foxycleopatra

May I ask which NYC Korean surgeon you're planning to see? Dr. Jeffrey Ahn? Dr. Edward Kwak? Dr. Eric Choe? Dr. Edmund Kwan? other?

 

I don't know about Texas, but if you're willing to travel to NYC, the best Korean doctor for Asian double-eyelid surgery here is Dr. Eric Choe (Chae In is his Korean name). A lot of gals on Soompi (a Korean-American/Asian-American forum) went to him.....which was actually how I first found out about Dr. Choe......you can read all about it on Soompi (there are hundreds of posts on that). Anyway, I went to him for both blepharoplasty and rhinoplasty (separate times).....and while I'm not entirely satisfied with my rhino results (IDK, maybe it's just my nose tip to start with, my family/friends say it looks fine but I still don't think my tip looks natural), I am 110% pleased with my bleph outcome.....I seriously don't think it could've come out any better if done elsewhere.....looks totally natural (I had full incision, tapered cut)......when I consulted other plastic surgeons for my rhino appointment months post-bleph, they were surprised to hear that my eyes were done.....anyway, maybe, just maybe, I should've insisted on getting epi, but Dr. Choe felt strongly that I didn't need it and that the risks outweighed the pros in my case, so I guess one can't aim for absolute "perfection" with p.s.

 

jamasian - wow your results looks so natural!! Honestly if I had never been told that you got rhino I would not have guessed that your nose had been operated on. Nice height, great side profile, and very natural-looking from the frontal view (I think it helps that the tip is not looking super-pointy but is rounded yet still defined).

May I ask how thick was the I-silicone implant you used (how many mm)? I have to admit that your nose (esp. tip) was already pretty good to start with.....the pre-op nose was mainly lacking height in the bridge area.....I guess this again drives home the reality that rhino results often depend not only on the skill of the surgeon but also what type of a nose one starts off with (in its natural state).

Sigh, compared to your results my rhino looks really fake IMO. I also had I-silicone with ear cartilage for the tip. My side profile is perfect now but the frontal view just looks peculiar (and fake) IMO. But then again my tip had zero definition to begin with......so I don't know if a revision could even make much of a difference.

 

I think you're referring to LATERAL epicathoplasty....which supposedly elongates the eyes (along the outer edges....kind of like cat eyes)....but I've heard that the actual results with lateral epi are barely noticeable and that procedure may not be worth the risk/cost.

 

Does twilight sedation refer to local anesthesia? If so, then that's what I had for my primary rhino.....open procedure, augmentation with silicone plus tiplasty (with ear cartilage). No osteotomy (bone breakage) or alarplasty involved (though I kind of regret not getting alarplasty now....but that's a story for another time). Right before the operation the nurse gave me a couple of pills to take then injected my veins with demerol and then there were a couple of injections to my nose to numb that area. I was awake throughout the entire operation....and felt little to no pain whatsoever (I did feel slight discomfort only when my surgeon was testing out the diff't mm of silicone implants before deciding on one that looked best on me....I could feel the silicone implant being pushed up my nose). My surgeon prefers local anesthesia and prefers the patient to be awake and communicative with him throughout the operation (it was kind of funny b/c of all the random topics we talked about during the op we touched upon Kim Jong-Il LOL, and that was while listening to Kpop music playing in the surgery room). Personally I prefer local anesthesia as well. General anesthesia has greater risks associated with it but if you're getting osteotomy or partial osteotomy then general anesthesia would be a must.

 

OK ladies & gents, I'm not sure if any of you know of Suh In-Young (a KPop star)........but from a purely technical/anatomical point of analysis, how was it technically/anatomically feasible for Suh In-Young's nose to be manipulated into so many different variations?

I mean, even in the hands of a top surgeon, a lot of how the final outcome turns out like depends on the shape of nose that you start off with....i.e. there are some types of noses that you simply can't "construct" unless you have a certain shape to start off with. So with Suh In-Young's nose (judgmental comments about her frequent PS aside), I'm just surprised how her surgeons were able to turn her nose into so many diff't forms (like the super-pointy tip she had at one point......how did they even shape the cartilage like that?).



