asian nose job 2

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Part 14

IX/ Consultation at April31 clinic :

A/ The consultation

Dr Kim is not friendly. He gives the impression to not listen. He will say "I know what to do." "I can fix this." He says he can fix all the things you ask, in a confident manner but doesn't explain how he would do it, so it leaves you with the impression that he would just do what he thinks is right.
He uses silicone mainly and ear and septal cartilage. He doesn't use fascia from butt or skull (I don't think so, for the skull).
I asked him about the alar rim graft, he knew exactly what I was taling about he said "I know" and seemed to want to move on. He seems like he doesn't want to talk and don't have time. But in a technical way, he knows all the procedures and is confident.
I was left with the impression that he could do all technical and difficult procedures.
Also, he remembered all my pictures and the surgery report. I was surprised because I had no online consultation, as they never answered to my email but they remembered all the content of my email.

B/ The before and after pictures

He gives flexible noses and seem to emphasize the natural looking nose.
I saw fake looking noses that became natural looking after. On their website page april31.co.kr , they say they get rid of the "operated looking nose".
There are no before and after pics on the website (needs a login, and even with the login there are only 4 pics). Nevertheless, basing our decision on the number of before and after pictures is really not a good idea, as they always put their best before and after pics and also because a beautiful profile picture is nothing like a person's nose in real (eg: the affected smile, or immobile nose)

C/ English

They have an assistant, he have a little bit of English, but enough to understand.

 

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Part 15

X/ Dr Paik from 101 clinic :

A/ The online consultation

He has taken the time to look at my case and answered explaining his plan on my surgery. He recommended the removal of all grafts to have a flexible nose again and be able to smile like before.
He signed with his own name. He wrote the emails himself and remembered all my pictures (around 8) and the surgery report.

B/ The consultation

He was very humane and asked what I wanted and how he would do it. What he thinks is possible and what he thought would be difficult to achieve, what he would recommend and what he wouldn't.

C/ Location

The clinic is not easy to find by taxi, it is far away from the Apujeong and Sinsa area, where all the clinics are. Also, I don't think he works on Saturdays.

D/ Before and after pictures

I don't think there are any on the website, but once again, I made a mistake to choose one clinic because there were 24 pages of before and after pictures.
Dr Paik showed me 3 or 4 pictures of my case (patients who wanted to remove all rib cartilage) and had derotation of the tip (turned downwards for upturned noses). The noses looked very natural after.

E/ What I mean by natural looking nose
When I say natural, I mean, apart from the columella scar, you could tell that you didn't have a rhinoplasty. Nevertheless, a bridge might not look natural because there isn't the natural hump, but in my case, I keep my natural bridge, so the only corrected thing is the tip and a natural look on the tip can be achieved.

 

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Part 16

XI/ VIP online consultation compared to other clinics

Overall, we can tell from these consultations, that Dr Lee is so busy doing all kind of procedures, he doesn't answer to patient who send an email concerning rhinoplasties. Only at VIP, do the receptionists answer to your questions. It may seem understandable because the surgeon is too busy (he just answers to few specific questions). But in other clinics, the rhinoplasty surgeon answers himself to your questions and they are not less busy, nor popular than Dr Lee. It is actually easier to get a surgery date at VIP clinic than it is for the two last clinics I mentioned.

 

