Failed revision and fat transfer - left with internal and external valve collapse

I just had a revision consultation with a top ENT/facial plastics surgeon and was told that I have the classic symptoms of empty nose syndrome, which if you know anything about, is like the kiss of death for rhinoplasty experiences. The dr said my right turbinate has been aggressively resected with little left and the inside of my nose is way too dry. He asked me to use moisturizing, healing sprays daily until I have a revision so that maybe my nostril can heal and said that there is a chance I will need them for the rest of my life almost daily. I feel so hopeless. I need to save money for the overhaul revision that is needed and don’t even know if that will solve my issues.
I asked Dr. R if a resident worked on me, because I thought that might be why my outcome has been so negative, but he said no.
Everything he did has to be corrected. It really is mind blowing. Please do your research on what is needed to correct your nose. For example, alar rim grafts don’t correct alar retraction. Just stuff like this I wish I knew going in and would have known he wasn’t the right doctor to and my case. I would have also loved an explanation of what a turbinate reduction was and the risks of the procedure. This is a non-reversible procedure that can leave you miserable for the rest of your life.

I wouldn’t have left a bad review if just for aesthetic because I understand that many people think my new nose looks good even though I don’t. The functional issues are my main reason for my review.

I have hesitated writing this review because I believe Dr. R seems like a good guy. At the same time, I feel that my experience could have been prevented and that by sharing, it will prevent things like this happening to his patients in the future. When I was researching doctors, I found the reviews and details within them so helpful, so here is the short and long review of my experience with Dr. R.
Short: Failed Revision Rhinoplasty and fat transfer. Need a rib revision to correct aesthetic and functional issues. I am left with internal and external valve collapse, mid-vault collapse, scar band/stricture, possible cartilage exposure, pinched tip, cartilage crowding, constant congestion and 80 percent airway on left and 20 percent on right.
Long: I had a preservation rhinoplasty in 2006 by a retired doctor, a rasp in 2007 and a rasp in 2013. Unfortunately the last rasp left me with retracted alar and a hanging collumnella. My nose also plunged when smiling and was slightly bulbous, but other than that, I had no breathing issues or major complaints. In fact I liked many things about my nose and wanted just a minor refinement. Begin the years-long search for a revision specialist, 10 consultations around the country and Turkey and covid cancellations, I found Dr. Roostaeian. I saw only 1 picture that I really liked on his profile and it resembled my problem with an outcome I would be ecstatic with. All of the other photos I was not a fan of, but at the time, I had a hard time putting words to why. What I did notice though, is that he was often able to fix problem issues without changing a person’s look hardly at all. This was extremely important to me, as I wanted to look as close to exactly the same as possible. I called his office, got a consult withing 2 weeks and was able to schedule surgery within another 2 weeks. This concerned me a bit, but again, I didn’t know what was normal or not.
This consultation was the first out of 10 where the physician was confident he could deliver what I was looking for in an end result. The main thing I stressed was that I didn’t hate my nose, I could breathe very well and would rather not have surgery than be left with any aesthetic issues or functional issues. I was also getting married in 6 months and didn’t want to deal with a problem before my wedding. The biggest concern I had had with my consults was that I had a cartilaginous supra-tip break that I loved and didn’t want to lose. He promised it would still be there because I had thin skin. Here is where things went south..
I showed him pictures of my nose before it started to fall apart. I just wanted my old nose back. He said that he thought my dislike of my face may actually be from the loss of fat that I had from the pictures til now and suggested that I get a fat transfer since I would be under anesthesia anyway. I was super shocked, as I felt this was super unprofessional, but I decided to take his advice, as I figured he is the aesthetic expert.
We also discussed that my nose would need to be lengthened like he did in the picture I used from his Instagram, that grafts would need to be used from my septum or rib to bring down my alar retraction and that my infratip lobule would need to be reduced. We also discussed bringing in my bridge slightly and addressing the bulbous area above my tip. He said that I would need slight derotation as well. The lengthening and dorotation scared me, as I prefer a female nasolabial angle of above 105%, as I told him over and over. He agreed that we could meet in the middle somewhere.
As the days led up to the surgery, I had so many hesitations. I studied his pictures and had so many doubts that he could do what I wanted. I sent morphs and pictures showing how my aesthetic preference seemed different than his (think Dua Lipa, Jessica Biel and Kate Beckinsale) and wanted to confirm that he could deliver what I wanted. He confirmed every time. I wish I would have trusted my gut.
