Rhinoplasty Journal: THE RHINO DIARIES

Ever since I was in high school I have hated my nose.I had a minor accident as a child and possibly broke it at that time, but now I have a hump on the bridge and a hanging columella, which makes for an unattractive profile in my eyes.I sought out a consultation with Dr. Bruce White three years ago, but at the time it wasn't financially feasible, nor was I ready emotionally to take the surgical plunge.I have since married, bought a house, have a job I love and am both financially and emotionally ready.My job is high profile; I am a table games supervisor, also known as a Pit Boss, in a casino, and I feel the need to look my best in this line of work.Also since the last consult I had with Dr. White I have developed a bit of a "turkey neck", where my neck profile isn't as shapely as it could be.

A few weeks ago I scheduled an appointment with Dr. White for today, September 11^th.I was nervous even though I have met him before, but when the consultation began he was incredibly nice and helpful.We discussed what I wanted done and my expectations of the outcome.Part of my problem is a deviated septum that is causing me to have chronic sinus infections, and the surgery will include a septoplasty to correct this condition.The septoplasty will be covered by my insurance, the cosmetic portions (the rhinoplasty and the neck tightening) will not. Those I will have to pay myself.My original idea was to have chin liposuction. Dr. White said that it wasn't that my neck contained too much fat, it was the muscles that were shaping my neck this way and suggested a neck muscle tightening, or platysmaplasty, combined with a bit of liposuction to create a better shape for my neck.

Dr. White went into detail about how the procedures would be performed, what I should expect afterwards and went over the drugs and vitamins I should take and what I should avoid.He has told me to avoid Arnica and SinEcch, both of which are highly recommended by many people on the cosmetic surgery forums I researched.Because neither are approved by the FDA and the lack of total understanding of what these drugs do, he did not recommend them.As much as I want a miracle cure for the bruising, I respect his opinion and will stay away from both.He also said the pineapple juice theory is just that, a theory, and there is no study to prove that drinking pineapple juice reduces swelling anymore than not drinking it.

Now I am at home, poring over the information he has given me, checking out the list of do's and don'ts before surgery and getting very excited.My surgery will be scheduled for sometime in next month.I know, patience is everything in cosmetic surgery, so this will get me started practicing my patience skills!

Thursday, September 13, 2001

I made the appointment today! My big day will be Thursday, October 4, 2001 with a pre-surgical consultation on October 2nd. The only thing I am nervous about is getting stuck with a needle, I have always been deathly afraid of getting injections! The surgery itself I am not nervous about, just the shots. Yeah, I am weird.

Sunday, September 30, 2001

I have received my packet of information including a step by step list of what will happen from the moment I get to the surgical suite to the time I leave. I have signed and initialed everything, so on Tuesday at my final consultation I will be set to go. From what I understand, they will do all lab tests on Thursday before the surgery. Hopefully I will be too groggy to know when they draw blood! I am just plain excited now. I have two great bedside buddies, TJ and Lisa, who just had their rhinos this past week. They have been great at keeping my spirits up and we have been helping each other with out fears and anxieties. I highly recommend finding someone on a plastic surgery forum that will be having the same procedure close to the same time you are to help you through everything. My husband is my best friend, but he doesn't know everything I am feeling regarding the surgery. It is helpful to have someone who knows just what you are going through!

Friday, October 5, 2001 - 24 hours post-op

It is done! I am beautiful! Okay, that's stretching it a bit (all right, a LOT), but the surgery is done. I went the surgical center at 9:30am yesterday, October 4th. I filled out paperwork, wrote out checks for the surgery center stay and anesthesiologist and was taken to a room with about 6 beds in it, with curtains around each. This turned out to be both the pre and post-op room. I changed and put my clothes in a locker and put on a sexy backless gown, footies and a hair net. Then I went to my bed and was given a really nice warm blanket, a blood pressure cuff that took my pressure every 5 minutes or so, and a pulse monitor on my finger. I was also given surgical stocking to wear, to prevent deep vein thrombosis.

immediately before surgery, 10/4/01

Then my pre-op nurse, Sue, started the IV. This was actually the part I was most afraid of, because I hate needles. Sue was so good, asked me questions to keep my mind off of what she was doing, and before I knew it, the IV was in! My husband came to the room and sat with me while they did a glucose test (I am hypoglycemic, and they needed to keep an eye on my glucose levels) and connected me to the heart monitor. Sue also gave me something to make me relax. At 10:15 I said goodbye to my husband and was wheeled into the operating room.

