Let's talk about rhinoplasty

[SJay]

Thanks, yeah it's a lot better than it was after my primary. The primary left me with a scooped bridge, upturned tip and retracted nostrils. I had:

- caudal septal extension graft - to lengthen and derotate a little
- columellar strut graft - for tip support
- bilateral spreader grafts - to widen the middle third and open the airway
- crushed cartiiage onlay - to add height to the bridge
- some shield grafts in the tip

I also had the lower lateral cartilages repositioned to fix the retraction, and the tip was deprojected slightly.

All grafts were from septal cartilage and it was open, taking about 4-5 hours.

Here are the photos. It's not perfect, the tip is still a bit too high but derotation is complex and I wasn't expecting perfection, just to look more like my birth nose again.

[Lazlo]

yeah it does look much, much better!

Can you pm me the price? What you had done is precisely the type of work necessary for a challenging rhinoplasty. And all of that work is typical of the Toriumi style rhinoplasty. Thanks so much for detailed account.

Could you PM me what you paid, I'd really really appreciate it! Thanks.

[Tezcatli]

lol Brad pitt has with 100 percent certainty and I would bet my net worth on it has not had a nose job.

I can think of very, very few cases where I cannot tell someone has had a rhinoplasty. Clive Owen for example admits to several having fractured his nose a bunch of times.

Brad Pitt gets a lot of work done, his skin for sure it's obvious but looks good and he may have had an otoplasty early in his career, but his good looks are his.

I'd have to see Cochrane's patients in person, Ilovemoon is right, it's a terribly unpredicatble surgery.

I think my rhino is impossible to tell, however it was closed and the surgeon only removed the dorsal hump and left the nose straight instead of concave. Tip work always look artificial, I'd only recommend if your nose is f**ked up. My nose is still big and large but I like it

[Lazlo]

You know, I'm looking at Spencer Cochran's examples of his results, they're "okay" but the photos are a bit misleading in the way the afters are framed, and also, I don't think he's done a very good job on some.

Any of you have any really good examples of rhinoplasty or recommendations of doctors?

http://www.rhinoplasty-usa.com/gallery/dr-cochran/rhinoplasty/patient-9/

[SJay]

I'm guessing you don't like the surgical plan for that patient, the execution seems okay. He had a saddle, so I guess there was two options, shave down the hump or fill in the hole. Ultimately, it's up to the patient, and if he wanted the former then I guess he's a happy customer. Granted, it does give him a softer look, and it's not what I would have done. They could have also put some height back with a graft after, but it doesn't look like that's what he wanted.

It's hard picking a surgeon, because they all have examples where they seem to scoop noses, but often this is the aesthetic which the patient wants. If the surgeon exclusively scoops noses and you want a strong bridge, then you've got a problem, you need to see some examples of the kind of result you desire.

In my opinion, he really made a mess of patient number 11

http://www.rhinoplasty-usa.com/gallery/dr-cochran/rhinoplasty/patient-11/

Whilst he did a fantastic job for patient 13

http://www.rhinoplasty-usa.com/gallery/dr-cochran/secondary-rhinoplasty/patient-13/

I guess they just wanted different looks.

[SJay]

I've probably mentioned the surgeons I like before, but I'll list them again since we're on topic.

You really want to go with someone who's double board certified, an ENT and a facial surgeon, who specialises in rhinoplasty and revisions, performing at least say 100 a year, with lots of examples of the kind of result you desire. And of course, one who you feel understands you, and won't ditch you if things go wrong.

I really like Rick Davis in Florida for female noses, but not so much for males. He seems to be an exclusive scooper.

http://www.davisrhinoplasty.com/revision-rhinoplasty-before-after-photos.html

I like Sam Rizk in New York, he seems to be very talented with thicker skin types. Again, I'm not so sure about whether he can do a solid strong nose. And he does seem a bit too media friendly. But if you've got very thick skin, he's worth a consult.

http://www.drsamrizk.com/mps-photogallery-nose-women.htm

My choice would be Andrew Frankel in Beverly Hills, he did my nose. He's very experienced, can deal with complex cases and can do strong noses, if that's what you want.

http://www.rhinoplastyrevisions.com/photo-gallery/rhinoplasty-revision-photos

I remember you being a fan of Dean Toriumi. Again, I like his approach but all the bad reviews just scared me away. I don't know if they're true or not, but I didn't want to chance 30,000 USD to find out.

