Planning for Rhinoplasty & Chin Implant Summer 2016. Seattle, WA

I'm not sure when I first realized I wasn't pretty. By the time I was halfway through high school I knew there was something off about my face, but I wasn't sure exactly what, so I blamed the bump on my nose. I thought if it was gone I would be just as happy and pretty and confident as my sister, who got my mom's straight nose.

Now I've decided it wasn't really the bump that bothered me, it was the disproportionality of my profile. My nose is a little big and my chin is small, making my profile quite convex. It makes every picture terrible if my face isn't perfectly dead-on. At this point my chin bothers me much more, and if I had been born with a better chin I doubt I'd even bother with my nose. But if I'm going to get a chin implant I might as well just fix the nose too, because the bump certainly isn't great.

I'm looking for a straight bridge, or maybe even a little curved outwards. Absolutely no scooping. I think it would look really weird on me and nobody else in my family has it. I know my tip is what a lot of you might consider "bulbous," and it's probably a little over-projected, but it looks like my dad's nose. I wouldn't be upset if it changed inadvertently after the surgery, but if possible I'd like to keep it. I still want to look related to my parents! And messing with the tip opens a whole big can of worms and possible complications that I want to avoid. Even though my nose is pretty big and humpy, it's still a little upturned and not at all droopy. I'd like to take as little risk of jeopardizing that as possible.

After Christmas my mother told me that she'd talked to my father and if I wanted to do the surgery this summer, they'll pay for it. I was fully expecting not to get it done until I was 23 or so and had saved up the money, but she told me that she wanted me to get it done sooner rather than later. I want to pay her back the money when I start working full-time after college... I just feel so guilty taking so much money from them for the sake of vanity. But so far she says no to that. I might have to bring it up with my dad later. I actually haven't discussed it with my father at all. I'm sure they both think I'm pretty insecure and silly for even wanting the procedures, so it's embarrassing to talk about. They're very practical people. Frankly I'm shocked they even offered to pay. (but I'll take it! lol)

(I feel like I've written a lot. Have I written too much??)

As far as surgeons go... I'm terrified of choosing a surgeon. I think I'm more scared of making the wrong choice than of the actual surgery. I want to go about this in the most logical way I can, so I made a spreadsheet of every surgeon in the greater Seattle area who's so much as sneezed next to a rhinoplasty in the past 10 years. I'm willing to go to 6 consults, so I'm in the process of narrowing down 150 names to 6.

My first set of criteria was:

-ASPS member OR certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology. (No ENT-only doctors. Need evidence of extensive surgical training. I wasn't blown away by most ASPS doctors because they generally seem to do more boobs and butts than noses, but I decided to accept them anyway if they've demonstrated a particular interest in rhinoplasty.)

-In private practice

-Between 10 and 25 years since their residency ended. (This number was hard to figure out in some cases, but I was pretty lenient with it. I just want to be sure my surgeon is neither ancient nor completely new at this. I feel like old surgeons might be less willing to update their techniques. Plus, shaky hands!! I'd rather have a younger surgeon who's still enthusiastic about his work and willing to keep up with the latest breakthroughs.)

-No disciplinary action on their license in any state they've practiced in.

That left about 15 names. I removed the surgeons whose specialties clearly weren't rhinoplasty and one surgeon whose noses I just hated and was left with 10 names.

I ordered my top 10 based on the ranking of each of their schools, how many relevant articles they've published in peer-reviewed journals, and whether or not they've completed any fellowships. So now I have my preliminary top 6. I still have to pull their license and lawsuit public records, though (which is such a headache I'll probably make a post about it when I'm done).

I didn't take reviews or top surgeon lists into account at all. I think it's pretty stupid to choose a surgeon based on reviews. There are so many fake reviews out there, and even when a review is real it's purely anecdotal. The only thing they're good for is evaluating things you're not likely to get a good idea of in the consultation, like whether the surgeon will still care about you after he has your money. And I'm pretty sure those top surgeon lists are more about politics/whether the surgeon paid off the magazine than the surgeon's actual skill.