At 10:20 I remember looking at the clock, feeling sleepy, closing my eyes and then I was out! I honestly don't think I had been even given anesthesia yet, I think I was so tired from not having slept the night before that I just fell asleep.

I woke up back in the pre/post-op room, very thirsty. It was 2:30, and the operation had only taken about 3 ½ hours instead of 4 ½ like they expected. The nurses gave me small sips of Sprite and ice cubes to chew on. My husband came in then and sat with me. I woke up quickly although I was a bit groggy. I had absolutely no pain, but the packing in my nose forced me to breathe through my mouth. The gauze pad under my nose (drip pad) had to be changed about every half-hour because my nose bled almost constantly for the first 8 hours. I recommend a paper tape for the drip pad that tears easily and doesn't hurt to remove. I have a small, hard plastic splint over the bridge of my nose, drip pad under my nose and a 4-inch wide elastic band that wraps from the top of my head around under my chin for neck support. The platysmaplasty left a small one-inch incision under my chin, but that is the only visible cut. The incisions in my nose are internal, and won't be seen.

1 hour post-op, 10/4/01

After an hour or so, I was released. I didn't have my contacts in or glasses on, so I had to rely on the nurse and my husband to get me in the car. The ride home was okay; I couldn't wait to lie down, though. The nurse warned my husband that I would probably throw up in the car, from all of the blood in my stomach. This never happened, I never felt sick at all. At home I lay down and rested all evening, drinking about a gallon of water and Gatorade through bendy straws, which are a must for facial surgery! I ate graham crackers and saltines, watched TV and changed the drip pad all evening. I put my contacts in as soon as I got home, with absolutely no problems.

I finally went to sleep (if you can call it that) around 2am. I dozed for a few minutes, but because I had to breathe through my mouth, I woke myself up by snoring. Then my mouth would be completely dry, so I would take a drink of water then doze again. Doze, snore, sip. Doze, snore, sip. This went on for about five hours. The alarm woke me up at 8am, as I had to go to Dr. White before 10am to get my packing removed.

1 day post op, with and without neckbrace

1 day post-op without neck brace (lateral view)

Packing Removal

I got up, got dressed and my husband drove me to Dr. White's office. I had been dreading this part of the process; I have heard some horror stories about packing removal. I got there and the receptionists and nurses were all amazed at how good I looked and how alert I was. One told me that Dr. White had come back from my surgery and told the office staff how well it had gone and how pleased he was with the results. She said that he didn't normally discuss how a surgery went when he returned, so this was good news. When Dr. White came into the exam room, he also told me how wonderfully the procedure went and that the result was going to be better than we expected. I was really glad to hear these positive comments. He then took the packing out. There was absolutely nothing to be worried about! Prior to putting the packing in he had coated it with a Vaseline-like substance so that it slid out easily with absolutely no pain. It was so nice to breathe through my nose again! I was given some saline nose spray to use and told to use it often. This would help soften the crusties inside my nose and help things stay moist. As he cleaned me up, I began to feel a little bit nauseous, probably from not eating. This was the only time I ever felt nauseous during the entire process. I lay down for a few minutes, but felt better in no time. I then made an appointment for next Tuesday to have the neck stitches removed.

