Rhinoplasty After Orthognathic (Jaw) Surgery

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Hello All, My story is VERY long-winded, so I'll...

Hello All,

My story is VERY long-winded, so I'll give the abbreviated version. In 2009, I had orthognathic (jaw) surgery. It is a process in which your jaws are (literally) sawed apart and repositioned from inside of your mouth. Gum tissue is removed, if needed. Permanent plates and screws are used to hold the bones in their new positions. Usually, this changes one's appearance, but the surgery in itself is NOT cosmetic. It is to restore functional bite for the patient. My severe overbite/openbite caused digestive issues (because I couldn't chew properly), breathing complications, headaches, and other symptoms. The list goes on and on forever.

My recovery was grueling, but "textbook"... until 3 weeks after the surgery….My bite had reopened, and after the healing process was complete, it was determined that I would have to do the surgery ALL. OVER. AGAIN. Fast forward to 2011, I did the surgery again (TWICE), two nights in a row. Basically, my bite kept opening, and my surgeon (who is very well known, and had nearly 40 years of experience under his belt), couldn't understand why my jaws were so stubborn. So in 2011 (on the second night of repositioning my jaw), he had to remove more bone/gum tissue than he had anticipated and he placed additional plates/screws in my face. During this process, my appearance changed drastically (negatively). My nose, smile/lips and profile were the most noticeable changes. Unlike many seeking rhinoplasty. I LOVED my "before" nose. Now, I just want to feel normal and confident again.

I, like many others on RealSelf, have spent countless hours researching surgeons. I am 99% sure I will be taking the plunge for rhinoplasty this summer. I have narrowed my options to 2-3 doctors, and I am in my final phases of planning logistics, days off from work, etc.

I am not ready to post "before" pics on RealSelf, just yet... It's a bit out of my comfort zone. However, I have an entire blog/journal which follows my orthognathic surgery (including TONS of photos) from the night before surgery in 2009 until present day. If it's not against RealSelf rules, I will provide a link.

Best wishes to all!

One Step at a Time

So…I have a Skype consultation set up with a surgeon on May 21 (in the evening). As of yesterday, the doctor is booked for surgeries until late July/early August. By the time I have my consult (if I decide to go with him), I will probably have a mid-August procedure.

I did not mention the surgeon's name in this post, just because I'd like a small degree of privacy right now. Once I have my consultation, I will mention the surgeon by name with details of our Skype consult & initial impressions of his "bedside manner".

A bit closer...

So, the good doctor's office contacted me to let me know they are moving my Skype consult to May 14, because he has other obligations on the 21st. I'll be sure to update.

Consult…Done & Done!

This evening, I consulted with "Dr. B" (I'll disclose his name at a later date) via Skype, and it went well. He answered my questions, made me feel comfortable & assured me that my surgical request were "doable". Overall, I am really thinking this may be "the one". I will sleep on it, and do a little more research, but I plan to have my mind made up by week's end.

I know my review will be infinitely more interesting with photos, and I promise to post them once I finalize my decision about a surgeon and get close to my surgery date. I am a private person, but I know the value in sharing as many "visuals" as possible on a site like this, as I am frequentley asking other RealSelf members to post photos. Ultimately, I'm hoping my rhino journey will be helpful to someone else in their journey.

If you have any questions, please ask! I'm an open book, and I enjoy helping others.

'Til next time…Be Well.

Not my first rodeo…

I should add that this is my 4th consult, so people reading this won't think I'm "jumping the gun". In fact, I put down a hefty deposit (let's NOT even discuss how much money) with a surgeon about a year ago, and I backed out once I discovered him to be less than truthful in his practices--(this knowledge was gained by total coincidence about a week after I made my deposit. I was able to verify the information I was given about him from VERY credible sources). The deposit is non-refundable, but my dignity is in tact, and in the grand scheme of things, if the "lost money" is the worst of it, then I just need to accept it as "lesson learned."

Save the Date!

I am 99.999% ready to commit. As it stands, I will be doing my face-to-face consult and subsequent procedures on July 30 and 31, respectively, with Dr. B.

I will continue to update periodically, as I close in on my surgery date.

The Power of Positivity

So, this particular post isn't about my upcoming procedures, specifically. It is a general "Truth" about life.

Often times when people talk about "being healthy", they factor in their eating habits and exercise routines. The aspect of mental/emotional/spiritual health often gets overlooked, because it's not something we can easily "quantify".

As I have been through MANY hurdles in my life, I recognize and honor the power of positivity. Mind-body connections are so important, and are key to living life to the fullest. That said, positive people often find themselves having to "defend" their positivity to people who exist merely to deplete the happiness of others….which leads me to my next point.