Soooo I guess my next steps are to keep investigating surgeons. I want to go to a regular ENT before I go on any consultations just to get an idea of the anatomy up there. I'm not sure if I have a deviated septum or anything, and I don't really trust a surgeon to tell me. He has a vested interest in finding something wrong. I don't want anybody messing with my septum or turbinates unless an independent professional tells me there's something really wrong with them. Besides, the ENT will also be able to tell me the reputations of the surgeons I'm looking at.

tl;dr - hi guys I'm getting a nosejob!!

I swear I'll take better pictures eventually

Pls be nice

I'm officially all scheduled!! It took me forever to get up the nerve to ask my mom if I could make the appointments. I keep worrying it'll suddenly become "real" for her and she'll back out. I also scheduled an appointment with a regular ENT to evaluate my breathing. I never thought my breathing was that bad, but I keep reading these reviews saying things like "it's so hard to sleep with the cast because every time I fall asleep my mouth closes and I can't breathe" and I'm sitting here like "I sleep with my mouth open every single night!!!!" I have to keep a water bottle next to my bed all the time because whenever I wake up I have to drink real quick. I can sit quietly and breathe through my nose, but if I try to walk somewhere or exercise at all my nose seems to close up. So hopefully she can check all that out! I also wanna ask the ENT if she recommends any surgeon in particular and whether the surgeons I'm seeing have good reputations in the medical community.

I have consultations on the books with Dr. Lamperti, Dr. Stella, and Dr. Salemy, all during my spring break. I went back and forth on scheduling with Dr. Naficy but decided against it for now. I miiiiiight end up seeing him depending on what the ENT says and what the department of health sends my way in February. They had a couple case files on him that I should be getting by the beginning of March.

Also! I have to go to the courthouse downtown in the next few weeks to pull up some court records. Dr. Naficy and Dr. Stella both have some cases I wanna take a look at. My sister is coming with me, but not because she's excited about the surgery or the doctors. She just wants to see the inside of a courthouse lol. She doesn't understand the fixation, but she's really beautiful so I wouldn't expect her to.

So that's where I'm at so far! In the next couple weeks I'll be visiting the ENT and going to the courthouse. Then consults about month after that! I feel like everything is moving so fast. It's crazy. I don't know how you girls do this whole decision process in less than a month, my head's already spinning lol. Oh, and if you've met Dr. Lamperti, Dr. Stella, Dr. Salemy, or Dr. Naficy I'd love to hear about it!

I just got back from visiting the ENT! It went pretty well. She said my septum is very slightly deviated to the right and my turbinates are "generous" (lol). That's about what I expected her to say. She sprayed a little Afrin in my nose and I can breathe SO WELL right now. Unfortunately it's apparently highly addictive so it was just for diagnostic purposes, but if I get my turbinates reduced I should breathe like this all the time.

She also recommended that I see Dr. Samson Lee, so I'm making an appointment with him for my spring break along with the others.

My mom keeps commenting on the cost. My cousin got his nose fixed in Norfolk, VA last year for $30,000 so she's expecting something around that number. I think that's crazy and I've never seen a number that high before. I keep seeing figures around $7000-8000 for the Seattle area (unless you're going with Naficy haaaa), but my mom says that doesn't include the operating room or anesthesia. $30,000 is waaaay high, right? It won't be that much?

I do think about the cost a lot. I won't do it if it's $30k. I keep thinking about how long my dad had to work to earn the money to pay for this and I feel so guilty. They could take a vacation to Montana or Alaska or something but instead they're spending it on this. They pay my college tuition as well, which I feel bad about but I can accept because it's an investment in my future. But this is purely vanity and I'm finding it a lot harder to justify wasting my poor father's money. It's not uncommon on here for girls my age to use their parents' money for this, right? How do you rationalize it in your mind?

Long time no see, you guys! Hope you all are doing well :)

Today I wanna talk about something not everyone likes to think about. How do you know if your surgeon is skilled?