When I got home I watched TV all day and evening. My husband went to work and I was on my own for the first time. I was just fine. I took it easy, drank lots of fluid, and ate a little bit. My face began to swell a bit, and I look like a pig now, but I feel okay. One thing everyone who considers rhinoplasty needs to know is that immediately after surgery you will look like a pig! This is only because the tip of your nose gets taped up and back, exposing your nostrils, and your whole face swells a bit from the trauma of surgery. Once the splint and tape are removed and the swelling subsides, everyone agrees that the piggish look does disappear. My eyes have hardly blackened at all, and I was given these eye masks that are made of a gel-like substance to reduce swelling. They are the greatest! They are called Swiss Therapy Intensive Transdermal Eye Masks and you soak one in ice water for a bit, shake it off (I like to pat it dry so the water doesn't run down my face) and put it over your eyes and cheeks. It feels so good, so soothing, and coupled with the ice pack I wear under my chin it is the greatest feeling. I have fallen asleep a few times with both of these on!

Saturday, October 06, 2001 – 2 days post-op

2 days post op

I slept solidly for about 7 hours last night. Hooray! I am okay with sleeping upright, now that I can breathe through my nose. The one thing I didn't count on is the really bad headache I got from sleeping upright. I woke up and my face was puffy and my head hurt so I put a cold eye mask on and an ice pack under my chin. I then fell sound asleep for about two hours. I felt refreshed and wasn't as puffy as before. The space between my eyes is swollen and hurts a bit, and my nose is sore, but the rest of my face feels fine. Dr. White said as long as the splint is on I can wear my glasses since they won't be resting on my nose, but after the splint comes off I guess I will have to tape them up somehow. My back is incredibly sore from sleeping upright. I suggest doing a lot of back stretches before bed to loosen the muscles.

Sunday, October 07, 2001 – 3 days post-op

3 days post op

I slept much better. I used just three regular pillows, and slept on my side with my head still elevated. My back doesn't hurt as much, and the splitting headaches I had experienced didn't happen. My only problem today is my uvula, more commonly know as the "little thing that hangs in the back of your throat". My uvula is elongated and dangles on the back of my tongue. This makes me feel like I have a popcorn kernel stuck in my throat and makes me cough. It is really irritating!

My nose is still very sensitive, but I am getting used to touching it. I am trying to use the saline spray as much as possible. Dr. White said that I can't use too much. I don't have the crusty stuff many people complain of, maybe because I am using the saline so often. Using the spray also makes your nose more pliable; I keep flaring my nostrils after I use the spray and it breaks up the mucous and blood dried in your nose. Of course I use drip pads like they are going out of style (didn't know they were in style, did you?) because they are easier than tissues and help keep the moisture in your nose.

My tip of the day is once your initial bleeding is done, take the 2 inch square gauze pads (I was given about 300 to take home with me and a roll of ½ inch paper tape) and cut them in half. Then fold them in half longways and tape them under your nose. This allows you to breathe over the top of them while catching the drips. I carry my pads, saline nose spray and tape in a one-gallon Ziploc bag and always have it with me.

Monday, October 08, 2001 – 4 days post-op

I slept laying down last night, just like I used to before surgery, and woke up with no headache and my swelling is way down! Hooray! My pain pills make me really sleepy, and I took one at noon when I woke up (I am still on my casino schedule, I can't fall asleep until 4am get up at noon. Habit, I guess) and was back asleep by 5pm. I woke up at 8pm and will spend the evening on the couch yet again with my cats and remote control. Not a bad gig, this surgery thing! I have an appointment tomorrow morning to get the stitches removed.

I took a shower today, second one since the surgery. Amen for clean hair! Showering is really easy, just take your time and make sure you have a hand towel with you to dab your face dry if you get water on it. When I got out of the shower I washed my face with a washcloth. I also assessed what bruising I have, and here is what I have today, just four days after surgery: under my neck on the left side there is some minor bruising, not really noticeable unless you really look. On my cheeks, under the cheekbone, I have very minor bruising which I think is from changing the drip pad so often, where the tape has been pulling at my skin. On my cheeks above the cheekbone I have a dime-sized light bruise directly under my left eye, and on the right side the bruising looks more like a shadow. I still have a bruise on my left hand from the IV, but it is really faint too. I consider myself really lucky with the lack of bruising I have. I think what really helped me is following my doctor's orders to the letter, which included no aspirin products for at least two weeks prior to surgery, as well as no garlic or vitamin E. Ask your surgeon for a list of medications, herbal supplements and foods to avoid prior to surgery. I was also religious about taking my daily vitamins, which include (for the last several years) one Stresstab multivitamin daily, a 27mg iron supplement ever other day, 250mg calcium tablet daily, and 500mg vitamin C with rose hips tablet daily. I can't say that this regime is what prevented my bruising, but it definitely didn't hurt! Even if you don't take any vitamins now, it is never too late to start, and they are definitely a good thing to do in today's fast food world.