I am looking forward to my journey being an inspiration and learning experience for others. Good, bad or ugly--I will try to be as candid and open as possible. I know there will be "trolls" and the like on RS. Much to their dismay, I will not allow a few negative comments to destroy the positive vibes I am delivering here.

So all who are at the beginning, middle or "end" of their journeys…Be well.!

Rhinoplasty, upper lip reduction and chin implant performed 7/3/14

Hello All,

My surgery is complete. I will provide details on the procedures, recovery, and how I'm feeling at a later time. For those of you who are interested, I've added pics.

More Info

For some reason, RealSelf isn't properly saving the changes I've made to my review--Here's info you may want:

Surgeon: Dr. Kofi Boahene; Baltimore, MD
Surgery Date: 7/31/14
Cost: $10K

Post Op Photos

Day 15

Hello! I am back to work today. I took pictures right before leaving out the door. (Ignore the hair--I've got static galore).

I promise (at some point in the near future), I will give details about the first few days/weeks of recovery. I've got so much going on right now, I just can't get into it.

I don't know if it matters to you guys, but I just want to say I don't wear foundation or any makeup on the surface of my face AT ALL. I only wear eyeshadow and lip gloss. So, my pictures are very candid. The size and shape of my nose, and the facial swelling (in general) is the real deal. Don't let it scare you!!! Lol.

I am still struggling to accept some of the changes, but I'm working on being patient during the healing phase. One day at a time….

Be well!

Sincerest Gratitude...

Here's a warm "thank you" to each of you whom have taken the time to leave a kind word and positive vibes. You are much appreciated! Each day that passes, my physical and emotional recovery becomes easier and easier.

Enjoy your weekend!

Better Late Than Never...Days 1-3

Well…I'm finally getting around to posting my experiences from the day of surgery until now.

On the morning of my surgery, I filled out a few forms and was called back to be prepped for surgery. The main nurse, Ashley, asked me a few health related questions and explained to me what to expect directed before and after surgery. I gave a urine sample and which was tested for pregnancy. My blood pressure, pulse and temperature were taken by a nursing assistant. Once everything was a "go", I was started on an intraveneous antibiotic and pain reliever. Dr. Boahene in and we repeated the details of my surgery and he studied my face a bit. The anesthesiologist, Dawn came in and asked a few health related questions. I requested a nausea patch to be placed behind my ear because I usually have HORRIBLE nausea after any sort of anesthesia. She complied, and explained to me how I would be put asleep, and what to expect directly after surgery. A few moments later, Nurse Amalie came in to walk me down to the OR, but I felt the urge to use the washroom. I went to the washroom, gave my husband a quick hug and kiss and headed straight to the OR. Once I got in the OR, the nurses helped me get on the operating table, and covered me with warm blankets. I remember talking about shopping at Target (??), and feeling really dizzy. My next memory was from the recovery room.

I remember very little about the recovery room. I recall Nurse Ashley encouraging me to eat some graham crackers. But I was VERY sleepy and dizzy, so I figured I'd take a few little bites and neatly place them on the food tray for later. I kid you not, when I finally "came to", I realized it looked like Cookie Monster had gotten into my room and had a field day. I was so embarrassed! LOL. I can't believe I was eating like a mad woman. Ashley helped me get dressed, and my husband and I headed back to the hotel. I don't remember much about the ride home. I vaguely remember him going to pick up something for me to eat, but I was so sore that I just wanted to lie down. I slept horribly that night. There was blood dripping from my nose constantly and I couldn't breathe through my nostrils. There was crust, blood and stitches thickly clogged in both nostrils. I tried to manage it a bit with peroxide and Q-tips, but I was so sore I really couldn't make any progress.

I flew back home the day after surgery….bad idea. I wanted to get back home to my family as quickly as possible, but traveling was a humiliating experience. I was very swollen, I couldn't breathe through my nose, my nose was till bleeding and I was "casted up". I looked like a total freak and I people at the airport were giving me the strangest stares. I think I even saw a few women grab their toddlers and hold them a bit more closely.

Days 2-3 were a constant cycle of cleaning my nostrils, dealing with my very sore lips (I had a lip reduction), and my VERY swollen jawline. I took lots of Bromelain, drank insane amounts of fluid and tried to keep my body moving a bit to encourage circulation and blood flow to reduce the swelling. The staff at the surgical center called to check on me for three days after surgery. Dr. Boahene called, also.

