The Rhinoplasty

WARNING: THIS ARTICLE CONTAIN STRONG IMAGES.


Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Almost 4 Months


Day 1

The receptionist of my medic called postponing the last medical appointment before the surgery by 5 days, and in the appointment day the surgeon said which he would enter in contact very soon to decide the day of the surgery and it passed 1 week without news. By day 28 he finally entered in contact out from nowhere saying which he needed me to do a quick covid test at the hospital chosen by the medic, called "hospital oto", which I should do it as soon as possible as the surgery would be in the next day. Surely I was happy, but at the same time the lack of a prior notification threw my schedule for that day in chaos; I had to stop everything I was doing just to do the test and I had do cancel other exam I had that day. My surgeon made what he could to hasten the process of doing the examination and receiving the results, and with that by 19:00 the exam was ready and I could fill the online form of the hospital in time. I also received a pdf document with general details about the surgery, which I am showing below (in portuguese). The surgery was almost half of the price compared to the bad medic I chose at first: R$ 15.000 including the hospital lodging, surgery room, pneumatic boots to prevent blood clogs during the surgery and the cost of the medic and its team. The health care plan covered only the health related part of it, not the aesthetical part. You can read my negative review about the mentioned bad medic and the hospital at this site blog area > ratings > hospitals or blog > ratings > medics.

https://yukoo.art/content/downloads/articles/transwomen/20220214_2/termo_rinoplastia.pdf (in portuguese)

At the hospital apartment at first my parents stayed, but due to the measures against COVID only one of them was allowed later. They gave a special soap for the surgery and asked to use the surgery clothing without a bra or panties. Gladly, it was not one of those revealing clothes, because for a trans woman who had still not done her gender confirmation surgery that would had been very, very embarassing and depressing. Once inside the surgery room, I went by myself to the surgery table while I was still healthy and there it was doctor "Paulo Manzano" (surgeon), a friendly anesthetist called "Elaine Soubhi" and a helper called "Daniel Chung". The funny thing is which before the surgery I "stumbled upon" (like that old site) with two of them while going to the hospital entrance. They talked a little with me and made some jokes in an attempt to make me feel less nervous, but it was not needed, as I recently had done 4 small surgeries to extract sebaceous cysts with local anesthesia at eacah one, and I also had done an endoscopy with general anesthesy. When the surgery was about to happen I already had some idea about the process, some pain resistance and which around 2 minutes after the anesthesia was applied I would faint and wake up only waaayyy later, without pain and a little confused. Other thing I knew was which my voice would fail and I would feel discomfort in my throat for around 3 days, as they would put a tube in my throat so I could breathe during the surgery. So, a hint I would give is: If you need to do smaller surgeries, do they before the bigger ones in order to increase your pain threshold and self-steem about that.

I asked for something to leave my head in a more confortable position and they gave me. At the moment of the surgery I was with the start of a migraine crisis and had to tell them that, but it was still manageable. To put the medication access in my left arm was painful not only because I am sensitive, but because the anesthetist needed 2 or 3 attempts to find a suitable vein while moving the needle inside my arm... the anesthetist from my voice change surgery got it right at the first attempt. While they attempted to open my surgical clothing, one of them made a joke about how I had tied it so well which it was difficult to open. I took the opportunity and asked them to remove the stitches from those cyst extraction surgeries I mentioned, as due to the surgery I could not return to the dermatologist at the appointed time for that. The doctor and his team were very professional.

I "shut down" as expected and woke up with me being taken to the public nursery. I do not record about the "immediate post-surgery" room where I stayed for a long time after that. Once at the nursery, I raised my hand and eventually someone came, I then asked for something which allowed me to pee and they brought and used a kind of vacuum machine to attend my wish. It took a long time for me to do it, a fact which wound repeat at the post-surgery of all the surgeries I made with general anesthesy, and that lasted for more than 1 day. Perhaps it was an effect of the anesthesy, perhaps they had put a tube in my urethra while I "slept" and that cause inflammation at the region. You have to do a physical effort and think about things which help you to pee otherwise you will not be able to do it. In the case of shy people and even more transsexual it is even more discomfortable. A funny situation was which an old woman to my side upon hearing my request also said "I WANT BATHROOM TOO!!!". After some time I was taken to my hospital apartment and with some effort I transferred from the mobile bed to my hi-tech apartment bed, with controls to increase and decrease the height and inclination worthy of a spaceship.

There I stayed for the test of the day and the next morning, when the surgeon came to see the results. Although he spoke to me I did not understood everything, neither could I answer or cared to I was feeling very uncomfortable; who took notes was my mother. He prescribed the usual medicines for the post-surgery together with some just for the nose, such as: One to protect the stomach, one to reduce bleeding, for pain and fever, antibiotics, a liquid medication for the nose inflammation... Until the morning I left the hospital, I had to pee at a kind of metallic flower pot which was uncomfortable, as it filled quickly and I had to ask my mother to empty it for me many times. Sometimes she was sleeping and I decided to wait, because all that was also tiresome for her. To receive constantly saline solution by means of my veins was one of the reasons for me doing it in such a frequency.