Most people seem to evaluate their surgeons’ skill by the ratio of positive to negative reviews. However, I think this approach is fundamentally flawed. When you read online reviews, you have no way of telling whether the person writing the review was even a patient of the doctor in question. Moreover, if a patient has enough of a case to file a malpractice suit or formal complaint with the Dept. of Health, they often are not allowed to discuss their case online. Factor in the fact that many surgeons pay for fake positive reviews, and that disgruntled patients might repost their negative review multiple times, and you end up with a very skewed picture of a doctor’s track record.

However! There is a way for you to read verified, factual accounts of your surgeon’s previous patients. You can look up his PUBLIC RECORDS.

So what are public records? I would argue the name is a little misleading. At least in Washington state, public records are not very public. The system overwhelmingly favors the surgeons over the consumer, but don’t let that stop you. As a citizen, you have a right to view any records of proceedings kept by a public body as long as those records don’t infringe someone else’s right to privacy.

There are two ways a surgeon can get in trouble with a public agency (and therefore leave a paper trail you get to read). 1. Someone can file a complaint with the Department of Health, which will launch an investigation. 2. Someone can file a malpractice lawsuit. You have access to both these types of records, although the process is different for each. I’ll note here that my experience with this has been strictly in Washington State. I think the basic steps are probably the same for most states, but your mileage may vary.

The easier records to view are the Department of Health’s. If you’ve been doing exceptionally thorough research, you’ve probably looked up your surgeon’s license’s standing in your state online. (If you haven’t, go do it.) In Washington, if a surgeon has gotten in trouble with the Department of Health and gotten sanctions on his license, you’ll be able to see it online. HOWEVER! They WON’T show you any previous or current investigations unless the surgeon is actively being penalized for them. So a surgeon might have had an investigation every year, but never been in trouble for them, and he’ll look like he has a clean record online. But these hidden investigations are still in the public record! For Washington, go to the Department of Health’s website for instructions on how to access them. You’ll email an agency coordinator with the list of practitioners you want information on. She’ll get back to you in a couple days letting you know how many case files she has and how long it’ll take (mine took about a month).

The harder records to access are the malpractice records. If you go to the Washington State court system website, you should be able to search their case records by name. Plug in your surgeon’s name and you’ll get a list of case numbers. Buuut… You won’t be able to see any information about the cases, just the ID number. If you want to see the actual case information, you need to go to the court it was filed under and pull the records yourself. This is free, although they charge you to make copies at the courthouse. You just need to go to the court clerk with your case numbers and they’ll help you out. I felt a little stalker-ish doing this (I uncovered a lot of speeding tickets…) but it’s well worth it if you want a primary source of confirmed unhappy patients.

Remember to use your head when you’re considering these files. A surgeon who is very new or has spent most of his career practicing in another state may have no records at all, but that doesn’t make him the better surgeon. Think of this tool as a reliable source of potential red flags – it’s good for eliminating surgeons off your list, but not so much for choosing them. Get what I mean?

I hope this helps someone out there become a more informed patient :) Feel free to ask any questions! Good luck!

My first consultation is on Monday!! I'm actually very nervous to be honest. I'm worried my mom will get cold feet once it becomes real to her. Or maybe I will! Who knows.

I've made a worksheet to fill out during the consult. Do people do this? I'm nervous he'll blow past my questions or think they're silly or something. At the very least it'll probably be a little dorky but oh well. I also made a list of questions to ask the references he gives me. I'll post them both below. Let me know if I've missed anything! I want to be thorough.

Consult worksheet
Surgeon’s name:_____________________________________
Date:______________________________________________

The Basics (I'll fill this out before the consult and just confirm it's accurate)
Board Certifications:____________________________________________________________
Undergrad:____________________________________________________________________
Medical School:________________________________________________________________
Residency:_____________________________________________________________________
Fellowship:____________________________________________________________________
Hospital Affiliations:____________________________________________________________

