Profile 911! Rhinoplasty, Chin Augmentation, Submental Fat Reduction - San Francisco, CA

My journey began with a desire to correct my...

My journey began with a desire to correct my deviated septum...which expanded into a chin augmentation (You will understand why when you see the my before and after photos). I figured if I was going to take time off work I may as well go all in. Go big or go home. Right?! My hunt for a surgeon and surgery was months in the making. Being the nerdy analytical person that I am, I couldn't just trust reviews. Since everyone has a different face, not everyone has the same challenges. After reading the horror stories, I wanted to increase my odds of success. I was willing to pay 100% out of pocket instead of having my insurance tell me which surgeons I could choose for my rhinoplasty. How did I choose a surgeon if I could see anyone I could afford? I made an excel spreadsheet. Yes, you read that right! A spreadsheet. I gathered all the info surgeons felt qualified someone to perform a surgery well. A surgeon received one point for every qualification. I didn't want to travel too far if I could find someone locally. I concentrated my search to surgeons in Northern Cali. I found my initial list of surgeons on the medical specialty webpage. My first step was to then check their medical license to see if any formal complaints had been filed. From there it was checking all the websites, including their own for all the other parameters (18). It was a lot of legwork. Those who scored the highest were my pool for consultations. Oddly, I found myself only going to one consultation. I was confident after our first meeting that I found the surgeon I wanted.

The procedure:
I had my deviated septum corrected, the hump on my nose reduced and the tip raised, a small chin implant and submental fat reduction. I was told everything went well during the procedure. The only issue I had was due to an allergic reaction to the antibacterial they rubbed all over my face. I developed a rash within 24 hours, turning bright red. Hello Benadryl!

The healing:
I had very little bruising. I was shocked at how little I actually bruised. I was able to go back to work in 10 days without many really noticing something had changed. No make-up required to hide bruising. I didn't tell anyone but my two best friends (one of whom was my babysitter the first 24 hours post-op) that I was having cosmetic surgery. A few people noticed something was different, but they just couldn't put their finger on it. Someone even asked me if I was doing something different with my hair. Even when I fessed up, they still couldn't figure out what I had done. This is a testament to Dr. Kim's ability to give a person a natural look. I still looked like me, just a better profile me.
The results: My profile, as you can see, underwent a fantastic transformation. My portrait, however, increased an already offset chin and my smile, I fear, will never be the same. Two months to 6 weeks is the estimated healing rate for the chin augmentation and 6 months to 1 year for the swelling to completely resolve for the rhinoplasty. I am currently 3 months post-op. I can breathe much better through my nose and don't have the nasal collapse as significantly when taking a deep breath. I still have numbness in my chin around the incision (submittal incision site) site as well as my columella. My nose is pretty well healed, but I still have sensitivity near the tip, which I attribute to the tip raise. I still have twinges in my chin from time to time. It may be that the nerves are healing. Whatever it is, it is usually a temporary sensation.

Things no one tells you:
1. The billy goat beard. What, you may ask, is the billy goat beard? The chin augmentation changes the anatomy of the face and if you are like me, you have peach fuzz. That peach fuzz no longer lays flush to my skin under my chin. I plan to get my chin waxed in the next week or two to eliminate this discovery.
2. Nasal discomfort/stiffness. Three months later it is still uncomfortable for me to rub/wipe my nose. As an allergy sufferer this is rather irritating when I blow my nose. As I mentioned, I attribute this sensitivity to the tip raise because that is where I feel it. My nose also feels stiff. If you have ever wiggled your nose, you will know what I mean when I say it feels like my septum is stiff. This may be a result of
3. Your smile may never be the same again. As you can see from my pictures I don't have the same muscle movement. My friends, who know me well, say I look constipated. My lower lip covers much of my top teeth and my lower lip is now pulled taught, giving me a strained look. I practice smiling everyday in hopes it acts as "physical therapy." Having seen photos of people a year post-op
4. Tripping over words. I still have some trouble articulating certain sounds. My chin has a stiffness that makes certain consonants a challenge. I think this falls into the "physical therapy" realm again. Talking more would most likely help and I do notice my chin aches more after I have been talking a long time. I don't talk much at all when I am at home since I live alone...and talk a lot when at work but I only work 3 nights a week.
5. Stir crazy. As an active individual, the 3-week exercise restriction was grueling. I resumed exercise as soon as I got clearance. The increased blood circulation made both my nose and chin tingle. The nurse, Natalie, stated it would also speed healing and swelling reduction.