and her latest nose

 

pleasance, I will be 100% honest.....you do NOT need that eye socket surgery. Seriously, please don't risk it. If I were you (and you ARE a pretty girl....I didn't even notice anything asymmetrical or bizarre with your eyes in that above photo), even if the top plastic surgeon in the US offered that surgery to me for free, I would not proceed with it. It sounds incredibly dangerous and the risks far outweigh the potential benefits (got to assess the "expected value" here, e.g. if there's 20% the surgery will yield perfectly symmetrical eye sockets and a model-eque face......and there's 80% chance a complicated surgery like that could go wrong and cause blindness/facial nerve damage/paralysis/etc......there's just no way you can convince me to proceed with it). I'm all pro-PS when it comes to relatively safe procedures that have been proven time and time over....e.g. blepharoplasty, rhinoplasty (as long as you find a reputable surgeon), etc. With any type of surgery (even oral surgery!), no matter how minor the procedure, there's the chance of something going wrong and unexpected complications arising, but at least with procedures like bleph/rhino those chances are minimal provided you do your research and go to a highly reputable surgeon. When performing a bleph or rhino, the surgeon is not touching areas where there are a lot of nerves. Also, Asian augmentation rhino is generally reversible (as in you can take out the implant if you don't like it.....only alar reduction is not reversible), and so is bleph (if you use DST; otherwise incisional double eyelids can also be revised w/o much difficulty). But with the eye socket surgery you're describing, it sounds even more dangerous than cheekbone reduction which is already a high-difficulty surgery with potential nerve damage side-effects. EVERYONE has something slightly asymmetrical about their face.....that's just how human beings are born, even the top runway & commercial models (yes, my PS explained this to me during my initial consultation)......with top models any facial asymmetry they have is extremely minimal and almost unnoticeable, while the rest of us mere mortals may have more obvious asymmetry present on our faces. But the type of "asymmetry" you noticed with your eye sockets is truly not the type requiring surgery, especially the complicated surgery your doctor described.

 

Yikes I'm really frighted about I-silicone extrusion!! It would be my worst nightmare come true.....coz that's what I have inside my nose right now. But could you please elaborate on how that happened?.....i.e. which part of the nose did that implant first start to show extrusion? What were the earlier signs of extrusion with the I-shaped silicone?

I have an I-shaped silicone implant and that implant is just a tiny piece occupying only the top half of my nose......the bottom half of my nose is all soft tissue/cartilage (cartilage from my ear) and just like a natural nose. I've heard of how some surgeons put in a huge/long piece of silicone and then just a tiny layer of cartilage on the bottom. By contrast my silicone is literally a tiny piece sitting on top of a ton of cartilage....the cartilage takes up more room than the silicone and fills up at least 1/2 of the length of the nose (basically the bottom half).....and AFAIK that's how most legit surgeons put in I-shaped silicone implants these days (e.g. just from following this thread I've read about Dr. Charles Lee and Grand Clinic in Korea doing it the same way, just a tiny piece of silicone at the top with tons of cartilage on the bottom to prevent extrusion). So physiologically speaking I don't quite see how that silicone will extrude from the bottom of the nose (tip area, where most extrusions happen).....unless it's the cartilage that extrudes first? I guess the only other possibility (a horrifying and dangerous one) would be the I-silicone extruding from the top....where the nose meets the forehead????.....but that doesn't really make sense considering the pull of gravity.

 

Ok that photo didn't show up, but here's the comparison of the different nose tips......the girl on the left vs. the girl in the center (photo 1), and then girl on the left vs. girl on the right (photo 2).

 

That website has some truly horrific photos of silicone implants gone wrong.....but it seems that most are L-shaped implants which are prone to extrusion (not I-silicone ones with tons of cartilage underneath for the tip). When I email-consulted with Dr. Charles Lee and asked him about silicone implants and calcification, he wrote: "The modern silicone implants don't have the same problems such as calcification or translucency as before. Both gortex and silicone are very good, and the material is not as important as the shape of the implant. I will keep in mind your concerns; they both can be very permanent. With silicone, small holes can be placed so there is tissue ingrowth into the silicone implant; and if placed above the covering of the bone, there is not as much resorption of the underlying bone." Hopefully that info is reliable......

BTW I have to say that Shimmian Manila website's bottom ad photo (scroll to the bottom of that page) is pretty bad, if that's their standard of "beauty" or a beautiful nose.....



.....I showed my surgeons this photo as an example of the bulbous nose tip that I definitely wanted to avoid.

 

Hey guys, does anyone know if ALAR PLASTY can change the shape & positioning the nostrils (with respect to the tip) from the type on the leftmost girl to the type on the center.......



