Cons outweigh pros. Choose your doctor wisely...

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I've had many issues with the way I looked, so I...

I've had many issues with the way I looked, so I finally decided on rhinoplasty this year (note that I had fat transfer and buccal fat reduction too, but I'll describe the rhinoplasty first). Shout out to Shakibabe88 for her thorough review, and I hope my review can be of help to other people, even though I have mixed feelings about my results. While some of my comments seem to be critical, please know that I do somewhat like my rhinoplasty results, but there are many caveats that I hope my help some of you when planning for rhinoplasty.

Initially, I had only been interested in alarplasty due to the wideness and droopiness of my alae (which is caused by a slightly retracted columella, if you see in my earlier pictures. During the consult with my doctor, he suggested augmenting the tip and lengthening the columella to help with the droopiness and spreading of the alae. Some cartilage would be added to the bridge to give a bit more definition. A slight alar base reduction would also be performed. I stressed that I wanted only slight modifications to my nose, so that it would appear natural.

I had surgery under local anaesthesia... which is common, but definitely uncomfortable; I should have probably opted for general anaesthesia or for some type of sedation and local anaesthesia. The nose is very hard to completely numb, so there were moments where I could feel painful pinching when the anaesthesia wore off. After surgery, my face was definitely swollen, as expected, although the pain was not so bad with the help of painkillers. I did look pretty disfigured though (puffy face, upturned nose) - --- try not to fixate on how you look coming out of the operating room! I know my self-esteem was pretty low the first month after surgery... Patience is definitely needed when trying to evaluate how your surgery went.

My initial thoughts of my nose, within the first two weeks of surgery were that it was too upturned and too augmented. This in effect narrowed my nostrils (augmented tip stretches the nostrils upwards), but also made my nostrils look slightly pinched, due to the existing lack of curvature in my alae. My doctor ultimately decided not remove part of the alar base so that I would not have slit-like nostrils. I realized that swelling causes the nose to be upturned, and it will take awhile to return to "normal", whatever that means. Swelling around the temples and zygoma due to the fat transfer was perhaps the most upsetting for quite awhile because I looked like a muppet.

Fast forward to nearly two months after my surgery, here is what I think:

1) My nose no longer appears to flatten or lose definition when I smile. Having the tip projection helps give me somewhat of an alar crease, which was what I was looking for, so that when I smile, I have a defined nose.
2) My bridge gives definition to the eye and brow area, at least in my opinion

1) My alae seem to droop even more now that my tip is rotated up (I think I had cartilage added to my columella, which fixed my retracted columella, but this did not address the issue of drooping alae sufficiently). This detail was most important to me, as I wanted my alar base to be parallel to/flush with my columella (I was hoping that alar base excisions could also move my alae slightly up, if that makes sense, to make my columella look less retracted).

2) most of the swelling went down, but one side of my nose looks too projected versus the other; it isn't super obvious until you start turning my head to a 3/4 view or profile view. The tip seems slightly crooked due to this asymmetrical swelling - I thought I looked normal at this point, but looking at some recent pictures of me, my nose looks slightly "done". I know that the swelling will take awhile to resolve, but I think any changes to my nose after this point will be pretty subtle; we'll see in a year I guess, and I will update everyone.

3) Long upper lip and drooping of corner of mouth more apparent. This isn't directly caused by the rhinoplasty, as I had both traits before surgery. But with a projected nose/tip, those problems are slightly exacerbated. This is probably the worst side effect I think, because it contributes to an unnatural look. I'm considering depressor anguli oris muscle release or worst case a lip lift to fix this in the future.

Yes, I have a lot of criticisms, but I think most of them are directed towards features that were already a part of my face. The rhinoplasty was effective overall-- I think the doctor applied the necessary and standard techniques involved in asian rhinoplasty, but I do wish I had considered how the rest of my face would look in relationship to my new nose. In general, my nose still seems overprojected (slightly, but surely), and since my mid-face and upper lips are pretty flat, my nose definitely sticks out. Going forward from here, I am considering very small cheek implants to fill out the midface. I will try to give updates every month! :)

Some opinions on Fat transfer: It was a great idea to get some subtle volume, but not the type of structural support I was looking for. Most of the fat in my cheeks disappeared within the first month. At least that gives me the indication that cheek implants may be a better option. Although my doctor also added fat to the temples, forehead, and zygoma to blend the fat transfer results, I think I should have veto'd the addition of fat to my zygoma much harder. It made my face look wider :/ I understand that this technique may appeal to my doctor's sense of aesthetics, but I respectfully disagree with adding any fat to the sides of my zygoma.

Effect of tip projection on nostrils

My nose tip is still a bit hard and stationary, but you can see that when I frown slightly, the projected tip tends to pull on my nostrils, making slit shapes. Hoping my tip goes down

before pics


2.5 month post. I'm hoping there is a way to lift mainly the sides of the upper lip; it looks too sunken.

