4/5 for open rhinoplasty based on 7 months result after postop abscess and reoperation.

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The cost of the open rhinoplasty was £7000 or ...

The cost of the open rhinoplasty was £7000 or $10,000 and was combined with jaw reshaping so the total was £10,000. I read the great reviews and saw my friend's nose perfected as she had had a hump. When I met with Mr Ion he mentioned his infection rate was 2% and that he would be using my rib cartilage to build up the bridge and tip of my nose. I saw him because my tip had drooped since I had tip rhinoplasty 16 years ago by another UK surgeon. I was excited as he showed me photo imaging of how much he would remove from my chin and also how much he would add to the projection of my nose. I had the operation at Welbeck as an overnight case. Healing seemed fine until 2.5 weeks after surgery when my nose swelled, became acutely painful and I diagnosed an abscess (I am a GP). I rang his emergency number and sent photos by email asking for incision and drainage and his office rang me back that same morning to come in. He saw me that same morning and incised the abscess and explored a suture hole in the transcolumella incision line that afterwards also continued to leak pus. He started me on doxycycline and ciprofloxacin while awaiting swab results. He saw me in follow up to make sure the infection was getting better and it seemed to respond. He prescribed me a further 2 weeks of doxycycline. The clinic informed me the culture grew +++ Staph aureus and responded to all the antibiotics they tested except for penicillin. He then saw me at 6 weeks and injected steroids to the tip of my nose which remained swollen. He explained that the infection had taken away some of the rib cartilage from the tip and he would consider injecting temporary filler, using ear or rib cartilage to rebuild at a later date. He gave me a prescription for more antibiotics, this time 5 days of azithromycin he said to cover the steroid injection. Unfortunately after completing the course, the infection has returned. For the past 2 days I noticed a foul odour from my right nostril. I shone a light and saw 2 ulcers and my septum is deviated to the left posteriorly. I have emailed the clinic urgently and asked to see Mr Ion when I get back and for him to consider taking me to theatre to clean out the infection once and for all. In total I have had one week of co-amoxicillin prescribed by the hospital on discharge, 2 weeks of flucloxacillin by online GPs, 3 weeks of doxycycline, 1 week of ciprofloxacin, 5 days of azithromycin and have been taking probiotics for weeks to combat all these antibiotics and now need to start antibiotics again. I am fed up and tomorrow is 7 weeks post open rhinoplasty. Meanwhile the jaw has healed well with no issues.

Advise future open rhino patients to ask for dissolvable sutures inside the nose

I found a US surgeon's comments that permanent sutures inside the nose are prone to suture abscess and infections which is why most surgeons use dissolvable sutures in the nose. Ion is a good aesthetic surgeon and I would just advise patients to ask if he intends to use dissolvable or permanent sutures inside the nose so you are aware of the increased risk of suture abscess and infection with a permanent suture.

Permanent vs dissolvable sutures inside the nose? Ask before your rhinoplasty.

Found another plastic surgeon who after his own rhinoplasty with permanent suture, now only uses dissolvable sutures in the nose of his patients. Appears some surgeons use permanent while others only dissolvable inside the nose. Have this discussion with your surgeon before you decide on surgery.

Final outcome 2 weeks post taken back to theatre...wonky nostrils

After I came out of theatre I noticed my nostrils were wonky but thought maybe it was the way the cast had been pressed against my nose. When the cast came off, again the uneven asymmetric nostrils persisted. I thought maybe with time it would change shape back to my normal straight symmetric nostrils. Alas another week went by and I see I am stuck with these wonky nostrils and a nose whose cartilage stability cannot be guaranteed after 6 months.

Improved the tip of my nose but left me with asymmetric nostrils

I have rated Mr Ion 4/5 after being prescribed 6 weeks of doxycycline total (had to come off it in the 5th week due to side effects of anxiety, melancholy and doxy nightmares, fortunately no suicidal thoughts as others have reported to the US FDA on this antibiotic), going to theatre again to find the base rib cartilage had dislodged which had caused the tip to droop and not from the postop abscess and now the final result, yes an improved tip but at the expense of wonky nostrils.

Told at last check up that the asymmetric nostrils unlikely to improve

I have since seen Mr Ion in follow up in June and he told me that the asymmetric nostrils were unlikely to improve and offered yet another nose operation in a year to try to straighten. I had perfect symmetric nostrils before Mr Ion operated on me, so I do not wish to pay him more money to do alarplasty.

