41 Yrs Old, 3 Months Post-surgery. The Before, During and After Story...

Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 109 reviews
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Before Like most people who have rhinoplasty, I...

Like most people who have rhinoplasty, I had been thinking about it on and off since around the age of 10. It was something I thought about to some degree every time I looked in the mirror or at photos of myself (one look at my "before" pictures and you'll understand why). The only reason I never did it before was because, frankly, I couldn't afford it (and I wasn't about to go thousands of dollars into debt for plastic surgery). I've had a great job for several years now, but I hadn't considered rhinoplasty seriously for a few years because of something someone told me when I was in my early 20s: "That's something you should do before you're 26—after that, don't bother."
I don't know why I chose to believe her, but I guess I did. After 26, I stopped thinking about it... until this past summer when I saw myself on video. As I sat there fixating on the unflattering camera angle, harsh lighting and everything else that seemed to conspire to highlight the one feature that I've always hated, I suddenly realized: If I wanted to, I could actually do something about this right now.
So I started doing research, looking at before & after photos, reading about rhinoplasty techniques and reading reviews of the various doctors in Vancouver. I ended up at watching a lot of videos, ordering their free eBook and making an appointment for a phone consultation with Mandy, the Patient Care Manager. After our conversation, she gave me a quote ($8,000 CAD) and I scheduled an in-person consultation for three weeks later with Dr. Buonassisi.

Consultation – July 28
When I arrived for my consultation, Mandy took some photos first and I filled out a medical questionnaire before sitting down with the doctor. He did a brief examination and we talked about what I hate (obvious) but also what I like about my features (honestly, just about everything else). I asked him about the age 26 thing, although I already knew from my research on Realself.com that's basically a myth—but I'd read somewhere else that people who have rhinoplasty later in life are statistically less likely to be completely satisfied with the results and that worried me. I wondered if the statistics matched his experience and what he thought the reasons for it might be. He told me that without a doubt the single most important factor in determining whether someone is satisfied with their surgery or not is their expectation going into it. Regardless of age, if someone expects "perfection," the end result will never measure up. Similarly, if they have a very specific "vision" of exactly what they want to look like afterwards, they are frequently less satisfied with the reality after surgery—and they're less likely to accept that it takes time for the results to be fully visible. I knew from all my research that there was no point in obsessing about little details or asymmetries or anything until a full year had passed after surgery, so I was prepared for that.
Dr. Buonassisi explained from a medical and aesthetic perspective why he thought certain things worked better than others, and he assured me that he thought I was a good candidate for surgery. He showed me many "Before & After" photos of his patients and pointed out the ones with similar features to mine who'd had the same procedures that he was proposing for me. We talked about anesthesia—twilight rather than full sedation—and why it would be an open rather than closed rhinoplasty, then he sketched out the surgical plan he had in mind. His recommendations: a subtle tip rotation and refinement in addition to a bridge reduction and cartilage grafts to even out the narrow section in the middle between the tip and the bridge, which would prevent it from looking too narrow and sharp from the front. Then he opened the high resolution photos taken of me before the consultation and edited my least favorite side into a nice, subtle, smooth, straight profile. The front view, he assured me as he edited that photo, would be much better than the edited mockup I was seeing onscreen—the front view is the hardest to edit realistically on the computer because of shading and foreshortening, while the side view is the easiest. The three-quarter "after" view was both the most realistic and the most convincing (so that's the one I emailed to my mother the next day). ;)
He also looked at the pictures I'd brought with me of noses that I liked, and he told me that what was actually helpful was that it showed him what I didn't want or expect (i.e., a dramatic reduction or a cute, upturned nose). He told me he doesn't think of himself as an "artist" because the human face isn't like clay or marble. He's working with a unique set of features with their own specific inner structures that behave differently from anyone else's. So while it's good to know what I like and what I don't, it's important to keep in mind that he isn't "creating" anything—if anything, he's renovating. I could have asked him to predict exactly what I would look like, or tried to nitpick his recommendations—are the cartilage grafts really necessary, etc.—but it was obvious to me that facial features are his medium and that he's done hundreds if not thousands of these procedures, so he knows better than anyone what will work and what won't.
Initially, I had thought that to be a well-informed, responsible patient, I should meet with at least a couple of doctors, and in theory I would still strongly recommend that to anyone considering surgery, but after my consultation I was fairly certain I had found my doctor. His calm demeanor, obvious expertise and the fact that he's a rhinoplasty specialist completely put me at ease. Although I never felt the need to talk to another doctor, I don't want anyone to think I'm suggesting that's the right way to decide. It just felt like the right decision for me, and in the end, my intuition was strongly supported by research—and quite possibly just good luck.
When I booked the appointment, I was surprised but very glad to find out they had open spots available just three weeks later, so I booked the surgery for August 19 (9 days before my 41st birthday). That's when they emailed me all the scary stuff—detailed medical complications and potential side effects that I had to sign off on, and extremely detailed instructions starting 10 days before surgery and ending 3 months after—all about what to avoid (alcohol, ibuprofen or smoking before; strenuous exercise, sneezing and sleeping in a fully reclined position after). The lists went on and there were definitely some cringe-inducing things in the "Informed Consent" form about very, very unlikely but unpleasant things you need to be aware of—and then put out of your mind completely.
As the surgery day got closer, I started getting nervous about the anesthesia and recovery, having never had surgery or even broken a bone before, so we had another 30 minute conversation on the phone and I wrote down all the medical details and drew myself little diagrams to better understand exactly what he would be doing. :)