Surgeon’s Practice
How long have you been in private practice?__________________________________________
How many years of that was in WA state?______________________________________
In which other states have you practiced?______________________________________
Do you carry malpractice insurance?________________________________________________
What is your percentage of happy patients?___________________________________________
What is your policy on revisions?___________________________________________________
What is your revision rate on your own patients?_______________________________________
What type of anesthesia do you use and why?_________________________________________
Who administers the anesthesia?_____________________________________________
What sort of facility do you operate in?______________________________________________
What is your protocol in the case of unexpected complications?_____________________
______________________________________________________________________________
By whom is it accredited?___________________________________________________
May I see the surgical facilities?
Do you yourself do the whole procedure?____________________________________________

Rhinoplasty/Chin Implant
How many rhinoplasties per week do you perform?____________________________________
Chin implants?___________________________________________________________
When did you perform your last rhinoplasty?_________________________________________
Chin implant?____________________________________________________________
What percentage of your practice is devoted to rhinoplasty?______________________________
Chin implants?___________________________________________________________
Do you have a particular interest in rhinoplasty?_______________________________________
Fellowship, publications, presentations, volunteer work, regular conference attendance? ______________________________________________________________________________
______________________________________________________________________________
What percentage of your practice is open vs closed rhinoplasty?__________________________
Can you use both techniques?________________________________________________

My Procedures
Can you describe the procedures to me?______________________________________________
____________________________________________________________________________________________________________________________________________________________
How long would you spend performing my procedures?_________________________________
Tell me about potential risks and complications._______________________________________
______________________________________________________________________________
What is the rate of such complications?________________________________________
______________________________________________________________________________
How might my breathing be affected?_______________________________________________
When should I expect to see the final result?__________________________________________
How will my nose/chin look as I age?____________________________________________
Can I see before and afters of cases similar to mine?
How confident are you that you can achieve the results we talked about?____________________
Are my expectations realistic?_______________________________________________
What is your usual postop follow-up schedule?________________________________________
______________________________________________________________________________
How much will it cost?___________________________________________________________
What does that include?____________________________________________________
______________________________________________________________________________
Are there additional fees for follow-up visits?___________________________________
When is payment due?_____________________________________________________
What is your policy on cancellations and refunds?_______________________________
______________________________________________________________________________
May I speak with any of your former rhinoplasty patients?
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________




Reference worksheet
Surgeon’s name:_____________________________________
Patient’s name:_______________________________________
Date:______________________________________________

Surgeon
Why are you recommending this surgeon?____________________________________________
______________________________________________________________________________
How well do you know him?______________________________________________________
______________________________________________________________________________
Why did you choose him?_________________________________________________________
______________________________________________________________________________
Did he openly respect your opinions and decisions?____________________________________
Did you ever feel like he was talking down to you?_____________________________________

Staff
How well did the office staff treat you?______________________________________________
______________________________________________________________________________
How accessible were the surgeon and staff on short notice and after hours?__________________
______________________________________________________________________________

Procedure
Was there anything about the process you weren’t prepared for?__________________________
______________________________________________________________________________
Is there anything you wish you did differently?________________________________________
______________________________________________________________________________
Did you have complications?______________________________________________________
How did the surgeon handle them?____________________________________________
______________________________________________________________________________
Were there any additional costs that hadn’t been discussed?______________________________
______________________________________________________________________________

Results
Were your results close to what you were shown in the imaging?__________________________
Are you happy with your results?___________________________________________________
______________________________________________________________________________
Would you recommend this surgeon to your own family?________________________________
______________________________________________________________________________

So I had my very first consult today! It was interesting. Not exactly what I expected. This guy was recommended to me by the ent we saw. He was very young and very laid back. Like suuuuper laid back. It's hard to express how chill he was.

He looked inside my nose and told me my septum deviated both ways and my breathing was probably poor 50% due to the septum and 50% due to the enlarged turbinates. Then he gave a big long speech about the whole process and I kinda nodded and smiled. He was good about answering all my questions at the end, even though I'm sure they were annoying. No red flags that I noticed. He's very much on the medical side of plastic surgery I think, if that makes sense. I feel like there's kinda a glamorous Hollywood variety and a very conservative medical side and he's solidly on that end of it. Not sure what his aesthetic taste is. He took pictures of my nose and we're coming back Friday to take a look at the imaging. He'll also give me references at that time. He kinda laughed when I asked for some. He said a patient has never asked him for something like that before.

