In this insightful episode of Plastic Surgery Uncensored, Dr. Rady Rahban, a Board-Certified Plastic Surgeon, and his patient Chloe explore the journey of revision rhinoplasty. Chloe opens up about her experiences, both emotional and physical, after undergoing a primary rhinoplasty followed by a revision surgery. The conversation sheds light on the importance of realistic expectations, open communication, and understanding the long healing process that follows nasal surgeries. Dr. Rahban emphasizes key elements for successful outcomes, including patience, mutual trust, and maintaining an ethical approach to patient care. Whether you're considering rhinoplasty for the first time or contemplating a revision, this episode offers valuable guidance on how to navigate this complex procedure with a trusted surgeon and avoid common pitfalls.
This is an automatically generated transcript. Please note that complete accuracy is not guaranteed.
Welcome to another episode of Plastic Surgery Uncensored. I'm your host, Dr. Rady Rahban, and we have a fantastic episode for you. It's a fantastic episode, not just because all of our episodes are fantastic, but because I'm very excited about the subject matter, because I think it's a subject matter that's very relevant and very poorly discussed, and I think we're going to have such an incredible dialogue about revisional rhinoplasty. So any episode we have, if we have a patient who's willing and courageous enough to come on the show, it's just that much better than me just babbling on my own.
So I'm grateful to you, Chloe for coming today. We've known each other for quite some time, right. We have at least four or five years now, four. Or five years.
Yes, I had the pleasure of meeting you for it. Primary knows right. You came to me and you said, hey, doctor. You came with your parents to just left, who are lovely people.
I just adore them. And it was a dialogue about, Hey, I have issues with my nose I don't like and I'm contemplating fixing it. You and I went through the analysis. We talked about what I saw, what you saw, what we thought we wanted to do, and lo and behold you opted to go ahead and proceed with surgery.
So fantastic I think that we did that in twenty twenty. Yes, right, yes, So we operated on you and for the most part you were happy, right, like, so take me through. So we did your rhinoplasty and talk to me about like the outcome in terms of like I didn't like it, I did like it? What did you? What was it like? I think, well, initially, I always appreciate your approach that we're not trying to match a photoshop image, that we were really trying to figure out a nose and proportions and features that we're going. To match my face.
Sure, and so we discussed. I felt very prepared going into the surgery because you didn't set unrealistic expectations for me. But we also were on the same page that I wanted a very natural look, and especially immediately before the surgery. And it's felt very validated and felt good going in.
Which is really important. Right, You're great to me, Like, I've never get my nose done because I have trust issues, and I'm such a picky person that I would never be able to do it. But the idea is like you go to sleep, you wake up and your face is not the same, And that to me is such a massive leap of trust and faith that is just mind boggling. And I never take it for granted that this person basically goes to sleep and based on a conversation, I'm going to alter their face.
So it really makes the patience, I think, be able to go into it with greater ease if they feel like we're on the same page and as you had said, feel confident that you know, you understand what we're doing right. And I think for me personally, having the education to really understand what you were doing from a technical perspective sure was also. I think it's different for everyone, but for me that was very helpful, just to really understand the steps, the process, how you were approaching it. So I felt like confident going in prepared I've seen all year before and after general was a big fan of the work, and I liked the result.
The result was great afterward. Right, But the result took a little time at. Some time, and then it also and I think This is something I didn't realize about rhinoclastic, is that you have your initial result, but it's going to keep changing over the course of that first year or two. So if we go back to our consult, if you remember, and this is something that I do in all consults.
I get to the area where it's his risks and I go bleeding, infection, super rare scars, tiny little incision, nobody sees, difficulty breathing, septum, turbine it, whatnot. And then I write irregularities, asymmetries, contour deformities, and then I circle it. I have this very specific thing that I do, and then I translate for you what does that mean? And I write your nose will not be perfect? Yes, remember that, yes, And then I say to you You're like, what does that mean? I mean, here's your current nose. Your nose has got a bump and a nostril is bigger, and it's downward whatever it was, And here is your nose if you and I were to draw it on a computer AKAA, photoshop or morph which is super common that I don't do.