5 months

I guess I was unhappy with myself enough that I didn't really consider the pros and cons of this procedure, and rushed it. Less augmentation probably would have been better, as in half the cartilage sutured into my nose, and I probably would have left my tip mostly alone. What bothers me the most still is that the nose sticks too far out of my flat face, that's what I mean by unnatural. For my (possible) revision, I'll definitely be more scrutinizing of the plan that the surgeon has in mind... In the meantime, I'll wait up to a year for the swelling to go down, hoping for the tip to refine itself to my pre-op days ._.

over projected nose IMHO

one picture is a two months

Over projected still

This pic is as of now. refinement for sure in the nose, but still oddly overprotected like a sharp tent. Not what I was looking for.

Revision options?

exactly 7 months after. I'm having a major objection to how my tip looks; still looks unnatural, and just gives me a big nose. Tips?

8 months

my tip lost a lot of it's former refinement. Wish I had a quantitative measurement of my nose projection before and after to tell you how different my nose is and why it bugs me so much. I hate that the alae seem to be "left behind" while the tip and dorsum got projected way out lol

I miss my old nose

New nose is definitely off.... Old nose tip was refined

The Hanging Alars

I wanted to justify why I feel my nose is too upturned/triangular by this photo. Relative to the columella, the alars hang a bit more now because the tip was turned more "up" than "forward, and because the alars were not repositioned in any way. I don't have a nice right angle between my alae and my face anymore.

9 months of a disproportionally large nose


I'm sorry if I'm repeating my personal grudges so often, and I'll try to hold off until I'm at the one year mark and if I see any changes. I realize being a Plastic surgeon isn't an easy job because it requires a sense of aesthetics that I don't think can be taught or forced, but then I hope surgeons realize the consequences of every procedure they do on the patient and actually try to improve themselves by looking at patient feedback... Not just their most successful cases. Looking back I shouldn't have put down 10k when the doctor didn't even draw out or show what my nose might look like, and didn't discuss any numbers/metrics about how big or rotated my nose would be. I at least need specifics like that to hold the doctor to his/her word, because that's the least amount of protection I can give myself as a patient, when surgery gives no guarantees. Maybe some day simulation technology will be able to predict outcomes so that "plastic surgery is unpredictable" will no longer be an excuse for misunderstanding patient desires. Someone should invent that.

11 months - looking at a revision procedure in the next year

Overly rotated tip still present and nasal refinement is just exposing poorly placed cartilage


Other than the swelling going down such that my nose isn't as horrifyingly cringeworthy and fake looking as it was the first 3 months, my tip stayed pretty much in the same place from months 7-11 -- permanently overprojected and borderline upturned like a fake caricature. It's slight but the 3/4 view screams nosejob to me - ESPECIALLY since my nose before looked very different and natural. As much as doctors say people don't notice, they really do when it's overdone.

Almost a year- it's getting worse

I need to fix this ASAP :( all the swelling has gone down and the nose just looks skinny and unnatural. Holy crap.

I think I may know what I need for a revision

Did some more research and going to a consultation in a few weeks. Here's what I'm proposing to address my concerns:
1) alar rim raising/ sail excision technique to address droopy alae (more common in Asian noses, contributes to less alar show and "hanging alae")
2) alar rim graft to address slight alar rim notching that was already present. You can see those notches more prominently when I put very light pressure on either side of my nose ( see pics).

3) trimming tip such that it isn't too upturned and projected.

maybe I'll need all three, perhaps just one but I'm hoping I can get some answers from doctors, for what I'm looking for.

Bulbous nose as of now

bulbous nose due to overly projected and rotated tip. No alarplasty performed but it would have been better to do so.

prepping for revision: ideas

Anyone done research on alar lift or lobule reduction ? Found a new article from this year m, first technique of its kind seems like. so far I haven't found any doctors in the US keen enough to pick up on the issue of hanging alae, all seem to default to using weir excisions to fix a broad range of features about the alae
Bay Area Facial Plastic Surgeon

Dr. Lay is an approachable and attentive person, but I think I would have liked to see a surgeon who did much less to my nose. I understand this is just my personal opinion and for some my result is what they are looking for, but in the end, beauty is in the eye of the beholder/patient. UNfortunately, it was only post op that I discovered two other similar reviews ( one chin implant, other rhinoplasty, mentioned in the comments) describing Dr. Lay similarly: a great person, but not right for the job. I either picked the wrong surgeon for the job or my expectations of a "conservative" result were just lost in translation, and I felt that this surgeon went a little too extreme. It doesn't take too much to make a nose look unnatural on an Asian face. In short, I'm unhappy with the result, I don't think it was botched necessarily, but I would have really liked less projection on the nose and more attention to the relationship between the tip and the alae. Sadly, I am considering spending a bit more to reduce my tip in the future and to forget that I wasn't more careful in choosing my surgical plan. Please be careful when choosing your doctors, whether or not this surgeon is the right fit for you; I don't get the impression that plastic surgeons get a lot of time to personalize your surgery due to their busy schedules, and in this case, a lot of my concerns post op weren't addressed, not that much can be done once the operation is over...Message me if you're considering surgery and would like pics. I took a lot of other pictures down for privacy reasons (coworker finding out etc. )

3 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
3 out of 5 stars Answered my questions
4 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
4 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
3 out of 5 stars Wait times
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