Revision Rhinoplasty

I had a revision rhinoplasty with Dr Nara. So the goals of this revision on the 6 day of my previous rhinoplasty are: to correct the dorsal hump and bring down the height of the nose radix (area between the eyes). He had to be convinced that this was really what I wanted because of the increased risk of infection and also that the final result is difficult to predict.

This revision had to be done soon after my first rhinoplasty as an autologous cartilage would integrate with the nose tissues during the healing process. Thus, delayed time would cause a revision to have increased risks and difficulties during removal of the autologous implant.

I believe he tried his best.

This is the result on the day after. The marking on the nose is still visible.

 

I'm liking the decreased height of the radix. The dorsal hump is still visible but looks and feels less obvious than previously. Right now, it only makes sense if I give it some time before assessing the final outcome.

As with my experience with my first rhinoplasty, swelling in my nose and face is worst on the 3rd day. I have taken arnica montana the first time but had to do without it this time.

I slept in a more elevated position last night as I wanted to maintain the low blood pressure to my head and face. It is a mechanical rationale whereby there will be less swelling as opposed to sleeping is a parallel supine position. Because in the day, the arterial pressure enables blood to flow from the heart to the head against the laws of gravity. And gravity assists blood to travel from the brain to the heart. 

But in the night the distribution of gravity changes with our flat sleeping position, so there is more blood pressure to the brain (and the face). This is usually ok as there are pressure receptors to control intracranial pressure in the brain to prevent too much blood in the blood vessels or a possible aneurism.

One symptom faced to illustrate the effect of gravity on physiology is when sometimes when people wake up abruptly, the blood pressure that was increased in their brain during the night falls quickly because of gravity, thus causing a momentary dizziness. The sudden plunge in intracranial blood pressure is soon recovered.

I heard of people claiming to be able to sleep better when facing the left side then a supine position, because the heart is positioned lower. There are also claims that sleeping with the head in an elevated position would be helpful for digestion in the night.

Day 5


My cheeks are still puffy but less swollen.

The side profile with the dorsal hump more evident...

Day 4

The swelling has now moved on to the lower half of my face. On the bright side, my eyes are not as swollen as yesterday. The little bruise you see on the bridge of my nose was caused by massaging the dorsal hump last night in an effort to reduce it. It's futile, and I have stopped.

Ok, more pictures...

A close-up of inside my nose. I'm guessing the white threads you see are dissolvable stitches, while the black threads at the alar base are stitches to be removed. They are not bloody as a staff at Dr Nara's clinic helped me clean up the excess blood with saline solution on the second day I went back. I notice the alar base doesn't hurt now, because I can laugh a little at things I watch on TV, which for the previous days I was unable to do so without pain.

This is the side profile. The bruise I accidentally made is hidden on the other side, but you may see a little bit.

Day 3

Anyway, I received my reply on Realself.com.

http://www.realself.com/question/problem-ears-after-rhinoplasty#354220

Ok, my ears are better today than yesterday, though my nose look about the same and my face is finally very swollen. At this point, things appear to suck. I'm quite certain the scars on my ears will not disappear.

On a separate note, I am reminded of another life experience that is totally unrelated to PS but somewhat analogous. Like one year ago, I had a house party with some friends. One friend got completely drunk and was largely irresponsive except for groaning, throwing up. His eye balls were flipped (meaning only the sclera, the white part of the eye, could be seen).

I was adamant that he got alcohol poisoning and wanted him to be sent to the hospital. Because I read up like a hundred different sources on symptoms. However, another friend (whose parents were dentists, he calls them doctors) suggested different remedies. He wanted the sickly drunk guy to drink coffee, take a cold shower and then let him sleep. These methods were contraindicated in what I read about alcohol poisoning. I disputed with this doctor's son. Finally, another friend called the ambulance. Turned out it wasn't severe enough to be alcohol poisoning. So I was wrong. The doctor's son followed the drunkard to stay overnight in the hospital to be observed anyway. Sweet chap.

Anyway, my drunk friend had insurance covered for his hospital stay, so it was not that bad.

Maybe I always assume the worst because of my lack of collective experiences. But I still believe that if logical steps can be taken to minimise risks, than do the logical things. The deliberation here is to choose between Logic or Intuition. Then again, I'm also addicted to risks to have PS in the first place. Right now, I can only cross my fingers and hope that things are alright, also to trust in Dr Nara. Because my other choice can only be to return to Singapore and seek a ear specialist. I might have to live with bad cosmetic results.

Day 2


This is how my nose look since after the surgery.

It is obviously very swollen. But the hump that you see in the picture on the left, it is there. I hope it goes down after a couple of months. But for now, I'm not loving the result. But we'll see in the coming weeks.

The scary thing was...my ears.