The day of surgery came without any work up to clear me for surgery and no preop appointment to go over last minute details. I was told that he would show up very early for my surgery to do the preop workup and talk with me to calm my nerves. Unfortunately he showed up at 7:30 on the dot, when I was supposed to be in surgery. He was rushing and didn’t seem interested in the wish pic poster I had made that also showed what I didn’t want. He instead pulled out my before pic with a drawing at the end of my nose showing the length he was adding. I panicked. There was no supratip break, or rotation like we had discussed. It was just a straight nose that looked like a beak. Exactly like what I noticed in his pics that I hated. I explained to him that I wouldn’t be happy with this and that it was different than everything we had discussed. I told him that I felt that I should cancel surgery and he said that I could and could find another dr or I could trust that he knows what will look good. I would give anything to go back and change my decision.
I woke up with almost an exact replica of a nose that was in my picture collage on the failure side. Long, pointy, skinny tip, no supratip, flat collumnella, derotated to about 90 degrees. The pain was a 10/10 even though he said there would be hardly any pain. I was devastated.
I looked like a freak for about 10 weeks. My then fiancé felt that I ruined my face. I fell into a deep depression and suffered from loss of self-identity. I lost the character in my face that my nose brought and when I asked him why he did this, he said that it is his job to make the nose not noticeable and to blend in with your face. I tried to explain to him that my whole reason for choosing him was to keep my character. Now I understand the anatomical terms I wish I could have explained I wanted to keep, ex.: high tip points, rounded infratip lobule, an hourglass shape to my nose with tip points wider than my bridge. I am left with a skinny tip that is at the very, very end of my nose. It is very masculine and aging in my opinion.
The fat transfer has completely dissolved, which at first left me with sagging skin from being blown up and then deflated. I think it is starting to look normal again thank GOD. I have gotten filler and there is so much scar tissue that the injectors have to fight though. The injectors have commented that it such a waste of money and also that mine wasn’t placed ideally.
I had 5 follow ups with Dr. R where we had so many things to discuss that we never addressed all of my functional and aesthetic concerns because he had to see other patients. I received 4 rounds of steroid shots to get me ready for my wedding. Our discussions during the appts are what has led me to leave this review. When I asked why he didn’t show me his plan during all of the times I was confirming with him that we were on the same page, he said, because he didn’t think I would go through with the surgery. I am still shocked to this day that a surgeon would operate on someone knowing that they wouldn’t be on board with surgery if they knew the plan.
What has concerned me the most is that our consult notes don’t match the truth or what he did in surgery. He said that we discussed spreader grafts when we actually discussed narrowing my nose. He made note that I had midvault collapse and wrote spreader grafts in the surgical notes for indications, then narrowed my nose, which has obviously caused me to be unable to breathe. I don’t understand any doctor who would do this. And I know we didn’t talk about midvault collapse or spreader grafts because I never knew what either was until my research regarding finding a solution to where I am now. The last things I will say are that he said that he wanted to do a revision on me because sometimes it takes him two tries to get it right. This contradicted when he said when I asked him how often he needs to revise patients. He of course said he pretty much doesn’t need to. I asked if he could do a morph for a revision, since I didn’t think he would ever be able to achieve aesthetically what I wanted and I was told that he doesn’t know how to do morphs. I found this convenient. I also asked if he was confident that he could fix my breathing, and he said not much and that I should see a sinus doctor. He never requested a CT and never addressed my midvault collapse which is where I told him the air stops. The final straw was that there were two instances of HIPPA violations.
This has been the most traumatic experience I have been through. I almost lost my relationship, I did lose my job, I can barely kiss my husband because I can’t breathe out of my nose, I now take antidepressants, I lost over $30K and now have to save over $35K to have a rib revision if I want to breathe through my nose again, as I am pretty much a mouth breather now.
While I understand that every surgeon will have bad outcomes, what concerns me is when lack of judgement is the cause of the bad outcomes, which I feel is a large part of my case. I also feel that I experienced so much unprofessionalism that needs to be addressed for an institution such as UCLA. I hope that this detailed experience can help those going forward with this surgeon.