In hindsight had his anaesthetist prescribed me doxycycline to cover nose staph on hospital discharge, I may not have developed a nose abscess. It is Ion's usual practice to prescribe doxycycline as a postop antibiotics after surgery. The anaesthetist thought he had until he checked and saw that he had given me co amox instead to cover mouth germs for the jaw operation. Unfortunate oversight. He was kind enough not to charge for the second nose operation but I was still out of pocket for the hospital fees of £1910 and now have to live with asymmetric nostrils in exchange for a tip that was raised and why I initially wanted rhinoplasty.

3 month update - upturned and very short

Sadly, the nose appears flatter now at 3 months, less projection and the angle is very upturned, 135 degrees. I have added today's photos. I think I now have a piggy nose. I also started to have a putrid smell in my right nostril again despite almost finishing my second bottle of sterimar spray and cleaning with dilute hydrogen peroxide, so I have restarted doxycycline which has helped stop the smell. I think at this stage, 5 months after the first rhino and 3 months after the emergency operation, I cannot personally recommend this surgeon for revision rhinoplasty based on my ongoing experience and piggy nose outcome.

Short upturned nose persists at 4 months. Only had perfect nose for 2 weeks postop

I thought I would add the perfect nose he gave me at 2 weeks postop back in March. It looked so perfect alongside the chin he shaved. I would have given him A* until it got infected and the nose shrank down to its preop tiny nose. The last photo was taken last week, 6 months after the first nose op and 4 months after he took me back to theatre. It is still short and piggy looking.

Photo of my short nose today, over 4 months since reoperation

Really sad at how awful the side profile of my nose looks today. This is not a nice nose and not worth $10,000 (£7,000). The infection was not my fault as I was given the wrong antibiotic, ie one that did not cover for potential nose infections. I have lowered the rating to 3/5 although feel I could even lower it further at this point.

It has been 7 months since the reoperation and I can live with my nose

I would now say that Mr Ion is an extremely skilled rhinoplasty surgeon and he loses a star simply because it was not the 5 star experience I had expected for £7000. I would say, make sure you get doxy for 2 weeks post your rhino with him and you should be fine against infections. Not sure whether the abscess was due to the permanent sutures or lack of appropriate antibiotic to cover nose bacteria but that is a discussion you will have to have with Ion as to whether you want permanent or 6 month dissolvable sutures. If you are a redo and need an extremely skilled nose surgeon, I would recommend Mr Ion. My nose ended up smaller than my 2 week postop ideal nose but I can live with it and it still suits my face despite being a bit short. I have seen other noses done by other surgeons and they have been left with a bump and not smooth nose or a nose that doesn't suit them. I think I can now recommend Ion for noses but again be wary and take precautions against postop infections with antibiotics and perhaps add a tips dipped in diluted hydrogen peroxide which I used after the reop and it has also helped keep the airway open and free from infection.
London Plastic Surgeon

My star ratings for Mr Ion is 4 stars based on the 9 months outcome after his first open rhino, handling of the postop abscess and 7 months after he took me back to theatre, as I have come to terms with this short nose and wonky asymmetric nostrils. I will not pay for alarplasty or any further revision. When confronted with a postop rhinoplasty abscess at 2.5 weeks, Mr Ion saw me same day for I&D, treated with weeks of antibiotics, and subsequently took the time to see me on a Sunday to reexamine and explained why he had used permanent sutures and at 2 months postop took me back to theatre for exploration, restructuring the rib cartilage and replacing all permanent sutures with the longest lasting absorbable suture, PDS. He listened and understood my anxiety over possible future infections with permanent sutures and agreed to take me back to replace with PDS, which dissolves in approximately 6 months. He did not charge for his fee or the anaesthetist's saying he would cover this himself and I paid the hospital overnight stay fee. The next morning after the operation, he sat down and explained that the infection had not taken away any rib cartilage but instead had caused the base cartilage graft to move which then dropped my tip. He repositioned the base cartilage and the projection is improved or as he put it he has left me with an even better nose! The clinical dilemma is will 6 months with PDS before it dissolves be enough time for my collagen to grow to hold the grafts in place. Fingers crossed the stability remains after 6 months! I am hopeful as why else would some surgeons use dissolvable sutures and some use permanent. There does not seem to be a perfect answer, which explains the ongoing debate among plastic surgeons over suture material inside the nose. Mr Ion gets 4 stars for aesthetic appearance in rhinoplasty (as my nostrils are now obviously wonky when before I had perfect symmetrical nostrils), however he is attentive and takes time to listen and address concerns of the patient , provides postop care and follow up and a willingness to see it through the end with the patient. Unfortunately I now have a very short upturned nose (see last photo). I have used a pseudonym for my real name on this forum.

3 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
4 out of 5 stars Answered my questions
4 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
4 out of 5 stars Wait times
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