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Part 17

XII/ My rib removal experience

I wish I could say it was 100% successful. It is much better than having the rib cartilage nose but I wish 100% of the rib cartilage was removed.
When I was there, I thought, maybe I should leave some rib cartilage in my tip because the doctor says it would not obstruct my smile, and I don't want to waste the fact that rib cartilage was harvested. After all, I have a 3cm and 2mm wide dark scar under one boob and it is inevitable that my boyfriend (when I'll have one) will ask me if I had a boob job. Luckily it was not on the left side, because otherwise we can appear as if we had a heart surgery...not the most attractive thing. Also, I don't think I am ready to say "I just decided to have my chest cut open to put a piece of rib in my nose."
So, I thought it was okay to leave some rib cartilage in my nose. The problem is that rib cartilage is so stiff.
So, my bridge was removed, leaving me with my natural bridge that I think is too high. Dr Lee has done an osteotomy on the left side, so my bridge seem higher and sharper than before. I wanted a lower bridge or at least my old bridge, but this is not possible. Also, he did an osteotomy that left lots of bumps that were going to be hidden under the rib cartilage ( which size was around 6cm long and 4mm width). The surgeon who did the revision only shaved on bump in the middle of the nose, but not the one at the top, we cannot see it, but we can feel it if we put the finger on it.
I could have been happy if it wasn't for the septal cartilage support made of rib cartilage that was left in my nose.
Indeed, Dr Lee remakes the entire structure of the nose. According to the information Jesse00 gathered, someone told her it is difficult to revise Dr Lee's work. But, nevertheless, it is still possible.
So, since my septal deviation that never bothered me has been sliced into a fringe, the septal cartilage that cannot hold by itself anymore, therefore it needs support on each side with some rib cartilage walls. Since he harvested rib cartilage, he may as well put some of it a little bit everywhere.
The problem is that we are not statutes, we are human being with soft tissues. Therefore, having all rib cartilage grafts removed except the one that suports the septal cartilage has still left stiffness in my nose. During my second trip in Korea, I thought it was due to the swelling of the second operation, but now, I realize that these two pieces of rib cartilage (around 1cm long and 2mm width) are extremely stiff and my nose has still not recovered its flexibility and will probably not until I remove these pieces of rib cartilage. I have made the mistake to not insist in removing all the rib cartilage. I am not satisfied of the fact that I'll have to plan a 3rd trip to Korea and lose again a lot of money to have these 2 pieces of rib cartilage left in the side walls of my septal cartilage that was sliced. I'm trying to reassure myself that at least leaving the support to the septal cartilage will allows the septal cartilage to heal, being straight. But I am not sure, as I read that septal cartilage doesn't grow back (on the thoracic cage, I am not surprised, but can it fuse ? if someone have an idea about this, let me know).
I remember a forumer Shrodinger asked if having a rib cartilage rhinoplasty was an endless trip to rib rhinoplasty revisions. I think it is the case until you remove all rib cartilages or not, if you can live with a very stiff nose making some facial expression more difficult to produce.
Because of these 2 pieces of rib cartilage, I still cannot roar like a cat, expression that I used to make to express miscontentment. The upper part, where the rib bridge was removed, can naturally wrinkles (the skin on the nose moves naturally now), but the tip does not move up because of the septal cartilage support, made of hard rib. Facial expressions are very important to me as I used to express myself with my face a lot.
Also, it is not only this, but because of this support, I still have the impression that my nose is fragile because of lack of flexibility, if I'm hit on my nose by accident, I have a fear that it's just going to break and it won't be able to heal naturally, as any nose without rib cartilage would do. If anything happen, a trip to Korea is necessary. So, that explains why it is better to be nice to Joann on the forum or in real if we want Dr Lee to fix all after sales problems, it is a sort of insurance.
So, because of these 2 rib pieces, when I make facial expressions, my nose would not go up like it would normally do if I roared like a cat. It is interesting to look at, you just look weird, if a person knows about plastic surgery, they would just say you look operated.
Every morning when I wake up the first thing that I feel is the rib cartilage on the sides of my septal cartilage that is pulling. It is very uncomfortable, but people can live with it apparently. But I am the kind of person who would favor comfort above beauty, for example, I would not wear high heals, because I like comfort, or I'd wear titanium frameless glasses instead of designer glasses for the sake of comfort, even if I look a little less good. If VIP clinic had warned me about the stiffness and difficulty in making facial expressions, I would have never gone under the procedure.

Concerning the appearance of my nose. Overall, it is like my natural nose, with a more obtuse angle, a defined tip (not bulbous anymore, the other surgeon used shield graft giving me a very nice and soft tip with ear cartilage) and more projection. So, it does look better and I am happy about its appearance, even though I still think the bridge is too high, I wished I had a small nose, but I guess I'll just keep it natural, as I think my nose is good enough now. The only problem is the fact that I have to go back to shave a bump from the osteotomy, and remove all the rib grafts remaining, it is very annoying that I have to fly back again, I thought that was over for me. The remaining rib grafts are so stiff, I 'd like to go as soon as I can, but the problem is because my septal cartilage is sliced, I am not sure the surgeon will accept to remove the rib cartilage supports that early. Also, I have spent all my money because the surgeries were not successful for me the first time. And I start to be scared of the columella scar if it is being open too many times.

My entire nose is close to flexible, only the septal cartilage walls is ultra stiff.