Thursday, October 11, 2001

7 days post-op

Not much has changed in the last three days. The stitches inside my nostrils are starting to fall out, which means the part of the stitches under my skin is dissolving. The inside of my nose is itching like crazy, which is good. The healing has begun! The bruising and facial swelling is almost non-existent now, and the stitches from my chin came out on Tuesday. I am still very tired a lot; the anesthesia takes a really long time to get out of your system. I get tired going up a flight of stairs! I cleaned some of the house today, and pushing the vacuum made me feel like I had run a marathon. Enough cleaning for today, I have another week off work!

I went out to eat with my husband on Tuesday night, and no one stared or made any comments about my splint. I got my nails done this morning, and my manicurist asked how the surgery went. I told him how well it went, and several girls in the salon started asking questions and were really supportive about it.

One thing I am curious about is if my tip will harden like everyone else's seems to do. Mine is still pliable, not at all stiff and hard like I have heard other's have.

Friday, October 12, 2001

8 days post - splint off!

Hooray! The splint is off! My nose looks great! The tip will need to settle some, and the swelling is still there, but all in all I love it! My nose is tender all over, and washing my face will become an excruciating chore now, but it is worth it. My bruising is almost gone, there is a really faint spot under my left eye and the bruises on my lower cheeks and neck are a lovely greenish/yellow shade. The internal splints in my nostrils were also taken out today. They were just two pieces of flexible plastic that were curled into tubes in my nose. It felt really great to have them taken out, and my breathing is even better than it was after the surgery!

Dr. White trimmed down the splint and gave it back to me, so I can still wear my glasses in the evening since it covers the bridge of my nose. This is incredibly helpful, since I usually take my contacts out and read in bed for a while before I go to sleep. I highly recommend asking for the splint back when it comes off if you wear glasses. You cannot wear glasses by themselves for the first several months after surgery, because the nose pads of the glasses will leave indentations where they sit on your tender nose. I have heard recommendations from people to tape the glasses to your forehead so that they sit off your nose, but I like this idea better. You will have to wear it as long as you still have swelling and your nose is sensitive on the bridge.

12 days post-op (lateral view)	13 days post-op (lateral view)
13 days post-op	2 weeks post-op (chin)

Tuesday, October 24, 2001

I had my final follow-up on Monday with Dr. White. I am so very pleased with the results, as is he! He looked up my nostrils with a speculum, and sent me on my way. I will have to see him again in 6 months for a checkup, and to have my post-op pics taken. I consented to having my pictures on his website and in his photo album.

I went back to work on Monday night, 18 days post-op, and had a great reception! Everyone had been worried about me. I had left abruptly, having gotten the flu and calling off the four days before I was to start my medical leave, so I never got to say goodbye to anyone. I colored my hair a really cool auburn red on Sunday night, so everyone was concentrating on that. Anyone who did ask where I was I told them I had sinus surgery (true) and had my septum straightened (also true) and that the surgery had left my nose shaped a bit differently (pretty much true). I didn't want to get into the whole "nose job" thing with anyone, so I left it at that. I also got hit on a lot, I wasn't aware how much guys like red-heads! All you blondes out there, I just learned that redheads have more fun!

Before & Afters (5 Weeks Post-op)

In all, this was one of the most positive experiences of my life. I am so glad I did it! I highly recommend having cosmetic surgery if you are emotionally, financially and physically prepared for it.