Day of Surgery + 3 Months

Day of Surgery – August 19
The night before surgery, I wasn't allowed to eat or drink any liquids (at ALL) after midnight, so I went to bed early by midnight and woke up around 9 am for my 11:30 appointment. My biggest concern was not being able to drink coffee all morning but as it turns out, not drinking anything at all is actually much harder (in the middle of summer, no less)! My boyfriend came with me so he could be there when I came out of surgery 2 hours later (and he was—coffee in hand!). There were three or four nurses or assistants in the room and they were all very friendly. They reminded me of my aunts. The Doctor asked if I was nervous. Yes! "Well, we're not," he said. "We do this every day and I'm not worried about this at all. I think you're going to be very happy with your results when this is all over." :)
I was put under "twilight" anesthesia, which was strongly recommended for several reasons, and although I was concerned about being "awake" during the procedure, I can remember almost nothing that happened after they administered it...
But I do have one vague memory, not of pain, just of... "ick." At one point, I remember looking up and hearing the Doctor say something like, "you might feel a bit of pressure but this won't hurt," and then I either heard, felt or was somehow dimly, psychically aware of a resounding crunch. And then another.
When I "woke up" again a nurse was handing me my clothes which I somehow managed to put on mostly without getting up or out from under the blankets they'd draped over me in my hospital gown and slippers. Dressed but dazed and drifting in and out of awareness, I sat there until one of the nurses came back in with my boyfriend, who I was delighted to see, and he handed me a large iced mocha. We were ushered out and into a cab in what seemed like quite a hurry, but which was probably more like a whole team of grownups trying to corral a half-sleeping, half-drunken child who's stayed up way past their bedtime. In the cab, he looked at my profile and said, "I can tell it's going to look great even with the cast on. You're going to have a little cheerleader nose." I rolled my eyes and laughed, very carefully.
My recovery was pretty smooth sailing, but a few things were incredibly annoying. I had to sleep not lying down for at least three weeks, according to instructions, and that was difficult because regardless of how I fall asleep, I tend to wake up face down. This would obviously be a very bad thing both with the cast on and after it was removed, so I forced myself to sleep sitting nearly upright with two thick, new pillows and a travel pillow (one of those ring-shaped things you attach around your neck). The first night I made my boyfriend promise to check on me a few times (he stays up later anyway) to make sure it wasn't choking me to death. After the first few nights, it got easier but I was really happy when I could finally put it away and just sleep with one pillow and wake up however I wanted (about 5 weeks, just to be safe).
2-3 Days After

Day 3 is supposed to be the worst according to lots of people, for swelling and feeling like shit (which I definitely did by the second day). I mostly spent the time watching zombie movies and trying to just sleep through it—but I kept waking up and having to eat, mostly yogurt, and walk around the floor of our apartment building for "mild exercise"). My boyfriend told me he was amazed at how quickly I was healing but I felt ridiculously puffy, stuffy and bruised—omg, the bruises. Reds, purples, pinks, yellows and greens—I haven't seen so much color on my face since this retro 80s party a few years ago... actually, not even then. It was yucky. No pain, though... just discomfort, annoyance and boredom.

