Revision with Rib Graft

Tomorrow morning I'm having a revision using rib...

Tomorrow morning I'm having a revision using rib grafts to hopefully restore some of my original features. My nose was thinner and longer before my first surgery, and I haven't felt much like myself since that was drastically changed. It's going to be a long surgery and recovery, so I'm feeling a bit anxious about it. But I think this will be a step in the right direction to moving with my life. Send me those healing vibes... :)

Surgery complete

My surgery was yesterday and I'm in a lot of pain. Not my nose but my rib. I spent one night in hospital and I wish I was still there, I was really scared to go back to the hotel on my own because it was so difficult to stand up. I've seen my surgeon 3 times since the surgery. He gave me some extra pain medication. The lady from his office drove me back to the hotel. The amount of time and care they put into their patients is great. I just wish I didn't have to go through this.

Tubes

I can pull out this tube when the numbing fluid is gone. They said around day 5. I'm not attempting to move around much or get changed, feel too fragile.

Trying to be good

My surgeon was pretty strict about keeping things iced and elevated. I don't have any bruising yet, whereas I did during my primary, so perhaps the protocol is working. Once in a while I've been walking around my hotel in my hospital gown, lucky it's not too busy lol. :/

Comparison photos

Looks promising since it's definitely longer, but can't really appreciate it in my current physical state. My nose feels hard and swollen, and there's a spot on the tip looks a bit purple/reddish. Hopefully this is temporary.

Scar

Tip

The tip looked purple for a few days but is back to normal now. I removed my numbing tube yesterday which was a huge relief. Still on oral pain medication and will be for a bit longer, as I can feel the discomfort creeping up whenever it's due.

Cast off!

The cast came off today and everything looks good. I have a longer stronger profile and everything looks symmetrical. I'm still contemplating my front view, the width looks similar to before so if there is swelling then maybe I'll really like it in a few months? Overall I'm feeling positive and I don't have a horrible feeling of dread like I had after my first surgery.

Back in the good ol days

I caved, here are my frontal views accompanied by crazy editing. I think my revision nose is an improvement and actually seems to look like the morphs... However I feel conflicted. I miss my natural nose. I'm going to ask my surgeon more about why it looks so different and whether some things can be restored. What causes that inward curve? Is it the upper lateral cartilages?

Brow tip aesthetic line

My brow tip aesthetic line was lost during my primary rhinoplasty. I'm wondering if it can be restored.

Expectations

There's a lot be grateful for and yet I find myself disappointed. Dr Davis was very forthcoming about the possibility of needing a touch up, so the fact my nose still requires narrowing is not the biggest issue. The biggest issue is the fact that my nose wasn't lengthened enough and I don't have any cartilage available. I brought this up with him and he said a tip onlay using ear cartilage will bring it down the rest of the way. I'm really concerned that it won't bring it down properly and also that my ear will change shape. My ears are already close to my head and there's no room for change.

You can see from the photos that there's a big improvement so I feel bad writing this. And yes my nose looks pretty good. But I want my dream nose and that nose is not upturned AT ALL. I'm really disappointed at the prospect of needing another surgery not just on my nose but also on my ear. We did detailed imagining so I just don't understand why this was not measured properly. I guess it's a case of different aesthetics.

Unwell

My rib harvest area feels okay now but I've caught the flu or something. I think my body is in self destruct mode after all this!

Still looks upturned

Here's a comparison of my profile. It still looks upturned to me... :( Less concerning is the fact that I have a pseudo hump from the dorsal onlay graft which will probably need to be shaved down.

Natural nose

Return of the hump

It's a bit ironic that I originally had rhinoplasty for a small hump and now it's back again.

Septal extension graft

I believe the problem is the shape of the septal extension graft. "To treat an acute nasolabial angle, the caudal septal extension graft is triangular shaped with the longer margin oriented inferiorly."

?