Right now my nose tip & nostrils resemble those of the girl on the very left....but I really want the down-ward pointing tip of the girl in the center (Pan Chen, one of top 10 Super Girls '09, basically the Chinese version of "American Idol"). I've done a lot of facial analyses of photos (of people I consider attractive) and thought about what best fits my face....and it truly is that type of downward-pointing tip that works.

But to go from the typical Asian tip/nostril (e.g. left-most girl) to the DOWNWARD-POINTING TIP of the girl in the middle.....is that where ALAR-PLASTY comes in?? Is there some way to reduce the size of those two little "tabs" on the left & right-hand side?

Does it also involve adding extra cartilage to the tip to make it droop more? (that's sort of like Dr. Tseng's aesthetic, except more drooping than he adds....but I heard that he actually adds a layer of silicone to the columella area/bottom of tip to achieve that droopy look.....and that sounds really suspect to me in terms of long-term safety....can't risk artificial implants in the tip area, only bridge/top portion and all autologous cartilage for the tip portion).

BTW here are more photos of the DOWNWARD-POINTING TIP on that girl















I just had my rhino 2 weeks ago (I-shaped silicone, with ear cartilage for tip) and have been quietly (but impatiently) waiting for the results to show. For some reason I recovered extremely quickly and didn't experience excessive swelling (just a bit, more of asymmetric swelling from week 1 to week 2....that has since subsided). Well, in terms of the silicone implant selection & placement and bridge & side profile.....it's fantastic.....the bridge and side profile (and basically the nose MINUS the tip) turned out almost exactly the way I dreamed of. I'm soooo glad I went with the 5mm implant and didn't opt for a lower implant or conservative change. 5mm made the difference that I wanted; yes in some photos now I do look a tiny bit Eurasian (just a bit), but I have no complaints about that as I definitely look better post-op than pre-op. I'd probably opt for even higher, i.e. 6-7mm implant, with goretex if I have to get a full revision later on.

HOWEVER, I still despise my tip and nostril positioning.....and think I'll have to get alar-plasty and/or possibly tip-plasty re-done later.....unless some miracle happens in the next 6 months, which I highly doubt. My family thinks I'm crazy though, as does my surgeon.....but I had a truly specific look in mind and don't want to settle for less. I love my bridge the way it is now and really want to avoid tampering with that for the time being (who knows, a revision could screw that part up), so I'm wondering if it's possible to get alar-plasty and/or tip-plasty revision while keeping the silicone implant intact (or do surgeons handling revisions insist on revising everything and replacing the implant)?.

I just really regret not going full out and getting alar-plasty when I got my rhino......in retrospect it seems that changing the nostril shape from circular to oval (typical of Caucasian noses) and reducing the size of the nostrils (even just a small reduction in size) can make a drastic difference. Case in point is the Vietnamese girl's nose on Dr. Toriumi's website.....he modified the shape of her nostrils and it obviously affected the tip and projection. According to all the surgeons I'd consulted alar reduction was "not really necessary" for my case and it would be my prerogative whether to add that option......but to obtain a truly truly beautiful nose (not just an above-average nose) I think I needed to go all-out and not hold back.

 

I'm not familiar with scleral show, but Dr. Jeffrey Ahn (also NYC) does a lot of lateral canthoplasty.....or so he says. Have you consulted with him yet? Might be best to ask him that. Though from the online research I did it seems that most people find lateral canthoplasty to do little to nothing in altering or improving their looks.....medial canthoplasty helps a lot (when needed), but from what I've read it seems that the benefits of lateral canthoplasty are barely visible.

 

Ok, thought I had to share this photo.......ladies regardless of what implant you get (silicone, goretex, or autologous cartilage) be 100% certain your PS doesn't make a nose like this......Park Shi-yeon's new nose......that goes all the way up to her forehead.....



Her old nose (and face!) was sooooo pretty.....granted that may likely have been an operated version as well......but why why why this completely unnatural new version?!

 

To the ladies & gents who've had ALARPLASTY......

1) can it be done independent of or after a full rhinoplasty operation (bridge augmentation, tip work)? Or would this be not advisable?