The one other thing was the painkiller, Tramacet. I took it for four days starting Tuesday, the day of the surgery. On Saturday I woke up around 4 am in a complete panic, feeling like I was having a nightmare or I'd lost my grip on reality. I thought I had a fever and I remember worrying that I would feel like this forever. My boyfriend talked me down until I fell back to sleep and I was fine the next morning, but I did not take any more painkillers. Luckily, I didn't seem to need them at that point. The only thing that bothered me after that was not being able to take a bath (due to the steam) or wash my face properly because of the cast. I felt congested and itchy and I could feel all kinds of stitches and sutures poking out of my nostrils but I forced myself not to look, poke or think too much about them...

7 days after
The cast came off on the 7th day and my first thought—aside from holy crap, look at all the crazy colors of my bruises—was... huh. I hope that evens out... I didn't know what to think. But I knew whatever I looked like then would not last, so I forced myself not to think about it yet.
Two hours later, we were back home and I took a long, hot bath and very carefully washed my face with a washcloth (oh my god, washcloths rule!!), scrubbed carefully to get off all the residue from the cast and surgical tape. Afterwards, I really looked in the mirror for the first time, turned from side to side and stood in front of an angled mirror so I could see my profile and all those angles that I used to hate and avoid. There was some minor asymmetry, sure, but I'm sure I was always asymmetrical... I started to smile. Well, I thought, I certainly don't look worse than before... and there's still a ton of swelling, but even if this is exactly what I'm going to look like (sans the bruises, of course), I will be goddamned elated.

10 days later
Bruising was still a big factor at 10 days, but I put on makeup and went out to lunch with 2 friends—one who knew about the surgery and was suitably complimentary, and the other who looked at me a little funny but said nothing and, for all I know, still hasn't got a clue. There was a ton of swelling at 10 days, probably more than at any other time. At that point, I also called the doctor and asked if he thought I should extend the antibiotics for another week because my nostrils seemed really inflamed around the incisions (where I could feel the sutures sticking out a bit—and still do, actually, 2.5 months after surgery, but they no longer bother me). They will gradually dissolve on their own. After the second week of antibiotics, the inflammation and stuffiness gradually calmed down (I also started taking probiotics and lots of vitamin C to balance out the immune system—I haven't caught a cold or flu since then either, which is very lucky).

2-3 months later
It's bizarre, but I used to always think I looked better in the mirror than I did in pictures, which really means that I looked better to myself than how other people saw me. That's a little upsetting psychologically, but the point is that somehow I always managed to feel attractive, for most of my life anyway, despite that one feature I always hated. I know many people who thought so too—and of course this sounds totally disgustingly vain—but what I'm getting at is that I'm glad I was able to manufacture a kind of confidence and positive self-image all those years, in spite of whatever flaws I had... And now? I am so ridiculously happy when I look in the mirror—and in pictures. I didn't think this was possible, but I don't really feel like I have a bad side anymore... Wow. That's so weird... and awesome.
It's tempting to think, "if only I'd done this sooner," but on the other hand, I'm kind of glad because I think having a feature I had to work around did "build character" (ugh, I know!). Besides, it's not like I could afford it before anyway. ;) I think my expectations were realistic—I wanted to look better, not perfect—and I completely trusted my doctor's expertise. I didn't pay more than I could afford. I didn't think surgery would change my life (anyone who thinks that, btw, should talk to several people who've done it before even thinking about talking to a doctor). I didn't think it would help me in my career or my love life—and I think any of those "reasons" would be a red flag.
I'm really happy with how it turned out. For anyone who is considering surgery as they're reading this—if you're doing the kind of research I was doing four months ago—it's been almost 3 months since my surgery, and I can tell you without any reservation that I'm delighted with the results. If you're in Vancouver, I absolutely recommend Dr. Buonassisi.

Just adding a few more "before" pics for comparison.

Posting the official "before & afters" taken at my Dr.'s office...

These are from a couple of months ago now, but I keep forgetting to post them. The first (2x3 pics) shows the 3/4 and profile before, the computer-edited mockup done during my consultation and then 3 months after. The second one shows my other side before & after profile, and the last one is a smiling profile picture -- I never would have let someone catch that on film before my surgery! ;) I'm sure some of you can relate...

So, these pictures are from a few months ago, and I'm still noticing tiny differences week to week these days, and that various things can cause swelling to dramatically increase from day to day (well, it's "dramatic" to me but probably not noticeable to anyone else). ;) Especially noticeable when I've been crying -- which I've been doing quite a bit of lately, unfortunately, but for reasons totally unrelated to my surgery. Anyway, I'll post some more recent pictures soon, since I definitely found it valuable to see long-term updates and how results still change subtly several months and even years after surgery.

Best wishes to all of you!
Vancouver Facial Plastic Surgeon

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 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
4 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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