Primary Septo-Rhinoplasty (Ear Cartilage/fascia Graft/burrito) for Asian Female ( Non-caucasian Augmentation) - Newport Beach,CA

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*Treatment results may vary

Let me start by saying I have been wanting a...

Let me start by saying I have been wanting a taller nose for as long as I knew I had Zero nose bridge. It is a common Asian problem with it comes to wearing sunglasses. Instead of having it sit on my nose, it ends up sitting on my cheeks... (lovely).

In April 2014, I had juvederm filler injected to enhance my nose for my wedding. After receiving it, I was sure sure sure I wanted to have the surgery.

Background: In the past 2 1/2-3 years, I have been researching anything and everything about rhinoplasty (silicone/gortex/ear cartilage/rib cartilage). Now that I learned of the techniques, it was time to decide on a method that was right for me and find the right Surgeon to perform it.

Surgeon search: After narrowing down my surgeons in a crazy screening, I decided to visit seven. I had paid consults as well as complimentary consults from 7 different surgeons in the Los Angeles/Orange County area. My consult fees ranged from Free- $350.

1) Man made material implants (silicone/gortex/mix). Three were free and one cost $60.
a) First one, super nice, insisted on silicone or gortex and did not recommend any cartilage grafts.

b) The second one was ignorant and rude. He never listened to what I wanted but instead insisted on what he wanted. I felt like he was ordering off of a fast food menu. It sounded something like this..."we'll cut a slit on your upper gum line, stick the silicone implant up there, narrow your notrils to give you a nice Caucasian look and get you back to work in a week." He shot me down at every chance he got when I mentioned autologus grafts. He lacked explanation and patience. It was either his way or the highway. The most horrid consult.

c) The third $60, was nicer but lacked patience during a paid consult. He was indecisive as whether to use silicone or ear cartilage fascia graft. He was also a bit cookie cutter and did not provide me with confidence in being his potential patient.

d) The fourth surgeon also recommended silicone implant with a chin augmentation? ugh...I never even thought about getting a chin implant. Were we not talking about my nose? I was completely shut off when he mentioned the chin implant.

2) Rib/fascia graft ($350): One surgeon recommended autologus rib fascia grafts for long term stability and safety. However, a rib graft would require me to stay in 24 nurse staffed clinic which cost an additional $1,200 a night. I would have a surgical site on my nose, on the side of my head and my rib area.

3) Ear cartilage fascia graft ( complimentary with Dr Kosins): He was very pleasant, kind, LISTENED and gave feedback to my desired look. I stressed how much I did not wish to have my nose look like a piece of silicone was stuck in it and have it look falsely Caucasian (No offense to Caucasians but it is a very UN-natural look for me). I wished to keep my ethnic look with little change to my nostrils with a natural enhancement to my bridge. I seriously needed to have my shades sit on my NOSE and not my CHEEKS. After informing me I have sufficient ear cartilage on my right ear and my desired look would absolutely be achievable, he started drawing out my plan on the paper you lie on during the exam. He took me step by step on the drawing so I knew exactly what would happen if I chose to continue with the procedure. I greatly appreciated the walk through and thorough explanation of events regarding my primary septo rhinoplasty.

The decision: After I returned home and shared my awesome consult with my husband, I knew I had found MY surgeon. I booked my procedure 7 months in advance.

Pre op appointment: I showed Dr Kosins almost 70 noses I liked so he could understand what I am aiming for. He understood. We narrowed it down to two and it was set. I planned a two and a half week Asia vacation and to return one day prior to my surgery date. Due to the fact that labs needed to be draw within a week or two of surgery, I had labs done in Asian and emailed it to the Dr for review. Once he cleared me, we were set.

Surgery day: I was very calm but also anxious (if that even makes sense) at the same time because the day had finally come. The pre op nurse had me prepped and Dr Kosins came in to reiterate our plan and ensure he had the right photos of the desired outcome we agreed upon. He made sure I did not have any questions, shook my hand and told me I was going to be perfect. The anesthesiologist came in, gave me a sedative to relax me and bam, I was out.

(Attached from my Yelp review because I simply babble too much)
When I woke up, the surgery was already done. I was super groggy and tired. I saw my nose cast amongst my blurry state but was too tired to care. My nose was very numb and I felt the cast in my right ear. My husband picked me up after waking up a bit more and we headed home.

Days 1-3 I slept like a dead person. Little to appetite. Pain meds taken mainly for ear and scalp discomfort. Little to none for the nose itself. Cotton pads changed frequently due to oozing. Frozen peas 20mins on and off. Slept on three pillows for elevations. Dr Kosins gave my husband his cell number so he can get updates on my recovery status. The Dr checked in daily to ensure everything was going as planned. (One pain tablet every 4-5 hours)

Day 4-5 diligently cleaning black sutures. Nose oozing finally decreased. Swelling reduced but scalp and ear still hurt from time to time. Very difficult to sleep due to ear dressing discomfort and could not hear as it was stuffed. The only reason for my pain medication. (One tablet twice a day). I was updating Dr Kosins by now and he assured me things will get better from this point on.

Day 6-7. Continued to clean sutures. Oozing is now clear. Only one pain medication at bedtime. Excited about getting the nose cast, sutures, staples and ear stuffing out.

Removal day 8 as requested (normally day 7). Wet my cast in the shower. It fell off but I kept the surgical tape on. Took a pain med one hour prior. Dr Kosins was ecstatic about the results. He was impressed my swelling was so minimal considering I had a bit more oozing than he expected during surgery. I told him it was due to his guidance/instructions for recovery and my compliance (team work).