I think a Davis revision would be around 14,000 USD, Frankel around 16,000 USD with Rizk and Toriumi perhaps being more. Primary would be a little cheaper.

[Lazlo]

Similar to the one you signalled out, this result is horrible in my view:

http://www.rhinoplasty-usa.com/gallery/dr-cochran/rhinoplasty/patient-5/

[ditterbo]

The grafts I've seen on the bridge often made the bridge look too sculpted almost like a stripe and as said the skin doesn't drape over it anymore in the same way like it does in a nose that was not operated on. Plus there's some fat loss.

I think I'm seeing that "stripe" affect on my nose (pics in my post), but I'm not sure if that's just from a moderately aggressive osteotomy? It looks kind of wide.

I don't know what you mean by 'fat loss' on the nose but I do think the nose bone helps hold up the mid face.  I've either lost fat around the orbital rims or simply lost that bony support since my primary rhinosepto.   I agree an operated bridge often times does have too perfect of a slope to look natural.

[Nataliepryor]

I had combined JS and Rhino and glad I had it done together. I've had 2 JS though so I didn't want 3 in total.

It has been a good move. Open with septum corrected...surgeon gets to see your face prior to swelling, so no better time really.

I've stopped snoring and breath so much better, the results were instant... As soon as I removed some blood clots ;-)

[Lazlo]

I had combined JS and Rhino and glad I had it done together. I've had 2 JS though so I didn't want 3 in total.

It has been a good move. Open with septum corrected...surgeon gets to see your face prior to swelling, so no better time really.

I've stopped snoring and breath so much better, the results were instant... As soon as I removed some blood clots ;-)

So what did you have done to your nose though? Was it just a simple shaving of a hump or did you have tip work done as well? with grafts and stuff? I'm just curious whether a complex rhino (mine would be complex) could be done during jaw surgery. I'm almost certain it won't be. Would you share your results?

[Nataliepryor]

Tip work, hump, setum... He spent 2 hours on it.

If you pm me your email I'll sent a before /after that shows changes.

[Nataliepryor]

He used open method due tip to work.. Better result.

I was told 1 year until swollen fully gone in nose so I am sure it will keep fining down, takes forever to see end result. The tip is the most swollen. When bandaid comes off post op, the swelling doubles! However what I saw before this happened, I was very impressed.

[SJay]

The swelling is a total killer. I've had 2 rhinos now and 1 sliding genio. The swelling from the genio has been a total breeze, I could literally go out in public the next day, I just looked like I was carrying slightly more fat around my face, and now at 2 weeks I feel the swelling has almost completely resolved. Swelling from the first rhino took about 6 months to settle and I had to get kenalog injections at about the 4 month mark to shift it. Swelling after the second was freaky when they took the cast off, I could barley leave the office, my nose probably tripled in size. In the end, my surgeon agreed to giving me kenalog at about the two week mark. He didn't like the idea of using so early as he'd never actually had to do it at that time before, and wasn't sure if it would adversely effect the healing, but it started to look a lot less freaky a couple of weeks later. I've been on the case since, I maintained a low sodium diet, avoided alcohol, taped the nose at night and stayed out of hot environments for about three months. This certainly helped minimise the fluctuation but it didn't completely stop them. Anyway, I'm just over five months now and the fluctuations have almost stopped. So, at least for me, rhino swelling is extremely persistent. I don't have the thinnest skin but I'm caucasian, so I imagine it's even tougher for other ethnicities. The swelling is like an exponential decay, I'd say 70 percent probably clears by month one, 80 percent by month three, 90 by month six and the remainder over the course of the following 6-12 months, but everyone is different.

I think my tip softened up after my primary around 8 or 9 months, but it's still rock solid this time, and I'm not seen sure it's going to soften due to all the grafting.

[Nataliepryor]

I found the jaw worse. Having said that I think my nose was numb anyway and I haven't touched it for 6 months  .

Facial surgery is uncomfortable anyway, the nose just followed suit.

One recovery, one op... Pros and cons but worked for my situation.

[SJay]

One surgery and one recovery is definitely better than two, although I imagine the first few weeks would be an emotional roller coaster, with all the casts, swelling and bruising. Plus, it's also pretty difficult to find a surgeon who can do both, unless your rhino is a simple case of shaving down the dorsum a little. Sounds like it worked out just fine for you though, I'm happy for you!