2) can it involve just RESHAPING of the nostrils (e.g. from a round shape to oval or triangular) WITHOUT reducing the nostril size (i.e. overall circumference)? My nostrils are not large by any means and no PS I'd consulted with ever recommended alar reduction in my case (plus I heard that you've got to be extremely careful when deciding whether to proceed with alar reduction since there's no going back if too much is reduced).......but some mentioned that nostril re-positioning & re-shaping from the round shape to oval or triangular can contribute more projection for the nose tip. So I was wondering if anyone here has done NOSTRIL RE-POSITIONING & RE-SHAPING without nostril size reduction?

 

BEFORE



AFTER






I've been going through old posts one by one and am AMAZED at this transformation. Holy cow.....PS is generally an enhancement procedure but this one takes the cake for complete transformation. And the end-result is actually quite natural-looking.

How thick of an implant would be needed to achieve such a drastic transformation in bridge heighT?.....going from nearly no bridge to such a high bridge? I'm thinking it's got to be even >5mm.....probably 6 or 7 or 8mm? Is that even possible with silicone? I thought thickest silicone implant they could use (safely, that is) is 5mm.....? Goretex supposedly can give more bridge height (safely), up to 8mm (e.g. 4 sheets of 2mm thickness each stacked together). But that post-op nose in the photos just appears so defined and pointy (almost looks like a L-shaped silicone implant??) that it doesn't look to be goretex based.

 

Wow I'm so sorry to hear that you did not get all your questions/concerns answered with Dr. Choe. He is a rather gregarious guy. I've always done my consultations in the Flushing office (on Wednesdays) and surgery in the Manhattan office so I guess I didn't know his Manhattan office had so many scheduling problems.

IMO it's definitely best to remove make-up (esp. eyelid tape, eyeliner, eyeshadow, any coutour make-up for the nose area) when going in to these consultations. When you meet with Dr. Kwak (who takes several photos of you and then performs the computer simulations), it'll be in your best interest to make sure that the before-photo is taken without any make-up......otherwise the simulated after-photo probably will be of little value.

As for before/after photos, I think you always have to ask the doctor and/or his office managers for them.....otherwise they don't necessarily show them. That's been my experience with ALL my consultations. Dr. Kwak was the only one who personally showed me the before/afters on his personal computer while we were going through the consultation (that's after I asked for the before/afters). For all my other consultations, upon asking for the before/after photos the surgeons all referred me to see their office manager/assistant after the consultation......so after you finish meeting with the surgeon, the assistant will show you the before/afters (either on a computer screen or in a binder) in a separate room or in the main lobby. With Dr. Choe my very very first consultation (for my eyes) last Sept. I didn't ask for the before/afters (coz I'd already seen so many before/afters of his bleph work from soompi, mostly of girls around my age) and they didn't show me any. When I went back for my rhino consultation and asked for before/afters, Sharon spent a lot of time in another room with me (after the meeting with Dr. Choe) going through the before/afters in a binder. With Dr. Jeffrey Ahn & Dr. Steven Pearlman, it's the same procedure -- the surgeons don't personally show you any before/afters, but instead refer you to their office managers who shows you the before/afters in another room.

 

I had an email/online consultation with Dr. Charles Lee last week and thought it was interesting that he felt the shape of the implant matters more than the type of implant and that the silicone vs. goretex decision is best made once the surgeon opens you up and sees your internal nasal anatomy. Initially I thought (and mentioned to him that) I really ought to go with goretex but he said that upon viewing the photos I sent him, either silicone or goretex could work but the best material is decided in the operating room.

Also, has anyone heard about small holes being punctured inside a silicone implant to allow tissue ingrowth? Dr. Lee mentioned this but I've never read about this being done before. If this is done, doesn't it mean that should implant removal or revision being needed in the future, it'll run into the same difficulties as goretex removal where parts of your internal tissue will inevitably be taken out as well?

--------------Here's part of the reply I got from Dr. Lee-------------------------------

For the bridge, I would use whichever implant will give you the best appearance. This is best determined in the operating room. The modern silicone implants don't have the same problems such as calcification or translucency as before. Both gortex and silicone are very good, and the material is not as important as the shape of the implant. I will keep in mind your concerns; they both can be very permanent. With silicone, small holes can be placed so there is tissue ingrowth into the silicone implant; and if placed above the covering of the bone, there is not as much resorption of the underlying bone.

In your case, I would place an implant - there is a gortex covered one that is 4.5mm which I may use, and raise the tip using cartilage as you mentioned, or sometimes donated cartilage from the tissue bank which has been irradiated and screened for viruses.

