Dr. Chuang-Hsiang KAO (Taiwan) - Revision Rhinoplasty + Rib Graft

Long post regarding rhinoplasty surgeons I've discovered in Thailand, Korea and Taiwan. This is subjective and others will differ. My case would be considered difficult due to my skin type being thick and other variables such as the length of trauma from my initial fracture to my primary rhinoplasty and the extent of the damage.

I will be undergoing revision rhinoseptorplasty next year in September. The surgeon will be either Dr Kao or Dr Montien. Both specialise in rhinoplasty and are well received by the rhinoplasty community. Additionally, Dr Kao and Dr Montien are credited by their memberships of international and national plastic surgery committees.

As back and forth I have been with both representatives of the doctors, this is their initial summary from the following doctors:

*Dr. MONTIEN, Bumrungrad Hospital, Bangkok, Thailand
Front view, your nose is not straight.
Profile view shows a slightly droopy tip.
Alar lobule is hanging low.

Your nose can be made straighter on both front and profile view.
Corrective surgery mainly involves with septoplasty and/or bony mobilization.
Attempt could be made to bring the mal-aligned structures back into a normal position.
Extent of the surgery depends mainly on the severity of the damage found inside of your nose.
Sometime unrepairable part needs to be removed and rebuilt back with your own tissue.
Generally, this requires rib/costal cartilage.
Airway problem, if experienced, can be addressed at the same time.
Alar plasty can reduce the size of the alar lobule.
Nostril reduction is probably not recommended as it could affect the air flow.

Please be advised that your tip skin is thick.
All tip definition is impossible to achieve.

- I emailed Dr. Montien through the Bumrungrad Office in Australia and I received a reply 7 days later with Dr. Montien's recommendation.

*Dr. KAO, Hope Aesthetic Clinic, Taipei, Taiwan
You have crooked nose, the nasal bridge deviates to left side and the right side nasal cavity, internal nasal valve is compromised.
Asymmetry of nostrils and nasal
Side walls.
It seems your dr (primary surgeon) did open rhinoplasty and alar base surgery.
You need to revise open rhinoplasty and straighten your nasal bony dorsum, open the nasal valve, etc. Then your nasal blocks can be solved right after surgery.
If your septal cartilage is not enough or was excised already, or you want to augmentation bridge; you may need ear cartilage or rib cartilage.

- I made contact with Dr. Kao's office through Facebook messenger and they promptly replied within hours; the latest time being 24hrs through email. Before offering their service, I was surprised to receive a message asking whether I just wanted a second opinion or if I wanted to fly to Taiwan for the surgery 'as it is a long flight'. It was humbling to feel a clinic's consideration of your time spent flying and abroad.

Initial Surgery: Dr ZACHARIA Sydney, Australia, July 2015
This surgery included rhinoseptorplasty and cost AUD18500. I was rebated around AUD4k from medicare. When I was 9, I face-planted nose first breaking it in a way that it deviated and grew in a different trajectory others deem normal. Side and quarter profiles looked very different, nose was bulbous, nasal bone on the right was steeper, hump, collapsed columella and obstructed airways. Aesthetically, it was disastrous and functionality was limited to 30% breathing and taste. Dr. Zacharia did mention he was planning to use rib graft which was paid for. Upon completion of surgery, he noted he didn't need to use it and refunded that cost. My post op nose was as you could imagine a dream come true. Everything was perfect except the steepness of my nasal bone and one side. 1 year later, it deviated back due to memory in the cartilage. He did disclose this during the consultation and now it needs to be revised as the tip is bulbous and nasal airway is blocked. I loaned 95% of the price however the rebate helped a lot.

I also emailed many other qualified rhinoplasty specialists. Based on my research and liaison with the doctors, this is my summary:

Dr. LEE VIPPS, Seoul, South Korea - September 21, 2017
Once I received a recommendation from Dr. Lee, it was evident that all they wanted was to extract every possible dollar. I requested revision rhinoplasty and received a response that the doctor also recommended a surgery to align the top lip (first I've heard I needed that). Even without the lip surgery, the asking price was USD14000 on top of the 10% government tax on foreign cosmetic surgeries. Goodbye.

Dr. PIYAPAS PPSI, Phuket, Thailand - October 30, 2017
I personally visited Dr. Piyapas at PPSI in Phuket, Thailand during October this year. Upon meeting him and noticing his brief observation of my nose, he seemed intimidated and the entire consultation became unsettling. He was somewhat nervous and I initiated conversation everytime the room fell silent. Also, he had his receptionist 10ft away peering around a corner. Dr Piyapas recommended I follow up with scans and tests that day in order to further evaluate which attracted a bill of THB5000 on top of the consultation fee of THB1300. I would prefer a doctor bluntly refuse my case and suggest I be assessed elsewhere than to waste both my time and money on false direction. In the emails, I was quoted THB500 for the consultation but this was inflated upon leaving because of 'the doctor's experience'. This was undeniably a bogus claim as I specifically asked for Dr. Piyapas in the emails and each consultation I have been to charged a flat-fee or at the very least honors the quoted price. I refused to follow up with scans and tests and left the clinic along with my confidence in Dr. Piyapas.

Dr. PARINYA PPSI, Phuket, Thailand - 4 November, 2017
I emailed PPSI requesting Dr. Parinya's recommendation. Upon 7 days later, I received a message stating that he declined to accept my case due to its complex nature. I was not disappointed as I found no reviews on him - it was more of a second opinion.

Dr. TANONGSAK Asia Cosmetic Hospital, Bangkok, Thailand - 8 November, 2017
Jeab - the coordinator - received recommendation from Dr. Tanongsak that he was confidently able to achieve my desired nose. He had requested I send a photo of what I wanted it to look like so I sent a photo with akin skin type and somewhat an achievable comparison. What discounted any possibility of going through with this surgery was the doctor mentioned to use 'artificial rib cartilage' instead of autologous cartilage. The price was actually the cheapest at THB250,000.

Dr. SOMSAK Yanhee Hospital, Bangkok, Thailand - November 17, 2017
After processing my case through the Yanhee website, I was unsure as to how long I received a reply. Nevertheless, the email from Anthony - the International Coordinator - formally constructed of an itemised table of the procedures and prices. Dr. Somsak remarks also included were:
"Since it is a corrective surgery then the result will not be 100 % perfect.
Corrective Surgery using Rib Graft will give the surgeon more wiggle room to work with in adjusting your nose
Septoplasty can be done but the surgeon will need to personally check the status inside as scar formations from your previous surgery may cause a limited adjustment." Overall, the communications were seamless and the hospital was portrayed well by both both Anthony and Dr. Somsak. This is my third best bet so far.

I will not list prices of some doctors I was quoted as each case is different and no one case is ever the same. I used other people's research to put me into the right hands of surgeons and if I can do the same for someone else, I would also feel grateful. I have come across reviews scattered across websites with no real conversation existing of only these doctors regarding rhinoplasty. If you have any genuine experiences with these doctors, photos or recommendations of others or on my research, we would love to hear your input. It would be beneficial to have a rhinoplasty-rich conversation that would help.

I decided to contact Dr. Montien through top doctor as well as I saw he operates at two hospitals; the other being World Medical Center in Bangkok. I was curious as to whether each hospital charged differently. Pending further enquiry, he proclaimed he no longer practices at Bumrungrad Hospital.

After emailing both doctors and negotiating a price, I am to pleased to say I have almost finalised my surgery with Dr. Kao for 7 September, 2018. Will be comparing flight dates for the next couple of months as I still need to meet budget.