This is your nose on that computer. It's perfect, meaning it's straight, nostrils match is high low, whatever you want. So when you're done with your surgery, irrespective of the surgeon, you're going to end up somewhere in this vicinity, which is let's say, eighty percent of the way there. If you're a generally reasonable individual, which I myself am not, you'll say, well, holy shit, this looks better.
I mean, this is way better than it was before. It's not perfect. The nostrils are a little off, and maybe it's a little crooked, but it's so much better. I'm happy.
Then I'm happy, and you're happy. That's what we do. But there are some individuals they find in that following that twenty percent, they're nitpicky there, Oh it's better, but like no, I got this thing here and that thing there and there will be unhappy. And I tell them, don't do your nose.
If you're a picky person. I'm a picky person, don't do your nose because it will have issues. Not maybe it will have issues, and as a result, you will end up thinking this was a waste of time. So I tell that to everybody, and then we also talk about how long it takes for your nose to heal.
And I say, you have a one week, a two week, a six week, and a one year follow up. Yes, And then I say it two year or three year, a five year and a ten year yes, Well, what the hell am I coming at two years and three years and five years? And what you think I see my breast dog at two years three year? I don't. I only see my nose. And the reason I see my noses at two years and three years and five years and is because the nose is a pain in the ass.
Like other areas, it takes forever to heal, eighteen months, twenty months, and it keeps changing. And it's one of those things that's incredibly frustrating as the surgeon and incredibly frustrating as the patient. And as a result, so many surgeons don't do rhinoplasty. They just don't do it.
The time and money I make, I could be doing five breast dogs. It would be ten tummy like. There's a million other ways to be spending my time. I do it because I love noses, but because of its unpredictability.
What unpredictably there's healing, there's scar tissue, there's contracture. The nose changes way more than you would imagine, and unlike a breast the changes who nobody notices it just looking at their breast and staring at it. In my right nipple and my no one's staring at their tummy tuck. But the nose is smack dab in the miliar phase and the slightest changing are going to be notable.
Whether they're good or bad is notable. So you did your nose, yes, and then we would you were coming to your follow ups, I'm like, how do you like it? Like? I like it? I like it. I like it. I like it.
And then at some point in these follow ups, because I keep following you, right, because you would have gone out to see nine out of ten surgeons after like two months, right, they're like, it's been great, right, Uh, call us if there's a problem, right, right, So you're out and it's five years ago, you know, six months, seven eight months go by and if you're having an issue, you actually have to call them and make an appointment, whereas an ours calendar you're coming in. Right, we were actively just like tracking correct. And in one of those events, what happened and I remember it was probably at your three year. Yes, and I think it was like both of us looking at the nose together and there was just a little on one side there was a raised bump correct that we were both both could like it was becoming a little bit bitter.
It was becoming more noticeable. So there was an area in your nose around three years that was becoming a little fuller and noticeable and kind of throwing off the aesthetic a little bit. Yes, right, And this is the most important part about this episode. It's when and how do we deal with ideas of revision in general and in particular with noses.
So you said to me, and I remember this very vivid, like, hey, doctor Rabon, I'm like, how's it going. You're like, it's going pretty good. And this is going to be very important for you to hear if you're a patient out there. You didn't come to the consult guns blazing.
You didn't come to the consult agitated, irritated, inflamed, argumentative. You didn't come in and say, hey, so, Hiloe, how you doing. I'm upset, doctor Rbon. Okay, what's the matter? Well you see this thing here? Well, what is this thing? You didn't do that, because had you done that, a normal surgeon, which is a normal person, would get defensive.
They're a person. So if you come out of the gate and all of a sudden start complaining and your argumentative, don't be too surprised that your surgeon is defensive. And then they're going to be like, what do you mean Your nose looks so much better? And then we go and get your photos, and then we look at your photos and it's unarguable. Yes, right, it's unarguable that you look.
Way better, one hundred times better. Right, But it's also unarguable that this thing is there. Right, And. I think too from you know, the non medical perspective, I'm just seeing it in my daily life.