I did not see a nostril view (straight front view with your head tilted back), but I don't think you need nostril narrowing.
------------------------------

 

I vaguely recall reading about Dr. Tseng (Taiwan) sometime earlier in the thread but just went through his website in-depth. WOW is all I can say. I really like his tiplasty style. His before/after's are consistently some of the best I've seen.

Has anyone here actually flown to Taiwan to undergo rhino with him?

His website http://www.drtseng.com.tw/ is pretty much entirely in traditional Chinese characters. For those who can't read Chinese or find it hard to navigate through, here are some before/after's that really caught my eye.

GORETEX augmentation (3 sheets, 2mm each) with septal cartilage for tip, 30-year-old female











Here's a (rare) page of before/after's all in ENGLISH:

http://www.drtseng.com.tw/contentbycategory.php?openview&start=1&count=10&catid=07b9eda15c39d9e9eb4b649e357702aa

 

Hi, may I ask why you're choosing to go to Korea instead of with one of the top suregeons here in the US? What was your impression of Drs. Lee and Kwak from the consultations? And have you consulted by email with the Korean surgeons? Did you feel that the Korean surgeons were definitely better?

Ideally I'd like to go to Seoul and seek out surgery with Dr. Jung but unfortunately I don't speak the language. There are already some things lost in translation when I speak with the assistants/office managers of the top Korean-American surgeons here; some of the office assistants I've met speak broken English and address me directly in Korean lol (till I tell them sorry I don't know Korean)....I've always been told I look Korean even though I'm not. And if a complication arises (sometimes a month post-op), it'll be hell for me to fly to Korea.....or the other alternative would be another $7-10k for a revision surgery here in the US.

I know that some US surgeons like Dr. Kwak go to Seoul every year for "training" and have held fellowships in Korea (supposedly with the top surgeons there), but I wonder if the rhino results in Seoul are drastically different from the results done here.

 

Yeah, Dr. Kwak's prices seem to be on the high side -- for my case of primary rhino using gortex Diana (his assistant, very friendly lady) quoted me $7,500 excluding costs for general anesthesia/operating room which they say insurance should cover (but who knows for sure). Dr. Kwak was extremely thorough with me though and even spent time inspecting the inside of my nasal structure (during consultation)....and said that he'd do work on turbicles/septoplasty in addition to the normal tip work that comes with Asian augmentation rhino. He uses general anesthesia (not local w/ sedation) only and all procedures are carried out at St. Vincent's hospital with board certified anesthesiologists (I'll admit that I'm personally afraid of general anesthesia but the thought of it taking place in a major hospital -- not just a plastic surgeon's private operating room -- is more reassuring......just in case something goes wrong).

Dr. Ahn's quote prices were surprisingly low -- for silicone primary rhino his price is $3,500 ($1000 cheaper than Dr. Choe's!) and for goretex primary rhino the price is $4,500. All anesthesia & operation room costs included as everything is done in their private office/operating room. Honestly when I heard that his prices were $1k lower than Dr. Choe's, I thought that it sounded too good to be true. My gut feeling might be on to something though. When I looked at the price list (even the all-English version had Korean annotations explaining the little nuances of the diff't procedures, too bad I can't read Korean) and then asked his staff in detail, I was told $4,500 for goretex primary rhino. I made sure to double-check that it would include tip work, and the lady I spoke with affirmed that it does. BUT she emphasized that the $4,500 doesn't include anything else....what else.....well if after careful inspection of the nose on the day of surgery (or once the doctor opens up your nose on the operating table) and it's found that you'd benefit from partial osteotomy or alar work or more detailed septoplasty (things that often times can't be ascertained until you open up the nose for inspection), those procedures wouldn't be included in the $4,500 and wouldn't be done unless you paid for them in advance. So in a way it's almost like going to a restaurant and ordering things from a menu.....and that menu was partially in Korean and partially in English. I guess I don't know Dr. Ahn & his staff too well yet to be certain that they'll have my best interests at heart (his database of before/after photos did look pretty good though).....I'll have to make a few more phone calls and/or possibly pay them another visit this week to get more info. By contrast with Dr. Choe I already know that he'll do everything he can to carve out a nose that he thinks best fits my face (I recall him stressing that often a surgeon won't know exactly what's required or how high of an implant best fits a patient's face until you open up the patient's nose on the operating table.....once you're knocked out and on the operating table, the doctor is the one with the cutting knife and it's essential to trust that he'll do everything he can to give you the best nose possible).