Spreadsheet

I based my search primarily on rhinoplasty experience. The nose is a complex organ and requires a lot of expertise. The chin? Not so much. I used the ABMS for my initial list of surgeons…you can look up licensure by specialty.

I gave one point for having each of the criteria listed in the column. Zero if they did not. The surgeon you choose does not have to have a point in every column (esp since the choices may be one of three), but the higher the number total at the end, the better your odds of choosing a qualified surgeon. Ultimately, you have to go with your gut when you do your consultation.

Many of the columns are abbreviated and you can find their descriptions in some detail below. Some of the information you can find on the surgeon’s website (you may have to dig). You can Google the abbreviations to find the membership and licensure pages. If you are not able to find information on the Internet, you can call the offices or email them your questions before scheduling a consult. Try to narrow any remaining questions down so you don’t waste too much time during your consult with your questions. That is the time you want to focus on what the surgeon can physically do for you and what kind of outcome you can look forward to seeing.

• The first two are the location/city and the year they were licensed. If you are considering more than one city search, it’s helpful to remember where their offices are based. In addition, I wanted a surgeon who had at least 5 years from their licensure, but 10+ best…plenty of time to brush up those skills.
• The next four are various certifications that a facial plastic surgeon may have:
AOA - an academic honor society.
ABMS - American Board of Medical Specialties and the ABMS-MOC is a voluntary recertification process. When you look up the physicians on this page, it will indicate if they have participated or not in MOC.
FACS - Fellow of the American College of Surgeons (yet another certification a surgeon should have).
• Face only - choose someone that specializes in facial, esp if you are considering rhinoplasty. If 100% of the practice is rhinoplasty...there is a good bet he/she is great choice to perform surgery on your nose.
• RH/yr 100+ - The surgeon should perform more than 100 rhinoplasties a year, if you are seeking a rhinoplasty.
• N&C - nose and chin (for me, since my goal was to improve my profile the surgeon needed to be able to perform both nose & chin).
• c/o - any formal complaints filed against the surgeon. If a formal complaint was filed with the medical board, I did not consider them at all. Some people want miracles and are never happy with the end result, therefore it is not uncommon to see some complaints. Yelp can help, too. If you find most of the reviews are negative, by all means trust your gut, but if there are only one or two among hundreds-no surgeon is perfect, but you want someone who is close as you can get. Formal complaints with the medical board are a pain to file. If there is one you can bet it was something the patient considered very serious.
• Primary - is what the surgeon lists as the primary/secondary part of his practice. Surprisingly, I did find one or two who did not list facial plastic surgery as their primary. Again, if you are considering a rhinoplasty you want a surgeon that has facial plastic surgery as a primary. If you need a functional rhinoplasty it would be wise to choose a surgeon who is an ENT. My guess is, you want a nose that is both esthetically pleasing and functional.
• School/tier - I tried to choose surgeons who went to top schools and top in their class
• The next 3 abbreviations are for the surgery centers, they should have one of the 3 certifications: JACHO, AAAASF, AAACH. If you surgeon doesn’t state which, if any on the website, you can search the facility individually if the surgeon lists it on their website.
• Hosp Priv - Every surgeon who has any skill should have hospital privileges. Hospitals do their own background checks so if the surgeon is in good standing at a local hospital, it’s another feather in their cap.
• Board Cert Anes - is the anesthesiologist at the surgery center certified? If you are undergoing a procedure that requires general anesthesia, you want to be sure you will wake up.
• Rhinoplasty soc mem - A membership for those who specialize in rhinoplasty.
• Natural outcomes - I wanted to find a surgeon that doesn't give the same nose to every person. Does the nose fit the ethnicity of the person
(there are surgeons who specialize in ethnic noses)? I wanted to look like me, just to be able to breathe better and have a better profile. Does the surgeon give you a realistic outcome? Does the surgeon have pictures of patients who have undergone procedures similar to what he/she is proposing?
• Total Points - gives your totals. Those with the highest totals became part of my consultation pool…though, as I stated, I didn’t feel the need to see any others after Dr. Kim.