I don't how I kind of approached it was like, maybe there's a different solution than surgery for this, you know, maybe there was other options, or maybe surgery was the option, but I just wanted to come in and get all my options explained to me. Sure, But what I want to highlight really for people listening is way in the manner in which you approached it is very important in that it sets up a circumstance for you to start having a dialogue with a good surgeon so that you can address such a thing. So you said to me, Hey, doctor Bond, I go, how's it going? You said, it's great? I go, how's your nose? You go, I love it, it's great. I noticed that this thump is forming.
I'm like, And then a good surgeon, when you have a good patient who is not being aggressive, should be like, yeah, actually, you're right, I do see that. And what did I say? I said, yeah, actually I do see that. And that's like really annoying. And I'm like, well, this is probably some scar tissue and some changes in your cartilage that's forming over time.
Let me take a look closer. Look. So I'm not defensive, I'm not argumentative. Then generally that's you know, it doesn't fall on the patient, but definitely if you come in agitated, you're going to agitate your And then we started having a dialogue and I said, well, okay, yeah, this is kind of shitty.
This is like having a scratch on a ferrari. Yes, exactly right. Is that what I said? It's like, here you have this ferrari and it's got a big scratch on it. And the question was, hmm, what can we do about it? And in your instance, really the only thing was one of two things.
Leave it alone, or I have to go back and revise it, right, And so this is really important for people to understand. Revising a nose is super difficult. Patients think you just go back in and shave that thing down, and that's absolutely not what happens. You have to open up this hood of this car which is glued on.
Right, you're super thin skin, which makes every little irregularity a thousand times more visible. Right, if you have thick sebaceous skin, we could leave a quarter in there accidentally and nobody would see it. But since you have paper thin skin, every little couple of millimeters like what is that thing? So we have to peel open the skin without damaging it. And then there's a wad of scar tissue and these pieces of cartilage all glued together, and then we have to dismantle what we did and rearrange it in a way that's more desirable.
So surgeons when it comes to revising a nose are generally much more reluctant than if you are revising other things. It's not just purely because we're defensive. It's just like, well, shit, this could go wrong, right, So then you have to have a conversation with the patient you have to say, well, we could go back and fix it, but here are the risk associated and the risk is it could get worse, right, you could have necrosis, you could create new issues that you didn't have, et cetera. But in your instance, what was our dialogue? I mean, I mean it was very very open.
I'm what I always appreciate when I'm in this office with the when is like we're working as a team to try to like make the best decision together. That's how I felt, sure, and you were giving me all the risk and what I was like, you know, what is the percentage that were weighing of like the good versus bad outcome? And when we were reviewing all those options, there was a much higher probability that we were going to have a good outcome than a poor outcome. Sure, And I was really doing off having trust in you and you've seen this many times before, and like the odds were likely that we did a better result than what we had. Right.
So this is really important now for the surgeon side. So the patient part is if there's something that comes up, approach your surgeon with kindness. If globally you're happy and something is not exactly the way you want treat them like you would some friend or family member who spent a lot of time and energy trying to make you happy. So don't come in there complaining without even at least acknowledge that you're so much better.
From a surgeon standpoint, you can't gaslight a patient. You can't be like, come on, you so much better than before. Let me bring out your photos. And I could get all inflamed, right, and I could be all defensive and irritated and insulted, and frankly, I also can be like, wow, I don't want to open this thing up because I don't want to deal with this shit.
There's not a lot of money in it, right for a surgeon, Like, we don't charge you almost anything, right because you're my patient. It's my policy. My policy historically is since my revision rate is small, I'm not going to end up trying to charge you a million dollars to fix something that we already spent a lot of money on. I just want you to be happy, So there's no money in it for me, So I can be really like, try to discourage you.
But a good surgeon is going to look at it in his mind or her mind and say can this be better? And the truth of the. Matter is that you're a beautiful girl. We did this rhinoplasty, those change which is no one's fault other than the process. And I had to ask myself, do I feel that I could go in there and improve this and give this patient instead of an AUS an A or an A plus? And I think that that's something that his churching has to ask themselves.