Initially when I when back to the clinic to follow-up on my ears, they told me that it was not necessary for them to do anything and that I'll be fine if I continue taking antibiotics. I could not sleep the night before because my ears hurt even more than my nose (which was quite painless). I was really afraid. Because my left ear which has 2 cuts will not stop bleeding. Dr Nara told me that this is a good sign as there is no clot there. Those 2 cuts were made during the surgery. As for the other ear, I was experiencing a hematoma. Thus, I posted my case on Realself.com. At 4 am I sent to Dr Nara an emergency email to come check up on me. At 11am I went to the clinic and was brushed aside, with the clinic claiming it's normal and antibiotics was all I need because he has never had complications with the ears, only noses.

Anyway, throughout the day, I did some research and even bought gauzes and tape to bandage my left ear to stop the bleeding. I was considering the severity of the situation and flying back to Singapore to seek medical treatment.

At 9pm, I was called up in my hotel room and told to come to the clinic because they just saw my "emergency email". Dr Nara was reassuring that my ears would have no problems. He said that it is not severe enough to warrant worry and told me to trust him. He sounded like an alpha personality type, which can be reassuring, though at times intimidating cause I was already scared stiff. And when I am in pain and see something that's obviously wrong and he tells me that it's alright and there's no need for any action, it was very difficult to believe. Nonetheless, I wanted him to drain the hematoma, which he did.

Rhinoplasty

Day 1


Ok, so this is how my nose look like before when I'm not smiling...(eyes have been edited out in first picture)

 

So it is not horrible, but I wanted a higher nose bridge and a smaller alar base. When I consulted Dr Nara. He claimed that any kinds of autologous rhinoplasty is possible for him as he has more than 20 years of experience on the table.

Rhinoplasty (with silicon implant) : 10, 000 THB

Rhinoplasty (with ear cartilage) : 24, 000 THB

Rhinoplasty (with rib cartilage, General Anaesthesia in a hospital) : 60, 000 THB

Though he thinks that a silicon implant is still has the best cosmetic results and is his flagship rhinoplasty procedure.

I decided to go with the ear cartilage. Though he claims the result won't be as "perfect" as a silicon implant. He also said I may not have enough height with the ear cartilage, like approx 2 mm. He also told me that implant could be used in 2 parts, meaning joined in the middle where the septum is. But I only wanted a minor enhancement, so I instructed him that so long as the bridge is straight and the base is smaller, I'm good to go with the ear cartilage, which is still a closed rhinoplasty procedure.

I regret not asking about a septal rhinoplasty, which I found out later on the internet that it would be a better first choice than the ear cartilage as it is less "soft" and more rigid in shape.

During the surgery, I did not feel as drugged as in Dr Chi's clinic, but nonetheless, there was zero pain. I was even talking a lot. Though, I felt my ears tugged, a lot.

Buccal Fat Pad extraction

Ok, the first procedure I had done was the Buccal Fat Pad extraction by Dr Chi. The cost is 10,000 THB.

I had some trouble looking for the clinic, which is located close to a temple under construction. (which name is i-don't-know-what). The only info of the relative location I have came from the forum, provided by a forum member (Aardvark). I was very lucky because I wanted to take a tuk tuk, but instead the driver gave me directions to that street, which about a 10 minutes walk from Lee Gardens. No one else I asked knew Phi Beauty Clinic, nor can they read the english name I wrote on the paper. So I recommend printing out the name and address in the Thai language so you can ask around.

Well, that area seem to have plenty of clinics, from skin care to dentists...I'm thinking of going to the laser clinic opposite Dr Chi's clinic to get rid of my milia seeds next time.

So I found Dr Chi's clinic, took off my shoes and entered. The staff there are rather pleasant. I had my consultation with Dr Chi. He has a huge Apple desktop in which he shows you pictures of his patients. He is a rather mild-mannered man who is very patient. I had a ton of questions and he just took his time during the consultation. Apparently, for buccal fat pad extraction, he will remove the same amount out of each cheeks (intra-oral, of course).

I was agreeable with the buccal fat pad extraction because it is considered a minor cook book procedure. One thing he recommended when I asked if he does autologous rhinoplasty, was to have a dermal fat graft (meaning fat with skin extracted from another part of your body, like the butt or thighs) to form the bridge. Other doctors I have asked do not agree and claim that this is not part of a viable option as the dermal fat graft would not hold its shape. Though Dr Chi did mention that the changes are only for those satisfied with the shape of their nose and want a very very slight height added on.

Back on topic, I was ushered into the operating room. The room and the operating chair looks something like what you'll find in your grandmother's house. Though comfortingly, there was a machine to monitor your blood pressure. I was strapped down and sedated. Ethanol was swiped all over my face. The only thing I remembered was that I was rather uncomfortable when I felt my mouth being pried open, but I do not remember the rest.

At the end of the procedure, I still felt drugged and it was at night. So one of the staff (whom are all female), gave me a ride back to the hotel on a motorbike.

The days after, I have no problem eating. Dr Chi gives painkillers (specifically, Tylenol), pills for swelling, antibiotics, sleeping pills & packets for ice-packs.

My face is swollen now. And I doubt I will post pictures in the future cause there is really no point.

(Quote by Dr Chi: "Fat extracted from each side will range from 5ml to 10ml." He will try to make sure they are the same.)