Things you may want to ask because no one puts this info on their website:
What is the surgeon’s revision rate?
If you are looking for a surgeon to do a revision, it is ideal to choose a surgeon who has done lots of revisions on OTHER SURGEON’S work. If you are looking to have a primary rhinoplasty find out the revision rate of his/her OWN work.

4.5 months Post Surgery

I am still not so happy with how the chin implant appears from the front. When I line up the edges of my lips with the outer edges of my new chin, it still appears to be off center. I'm not sure I can still attribute this to swelling. I have puffiness in my right chin/lower cheek. I still get strange twinges in my chin and it aches from time to time. I still have some numbness, but it does seem to be getting better over time...may be the twinges I have been feeling - nerves regaining their connection?

My nose has become much more pliable and I can now rub my nose without much discomfort. When I run my finger down the ridge I can feel the irregularity of the cartilage where my hump was reduced. Visually it is not noticeable. I have been taking photos with regularity and I am putting together a gif so I can see the progression of the swelling reduction. The swelling has gone down significantly, and as my research suggests, most of the swelling goes down in the first 6 months. I try to keep in my that total swelling/healing time is said to be a year. I am patient.

Because of how off center my chin looks I find myself taking pictures at an angle, esp now that I have a better profile.

Revision Required

I had my 6 month follow-up and the surgeon agrees that the implant has slipped to the side. His best guess is that the dissolving suture that temporarily holds the implant in place may have broken at one point before I healed well enough, allowing the shift to happen. During my research, I had already asked what his revision rate is for chin implants and rhinoplasty. It appears that I am part of the small percentage for chin implants. I did ask, prior to my surgery, what the cost of a revision would be if there is an issue. When interviewing your surgeons be sure to ask what cost you will incur. In my case, the surgeon will not charge me for the work but I do have to pay the fees for the surgery center. The particular facilities they use also block out their time in hour intervals and though I am told the surgery will only be 30 min, I have to pay for the full hour. They do, however, charge for smaller intervals if your surgery runs over the quoted time. After my primary surgery I received a bill for running over 10 min. My revision surgery is scheduled two months out.

Smile update 6.5 months Post op

Smile still isn't the same but very close to the before...just have to get centered now.

9.5 Months post-op and Revision on Friday 3/25/16

It has been almost 9.5 months since my original surgery. I am posting my recent pictures. As far as I can tell my nose has been great. I have had no issues and I am happy with the result. I still have a tiny bit of numbness at the tip of my nose, but all sensation has returned everywhere else. Most, if not all, the swelling is down. The texture of my nose feels, as best as I can describe, scaley. However, I can’t say I ever really felt my nose prior to the surgery so this may not be a change at all. I can still breathe great, when my allergies aren’t causing me issues. I can feel where my bump was shaved down. It is not completely smooth, but is not visible and so I don’t believe it needs any attention.

Both my surgeon and I agree that my chin implant appears to have slid to the Rt side. Dr. Kim is confident that this can easily be corrected. As I mentioned in an earlier post, his best guess is that the stitch may have accidently broken when I was being wrapped post-op. His solution is to shift the implant back into place and use extra stitches to secure the implant to avoid any future issues. These sutures are dissolvable so it is impossible to do any investigative work while he is in there. I have more nerves than I did the first time, mostly because I hope the revision won’t make things worse. I have posted a new picture of my scar. The incision healed up really well. I still have numbness under my chin around the incision site. The chin itself feels real to the touch. The tissue feels soft and pliable as it did before the surgery. If I didn’t tell anyone I had an implant, no one would know. I feel like I have recovered my smile, though not quite the same as before, but pretty darn close.

I haven’t had any complications from the submental fat reduction. In fact, people who have not seen me for a while still recognize me, but often comment that I look like I lost weight.

I will continue to update after my chin revision on Friday and as I recover. I am not looking forward to going through the talking and smiling recovery all over again.

