Primary rhinoplasty

My experience with Dr. Reish and his staff was top-to-bottom excellent. I’m currently five weeks post-op, and very pleased with the initial result. It will still be about a year until my nose settles into its final shape, given that Dr. Reish did significant work to the tip (bones heal on a fairly predictable 8-ish week schedule, while soft tissue takes much longer to recover).

The initial consult was fairly quick and painless — I was probably in and out of his office within half an hour of the appointment time. His office is generally quite punctual, so much so that I’m not sure that many patients even get the chance to take advantage of the Nespresso machine in the waiting area. So long as you are able to express your desired outcome, any competent doctor (and Dr. Reish is very much so) should be able to quickly determine what s/he can or cannot accomplish and explain to you the steps s/he intends to take to get to that final result.

I wanted to narrow my nasal bridge and refine and add support to the tip — not a drastic change, no need for a hump reduction etc, since my nose was straight to begin with. My biggest issue was how much my nose seemed to “spread” when I smiled — I really felt like it took over my face, transforming from this fairly unremarkable feature to the whole damn thing if I twitched in the wrong direction. The primary solutions proposed were a columellar strut graft (cartilage graft typically using nasal cartilage, placed in the mid line of your nasal tip, roughly parallel to the columella) to add support to the tip and an osteotomy (breaking the bones) to narrow the bones.

The lone pre-op appointment is scheduled within 30 days of your surgery date, where you go over your medical history once more with a nurse and recap your aesthetic goals with Dr. Reish, who is kind enough to dole out his personal cell like the girlfriend you just made in the bathroom during last weekend’s late-night escapades just so you can text him with any and all questions you may have. A true professional, no question is too trivial to merit an answer. Dr. Reish reviews his surgery plan with you and makes sure that you have a good grasp on how you’ll have your nose sliced-and-diced in the coming month. At some point you’ll also receive the VitaMedica clinical support vitamin regimen and your prescriptions will be sent to your pharmacy of choice, to be picked up at some point before the surgery. Your anesthesiologist will also give you a ring the day before your surgery to go over any potential allergies or contraindications and review her own surgery plan.

Everything went fairly swimmingly for me on the grand day-of — the surgery itself was fairly painless, thanks to Dr. Reish’s excellent staff. I was reasonably alert in the immediate aftermath, and the pain in the days following was minimal. The worst of it is really that the cast is in the middle of your money-maker, and your breathing is blocked up from the dried blood forming an embargo on oxygen flow in your nose. Fun, isn’t it. The nurses do tell you to avoid putting anything up there, even if you’re tempted to use saline spray (which, in hindsight, I would absolutely disobey instructions and use, given that I have a gentle touch and Dr. Reish neither used nasal packing nor internal splints in my case, in an effort to drain the blood and prevent so much of it from drying into literal blocks in the nasal passages. Especially because the blood is not simply coagulating to the sides of your nose — it is drying around the dissolvable stitches, and those blockages, attached as they are to your person, will be incredibly resistant to being pulled out when Dr. Reish tries to grab them in your post-op appointment. It’s simply more likely that you’ll have to suffer and mouth-breathe until the dissolvable stitches come out), to avoid further traumatizing your recently-brutalized nose. Listen to your medical providers. They know best. Sleep next to a humidifier. Or maybe eight, like Mariah Carey does, because the most pain I felt post-op was my throat drying out. It feels like sandpaper grating where your vocal cords used to be.

My post-op appointment was exactly a week after the surgery, where I had my stitches taken out and cast taken off. By this time, enough of the initial swelling had subsided so that the cat was practically falling off by itself. I will say that I wish Dr. Reish offered a Botox/Dysport/Xeomin add-on, because you are so stiff through this point that you can’t even smile. Or at least, I was that stiff. Hope you have a good poker face, or else are prepared to suffer the consequences. Crack a smile? Now wince in pain. [RS bleep], that also pulls on the recovering cartilages. Try to not wince again. [RS bleep]! Do I take more Tylenol, or is this what the Percocet is for? It’s an acute punishment for any sense of humor, but it does subside quickly. Really, having your face actually frozen in place with a mini-dose of facial paralytic might not be the worst idea, especially since too much facial movement can also shift the cast (true for me, maybe not for you).

I’m very pleased with the initial result — I could see immediately that my nose was narrower and more refined even just a week removed from surgery. It’s difficult to tell how much I’ll like the final result, given that I’m probably still quite swollen at just five weeks out. I don’t think a rhinoplasty should really be judged until at least three months post-op. My bones haven’t even fully healed yet, and I’m still just stiff enough that I can’t smile all the way yet without feeling acute soreness. That being said, I can see that the dorsal aesthetic lines appear to be in the right place underneath the swelling, and my nasal tip is now very well-supported. My nose no longer dominates my face when I emote positively, and will hopefully continue to shrink a bit. Amazing, that. Dr. Reish definitely seems to have achieved our shared aesthetic vision here with the way the swelling has gone down.

If you are looking for a skilled rhinoplasty surgeon, I would wholeheartedly recommend Dr. Reish and his team. Everyone is friendly, patient, and knowledgeable. I felt safe and secure in my decision the entire time. They are consummate professionals who go above and beyond for their patients — really, how could you say otherwise when both your surgeon and nurse give you their personal phone numbers and answer your questions even on their days off? Don’t take advantage of it.