Suture removal (tender 4/10; nurse), ear stuffing removal (ouch 6/10 for a second; done by Dr, scalp staples (3/10), splint removal (peachy 0/10; done by Dr). Overall the pain was less than I prepared myself for but remember, they're surgical stitches. It is going to hurt a bit.

Taping: homework for the next three weeks. Dr Kosins walked me through what I would be doing to further reduced swelling.

The look: my nose looked like a garlic clump due to the swelling but goodness, the bridge looks absolutely amazing. My husband was so very impressed. I look forward to the further reduction in order to see the final result. As Dr Kosins told me many times, patience is key. Remember, swelling reduced in stages 3months/6months/9months and 12months. Even though I am nowhere near my 12 month period, the swelling is already decreasing on a daily basis. :)

******2/24/15 follow up appointment (less than a month after surgery)*******
My swelling has greatly reduced due to diligent, nightly taping. Dr Kosins was so proud of me and himself because my progress was better/faster than he has expected. Seeing him so happy made me even happier because the Dr and patient need to work TOGETHER to achieve the desired result ( well, he did most of the work and I just could not mess it up). I shared with him that it felt nice to have sensation in my tip after being without feeling for so long, he was surprised because tip sensation does not usually return until months later. Yay for me following directions and recovering so well. Because of the great progress, it was picture day ( who would have thought it would look great enough for photos so early after the surgery). :) Smiles all around!

To conclude...I am so grateful I found Dr. Kosins. He is a doctor who listens and truly cares about his patients. It's not about the money and in the end, the last thing you'd want your doctor to focus on is the money instead of YOU. If you're looking for a great doctor for your cosmetic or reconstructive needs, please get a consult with Dr Kosins. He is truly wonderful in ways one cannot describe.

Don't rely solely on internet reviews. Go see him :) He is very approachable, thorough, educational, respectable and reasonable with pricing. Thank you so, so much Dr Kosins!

Progress update 3/11/15

I am posting a nose/smile progression collage. My iPhone dated some and I inputted the last two dates.

2/11/15 Nose is still a bit swollen and pronounced (still taping nightly). Smile was very awkward and unable to move upper lip. (the feeling of my nose being held in place by sutures).

2/13/15 Nose status same as above (still taping). I tried to smile with teeth but it looked so bad I had to delete the photo. Re-took a photo with no teeth. Smile is still stiff.

2/24/15 Nose swelling reduced (still taping). I have gotten used to no teeth while taking photos now by this point. The change from the beginning of the month is the area above my lip. That area is starting to soften up. My non teeth smiling is less awkward.

___________ I stopped taping my nose 3/1/16 since no further changes were observed _____________

3/6/15 Comfortably sporting my nose and no teeth. Upper lip continues to soften up. I feel my nose is finally becoming ONE unit (less of a "pieced together feel with sutures").

3/11/15 frontal face shot no teeth & frontal face shot with slightly less awkward smile. The only region I feel slight tightness is the front septal area (closest to tip).

I am sleeping more comfortably with my nose at night. My dog paw smacked me a few times during the night and I did not have any pain. My nose is starting to feel like my own again.

********* I will attach a photo pre-op smile so you can compare ***********

4/16/15 photo update

I am still a happy camper with my results. I did notice a slight change today in which my nose is showing slightly more "line definition." Hard to explain and kind of hard to tell from the photos but I will try and continue to update monthly up to a year.

5/23/15 ( a litte over 3 month update)

Due to my work situation, I was unable to see Dr Kosins for a follow up during regular business hours. He was so, very kind to accommodate me on a Saturday morning right after he had finished a reconstructive surgery.

He examined my nose and informed me I was exiting my first 3 months of swelling reduction which occurs at the top of my nose. Even though he said I still had quite a bit of swelling, I honestly did not feel or look it. He explained it further by comparing the softness of his nose to my nose. I quickly understood what he meant by the swelling. As time progresses, my nose will start to soften up and feel like stiff and hard. The next phase of three months is mid nose swelling reduction.

We then proceeded to take some updated photos of my nose progression (ahh, always feel like I am graduating when I get photos taken). He is very pleased with my recovery and reminded me to remain patient as full results will not show until a full year.

I love my nose where it is and asked him if the shape would change with swelling reduction. He assured me it would not. It will only soften up and make it feel more natural :) happy visit.

So blessed I found such a wonderful surgeon!

Nose taping instructions

2 months shy of a year post op. Still in love with my nose.

Hi Everyone,
I apologize for the silence these past few months. I have not been receiving notifications from realself when there is a private message or post to this thread. I will make this brief and bullet point the changes I have seen since my last post.

Update since my last MD visit on 5/23/15:

- Swelling has drastically decreased ( I did not believe Dr Kosins when he told me there was still a significant amount of swelling at my last appointment

- Nose is softer to touch and has a more natural feel (before it was very stiff and hard)

- It feel less and less foreign to my body and more like a "natural" part of me

- The burrito graft and smooth without any lumps or bumps

- No complications thus far

- I am able to blow my nose normally and not be afraid it will fall off or detach

- No one knows I had my nose done. It looks very natural

***PHOTOS are taken 12/30/15 with exception of dressed up face 12/24/15

Please let me know if you have any questions. :) happy nose wearing

A little over two year update

Everything is still peachy. I am still very content with my nose. Things have really anchored down. In the past (prior to one year), I would have occasional feelings of the internal stitches pulling if I laughed too hard or smiled the wrong way. I no longer have those feelings.
Newport Beach Plastic Surgeon

I cannot think of any other words to describe Dr Kosins other than nice, humble, patient, thorough, educational, skilled, professional and AWESOME!

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