Tamara's Rhinoplasty Journal

A Bit of Background Info on Me:
I was 23 at the time of my surgery. I had hated my nose since middle school and had received the random rude comment about it from time to time. ("You have a big nose" "Your nose is really wide" "You'd be prettier if your nose weren't so wide" "Your nose has a landing strip (in reference to the flat bifid tip)", etc.) I had my surgery after graduating from college during a year that I took "off" and worked before starting med school. I figured, "I'm about to go ~$200,000 in debt to pay for med school, I might as well spend the money I have now on something I want because I'm not going to be able to afford it for a long time." (Yes, getting a medical education really is this expensive.)

Finding a Surgeon:
After deciding that the time was right, I had to find the right surgeon. I knew what I was looking for -- someone who specializes in rhinoplasties, that is board certified, who I like and who practices somewhere in Florida. Fortunately, Florida is not lacking in plastic surgeons because I couldn't really afford to travel as well as pay for the operation. (Let me interject now that if I had not met a surgeon who met my criteria I would not have had the procedure – I wasn't going to settle.) I started searching the internet looking for rhinoplasty resources and I happened to stumble upon http://www.rhinoplasty4you.com/  which I am so grateful to have found. On the message board I heard about Dr. Richard E. Davis who is the Chief of Facial Plastic and Reconstructive Surgery at the University of Miami, he is also a board certified ENT and Facial Plastic Surgeon – the credentials sounded great to me. I also happened to see some photographs posted by a few of his patients on the message board (thanks Avaria and Vianna) and I was extremely impressed by them. Finally after staring at Avaria's pictures for the millionth time I decided to call Dr. Davis's office and schedule a consultation – I had nothing to lose since his consultations are free. This was around the end of November 2004 and Dr. Davis's secretary told me that there were no openings for a consultation until the end of December. I took the next appointment and also asked if it would be possible to have the surgery sometime between mid-December and mid-January during which time I had a break from work. Carmen, Dr. Davis' secretary kindly said she would pencil me in for the 4th of January so that I could have that spot should I decide to go ahead with the surgery after the consultation.

A few days after scheduling my consultation I starting thinking about how long away the appointment was so I called Carmen back and asked if it would be possible for her to let me know if an earlier cancellation opened up for a consultation. Sure enough, she was able to squeeze me in later that day, December 2nd!

The consultation:
First of all, let me explain the setup of Dr. Davis's office. He works in downtown Miami in the Sylvester Comprehensive Cancer Center (SCCC - across the street from Jackson Memorial Hospital). Apparently the way he came to work in a cancer center was because earlier in his career he did a lot of reconstructive work on cancer patients, though now his practice is mostly dedicated to cosmetic procedures. He has kept his practice at the SCCC because it has operating facilities very close to the exam areas – making it very convenient for him and for his patients. The SCCC is set up "clinic style" which is different from the other doctor's offices you may have visited – it is more like a posh hospital of sorts. In order to get to Dr. Davis first you go from the ground floor (where you can valet) to the first floor and check in, and after checking in, you register. After registering you go to the second floor (Desk A) and check in – here there is a waiting room and from here you get called in to Dr. Davis's exam rooms. There, now you won't get lost on your first visit to Dr. Davis!

During my consultation Dr. Davis first discussed what I didn't like about my nose. He did an ENT exam and pronounced my nose functionally healthy and then he took some pictures so that he could do some digital imaging. He also showed me lots and lots of patients with similar noses to mine, which I found very comforting. All of his noses were beautiful. He also suggested a chin implant, which I originally agreed to but decided against the next day after discussing it with my family and boyfriend. What it came down to was that my chin really didn't bother me as it was and I didn't want to go through the extra risk of complications associated with a chin implant. He and his staff were very nice when I called to cancel the chin and told me that I shouldn't do it unless I am totally comfortable with the idea. Looking back I'm glad I didn't get the chin done, the idea of a foreign material being placed in my body really freaks me out. Maybe one day when I am old and chin starts looking weaker I'll consider it again.

