority to tell a surgeon to leave a bridge alone if you don't want it touched, like a hump. If you need to sit down and look in a mirror one more time to reflect on what needs to be done--a droopy tip angled slightly upward so you can smile without it pulling down, a septum twisting, a nose full of fatty tissue--write it down as you say it.

f) This is the hardest, worst lesson of rhinoplasty--if something goes wrong, if you are injured, if you are infected, if a surgeon puts in something the wrong way, rasps down a bridge you liked because he saw a "hump", resects too much cartilage, or otherwise does you harm, the bad ones will ignore you and will not revise their work, guide you, or treat like their patient anymore. It's that simple. You will not be able to go to another surgeon for help until you are "healed" and then you will have to start over again with new problems.

The good ones will care if you are unhappy or experiencing physiological issues, but even then, they have a limit on what they might be able to do based on your bone structure or natural tissue.

Choose wisely. You are changing your body forever.


Communication is one thing; bedside manner and doctor willingness to listen to patients, prompt questions, explain, and behave like good doctors is another; and technique is another. Be empowered as a patient and be a proactive communicator/info seeker because you are probably one of many patients a surgeon sees that week. Don't allow of lack of clarity. Don't give a doctor the opportunity to forget something about your desires and needs.

And finally, don't go with someone that is so oldschool, so conservative, so aggressive, or such a poor communicator he will leave you with a nose you absolutely hate or can't breath out of.