Days 4-7

After to first 3 days, things improved very slowly. I was struggling to stay positive because my lips, nose and jaw were swollen and throbbing and I couldn't breathe or sleep properly. My chin/jaw and particular were a point of contention for me. My jaw was SO BIG and very masculine looking. On Day 3, I ended up doing a Skype with Dr. Boahene, and he reassured me that the chin implant was tiny, and that once the swelling goes down, things will fall in line beautifully. I think he's amazing, and I wanted to trust him, but I just couldn't see the vision. I spent the next few days filled with regret and anger (toward myself), wishing I hadn't gotten the implant at all. It was hard for me to smile, bite, chew, talk, and "look normal" in general because of all the swelling and I just wasn't happy about it.

On Day 6, I flew back to Maryland for my first postop appointment/cast removal. I ended up meeting with Dr. Ahmed first, and he reminded me that he assisted Dr. Boahene with my procedure (I don't remember him at all). He informed me that he would be taking out my permanent sutures in my nose and chin and remove my cast. He also stated that Dr. Boahene would be in afterward to meet with me. He proceeded to take the sutures out and it was VERY painful. My tip was so tender and sore, and it felt like he was cutting me, even though I know he wasn't. Dr. Boahene came in a little while later and asked me how things were going and how I liked my new nose. I expressed to him that the chin/jaw area was driving me a bit crazy and that I hadn't seen my new nose in the mirror yet. He told me to give the chin about a month to settle, and I would see a huge improvement. Then, he gave me a mirror to look at my new nose….I was a bit taken aback. (I thought it was "okay", but it was so different. I wasn't sure how to "navigate" my new face through all the swelling and the changes.) I smiled a bit, and thanked him. He asked me to follow up with him in 1 month.

I have to mention that while I was in the waiting room, I ran into Zooster! It was by total coincidence, as we didn't know each other before that. I recognized her from RealSelf, and introduced myself. Then I told her it was because of her (and a few others) great reviews of Dr. Boahene that I decided to consider him for my surgery. Zooster looks amazing and she's about 5 months post op! I'm excited to see how I will look by the beginning of 2015.

Days 8-15

The second week of recovery was "up and down". I was getting back to normal routines, but still not feeling entirely normal. Some days I would look in the mirror and be really excited about the changes I know I will see in the coming weeks. Other days, I would feel "odd" and unprepared to deal with the changes. It's hard to express in words, but the feelings are very real. I've had such a long road getting to this point…it's new territory and I'm still learning to be patient and take things one day at at time.

Dr. Boahene: The Man & His Staff

If I haven't made this clear before, I'd like to now. Dr. Boahene is amazing. His level of professionalism, HUMILITY and bedside manner are nothing short of outstanding. He has such a calm and inviting presence and I think you'd be hard pressed to find someone with equal parts talent and warmth. I've met my fair share of doctors who may be good at what they do, but they have a knack for making people feel small and inadequate. Dr. Boahene is quite the opposite. His work speaks for itself, and he doesn't have to "put on a show".

The staff at White Marsh Surgical Center were outstanding! Nurses Ashley and Amalie made me feel like I was a welcomed guest in their home, instead of a patient in the OR. Dawn (the anesthesiologist) was HILARIOUS! She so warm and charming, but also funny. It was nice to have someone take the pressure out the situation, and help me relax.

I mean this from the bottom of my heart-- Dr. Boahene and his staff are blessed to have each other. I get the sense that everyone at White Marsh loves what they do, and respect is mutual between the Dr. and staff. In the end, it results in great patient care and it sets the bar for what people should expect from medical professionals.

Day 18

Just one pic...I'm feeling awesome today! What a difference a few days makes...

Day 25 -Pics & Update

Hello, All! I'm updating with photos I just took about an hour ago. Excuse the oily skin…it's been a long day! So, my progress so far has been pretty decent. The swelling in my chin is pretty much gone. The swelling in my upper lip is gone, but the scar line is still tender and smiling still hurts a little. My nose only hurts when I touch it too firmly and when I first wake in the morning. About 3 days ago, I woke up for the first time without crusty nostrils or dried up drainage. The last few scabs from inside my nose came out yesterday. I can flare my nostrils without any pain. My nostrils are uneven--it could be swelling, or it could be simply do to the fact that they were uneven pre-surgically. It doesn't bother me too much.

Cosmetically, I think things are really balancing out. I feel more comfortable with everything, and it's nice to feel normal again!

I've received a few messages that I'd like to address in a little Q & A:
Q: What did Dr. B do to your nose?
A: He refined the bridge, narrowed the base, refined the tip and changed the shape of my nostrils.

Q: How/why did you choose Dr. B?
A: In short, because I'd seen his work on RealSelf and I was impressed. When I met with him on Skype, it just "felt right".