And because you're such a lovely patient, it was worth it for me to do because the inherent risks you were the type of person that I'd be willing to take that in. You see, patients don't understand their contribution to it. If you're a difficult person and you're challenging and very nitpicky, Do I want to open up your nose a second time only to have it create new problems? You damn well know I'm not going to. But if you are sweet and open minded and reasonable and understand the risks and we do it collectively, then I'm more inclined to want to do that.
Because as a surgeon, from the beginning, your goal should have been what to get the best out come possible and sometimes and with rhinoplastis often it is in the first time. So the revision rate in rhinoplasty is by far the highest rate. There are papers that say it's well over twenty percent. Think the Lord, my revision rate is substantially less, but it's not zero obviously not right.
I'm gonna do hundreds of these, and if I'm just par for the course, twenty of them are going to need to be revised, let alone less. I'm just gonna want to make sure that I revise them in the people that it's got a possibility of being a good outcome rate the right patient. We have people who call in all day long who want revision rhinoplasty and I say no because it's their third time redo revise. There ain't no way I'm going to make this better, no matter how much money they're willing to pay rates.
And it's really just about having realistic aspectations that I mean, I don't think we're gonna have any more here, but if you're on your third or fourth you might be pursuing something it's not realistic. Yeah, And also it gets harder to get the outcome, and so it's not that you're unrealistic. Yeah, I see a lot of things wrong with your nose, but no one's going to be able to fix that, and the surgeon should be able to tell you that I could. The likely of making it better is small.
The likelihood of me making it worse is high. This is a bad investment. So the next thing is, so you had your surgeony in twenty twenty two. Yes, we did your revision in twenty twenty four.
Yes, right, was it twenty twenty four to twenty twenty three? It was last year because where you're in a half so twenty three okay. So what that tells you is that it was a long ass time. That's critical. You do not, and I underscore, do not want to do a nose job and within five months be freaking out and demand a revision rhino plasty.
The reason you don't want to do that is because there's so much inflammation and so much scar tissue in there that the dust has yet to settle. And in your instense, luckily you're issues were not so dramatic that you were like besides yourself. But one of the things that led to your successful outcome, asides from you being an easy going patient, besides from me being a good surgeon. Is that time was on our side.
Yes, we waited and you showed up and we operate on you when your skin envelope was soft, the scar tissue had settled, and we had the more of a probability of getting it right the second time. Yes, And I actually felt like that was one of the best decisions we made together. Was I came in maybe like the eighteenth month more and I still waited like six more months after that, just to really like be sure the decision and make sure that nothing it wasn't going to get worse, And it didn't get worse, but it wasn't going to get better either, right on itself, you know. And I think that's really important that Again, you can't do that when a patient's coming here demanding and screaming and yelling.
So the purpose of this console, this episode is to underscore all the key elements, And one of the key elements is patients, the patient themselves being a great candidate and being one that you want to go that little extra mile. For the second is surgeons that are not going to get offended and gaslight and and and be angry that a patient wants a revision and The last is if you're going to go for it to create an environment that's going to lead to the possible you know, the best outcome, if you're going to do it right. Yes, absolutely, so, now you're out. How long? We're about a year and a half out? Great? Originally let me oh, I love it, fantastic, you look gorgeous, and I'm kind of irrelevant.
Do you like it? Yes? Yes? Better? Even better? It was great? And then this is like the best version of it. And even if I had decided to not do the revision, it would have been okay. But I'm so glad we made the decison. No, listen, And the purpose of this isn't isn't to say that you need to you need to keep going until it's amazing.
This was something that was fixable. Sometimes the things that we don't like are not fixable. And then the reality is that good enough is good enough. I'm saying that if the patient and the surgeon are correct, when things are good enough but can be better, then you should go for it.
