Dr. Paulo Manzano was a good choice for a MtF. Fortaleza, CE, Brazil

It has been a while without me registering my post-op. What I still remember is:

After the last post, for a long while breathing through my nose was still not optimal, more difficult at the right side (the one which bled a lot) than the left one. During cleaning it came out twice (one for each side) a big, long dry thing with the colors between white and yellow. One of them by some reason went down my throat instead of coming out by my nose, making breathing hard, but I managed to swallow it without choking. I talked with the doctor and he said it was a substance he had put inside my nose to prevent further bleedings during the surgery, which it was normal for it to come out with time. My nose bled a little after each one came out but not much. Sometimes it came out with dried blood and stitches from the surgery. It hurted a little but I also took some remaining stitches out myself; they had already been cut by the doctor, being only lightly stuck at areas which were still healing. The doctor had said to leave them there for a while before taking them out, so I waited a long time before doing the above.

Now, the left side is fine, but I still cannot breathe fully at the right side. Currently, I still do the nasal washing with saline water because it is also useful against diseases as I said before; but the dry mucus already comes out without that if I force air out by one of the sides. I caught H3N2 in december, but the nose was already healed enough to endure that.

Every time I use a mask to protect myself and others from the corona virus in case I get it without knowing, the nose gets swollen; taking hours and hours to become pretty again. The longer I use mask, the more it gets swollen. It does not matter if the mask has a metal clip or not, the pressure from it is enough.

I also had a strong bad smell coming from my nose, but not strong enough for people to perceive it. I talked with the doctor and he said which one reason may be which a part of my carthilage/bone may have become exposed due to surgery, but which with time tissue would grow to cover it inside my nose. Washing the nose as said above improved the smell, but it always returned. It indeed is getting weaker with time however. I also had green mucus, and that meant infection. Later it became yellow, then white.

I complained with the doctor which one side of the nose (the right one) was in a different shape than the other, and he said back then which there was still many months for healing to happen. It has passed additional months and although the nose is smaller and prettier, the shape difference is not changing... perhaps I need a revision surgery? It would perhaps be quicker and easier as I solved most of my nose problems at the first surgery. He also said I still had a deviated septum, although at a lesser degree. I am still happy though.

Was the remaining issues caused by the medic? Was that how my body is healing my nose? Was it something which happened during the recovery process? I cannot tell. What I can tell you is: If you are restricted to Brazil, or Brazil northeast for your surgery; I recommend the medic but not the hospital he chose, but if you choose him you will probably have to endure that hospital. If you can do it elsewhere, it may be better for a nose surgery. As for the voice surgery, I did here at brazil northeast and it worked flawlessly until now. I will do my gender reassignment surgery in thailand with a famous medic, which seems to have a good customer service (very important) beyond superior skills, it is a place known for that. I will write here about both the voice surgery and gender confirmation surgery later.

Many months in the future, I will give the community an update on my nose state. Hope those informations are being useful.

Between 1 week and now I am already able to sleep by my side instead of always with the chest up, the pain in my stomach is decreasing, and I kept waking up in the night without air. Although at day 7 I could breath well for a while after the doctor cleaned it more deeply, my nose got obstructed again later but this time with mucus and not blood. Today I went to the doctor again and he removed the secondary bandages and remaining stitches, and it was so much more comfortable than last time. He said I now must do a soft movement with two fingers (like if they were a gripper) from the center of the nose outwards 10 times, from its top to just before where the cartilage ends, 3 times a day. He said to not do it at the nose bottom where there is not a center cartilage, and which that movement will help the fluids which filled my nose to be processed by the body. He also sucked mucus accumulated deep inside at the right side of my nose. I am now sending 3 photos about today and 1 I forgot to send before, so you can see which although I was a harder patient to work with due to many allergies and the extra bleeding which for a while made me prone to faint and waking without air at night, in the end it worked for me! You do not need to be a super healthy person to do a plastic surgery.

Day 29 I will send further photos. I do not see issues from now on; and my nose is already better than it was before even with the swelling, and I have not reached even 1 year. It will yet to be seen if I will need a revision surgery, but I believe the surgeon did if not all, at least most of it right. Due to that, I am already marking this as a "worty it" surgery and am in the process o verifying my surgery with realself.

Realself had a bug where my update was posted without the photos... so I am sending now only the photos. You can read the review below this update. It also complains now I must make a minimum review of 200 characters, really? One thing I forgot to tell before, was which I am sending now also 4 photos I forgot to send before.