Shifted chin implant

I forgot to include the photo of the shifted implant.

Chin Implant Revision

I had my revision surgery on Friday, March 25th. The morning of the surgery I spoke with Dr. Kim, he reviewed my case again and felt that I do have have natural asymmetry which was most likely enhanced by the size of the implant and the minor shift to the side. He suggested changing out the small with an extra small as well as centering the implant. As you can imagine having that kind of information sprung on me, a person who researches, I wasn't sure what decision to make. As before, I told Dr. Kim I would leave it up to his judgement. After surgery he said while in there, he did ultimately decide to go with the smaller implant and made certain it was centered. I would still have some asymmetry but it should be markedly less noticeable with the changes. I will lose a few mm of projection but it sounds as though it will give me the results I prefer. Time will tell as the swelling goes down.

I am shocked at how much easier the recovery has been so far. I am 3 days post-op and I halved my pain meds during the night last night and stopped taking them all together this morning. I am feeling achy with a mild headache, but the pain is manageable. Swelling seems to be minimal with some minor bruising. I am already able to smile and talk easily, though my chin does ache when I do. I was able to eat solid foods the same day as the surgery, though still kept the chewing to a minimum.

I am posting before/after pictures, though, it appears to be a subtle change at the moment. Swelling is estimated to be down at 1 month...so it may still be too early to tell.

Chin Implant Revision 6 days post-op

Stitches out today. I still have some swelling. Recovery is still going along great. I now understand the postings of people who just had implants. They mentioned how quickly they bounced back. If you are considering having more than just a chin implant, your recovery will take longer. Just the implant? I could have gone back to work 4 days after the surgery, minus the sutures hanging out and the still visible bruising on my jawline and below the incision.

2 wks Post Chin Revision / 38 wks (9.5 months) post original

Recovery is still going great. I have some muscle stiffness which I notice most when smiling. I still have some swelling. I am getting the familiar twinges I experienced with the first surgery as the tissues shrink around the implant and heal. It's still hard to tell any changes in projection and how centered it will appear due to the still-present swelling.

Chin Progress

I am a little over 2 months post-op for my chin revision. My chin IS more symmetrical. I haven't lost much in projection. My profile still looks good. I know it will never be perfectly centered since I wasn't symmetrical to begin with, but I am much happier. Speech has been back to normal for several weeks. My smile is still a bit stiff, but almost back to normal. I still get those infamous random twinges which I attribute to nerves healing.

Little over 1 year post Rhinoplasty, 4 months post chin revision

Rhinoplasty is, now, a little over a year post-op. It looks good and works well. I am very please with the Rhinoplasty!

The chin revision, I'm told, still has some swelling, but I should expect to see most of the inflammation down by Sept. I still have a boxier chin than I did originally but the implant does appear to be a bit more centered. My bone structure is off-center so I cant expect it to be perfect. I am, however, hoping that I will lose the boxiness. I did like my straight-on-chin-shape prior to surgery and was just looking to improve my profile. It may be something to which I will just have to adjust if I never get that shape back. I did not lose a significant amount of projection from the smaller implant. I am still very happy with the change in my profile. I'll just have to see how the chin revision progresses.

Chin Scar & Straight-on nose

My scar was invisible with the first implant. I now have an obvious scar with the revision.

To show no real change in my nose straight-on I added side-by-sides of my nose.
Bay Area Facial Plastic Surgeon

Dr. Kim had patience in answering my list of questions during my consultation. The rhinoplasty was, as far as I can tell, perfection. The jury is still out on the chin augmentation. I still feel that my chin appears more off center than before the procedure (the implant may have simply increased the irregularity that was already there). When I had a reaction to the antibacterial solution they apply for surgery he took my call immediately. I sent him a photo and he was able to identify the issue. Almost a moth post-op, I had a freak-out moment about my chin's appearance. Not usually an alarmist, I emailed the nurse, Natalie for reassurance. She returned my email with a phone call within minutes of me hitting send. She answered all my questions and and set my mind at ease (though 3 months post-op I still see some asymmetry).

5 out of 5 stars Overall rating
4 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
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
4 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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