 

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Part 18

XIII/ The smile

Concerning the smile, apparently, every open rhinoplasties slightly affect the smile for a temporary period after the rhinoplasty. It is because nerves have been cut, and some nerves can grow back, probably the ones on the columella can.

Concerning the rib columella strut, it was in between the septi nasi muscle, like a fork, it had a shape of a Y and was 2cm long. The two ends of the Y was in the muscle. So, it was obstructing the smile and waiting few months would have not changed anything, from what I could observe and from what surgeons (professor at universities) have said. This is my case, maybe others have been operated differently and will recover their smile, but I doubt that they will recover their smile fully. We may get the impression that we have recovered but pictures are a good reflection of reality sometimes. I also have the impression it is okay in real but on pics, I am horrified again.

Also, the stiffness of the nose does not contribute to flexible movements of the face, leaving our face with a "distant attitude look" or just a less smiling face. As we are healing (healing process with rib takes months, but even years as it reabsorbs), we tend to smile less, it is also much more effort to smile.

 

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Part 19

XIV/ I am not revealing the surgeon's name

I am doing so on the forum because, my case is still unfinished and I remember that when I went to Dr Jung's manager (Jay Lee) he said he'd prefer that I do not see Dr Jung because they don't want VIP clinic to think that they still their clients. He said VIP marketing power is very powerful. Also, Dr Jung would accept to fix me only if I ask Dr Lee first to ask Dr Jung to do so. I met a forumer in my linvingtel in my 2nd Korea trip and she said that Dr Jung corrected some VIP patients. Nevertheless, I also think that Dr Lee has done revisions on Dr Jung's patients.
Also, all the rhinoplasty specialists in Seoul know each other and they respect each other. I always said that Dr Lee was a good surgeon but said that rib cartilage was too stiff, they all understood and they would have done the revision for me. They correct Dr Lee's patients, as well as Dr Lee may have done revisions on their own patients too.

XV/ Prices for rhinoplasties

-rib rhinoplasty at VIP : USD 9000, add USD5000 if rib revision -to remove the rib-, so total rib revision is USD14 000 (or a bit more than 14 000 000 KW), add USD1500 for paranasal implant or maxilla implant.

-rib revision at Dr Suh : KW 5 000 000 (KW1000 is a bit less than a dollar)

-rib revision at Dr Paik (101) : KW 6 000 000

-rib revision at Dr Kim (April31) : KW 5 000 000

-rib revision at Dr Jung : USD5500 (rib rhinoplasty is USD8500 because it includes the harvesting of the rib)

You see these differences in price and you must think VIP clinic must be the best. It is not the case, Dr Lee is a good doctor but the others are very good too as they are university professors or have important positions in rhinoplasty commitees.
I had a lot of money to spend before my Korea trips and I thought I would not make a choice based on money, but only on quality. So, I thought I'd go for VIP as I thought the price must justify the high pricing. But the only thing you pay is airport pickup, accommodation and two nights in the recovery room that you don't get at other clinics. It's a service for foreigners who like to be taken in charge from the day of arrival until the end. Once we're in that VIP atmosphere, we're left with the impression that only VIP is a safe place with a good after sales service but it is not the case. After my rib revision, I was offered a teeth whitening of a value of KW 200 000 and they offered to accompany me to other clinics and act as translators (without getting a commission as I said to which clinic I wanted to go to). They gave me pictures of the actual surgeries, whereas in VIP they refused to even give me before and after pictures they've taken of me. And the staff at the clinic where I had the nose revision spent hours advising me on where to go to visit Seoul (shopping, museum etc.) and most importantly they did not remind me that they did a favor for me like "we fed you when you were hungry", when you actually never asked for anything. That's just a detail, but the thing is the price is almost double and it only includes the accommodation and pick up, no other extra services, or maybe the facials and shampoo, but still, the price is not justified, not even by the quality of the nose job which is just equal to others. At least it gives them enough means to have a powerful marketing power and probably enough money to pay English speaking people or old patients to praise their clinic on the forum (even though they already have the pressure of free revision). Also, I always found it weird that people would come on the forum to just day that they are happy about their VIP rhinoplasty. We never see patients from other clinics going on the forum just to drop a line and say that they are happy without bringing info about their experience or the consultation they had.
Anyway, compared to other Korean clinics that are sometimes better, VIP clinic is just overpriced.

