Asian Rhinoplasty - Ear Cartilage Graft/fascia and Incisional Upper Blepheroplasty

Hi All,

Asian ear cartilage graft rhinoplasty and incisional upper blepheroplasty was done by Dr. Charles S. Lee (Beverly Hills, Enhance Medical Center). The results are preliminary (Day 8 post-op), but overall surgery was successful. I am still scared because I look a little "too straight" in terms of having well-defined and sharper angles on my nose, and my eyes look like they have deep eyeshadow on. It's very early, but I am still a little nervous getting used to my new face. Now the details of the procedure, and what I did everyday post-op are below. I will be posting pictures daily, to soothe myself and calm my nerves, as well potentially help others who are considering the same procedures.

* Disclaimer: All opinions are my own, and do not represent that of any other party or individual. I am speaking honestly about my feelings and experience, although these vary from person to person, and I may have drastically different body type, recovery, results and opinions than others even if we share similar ethnicity and bone structure. None of these reviews and comments here are meant to substitute for professional, face-to-face medical advice."

Consultation: I reached out to Dr. Lee via email and attached 3 pictures of myself: front view, side view, and upside down angle of my nostrils only. At this time, I was only inquiring about rhinoplasty. Dr. Lee's staff reached out immediately, followed by his personal email response. He agreed with all of my initial suggestions of changes to make to the nose: sharpen/define the bulbous tip, narrow the nostrils, bring the projection of the tip outward a little more and downward. I originally just wanted these 3 main things to be changed, but Dr. Lee added that he would like to add more height to my bridge, the space between my eyes farther up my nose, right when the hard bone ends and the cartilage part starts. His reasoning is that he wants to improve my front profile image and raising the bridge would give more definition. At this point I was reluctant, but agreed to farther hash out the details via Skype consultation. I simply seen pictures (mainly from Korean/overseas doctors) who try to mold the patient into a this "soap-opera" doll-like figure with overly sharp bridge that instantly looks fake. The bridge is one of those things that, IMO, easily makes the nose look fake and cartoony, so I was adverse to this suggestion at first.

Skype Consultation (~ 30 mins): Dr. Lee and I rehashed the changes to my nose, and I agreed to add the raising of the bridge simply because he suggested that it would balance out the other changes to my nose. Since he's seen 1000's of patients, I decided to trust his suggestion. However, I emphasized a very natural and small change to the bridge. He and I both agreed that too high a bridge, especially if the angle is too vertical/too high, makes the patient look too masculine. I am much more assured now that our aesthetics match. :) After agreeing on aesthetics, Dr. Lee carefully explained how the procedure is conducted. Cartilage from behind 1 ear will be excised and diced into cylindrical tubes, and then wrapped with fascia (skin) from the scalp (no hair is removed and scalp incision is stapled for week 1 post-op to close the wound. Staples are taken out painlessly at the same time of stitch removal - more on that later because STITCHES HURT like a mother!). Diced cartilage fascia (DCF) will be added to my nose bridge to raise the height, as well as to the nose tip to project it slightly out. Septum cartilage (from deep inside the nose, not the ears), will be excised to add a little more projection to the front tip of the nose, as well as strengthen/stiffen the alar base (2 sides) of the nose. This is to make the entire structure of my nose tip (top, front, sides) more resistant to widening when smiling, leading to a less bulbous look. Basically everything is done to strengthen & define. Nothing is shaved down or taken away. The resulting nose will actually have more "material," but it will also assume a more "3D" shape that allows the final look to actually be smaller and more angular than before.

[Sorry for the technical rambling. I like being exact and understanding EXACTLY what is going to happen]

In addition to discussing rhinoplasty, I also requested an upper blepheroplasty. He said that once I come in, he will conduct an additional in-person evaluation right before surgery, and at that time he will measure the desired crease height as well as decide if he needs to cut the "mongolian fold"/inner corners of the eyes to open up the eyes more. Lastly, Dr. Lee showed me pictures of past patient results, including some individuals with a similar nose structure to mine. We were mainly discussing noses since that is the more involved procedure (3D shape instead of just a skin like in eyelids, more potential for harming bodily functions like breathing and nerve connections, more complicated structure than eyelids, and longer surgical duration and skill needed).

My only suggestion is to emphasize how conservative you want Dr. Lee to go during surgery. He has some patients request a drastic change, and although I hold no judgement to his other patients aesthetics or requests, I personally wanted a very subtle and conservative look. His skill is definitely there to give a more drastic change. HOWEVER, if I could go back, I probably would have requested a slightly less bridge height by ~ 1-2 mm and smaller eyelids by ~ 1/3 or 1/4 less crease height. However, only 8 days post-op. So these opinions may be unwarranted as everything is still swollen.

Surgery Day (May-12-2017): There was only 1 patient that day (me), and I highly suggest if you are flexible with scheduling, to book your surgery on a day where Dr. Lee only has you for his patient. It is simply easier on both the surgeon and patient if nobody has to rush, and the physician wakes up thinking about only your procedure. It's your face and money, so be picky and a little controlling about how you want the process to go!

Final Consultation (in-office): Dr. Lee took pictures of multiple angles of my face, smiling and stone-faced expressions. Our initial evaluations for rhinoplasty still holds. He asked me "Where do you want to focus most of my efforts?" I replied: "Tip please. If we can make the tip more defined and sharper, I'd be very happy." While drawing lines on my nose in prep for surgery, he also asked: "how important is the bridge to you." I replied "I'm more worried about the tip. Basically, I'm not too worried about it." He stated the reason behind this last question is that the higher a patient desires the bridge, the more room for error, even with the best surgeons. That is something even he cannot guarantee. I added "The bridge is really secondary for me. If 100% is the max you're comfortable doing, go 60%-65% on me." We have an agreement. Dr. Lee truly takes time to evaluate what YOU want, and added with his own medical expertise, crafts a customized plan for you. He essentially consulted about my nose 3x's, and my eyelids twice. He measured my eyelids and consulted about the crease height TWICE (once during his office, and once after I gowned up/before anesthesia). He is careful to make sure the crease is exactly where the patient desires.

Surgery: I remember stating: "Now I'm getting nervous." Dr. Raymond (I think that's his name) said "Here, I'll give you something to relax you." After my head touched the surgical bed, I remember nothing, except when a I felt like a dull paperclip was gently scraping across my upper lids. << Ahh, the blepheroplasty has begun >> Dr. Lee asked me to open my eyes 3 times. Then he sutured on the stitched, which HURT like crazy even during local anesthesia. I have no idea why, but I seem to be super sensitive to stitches (getting them on, removal!). I faintly heard Dr. Lee describe to a trainee (?) or observer next to him about getting the cut even, stitching height...etc. I also remembered him saying that he redid my right stitches to even both eyes out, and then considered redoing my left, but that "it's about 1/2 a mm off. But I think I will leave those stitches in because usually that is not noticeable at that small of a difference." --> Something along those lines was said.

Waking Up: My eyes were bandaged and nose felt big and stuffy. No actual pain, just extreme nausea (likely from anesthesia and the IV drugs). My throat felt like it was on a LA summer fire (from intubation); it was swollen, mucous-filled, and patched. To make myself feel better and less scared, I began reciting the Quadratic Equation. All the nurses and staff laughed. That made me happy.

Mom helped me to the car. I thank her with my life for being there for the whole week post-op. My recovery would have been extremely inconvenient and painful without her care. I highly suggest having a close friend/family member take care of you for at LEAST 3 days post-op. This includes meal prep, playing music for you or helping you to the bathroom during the first night because your blepheroplasty bandages will still be on.