The Pre-Op Appointment:
My pre-op appointment happened to be the day before my surgery on Jan 3rd 2005. On this day I met with a nurse anesthetist who did a simple exam and asked all the basic questions about my medications and such (a regular MD anesthesiologist did my anesthesia for the actual operation). I also had blood-work done: a CBC and a pregnancy test (this is routine before any surgery, at least if you are a girl). Then I met with Dr. Davis again. He discussed post-op care and what to expect and he also went over my imaging pictures again to make sure that I was completely happy with what I was seeing. I asked him for the prescription for any medications I would need after surgery and he gave me a couple of scripts for pain and one for antibiotics. He told me that I probably wouldn't need to fill the pain meds since he would give me some samples after my surgery. Then Dr. Davis left a resident ENT re-examined me to make sure everything was good with my nose. (He works in a teaching facility so residents are around but Dr. Davis does the actual surgery.) I also paid for my surgery this day - $5,000 for everything (Davis's fee, OR fee, bloodwork, post-op visits, anesthesia, etc)

The Big Day – Surgery!
I showed up to the operating center at 10:30 am. I had taken a couple of anti-anxiety pills with a half-sip of water earlier that morning so as soon as I got to my bed I settled in and took a bit of a nap until Dr. Davis and the anesthesiologist came out. The nurses were all very nice and friendly. I kind of remember chatting with the anesthesiologist and holding the mask to my face after being wheeled into the OR and falling asleep. When I woke up in the recovery room my mouth felt really dry since I had to breathe out of it exclusively with all the packing up my nose. I wasn't really in much discomfort except for the dryness of my mouth. I asked for and received some lip balm and ice chips, which made my mouth feel much better. After I woke up a bit more Dr. Davis spoke to my mother and came by and let me know that everything had gone well with the operation. He settled a glove full of ice on my face and that felt very comforting. I left as soon as I could (I'm always very motivated to get out of the recovery room after surgery) and I got to go home and rest.

Here is what was done to my nose: deprojection, tip narrowing and correction of bifid tip, tip was raised slightly, nasal bones were broken and narrowed, a columella graft (of septal tissue) was placed for support and definition and work was done in the area around my nasal spine/columella (not sure exactly what… I should ask for a copy of the operative report).

I didn't really sleep very well my first night. I situated myself on our recliner-couch in the living room but I could only sleep in spurts, as I had to keep icing. My mom was nice enough to stay up with my and help me change my ice bags.

Day 2 – Getting the Packing Out
The day after surgery I went to Dr. Davis's office and had my packing removed -- what a relief! First he squirted a bunch of numbing fluid up my nose to wet the packing and ease its removal, then he pulled out all of the gauze and sprayed the insides of my nose down with some more fluid to clean things out and open up my nose again. I could breathe! He also showed me some intra-operative shots of my nose, which I had requested that he take prior to my surgery and a couple of shots of my finished nose before the cast went on. 

Recovery, Days 3 – 6
My recovery was pretty uneventful. I wasn't in too much pain; the worst pain was around day 3 when I had an achy feeling in my upper front teeth and lip. I didn't do any icing after I got my packing out (though I was told I it might be beneficial through day 3) because the ice packs made it difficult to see and it would get very boring lying around with ice on my face. I napped a lot during this time period and generally slept more than usual and would get tired out easily. This didn't prevent me from going shopping and out to eat, however. 

My appetite wasn't strong for a few days after surgery but I didn't suffer from any nausea either but the end result was that I lost a couple of pounds. I was diligent about sleeping with my head elevated and had bought three new pillows before my surgery to make sure that I was extra comfortable after I moved out of the recliner. I used the computer frequently to entertain myself and watched TV and DVDs. I didn't read as much as I had planned because I found that tilting my head down to read was unpleasant as it sent the blood rushing to my nose. I showered during my recovery but only from the neck down. I used Clean & Clear pads to clean my face to avoid wetting my cast and my mother washed my hair in the sink. I also was able to accomplish washing my own hair after getting a bit braver by getting in the shower and leaning my head back into the water with a towel over my face. I held the towel over my cast while I wet and washed my hair with the other hand. This turned out pretty well and I wish I had figured out how to do this earlier during my recovery. I kept the insides of my nose clean with saline spray and Afrin (recommended by my doctor) but I was still pretty stuffy until I got my cast off.