In general, a tip work for a primary rhinoplasty with alarplasty is around 2 500 000 KW (a bit less than USD2500) in most clinic even those where the Korean stars go to (eg: Dream clinic -I do not recommend Dream for eyelid surgery though-, Dream seems to be good for natural, small corrections and closed rhinoplasty that I recommend over open rhinoplasties for primary nose job).

Dr. Moo Hyun Paik : 101 Plastic Surgery Clinic http://www.ps101.co.kr/language/index1.jsp
Dr. Young Hwan Oh : O & Young Plastic Surgery Clinic http://koclub.com/
Dr. Man Koon Suh : Jung Won Plastic Surgery Clinic http://jwbeauty.net/
Dr. Jae Hoon Kim : April 31 Clinic http://www.april31.co.kr/

 

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Part 20

XVI/ Banobagi

Dr Lee from Banobagi, I did not consult with him. I thought the clinic was too big, a bit impersonal.
I talked to Reiyuna who went to Banobagi with two other forumers. The 3 of them are unsatisfied. I think they had small changes though, maybe they had too high expectations, I did not ask why they were unsatisfied. For Reiyuna, it seem that her 3/4 angle is giving her a bird nose (because it is too big).

In my livingtel, 2nd Korea trip, I met one girl that was happy. She had an alarplasty reduction and tip projection. Then, she had free filler injection because her projection made the tip a bit too high and the bridge was very curved in almost an unnatural way. She had a slight change and it was a very good improvement I think, compared to her before nose.

XVII/ Going for rib or not

If you don't mind living with the discomfort of a stiff nose and you don't plan in doing any sports in which the nose might be touched, rib can be an option.
If you're a male and want a significant augmentation or if deep inside you, you always wanted to be caucasianized, rib cartilage is a good option.

I think rib can be of a good use for the bridge but it is exactly the one part where surgeons do want to use the rib because the radix part with a rib cartilage is difficult to make natural. Dr Oh from O and Young offers rib cartilage bridge but wants to finish the radix part with silicone.
I don't think rib is a good option anywhere around the tip that should remain flexible.
As for the person who asked me why, if rib has existed for years, it has not been improved. It just can't be changed, rib is very stiff and wherever it is used, the patient will feel the stiffness in that area. Some can live with it, but in my case, every time, I wake up, even though I only have these 2 pieces on the septal cartilage wall, I can feel its stiffness and when I try to make a facial expression the nasal base is not lifted up just because of these two pieces, so I let you imagine when you have 8 pieces. I inititally had 8 pieces of rib cartilage (that I am aware of) : 1/bridge, 2/ 2 for paranasal implants, 3/ 2 for each alar rim, 4/ columella strut 5/ 2 on each side of the walls of my septal cartilage. Also, I guess stiffness can occur with silicone too if a great amount of it is used. Dr Lee likes great changes and tend to modify noses more than slightly enhancing them. The person I met in my second trip said she decided not to go to VIP because she felt that Dr Lee would be disappointed to just operate a slight change, but in her case I already thought the alarplasty and tip definition work was already a huge change from before.
Also, rib cartilage reabsorbs unevenly sometimes, Townstory came back for revision after she had the rib cartilage rhinoplasty at VIP because of uneven reabsorption, so the skill of the doctor does not prevent from rib cartilage revisions.

 

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Part 21

XVIII/ Other autologous tissues

-fascia from skull, from butt
-ear cartilage
-septal cartilage
-diced cartilage
-septal cartilage filler

Conclusion

By writing long posts, I expose myself and give more opportunities for people to attack me. I think I have done what I should have done to help people who will chose to do a surgery in Korea or for those who have already done it and are currently healing. I am sorry if I offended anyone for mentioning nicknames or saying positive and negative sides of my experience. I did not re-read my post, as it has already taken a long time to write it. I hope there aren't too many spelling mistakes.
Anyway, I hope the information I just posted will be helpful.

 

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Part 21

XVIII/ Other autologous tissues

-fascia from skull, from butt
-ear cartilage
-septal cartilage
-diced cartilage
-septal cartilage filler

Conclusion

By writing long posts, I expose myself and give more opportunities for people to attack me. I think I have done what I should have done to help people who will chose to do a surgery in Korea or for those who have already done it and are currently healing. I am sorry if I offended anyone for mentioning nicknames or saying positive and negative sides of my experience. I did not re-read my post, as it has already taken a long time to write it. I hope there aren't too many spelling mistakes.
Anyway, I hope the information I just posted will be helpful.