I really feel like despite a lengthy consultation, detailed morphs, and a USB full of photos my aesthetic goals were abandoned on surgery day. I asked for my nose made narrower and I found out only by reading the surgery report that no work was done to narrow my nose. The spreader grafts add width to the middle vault and tip, while the added length gives the appearance of it being narrower. But as far as I can tell it isn't physically narrower. I asked for my nose to be lengthened and tip to be derotated, and instead of designing a triangular septal extension graft that would achieve this, a rectangular graft was used to lengthen my nose evenly. I don't see any good reason for this decision because I provided a morph showing a tip that is neutrally positioned... I also asked if my nose could be slightly deprojected and I was told this may affect the front view, so I accepted this may not be possible. But since the dorsal onlay graft was placed on the highest point of my bridge it actually adds 1 of 2 millimeters of projection. I don't get it.

Not worth it for now

I'm marking this as not worth it because I have a small improvement that is not worth $15,000 plus travel costs and rib pain. The worst thing is this used up my chance to derotate my nose. I'll never have my old look back unless I'm crazy enough to have another rib surgery. Make sure you ask your doctor if he will store your leftover rib cartilage or throw it away, just in case.

Swelling comparison

Here is a swelling comparison of my primary at about 4 or 6 weeks vs now. It hardly feels swollen this time.

Firm

When I was researching rib grafting a concern that came up sometimes was the firmness of the grafts. My nose kind of feels like a rock. But it actually feels better than my last nose because the grafting was done so poorly, with grafts that were too long or large, causing tension and pain. I think my smile has improved because of the better shaped grafts also.

Happy but not happy

I feel really anxious thinking about the prospect of another surgery, and can't help but think this situation could have been avoided. There are differences in swelling and how the grafts feel but I did this purely for cosmetic reasons, meaning I wanted to change the length, upturn, width, projection of my nose. I'm just not seeing enough changes that I BELIEVED were going to happen. And the sad fact of the matter is that my morph was not in the operating room... That's the second time this has happened because my primary surgeon also worked without a reference, and guess what it's the second time my nose has been made upturned against my wishes! At the moment I still can't wear a bra because of the chest area is sensitive. It just seems like a lot to go through to not be really happy..? And I don't know how satisfied I would be if the nose was just made thinner without harvesting from my ear or rib, maybe it would be enough but maybe not as well.

Wish I'd never touched my nose

I miss my old nose. I can say my nose looks normal now, but I can never say that I like it as much as my old nose. If I could do this again I'd probably go to Raj Konodia in LA because he seems to be good at not changing the front view and it's a closed procedure. I just wanted minimal changes. I emailed Dr Davis asking why I needed spreader grafts, because I saw articles that show you can secure use a septal extension graft without extended spreader grafts... Of course spreader grafts add width to the middle vault and tip. I'm clutching at straws really, because I thought if he can take out the spreader grafts he could use it to lengthen the septal extension graft more without another rib harvest. But I don't think that would work, it probably needs to be a solid piece. I just miss my old nose, it looks so different to before in every sense. I'm glad I don't have deformities or asymmetries but it would be nice to look like my old self again and pretend this never happened. I'm quite ashamed and embarrassed of this whole saga, what a waste of time and money and thought. The feeling of regret stings. Btw the revision photo is just from 1 week post of so it's swollen, but you can see the difference between that and my natural nose.

Informative website

I found a web page with some interesting information about lengthening the nose, such as likelihood of warping. It's for a doctor in Japan. I can't post links so can I post the website address like this? veriteclinic (dot) jp (/) academic (/) 2010 (/) asian_nose (dot) htm

I do wonder if I could have found a good doctor in an asian country for much cheaper, since lengthening the nose is more common. I guess I couldn't research it properly without speaking the language. On the webpage it looks like I could have avoided spreader grafts?

Incidence of warping

This is just for this particular doctor but it's quite informative. The lowest rate of warping is 12% with a double layer septal cartilage graft.