Day 7 – Cast Off!
By this day I was so ready to see my new nose. I had watched what I could see of my tip unswell and refine during the previous week but I was dying to see what I cared about the most -- that my nose was actually thinner in the bony region. Getting my cast off was not at all painful. First a nurse sprayed a solution of anesthetic and a decongestant up my nose again to help unstuff me. Then she dripped this oily stuff around the edges of my cast to loosen the adhesive. Dr. Davis took over from there using a cotton swab soaked in the oil to gently loosen the edges of the cast and slowly peel it off of my nose. This did hurt a tiny bit -- just because my nose was so sensitive to any sort of pressure after undergoing the trauma of surgery. When I saw the final result I was more than ecstatic -- it was better than I could have imagined or hoped. Really truly I couldn't believe how perfect it was. Dr. Davis told me to put ice on it for the rest of the day to help with the swelling that happens once the pressure of the cast is off. It did swell up a lot in the hour it took me to get to my house from downtown (it was rush hour) -- especially in the tip, but at least I knew how much smaller it would be once the swelling subsided.

Reactions of Others
Mom, Dad and Grandma (whom I am currently living with) said they saw absolutely no change or didn't comment. We didn't talk much about my rhino beforehand, though my mother was very helpful during my recovery. It was something that I had talked about for years and years but they thought "I didn't need it" so this is why I think they wouldn't acknowledge the change. 

My boyfriend and friends on the other hand were immediately impressed by how different I looked. My face was no longer all nose! They were all very complimentary and excited about the change, most of all, my boyfriend (who was very diplomatic in letting me know that I looked fantastic but that he still thought I was pretty before). 

I returned to work two weeks after my surgery and my co-workers (whom I had told I was having cosmetic surgery) couldn't really tell the difference (until I whipped out my disgusting driver's license photo). My ~50 college aged students either didn't notice or didn't say anything.

Looking Back at 3 Months Post Op
I met with Dr. Davis again a week after I got my cast off, then a bit over a month later (I was supposed to come in sooner but I was really busy). Since I'm moving away from Miami for med school Dr. Davis made me promise to come home over the summer for a 6 month appointment. 

Every time I have met with him I have never felt rushed, he is always very kind and very humble about his work and listens to my questions and concerns.

Over the past few months the swelling in my bridge has gone down a lot but there is still a little swelling left where he took down a small bump. My tip has also gotten a lot smaller but it is still hard at three months post op. Dr. Davis told me that I'll know it is healed when I can smush it around like a normal nose and it is all soft. The scar on my columella is all but invisible and there was a small swelling in my right nostril after surgery from an inflamed stitch that has gone down.

In the weeks first following getting my cast off, my nose was really tender. I hit it a few times accidentally and boy did it hurt! It also was a little bit drippy. My upper lip also felt stiff, though I did not have any muscles cut and this resolved within a month and a half after surgery. Dr. Davis gave me the OK to sleep any way I wanted (except on my nose!) at about 2 weeks post op. I asked him at my 2 month appointment if it was ok for me to wear glasses (I loathe contacts) and he said yes but to be careful that I didn't notice them creating any large marks or dents in my nose. I had been wearing my glasses for short periods of time since about a month post op (oops!) but most of the time I would tape them to my forehead for long driving trips, or movie watching (I must be the only person in the world that would prefer taping to contacts but I have VERY dry eyes). I found that plastic frames without the little nose pads distribute the weight of the glasses best and those are the kinds of glasses I am now using.

Basically I took to my new nose right away -- no regrets, this is one of the best decisions I have ever made. The impact on my self esteem has been enormous -- now I don't feel like the "ugly one" when I go out with friends. This surgery by no means was a panacea for all my troubles but at least now I can look in the mirror and be happy with my reflection.

Most of all, I concentrate on the *change* I see in my nose from before to now. I didn't go into surgery expecting perfection but Dr. Davis came pretty darn close. Expectations have a lot to do with how you will feel about your outcome. I hated my nose so much that basically anything was better than what I had. I feel blessed to have found Dr. Davis.

I update frequently (if you get queasy easily be careful about the intraop album -- there are some pictures of the insides of my nose on there).

Tamara