 

sandy816, I tried to PM you but it seems that your account can't receive PM's at the moment (probably due to insufficient posts?). I'd definitely want to get in touch with you by email and exchange more info about Dr. Choe & Dr. Ahn......I'm really shocked to hear that you got your primary rhino from Dr. Ahn and are now needing a revision. This is truly scaring me as I'm considering going to him for a goretex implant. I'd greatly appreciate hearing more from you about your experiences with Dr. Ahn. To be honest I actually do want a high nose, a Eurasian nose, but one that still looks NATURAL and not operated.....i.e. not a Greek nose.....and I know that one of the major rules of Asian rhino is that (1) there has to be a curvature from the forehead to the start of the nose and (2) the nose should start NO higher than the eyelash line (anything higher, like at the level of the eyebrows, would scream artificial nose).

When I consulted with Dr. Ahn, he basically said that 50% of his patients want a natural look and 50% don't mind an operated/artificial look.....and that it would be up to me (the patient) to decide which look I was going for. I was actually a bit taken aback by that. I guess it just shows that diff't surgeons have diff't philosophies. Dr. Choe is ALL about a natural, non-operated look......that's his #1 philosophy from my experiences dealing with him. In fact I'd almost bet money that if someone went in asking him to start the nose at the eyebrow line or higher (not natural), he'd turn the patient away saying he won't do it.......if someone walked in w/ Dawn Yang's before/after photos and requested a Dawn Yang-esque TOTAL MAKEOVER (literally morphing into a diff't person and a diff't race), I suspect that Dr. Choe would probably not accept that patient (unless you convince him with good reasons, maybe if you're an actress and need to go for a certain look, maybe). Anyway, that's just my 2 cents from my experiences and from talking to him & his staff.

Based on what I saw during computer simulations with other doctors, I really want a 5 mm-high implant (that starts right at the eyelash line, the highest it can start at w/o looking unnatural) -- and when I told that Dr. Choe & Sharon (his long-time assistant, very knowledgeable lady) this, they told me not go by a certain mathematical # per se when it comes to p.s.......that the key is building a nose that best fits my face......b/c a ___mm-high nose by & of itself might look fantastic (standalone) but if you look at the whole picture, i.e. the entire face, that nose might not fit the face at all. This philosophy I do understand. Basically I think Dr. Choe won't promise a certain __mm implant and will go by what he thinks works best for my face (this might also be b/c he's gotten to know me/my future career transition objectives and doesn't want me to turn out with a plastic/freak face.....he really believes in "less is more").

My dilemma is with the silicone material -- I'm a really OCD person and if I can feel an implant moving in my nose years later (after the several-month-long post-op recovery/stabilization period), I'm going to go bizzerk. That also explains why I ruled out getting the double eyelid via DST and went straight for the full incision (if I sensed suture bonds breaking and the fold partially unraveling I'd go crazy). Did Dr. Choe give me a *perfect* double eyelid? I'd say no, b/c I'm a perfectionist and can always spot room for improvement....and I'd most likely say the same thing even if I went to any other surgeon . But did the double eyelid fold Dr. Choe gave me fit my face/eye anatomy/features and improve my appearance? Absolutely. I asked for a small tapered/inner fold (as my eyes were relatively big to begin with), and the fold he gave me is a very NATURAL one (for some reason I also recovered extremely quickly, 7-days post-op when I went in to get my stitches out one of his staff members was quite shocked and said I looked almost natural....that was at the 7-day mark & w/o any make-up).....now I'm at 11 weeks post-op and when I went to see Dr. Ahn last week, one of the ladies in his office asked me about prior surgery history and was surprised when I told her that my eyelids were operated on (she thought it was natural.....and then asked me where I got my eyelids done). So do I have any regrets about getting my eyelids done? Hell no (only "regret" might be not asking for a slightly higher fold....but that has nothing to do with Dr. Choe.....and at my most recent post-op check-up he said he didn't think a bigger fold would fit my face/eye anatomy). Anyway I just hope my fold doesn't become smaller later this year and onwards.....hopefully it's fully stabilized by now.

