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Im Vs BM - consultation outcome

Functional Septoplasty

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Im Vs BM - consultation outcome

Postby miki97 » Tue Sep 09, 2008 11:15 pm

I had a revision rhino consultations with IM and BM today so I just thought I'd summarize what the impressions of the two were. I am quite a realistic person, I knew already that my nose is a complicated one but I am more puzzled now having seen these two than I ever was before. Here is a bried summary:

- Both said my nose is a complicated one and would require high technical expertise.
- Both said I'd need cartilage grafts, taken from my ear, across the middle of my nose.
- IM said he'd need time to think about what the best way to do this would be in my case. BM didn't discuss the details of how he'd approach my nose.
- BM said my septum inside the nose was clearly very much deviated, IM said it was the nose pinch that was giving this impression and that septum itself is not really that deviated.
- IM said my skin is very thin and my cartilage very strong and hard hence the possibility of very visible effects of skin shrink (I think that's the terminology he used) would be very prominent. He discussed possibilities of tip refinement, but said he would have to wait until he has a look inside during the surgery before he decides on the best technique. BM didn’t mention thickness of my skin at all, nor refinement, nor any other technical details for that matter.
- Both agreed there is a high chance of me requring a tertiary revision.
- Both took photos of my nose, and both failed to show me what my nose would look like. It required photo alterations from the front and neither attempted this. Hence neither gave me any indication of what my nose may look like.
- BM said he does 2nd consultation for free only if the op has been booked with him. IM said I can have the 2nd one for free.
- IM does approx 2 rhinos a week, BM didn't reply to my question clearly (does anyone know what this number is for BM).

I think it may be quite obvious that I'm 100% less hopeful and optimistic and 100% more devastated than a day ago. The thought of having cartilage from my ear in my nose terrifies me and I cannot believe there is no other option. Also I feel very low about the fact that they both expressed a high chance of me having to have tertiary op. But above all I'm terrified that 2 expert surgeons couldn't give me any details of their proposed technical approach nor an indication of what my nose may look like.

Also as for BM, he's a plastic surgeon in general, so he does lipos, breasts etc, so does anyone know if his workload consists significantly of those too?? I don't think I'd want a surgeon who's main speciality isn't rhinos.

I originally had my nose job last year to make me look better, it hasn't and now I feel like I have no other option but to follow Michael Jackson road!! I have long few hard years ahead of me, which will be filles with anxiety and frustration over my nose. Neither IM nor BM seemed to be confident that improvement will be successful nor visually pleasing. And this makes me question the following two:

- Are BM and IM famous because they deal successfully with demanding hard noses, or simply because of the huge number of routine ops they've done?
- Has either of them actually got any good reputation in cartilage grafting?

I would very much be grateful for any feedback from any of you
Many thanks
x



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Postby miki97 » Tue Sep 09, 2008 11:31 pm

oh and bM said it would be an open surgery, IM wasn't quite sure yet and said he'd need to think about it.



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Postby *harri* » Tue Sep 09, 2008 11:33 pm

It required photo alterations from the front and neither attempted this


This is really difficult to do which is why they don't do it. It's a limitation of the software they use. But the imaging is only a tool and isn't a guarantee of what your nose would look like.

The key thing is IM said he would have to think about it. Matti would do this too if you went ahead. It's unrealistic to think they can make a decision in a first consult. They've both given you the same expert opinion that it is a difficult nose.

I hope the people who think a nose job doesn't always need an expert surgeon are hearing you loud and clear. ):O

Did they say your op had affected your eyes as you thought :?:

These 2 surgeons are your best bet in the UK. Otherwise I would think about going to the US but there are no easy answers on the US boards either.

Ear is no big deal really. I had both ear and rib grafts. These are the best materials if you don't have enough septum.
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Postby miki97 » Tue Sep 09, 2008 11:51 pm

Hi Harri, thanks for your reply.
You say " I hope the people who think a nose job doesn't always need an expert surgeon are hearing you loud and clear. "

Cpmpletely agree – would you consider BM to be a rhino specialist or more generally a plastic surgeon specialist?

I asked them about the possible side effects of having ear cartilage grafts and they said it can get infected, move from its original position and few other possible complications. By that point I was so devastated by what I was hearing that I was just imagining myself in 5 years time going through the same thing yet again….

In the research that you did, and in your own experience, did you find that grafts leave bigger visual marks from the outside?

Sorry about all the questions but I'm quite anxious about the whole thing.

As for the way the first op affected my eyes, I didn't even get a chance to ask about this. It seemed so irrelevant compared to extreme possible risks that they were talking about…



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Postby *harri* » Wed Sep 10, 2008 12:00 am

would you consider BM to be a rhino specialist or more generally a plastic surgeon specialist?


I ignored your other questions because I don't really want to influence you. I'm happy to recommend the names I consider to be the best in the UK but then it's really up to you based on your consults.

In 2004 when I had my op a nurse at the HSC told me Matti had started to specialise in rhinoplasty a few years before that. I think he has done about 2000 noses which is a lot in the UK and many of these have been complicated revisions.

I would definitely say he is a rhino specialist.

If you read my consults (I'll fish out the link) I choose Matti over Rowe-Jones because Matti was prepared to do a lot more to my nose. It was an easy decision for me but you haven't mamaged to get that much out of them. :dontknow:
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Postby *harri* » Wed Sep 10, 2008 12:02 am

http://www.lookyourbestuk.com/info.php?pgId=46

I'm surprised IM said closed.