When the patient is not a good patient, the doctor is not a good doctor, or the circumstances don't lend themselves, then listen, good enough is good all day long, no problem. The enemy of good is better. So you don't want to you don't want to push it if it's not indicated. Yes, So I thought this was going to be a great episode because I think it's a subject matter.
I mean, we because I do a lot of nos is, we get ten increase a week of revision noses from outside our practice, and unfortunately I really only operate on maybe one or two because I feel wholeheartedly I can't help them, and I don't want to take their money when patients are desperate, right because the most patients we charge more too, because it's very complicated. We have to take rib and ear and fascia and da da da da dah, and so I don't want to do that because they're vulnerable. Off tell them, you know, just blow smoke up there, you know, and then just be like, well I tried, I told you it might not be better. Right.
So We've actually had somebody who got angry that I wouldn't operate on them, which is ironic, but nonetheless I'm game for when I think it's. Doable, and I think for people listening, it's really important to trust what your doctor is telling you. You know, if you're saying I can't do it, you should trust that. I mean, what do I have to gain? But I don't really understand that way.
It's like least you know, it's like you're looking out for their best interest. Yeah, they were actually upset that they had sent in. What I try to do is not even waste their time, right we Actually the only thing I screen a revision rhino plasties. So I have them send photos free of charge.
I look at them, and then I I tell them if they should waste their money on a console, because I don't want them coming in here wasting a consult fee. And for me to tell them I can't help them, that's devastating. So I'll tell them before they come in that hey, listen, based on all these questions, we have a huge questionnaire that I I didn't say anyone, I don't think I can help you. And she was so mad that I didn't bring her in to evaluate her when we're trying to save her the agony.
It was just it was ironic. Anyways, I understand in her instance, she was so unhappy that she was praying that somebody would fix it. I just I felt bad all around at any rate, So any imparting wisdom for people either who are contemplating a rhinoplasty because you are a rhinoplasty patient and were contemplating a revision since you are a revision patient, anything you would share with anybody before. I think when I was when I started this journey and I knew I wanted to do this and was researching surgeons and had met you during my consults, I think a huge reason that I chose you was that you were very honest with me.
You educated me really well on all possible scenarios and outcomes, and it just felt like a really good match based on your work that I'd seen previously. There's just different things that made me feel comfortable that I know this is a doctor that does great work, but it also stands behind what he's doing, and I can just get all that from our conversations and the preparation and the whole team at your office that was working with me together. So I felt very comfortable. I felt really good.
And if someone is researching and trying to make that decision, if you don't have all those things or it doesn't feel good, like I wouldn't move forward with that surgeon, because if this were to happen as it did in our case, we had a great relationship, we had a great foundation, and we were really able to work as a team to figure out a solution for what was best to move forward. And I think that's a great ending point, which is what I always say, is you're selecting a great surgeon for when things go wrong. Yes, you are selecting them for as the insurance policy. Because when everything goes great, everyone's great.
But when things don't go as you had anticipated or planned, which happens in every surgeon. Yes, the question is how do you and your surgeon respond then? And I think that's when you realize if you pick the right surgeon, just the same way you find out if you marry the right person. Right, not when you guys are on vacation, but when the shit it's the fan. So Well said, all right, well, we're so grateful that you came.
I'm so happy that you're happy. And I think this was a very valuable discussion that people are are going to really appreciate it. So, guys, that's a wrap on plastic surgery and centered for this particular episode. As always, our parting two wishes are one.
If you enjoy the show, please share this episode with friends and family. You got to get the message out because you don't actually know who's considering what, when, where, and only to find out afterwards like oh, why didn't you tell me? Just pass on the information. The second is you enjoy our show, you find it to be educational in this podcast, go on and write us something positive. Positive reviews make everyone want to come to work and do the job.
So again, thank you so much for coming. I appreciate it. You look fantastic, and until next week, I'm your host, Dr. Rady Rahban signing off on plastic surgery uncensored.
When Dr. Rahban does a consultation with a prospective patient, he wants it to be two things above all others: thorough and honest. He will find out from you just what you want from cosmetic surgery. And he will tell you honestly if you can get the result you want, and how he can best help you do so.
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