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

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.

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.

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.