The office was SO fancy. I've never been in such a nice doctors office in my life. The staff were all very sweet as well. My mom is already sold on him. She doesn't even want to see other doctors. I hadn't actually considered the possibility we might not agree on who should do the surgery, but I'm thinking about it now. I would be very comfortable with Dr. Lee performing my surgery based on the initial consultation, of course. He seems capable. But I wanna explore my options too!

She gave me a big speech about insurance in the car ride back. She still thinks it'll be 30k+. I've given up arguing about that. I still think it'll be 8-10k but until an actual quote is in front of her she'll never believe me. I was disappointed they didn't give us a quote today, but they have to put things through insurance to know how much it'll be for us so oh well. Oh, and we didn't discuss a chin implant at all. I'm OK with it not happening now, actually. Maybe when my nose is changed I won't feel the need to change my chin. And if I still do, it'll still be there when I'm old and have my own money.

Tomorrow we're seeing Dr. Lamperti!! Trying not to get my expectations for him too high.

I'll put down some facts here for reference later:
10 years in practice
2-3 rhinoplasties per week
20% of practice
2.5 hour open procedure
3% revision rate
Medical revisions billed to insurance, cosmetic revisions no surgeon fee, just anaesthesia and OR fee
General anaesthesia under MD anaesthesiologist

So I consulted with Dr. Lamperti yesterday and Dr. Salemy today.

Dr. Lamperti couldn't have been more different from Dr. Lee. I didn't expect him to be sooooo... peppy. He must be a heavy coffee drinker. Or a morning person? He's clearly really excitable about noses anyway. My mom found him a little too intense and preferred the mannerisms of the first guy, but I think that's a silly way to choose a surgeon.

He took pictures and told me he'd do an open procedure, shave the hump, break the bones, and add spreader grafts. He would also fix the septum and deflate the turbinates. Exactly the same as Dr. Lee. The pictures make me cringe but I guess I walk around like that already so no reason not to put it online... haha.

Dr. Salemy was a little bit of a surprise. My mom was completely against going to a non-ent until she met him. She was texting me things like "look at all the high maintenance women!!" the entire time we were in the waiting room, then warmed up to him immediately, haha. He didn't take any pictures or do any imaging, he just felt my nose and described to me what he would do. He said he'd shave the hump, trim the cartilage in the tip (which neither of the other doctors mentioned), and break the bones. He told me I have thick skin so it won't change too much of my tip, but if we leave it as is it'll look too full when the hump is gone. He wouldn't use spreader grafts or touch the septum or turbinates, and he's the only one who would use a closed procedure. He's also the only one who said he uses packing.

My mom really liked him. He was very calm but not I'm-about-to-fall-asleep calm like Dr. Lee. He also mentioned I might like a chin implant, but I turned him down for that. He didn't pressure me at all about it, which I appreciated. I agree that I need it but the more real it gets the more reluctant I am to change too much. His price quote was the lowest, at $7000. Dr. Lamperti's is between $8-10k depending on insurance and we'll see what Dr. Lee's will be on Friday.

I'm honestly conflicted at this point. I thought I would like Dr. Lamperti the best, but I don't think I do, which is a little disappointing. He wasn't CLEARLY better than the other guys I saw, based on the evidence I recorded. And... I didn't like the imaging that much. A little odd considering it's what I want. But I still see the same old ugly girl in the morphs. It's made me feel a little down about the whole thing, actually. Maybe it's a bad idea. Maybe it's silly to think changing something on the outside can change how you feel about yourself. I dunno.

I really did like Dr. Salemy, but my breathing wouldn't change at all and I'm a little skeptical about him not using spreader grafts, as I thought those helped prevent collapse. He also doesn't do as many rhinoplasties as the other two - one fewer rhinoplasty per week than the others. AND he didn't do any imaging. I wonder if he would if I called and asked?

I still have to see what Dr. Lee says on Friday. He promised to go over the imaging he did for me and some before and afters. So I guess I'll listen to what he says and then I have to do some soul searching...