 

Pearlman, Ahn, and Kwak all do rib grafting. I had expected these doctors to unanimously cite rib grafting as the best, safest long-term option but surprisingly that wasn't the case -- at least for me (note that these things vary on a case-by-case basis and the surgeons need to see you/your nose to decide on the best augmentation material).

Drs. Pearlman and Ahn both ruled out rib grafting for me, saying that my case of primary rhino (needing bridge augmentation + tip work....but nothing too complicated) would not benefit from rib grafting. They cited the potential for warping in the long-term and also mentioned that while Caucasion nose jobs benefit greatly from autologous material, Asian rhino is different and rib grafts don't work too well in the Asian nose (the pros don't outweigh the cons). They said that only if I had to do a highly complicated revision case would they resort to rib grafting.

Dr. Kwak initially recommended either rib grafting OR gore-tex as an option for me....but when we talked at length (and I mentioned that I don't want the most invasive procedure and want there to be an option for revision later on, just *in case* b/c you never know what can go wrong and what new technological advancements emerge decades down the road), we settled on goretex as the best option of choice. He said both options would likely achieve the same result for me, and of course rib grafting is more "final" (in that it's harder to revise.....and is most suitable for revision cases where you can't use silicone or goretex anymore). As for his opinion on silicone, he mentioned that silastic implants can be fine and can achieve great results, BUT he's seen way too many silicone implant fiascos in the long term -- i.e. the patients who come to him for revision after their silicone implants shifted or extruded -- that he's abstaining from using that material himself and is sticking with goretex for his patients (either that or rib grafts). During my consultation with him, I saw some truly horrifying silicone extrusion before-photos (those who came to him for revision)......one was a lady who got her silicone implant in Korea and the extrusion was so severe that it left a big, obvious scar.....another was a lady who got a silicone implant in Hawaii......and another was a man who got his nose done in Korea years ago and the implant clearly shifted side-wise.

In terms of using silicone, Dr. Pearlman mentioned that if I want a high bridge implant (5mm), the silastic implant has greater chances of shifting down and being mobile (as it's much heavier than goretex). For me, he didn't even offer silicone as an option....basically only goretex.

Dr. Ahn offered both silicone and goretex as options in my case, but highly recommended goretex over silicone. He mentioned that research has shown approx. 50% of silicone implants will show calcification in 10 yrs. and 100% in 20 yrs.....you can google this topic and pull up some articles. So he said that while silicone is an option, it's not the best long-term choice comparatively speaking and that goretex is now the technically more superior material. He told me that he could use goretex to achieve the same height (5mm up to even 6-7mm) that silicone implants can achieve. He showed me sample silicone and goretex implants and of course the gortex felt a lot lighter.

 

For top Asian cosmetic surgeons in NYC, I've pretty much done the whole doctor-shopping round.....the top ones (all of whom I've consulted with during the last few weeks) are:

- Dr. Eric Choe (free consultation - he did my eyelids back in May and I trust him completely in that I know he has my best interests at heart and will do the best, most natural work possible; we developed a great rapport (even giving me advice about career, long-term goals, etc.) and he tells me he treats me like a daughter and doesn't advise me getting any excessive, unnecessary work on my face at this age (definitely not a doctor out for money or one of those pushy doctors who tries to sell you a menu of procedures; in fact he turns away patients who ask for unrealistic results or seem to be seeking p.s. for all the wrong reasons).....he's a great person in addition to a great surgeon (a truly CARING doctor), so much so that I've recommended my mom & other family members to go to him first......only CAVEAT is he only uses silicone for bridge augmentation (w/ septal and/or ear cartilage for tip work); does not use goretex or rib grafting.....so I trust him/his aesthetics/his skills completely but I'm not sure if I trust the silicone material completely)......BTW he also does not do computer simulations

- Dr. Jeffrey Ahn ($100 consultation fee - does silicone, goretex, and rib grafting, yes all 3 techniques available.....however for my case of primary rhinoplasty, he recommended goretex and strongly advised against rib grafting.....one of technical leaders in the field, Columbia Univ. plastic surgery dept. head, lots of publications & conference presentations.....I did feel a bit rushed through the consultation though but I did come away with the feeling that he was very technically proficient)......no computer simulation either