Does he do opens :?:
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Postby miki97 » Wed Sep 10, 2008 9:09 am

"I'm surprised IM said closed."

he didn't say closed, or open for that matter. He said he'd need to think about what the best procedure would be. I'll be seeing him again in october



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Postby *harri* » Wed Sep 10, 2008 9:37 am

miki97 wrote:"I'm surprised IM said closed."

he didn't say closed, or open for that matter. He said he'd need to think about what the best procedure would be. I'll be seeing him again in october


Sorry I must have been thinking of someone else. :dontknow:

He discussed possibilities of tip refinement, but said he would have to wait until he has a look inside during the surgery before he decides on the best technique.


This is another key point. It's very hard to compare op plans because really it does depend on what they find on the day.

It's also textbook advice to tell a revision patient they may need another revision.

I'll say this although maybe I don't want to - if you were asking about JRJ and Matti for a complicated revision I would say IMHO Matti would be a better choice. That's not because I don't rate JRJ very highly because I do, as do the majority of his happy patients.

However, this forum just doesn't have IM stories for me to form a judgement. He's highly regarded in the rhinoplasty world so he's a very safe bet for a consult and as you know i don't say that about many surgeons. :LOL:

If you read Sally A's story Matti was prepared to do a lot more to her tip than IM was (and Matti delivered). This is why I asked about open v closed because my guess is that complicated tip work would require an open.
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Postby *harri* » Wed Sep 10, 2008 9:44 am

The good news is that Matti didn't mention rib which is the worst case scenario (IM doesn't use it and Matti doesn't use it very often) and both surgeons seem to be willing to tackle your nose. :Rhino:

I would think you have a good chance of improvement but improvement is the name of the game.
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Postby *harri* » Wed Sep 10, 2008 10:17 am

Miki is your surgeon the one in the BAAPS register :?:
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consults

Postby irishgal » Wed Sep 10, 2008 10:26 am

Hi,

I just wanted to add that I was devasted after my consult with Matti. I burst out crying in the street outside his office because I felt he was so indifferent to my nose. The image he did of my nose wasnt any different to my existing nose even his admin couldnt tell which was before and after.

Then I asked for my letter outlining what he would do and boy was that a whole other story. Matti is taking everything in. He suggested stuff, repeated stuff that I thought he wasnt even listening to and he got me down to a tee.

Get the letter first before you write Matti off. I cant offer advice on IM as I didnt see him at all.

Dont worry..... I'm sure matti's letter will certainly shed some light.

Irishgal
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Postby miki97 » Wed Sep 10, 2008 10:52 am

“The good news is that Matti didn't mention rib which is the worst case scenario”

Harri, he actually did mention the rib.... he said ear or rib…but I chose to ignore the rib part, because the whole idea would be way too much for me to deal with.

Irishgal, I felt the same after my consult yesterday….with me he didn’t even attempt to provide any images of what my nose may end up looking like, I know these things are hardly ever realistic but it would be good to have even the vaguest of ideas.
I hope you’re right about the letter, though nobody in his surgery mentioned anything about it.

Thanks for all your replies, it sure is comforting to know there are people who can understand my concerns
x



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Postby *harri* » Wed Sep 10, 2008 11:15 am

Then I asked for my letter outlining what he would do and boy was that a whole other story


I'm not sure he routinely sends letters so you may need to ask for one.

I never got one but maybe he does now. :dontknow:
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Postby freezer » Wed Sep 10, 2008 11:40 am

*harri* wrote:http://www.lookyourbestuk.com/info.php?pgId=46

I'm surprised IM said closed.

Does he do opens :?:


I had a consult with IM this very morning and he said he does 99% closed - he only does open if there is no other option - e.g. rugby players with multiple old breaks that require complete remodelling. At the end of the consult, you get to talk to his secretary about the mundane stuff (where the hospital is, post-op consults etc) and she also talked about the fact he does closed (i'd wanted to check that would mean I had no external stictches, which I'd forgotten to ask IM myself). quote "yes... open was very fashionable a few years ago in the US and people just seemed to jump on the bandwaggon" in a tone which suggested those people should know better!

I'm not trying to provoke a debate about the relative merits of open vs closed, but thought it might help shed some light - IM is def a closed man (but a very lovely one).
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Postby *harri* » Wed Sep 10, 2008 2:10 pm

The top rhino surgeons in the world use open. It's not a fashion fad. I've seen no signs that's it's falling out of favour on the US boards. If anything it's becoming more popular but that's perhaps because less experienced surgeons do open because it's easier and that's the way they were trained. That's why I've always said go with a surgeon who is happy to do both. :dontknow:

There is also a US surgeon called Clark who won't do opens and some surgeons refer patients to him who refuse the open because they think he can get a better result closed than they could.

However, the question I really can't answer is can IM do as good a job closed as Matti can do open. IM wasn't going to touch one tip that Matti improved drammatically with an open.

JRJ used to be against the open too - he told me 'the court is out' but i've seen a few cases recently where he's opted for open.

Matti does a lot of closed surgeries too - he only uses open if he can't get the result closed and sometimes he decides this half way thru the op.

I don't think anybody has asked Matti for his open v closed %. It might be worth asking the question :dontknow:
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