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. :)