Q: What did you ask Dr. B to do your nose?
A: I'll start with what I did NOT do. I did NOT ask him to make me look like any particular celebrity, or to give me a "Barbie" nose. I did NOT bring him a "wish pic" nose, because I didn't want to get wrapped up in expecting someone else's features on my face. I kind of feel like that leads to disappointment when the end result doesn't look like the "wish pic". (By the way, I'm not knocking wish pics, I'm just saying why it didn't work for me).

I DID ask him to make my face look more elegant, refined, and pleasant all while preserving my ethnic features/character in my face. I also wanted my results to look natural. I KNOW that wasn't any easy task, but I believed that if any one could pull it off, he could. I am not disappointed.

Q: What's been the hardest part of your recovery?
A: I'm not sure. But, I can say the swelling in my chin bothered me. I really thought I would end up looking like a drag queen.

I hope those answers helped you guys! On another note, I have had about 6 people flat out tell me that something is different about my face, but they can't figure it out. A few of them say it looks like I've lost weight. (I just say, "Thanks for noticing" and leave it at that--Haha).

I went from sleeping at at 90 degree angle right after surgery to a 45 degree angle within about 2 weeks. Now I sleep about a 25 degree angle. I still use a neck pillow, to keep my nose from pressing against pillows or the mattress. I am getting MUCH better sleep at 25 degrees!!

Breathing out of my nose is still a bit tricky. It's hard to explain--my nostrils are clear, but I still can't take deep, clean breaths on a consistent basis without opening my mouth a bit. I know I'm less than 4 weeks out, so I'm being patient.

I will start back working out once Dr. B clears me. We will be Skyping (that's not a word?--so what!) :-) within the next week or so.

I think that's about it for now. Be well, y'all!

1 Month post-op; Pics & Tidbits...


So, I'm officially one month post-op today. I am going to "bullet" my thoughts, experiences, advice, etc. in this update:

-My nostrils are still tender on the inside
-I still sleep with my neck propped a certain way so that my nose doesn't bump any bedding at night
-I will resume some of my cardio workouts this week
-Would I do it all over again? In short, probably.
-My chin scar is getting lighter, but I'd like it to improve. I realize that I'm no "spring chicken", and I have a dark skin tone, so it probably won't disappear completely.
-My chin (where the implant is) is sore. It feels like there are bubbles/small pockets of air that are pretty tender to the touch. I wonder if it's the tissue trying to settle around the implant and the screws (??) I will mention it to Boahene when I Skype with him.
-I feel like there may be a small hole in my right nostril, toward the base of the nose. It's hard to explain, but the sensation is odd. I may see an ENT within the next couple of weeks.
-I'm really enjoying the fact that I don't really have any "bad" angles. I think my face is balancing out, and it doesn't look "surgerized". New word; don't hate!!
-My energy levels are about 85% normal.
-Ladies, if you are prone to yeast infections, I would HIGHLY suggest being prepared for the side effects of antibiotics...because broken nose + itchy nether regions= NO.THANK.YOU.

My updates will probably be once a month following this one. However, I will still be open to answering questions between updates...Enjoy your holiday and be well, y'all!

The "Stanky Stuff"

I forgot to add this to my most recent post. When I was about a week post-op, (and I could finally smell things again) I had an unpleasant experience… I kept smelling something rotten, and I was REALLY irritated that no one else in the house could smell it. I went through every nook and cranny in my house searching for the smell, because I smelled in every room. I went outside, thinking maybe there was sewage back-up or some sort of chemical spill. The smell was awful, and I couldn't pinpoint where it was coming from. Then….it dawned on me. The smell was inside my nose! As it was healing the scabs, blood, drainage, etc, had a gross smell, even though I cleaned out my nose (the best I could) a million times a day. It lasted off and on for about a week or two, then it went away completely.

My point? It may happen to you: Don't tear up your house. Don't threaten to choke your spouse because they don't smell it. Don't yell at the kids about taking out the garbage. And don't delcare that everyone on your block is "certifiably insane because the sewer MUST be backed up and none of them smell it but you."

Mmmkay? Kay.

Be well.

8 Weeks

Hello, All! Today I am 8 weeks, 5 days. Things are going well, overall. Work is BUSY! So I can officially say everything is back to "normal".

Nose: No pain, although I'm still scared to blow it, LOL. It is looking a bit bulbous, now that the tip is settling. I am NOT entertaining the idea of a revision. Honestly, I can live it with it "as is". I'm excited to be moving on to a whole new chapter in my life, and I am hoping to not find myself in a constant cycle of surgeries and revisions. That said, I am going to leave well enough alone.