 

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@Kain: I think your nose structure could have made possible using your own tissues as it was your primary rhinoplasties. An assistant of another clinic told me it is very rare to use rib cartilage for primary rhinoplasty as there are still all the other cartilages. Nevertheless, it might have been a good thing to have your rib harvested for a dorsum augmentation.

@Izora: Even though rib cartilage was not for me. I would like to thank you for your long emails. During my other consultations, I have seen before and after pictures of patients who had a short nose like you and they have been elongated the same way your nose was, using other materials than rib, but they may not have been done with autologous tissues, or maybe they were, I don't know.

@Bisousx: When I saw the Teri Hatcher picture, I thought I had the exact same smile after my rib rhinoplasty, I could not lift my smile more than her on the after picture (the right one in my post), even though in other pictures or in her current series, Teri Hatcher can smile more widely than on the after picture of her I posted. In my case, I couldn't. I was glad to find a picture that exactly described my smile.

 

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For those who asked me about Dr Suh (JW clinic), when I saw the picture below I thought it looked like the tip she had with Dr Suh.
This picture is not from JW website by the way (I don't remember which clinic's website I took it from).
It may look good on the picture below because her alar rim (wings) fit with the tip, but the Vietnamese girl from Canada that I saw had very round alar rims and it did not match with the sharp tip. When I asked why Dr Suh did not touch the alar rim (eg: putting a ear or septal cartilage graft -but from my consultation he didn't know about this or didn't do it on his patients-), she said he wouldn't touch that area. So, I am not sure what he does to correct alar rims, but it appears to me that he tends not to touch it.

 

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Dr Suh's type of nose tip (from one patient I saw).

 

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Sorry, I didn't think the pics would end up that tiny...
I don't have other pics.

 

[catcafe]

Thanks angleplane for the write up! Who would you recommend for a primary nj? I want it to look very natural but most of the ones I read about make them too high etc.

I'm thinking about 101, april31 or banaobagi. Maybe dream?

 

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kayrider said: ↑

JUST came back from consultations with Banobagi and Dream. Banobagi at 10 a.m.: I arrive at their yeoksam location, which I booked a hotel there for 4 days and planned on booking the hotel for a longer period of time. Then I get at Banobagi at 10a.m sharp and mira calls me and tells me that the doctor is at their new location. She tried calling. Well, I asked her why didn't she email me? This is now at 10:40ish. But in their defense, I do call from my skype number. And they also paid for the cab to get me to their new place. No harm there.
So off to see doctor Lee who knows very little english. I guess it was Mira who was there too to make sure I knew and he knew what I was talking about. They took pictures, and we critiqued together. He said that he wanted to do lateral osteotomy, then do a septum cartilage to add to my nose, to keep the tip stronger. Then add Silicone to fill in my radix that is slightly shallow. Then shave down the bump of my nose. No heightening of the bridge like I thought, but more work then I thought. his prices were fair, but his eye procedure is more expensive than Dreams.

Dream: I see a woman named Kim first and she knows more english than doctor Lee from Banobagi. I get to see dr. Park personally. His humor and personality is very dead. But what I liked about him, was that he showed me what he wanted to do by touching and using his little metal stick. He pointed and squeezed to show everything. Now this is the complicated part: He wants to do 5 things to my nose!! BUUUUTTT, no implants from silicone or gortex. He said he wanted to do septoplasty, get rid of the hump, clateral septomy, and something else and U-graft.
WHAT IS A U-GRAFT? the way I heard from kim the consultant and person who works out prices, its to strengthen the tip of the nose but not change it, and will make the outter part of the nose look slightly tighter by harvesting some cartilage from my nose. And also, Dr. Park said he would harvest something from the inside of my nose to add to my radix. All this was more than I expected. But since my nose is slightly curved to my right, which is something I give dr. Park credit for seeing without taking pictures, he showed me how to straighten it, but would have to re-fracture my nose. He said the swelling and everything would go down in 3 weeks and will be able to take photos again.
What are people's thoughts about this? Is the U-graft good? He agreed that everything I was doing was not drastic, but it is an invasive procedure because of the refracturing and straightening of my septum. And he did tell me everything is going to be very small changes. And I mentioned, less is more on my nose.

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did you do your surgery already? xxx i'm going to korea in 10 days and want to make i'll choose the right doctor!