- Dr. Edmund Kwan (free consultation - uses silicone only......he has great credentials (i.e. looks great on paper) but I didn't emerge from the consultation convinced at all that I'd benefit from getting it done there.....I felt like they were trying to sell me add'tl procedures and promises that sounded too good to be true.....he struck me as a doctor who'd agree to pretty much anything to patient suggests, which in my experience is not a good sign when it comes to plastic surgery.......plus I didn't feel like I clicked with him or his staff......personally if I do silicone I'd definitely stick with Dr. Choe)

- Dr. Edward Kwak (free consultation for the month of August/Sept. only - does goretex or rib grafting - extremely knowledgeable & thorough in consultation, I could not have gotten a better consultation......does computer simulation during consultation which proved immensely helpful.....very scientific & no b.s. or empty promises in his explanations (generally I can sense when a doctor is giving me b.s. answers as I also come from a science background).....he spent a full hour with me in consultation (not even counting time for photographing & computer simulation) and I was very very impressed.......great before & after photos.....he's quite young though -- 8 yrs experience which includes ~4 yrs residency......but reportedly highly skilled, well published/cited.....highly recommend that you go to Dr. Kwak for a consultation -- if anything you get to see a computer simulation)

- Dr. Steven Pearlman ($250 consultation fee - very friendly, professional, and knowlegeable.....but the priciest NYC surgeon of all, likely b/c of his reputation in fashion magazines/etc. and amongst the Upper East Side socialite scene.......does silicone, goretex, & rib grafting but ruled out rib grafting for me and also recommended against silicone.....basically recommended only goretex in my case.....does a computer simulation which is helpful -- BUT I went to him before seeing Dr. Kwak and kind of regret it, b/c I basically wasted $250 on a computer simulation when Dr. Kwak does it for free AND is more thorough and scientific in his analyses & explanations.......also keep in mind that Dr. Pearlman doesn't do Asian noses that often, in fact they had 0 Asian rhino before/after photos to show, saying that his Asian patients (which are few & far in between) were mostly very private people who didn't want before/afters shared.....anyway I was only able to view bridge augmentation before/after photos of African-American noses to get an idea of his aesthetic for augmentation)

IMO you should go consult with Drs. Choe, Kwak, and Ahn. Omit Pearlman and Kwan and save some money & time.....unless you're needing a revision and expect it to be a highly complicated case, in which case you might consult more doctors just to get additional opinions.

As for me, I actually have a date booked with Dr. Choe for silicone but am now having serious doubts about the implant material (not at all about his technical ability/aesthetic) after talking with Drs. Kwak & Ahn and hearing about the long-term side-effects of silicone (including calcification, extrusion.....even saw some truly disturbing photos of silicone extrusion on some patients who got their primary rhino done in Asia/elsewhere and subsequently had to seek out Dr. Kwak for revision with goretex or rib grafting). So I need to decide by early next week whether to cancel my silicone date and go with goretex (in which case I'll be deciding between Dr. Kwak and Dr. Ahn).

HTH!

 

I have a post-op skin care question for those who've had rhino (with bridge augmentation + tip work).......I know that of course one must be extremely careful with the nose for the first 1-3 months post-op, but from 6 months post-op and onwards, can you go to an aesthetician or dermatologist to do say, a facial with blackhead extractions on the nose area? Or is that no longer possible after rhino? Also, does the skin on the nose area break out more (pimples, blackheads) during the months right after rhino? My T-zone/nose area have been acting out lately (these past few months) with blackheads and excess oil problems (I have combination skin but never had acne before on other regions of my face, only severe problems on-and-off with blackheads in the T-zone area). Facials and dermatologist appointments are helping a bit (and gradually), but these types of skin imperfections don't go away overnight.....literally take weeks to months. Ideally I'd want to get those completely under control before undergoing rhino....but schedule-wise I only have a 2-week window later this month to undergo rhino (and recover for 2 weeks at home) and that window of opportunity won't be available till probably next year or years later.......so I'm wondering if rhino could exacerbate any existing skin conditions and rule out the possibility of blackhead extractions later on? Any advice from those who've undergone the procedure would be greatly appreciated!

 

Has anyone heard of Dr. Kim based in Atlanta?

I came across http://www.kimfacialsurgery.com and was pleasantly surprised to see some of his before/after sample photos.

In particular, this set at http://www.kimfacialsurgery.com/rhino2.html





Is it possible to discern the type of implant likely used for this bridge augmentation? Silicone? Goretex?

I've seen a lot of before/after photos where the change is almost unnoticeable whereas in this set of photos there's obviously a significant change (and very much for the better, IMHO).