Chin: Of all things, my chin is bothering me most. It's still quite sensitive to touch, but not all the time. Some days it totally fine; other days, it hurts even at the slightest touch. Also, the scar (itself) is still more sore than I'd thought it would be at this point. I will definitely mention it to Dr. B when I do my post-op Skype with him. He only Skypes on Wednesday evenings, and my Wednesdays have been sewn up.

Lip: My upper lip is okay. The scar line is still a bit tight, particularly when I wake in the morning. Also, the midpoint of my lip healed crooked…it's veered over to the left, so it kind of makes my smile look crooked. Again, not a major biggie. But it bothers me a bit.

I'll leave you with recent pics. (They were taken 2 days ago). Ignore the wild hair! :-)

…Til next time! Be well.

Side-by-side before and after pics

Just thought I'd add side-by-side before/after pics so people won't have to flip back and forth between pics.

3 months

Hello, All!

I am approximately 3 months post-op (12.5 weeks to be exact). This will likely be my final set of photos until my 1-year post op review, as I don't anticipate any noticeable change beyond this point. I will also likely be deleting my photos within the next week or so. If so, I will re-post them for my 1-year post op review.

Overall, I am happy with my results. I think my face looks balanced and "natural". I don't think I look like I've had work done, and I could easily blend into a crowd (which is a good thing).

I honestly have to say the surgery has changed my life--in the sense that I find myself smiling more often and feeling confident in casual interactions. I'm not as self conscious about my appearance, and I think I look more approachable. Prior to surgery, people would mention that I looked mad (even when I wasn't). I think it caused people to be a bit hesitant to interact with me until they got to know me a little better.

My nose is still a bit tender inside, so if you haven't had surgery be aware that the soreness may not dissipate as quickly as you'd think. This is particularly true if you have open rhinoplasty. My lips are still a bit tender/tight upon waking in the morning. When I think of it, I stretch my mouth/lips to loosen up the scar tissue. My chin is still giving me off-and-on pain. I suppose it will resolve itself as time goes on.

Do I think it's all been worth it?
At this point, I'd have to say "yes". There are some minor things that I would change in a "perfect" world. In an ideal scenario, the tip of my nose would be slightly more refined. Interestingly, I think it was more refined in the first few weeks following surgery. I think my chin has a slightly noticeable "double chin" appearance. The position of the implant in relation to my natural chin is causing this effect. However--all in all, I am happy and immensely grateful that things turned out well for me! As it stands, I would still recommend Dr. B to others.

Best wishes to all…and be well.

Photos Have Been Taken Down

Hello, All!

I have removed my photos from my review. I would like to maintain some privacy, but I want to stress that I have not had any negative experiences on RS. My interactions have been candid, yet very positive. I am grateful that I found this site, because reviews here helped me make well-informed decisions about my surgeon. I remember spending countless hours browsing through RS reviews and photos and going through all the pre-surgical emotional highs and lows. I realize my photos may sway some people one way or another, so I won't make them "off-limits". I will send photos to RS members by request.

I don't know how often I will post beyond today's date, but I'll leave a few words…

-Thanks to everyone who cheered me on, extended a kind word, or simply thanked me for my reviews.

-If you are "pre-surgery", PLEASE do your research before making a final decision. Take every review with a grain of salt, (even mine!!!) No surgeon is perfect, and no surgery is perfect. But if you are realistic in your expectations, you are more likely to be satisfied with your results.

-Know your self-worth, with or without the surgery. Nothing that a surgeon does to your face will increase the value of YOU. Self-love is the greatest love of all!

-Find a good support system. It's great to have a few people in your corner who will cheer you on, wipe your tears on a bad day or simply hold the "vomit bucket" after your surgery. :-)

As I part, I would like to leave an excerpt from a comment I posted in the early stages of my recovery:

"The only way I can explain [my recovery] would be comparing it to buying your dream home….So for years you've thought about the home, saved for it, talked about it and then you finally buy it. But, once you get it, you have to figure out what all the the furniture is going to go, the new route you will take to work, getting the utilities turned on, transferring your new address to all your paperwork, and unpacking endless boxes to get "settled". So, you love the house, but hate the "settling in" process. Then, a couple of months down the road, you have everything in place, and life feels normal. You forget how it felt to be in the old house, because you've become so used to the new house….And life is great..."

I can finally say life in the "new house" is great!!!

Be well, y'all!
Baltimore Facial Plastic Surgeon

I have nothing but great things to say about Dr. Boahene and his staff at White Marsh. I've provided a more comprehensive review of them in my updates.

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