Questions in my mind

Do I need another rib graft? Will another surgery EVEN result in a successful outcome? Will I need a forth surgery then? Can I afford this again? Will I have a complication next time, even if it's made to look how I want? Too bad the stress has not been alleviated at all. Honestly, was it that hard to match my morph. I do some quick googling and it seems the mistakes were avoidable, this upsets me. If I was a surgeon I'd have the morphs plastered around the room, and I'd have a checklist of the changes in all cosmetic aspects. Where is that super perfectionist, anal retentive doctor, who dots the is and crosses the ts I bet they are out there??

Nice results in asian countries

I think I should have found a doctor in asia for this procedure. I believe I only needed a septal extension graft but have been given 2 UNNECESSARY spreader grafts which have widened my nose. I would have had less rib removed and a smaller scar, the. :( After the surgery Dr Davis said "I think I made your breathing better" and I said "I didn't have a problem with my breathing"... Why fix something that isn't a problem...??? This is SO DISAPPOINTING AND CONFUSING?!

PROBLEMS

~ I asked for a thinner nose = unnecessary spreader grafts placed in nose = wider nose
~ I asked for a derotated nose = septal extension graft designed for rotated nose = continued rotated nose
~ I asked for a deprojected nose = dorsal onlay graft placed on highest point of bridge = projected nose
UM OK THEN?! THE RIB SURGERY WAS THE WORST PAIN OF MY LIFE AND I FEEL LIKE MY DOCTOR DIDNT LISTEN TO ME AT ALL AND NOW I THINK I NEED TO DO IT ALL AGAIN?! I AM ABSOLUTELY FEELING DISTRAUGHT READING THAT I DIDNT NEED SPREADER GRAFTS ON TOP OF EVERYTHING ELSE?!

Alternatives to spreader grafts

So here's some other ways of securing a septal extension graft without spreader grafts. I am still trying to find out why they were placed in my nose. I wasn't told my nose was going to be made wider.

I'd like more derotation

Sorry if my review seems harsh but I think my nose should have been derotated at least half way. I'm not happy to be considering another rib surgery... During the follow up I said it should be longer, Dr Davis responded "you'll look like an old woman" and then I asked to compare the photos on the computer. At this point he offers ear grafting like it's no big deal. I think these things should measured during the surgery as obviously he was not aware of the big difference. It's easier to shorten a graft than lengthen it which is what I would have to do. My nose looks ok but basically still upturned and fat and lacking character. I thought he would be more understanding of my goals as he works on ethnic patients..

Doctors in Asia

Dr Ting Wang in China has some nice results.

Davis style

I morphed a few of Dr Davis patients to show his style vs my style. He likes a rotated projected tip which is what he gave me basically. I don't know why doctors can't tailor their style to suit the patient?

Just to clarify

Just to clarify I think Dr Davis is a skilled surgeon and ten times better than my quack primary surgeon (who charges similarly and cares way less). I just wish he paid more attention to the look I wanted and also that he would just be straight forward instead of talking in circles like I'm stupid. If it's possible that I would need another rib graft to achieve what I want then just say so, ya know? I'm not living in the land of denial. Anyway he is maintaining communications with me at this point so perhaps there will be a successful result in the end, perhaps I'll be happy with things and leave it alone, or perhaps I'll attempt to improve things more. I'm glad things are better and not worse but I do not feel the improvement is enough and I do not feel the look is ideal. I started off with a niceish nose so I guess my expectations are higher than if I had a honker in the beginning.

Maybe it will be fine

Perhaps some deprojection will make it look nicer and I won't be wanting more length.... Can it be thinned from the front without rotating it upwards? Hmmm questions questions.

Rib can be stored in a freezer bank

I found out that rib can be stored in a freezer bank. If this is true in florida then this should have been done. I think I should have found a doctor with a more similar aesthetic style. I was looking at Bahman Guyurons pictures and I think they are closer to what I was wanting.
Pembroke Pines Facial Plastic Surgeon

I had this surgery to derotate and thin nose. Neither issue was resolved. Overall a mild improvement.

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