I asked to my mother to incline a little the bed so I could be in a sitting position, and my nose started bleeding again by the right side. It was then which I realized which I could not raise my head. Sometimes my mother made things difficult for someone who could still not talk by asking the same questions again and again, being it which not all of them were important. Sometimes I answered with a low voice or with a thumbs up or thumbs down gesture and she did not understood, or understood but did what she thought was best anyway. At least once during the cleaning of the stitches she put too much force over them and it hurted, and the pain remained for a significant period. My mother was nervous and that clouded her judgement to an extent. I felt so much anger about not being left alone which I could almost cry, and that started damaging my recovery. Other hint I give is: Know how to medidate, as it will help you stabilize your condition. With it I was able to fight back the anger and to actually start feeling good, improving my recovery.

One day and one morning laying in a bed may appear to be a long time, but you will feel such a great fatigue which you will sleep most of the time. You will only feel time passing when you have slept so much which you can no longer do it. Eventually, you can go to the bathroom by yourself with the help of your companion or nurse, do not go alone, as you can faint and damage your new nose. You will swallow a lot at day 1 and 2; it will be a thick saliva containing blood, mucus and other things. To eat, people will have to put liquid like food (jelly) and liquids (water) with care and in small quantities at the tip of your mouth, you will then use your tongue to put everything inside and attempt swallowing it. Your lips will get white and dry for days, to the point of it flake off.

When you for a whole life had a nose which usually became so obstructed which it was visible outside, sneezed so much to the point of feeling pain, with so much mucus coming out which you felt a light fever, having a deviated septum, hypertrophy of the nasal turbinates, skin allergies which could close your throat and headaches which were intense enough for you to wish death... then my dear reader, you will be well equiped for any surgery. The sensation was a middle ground between my worst and best expectations, manageable.

Day 2

By the morning of day 30, my face got really swollen and would remain that way for many days. The saline solution had ended and it was not required a new one, so a nurse came to take out the medication access from my left arm and she warned which it would hurt. It indeed hurted, a lot, as the bandages were made to not come out easily; but there is also that possibility which she was just a brute person. Once taken oit, the small hole would not stop bleeding and she looked a little concerned, she put a bandage there and gave a piece of cotton in case the bleeding continued. I prepared to get up after a long time and finally go home, and my nose still was bleeding to the point which it was necessary to put a bandage below it as you can see in the photos.

As expected, I passed most of day 2 sleeping. As Brazil northeast is extremely hot in the afternoon, I always felt worse in this time and better during the morning and night. At a given moment I get up too quickly, and as I was weak for not having eaten well since the surgery and with a bandage at my nose which made breathing harder; the result was which when I went to the bathroom I started feeling dizzy to the point I had to sit at the floor. I should had remained there, but sadly I decided to attempt go to the bed and halfway I felt a strong pain the chest, heat, weakness, lack of air, my nose started bleeding again aaaanddd... I fainted. My mother was nearby as the doctor had requested her to do in the first days, and she could grab me before I stumbled in the ground and damaged my new nose. When I woke up my mother was calling my father and both put me in my bed, and that was the first time I regretted doing the surgery. I started then to have fear of doing anything, but when you are recovering yourself it is very important to move. In case you have no one to care for you at home, I suggest which you do not leave the hospital for 3 days.

That day I took a "bath" using moisturized tissues for bath and my mother helped me to wash my hair. Other thing which was useful was my mother putting tissues with cold water over my hot and swollen face, changing them at each 15 minutes until it improved. You will look like a mummy from a terror movie, but it is necessary. I do not know what to say about the liquid medication for the nose inflammation, as with the nose obstructed by dried blood it could not reach the necessary area. I decided to use it upside-down, as drops instead of spray and it got better to where it should go, but a small quantity went beyond to my throat and it resulted in a burning sensation of discomfort which lasted for a while. At the night of the second day I could already eat pressed papaya and banana.

Day 3

By the end of day 3 it was already possible to notice greater progress: I took a shower without soap using with care water stored in a small bowl, but still with my mother suprvision in case I fainted. The water from the shower hurted as it gets to you after a certain distance over your damaged skin, and it does not allow you to control where the water will go. Everything I did for most of the day 3 left me tired and with seizures. To stop the bleeding at the right side of my nose I had to continue not raising my head too much, and although it worked it had the side effect of creating a huge dried blood clog which would go from deep inside my nose to its outer area. It made my recovery slower and may had affected a little the final aesthetical outcome a bit. At night I woke up without air and that was very uncomfortable, although brief. To solve that I had to incline the bed as soon as the nose bleeding improved. For the second time I regretted making the surgery. My mother was there with me to calm me down at such moments, and made soup while I could not eat other thing. Soup is very useful for when you are recovering. I started to get anxious because my time awake slowly increased but I still could not do any activity. I could do a light cleaning of both side of my nose; you know your body better than anyone, what you can and what you can't in a given moment. When it did not hurted I proceeded, if it started to hurt I payed more attention to what I was doing, and when it hurted I stopped the cleaning of that area.

The hydrogen peroxide and cotton swabs were very useful for cleaning my nose, together with the nasal cleaning spreay and other medication for the nasal inflammation. When I could not breathe by my nose, I used a cotton swab wet with that and gently inserted it at the obstructed side of the nose until where I felt I could fo. You do not need to move a lot the swab inside de nose, you just need to rotate it a bit if needed. The contact of hydrogen peroxide with the mucus, blood and the like make a strange "sssshhh" sound and start a reaction where it all comes out as a liquid. That noise is useful to know if you are really cleaning something or just think you are. After that I used the nasal cleaning spray.

Day 4

In day 4 I already felt moderately well. I cleaned my nose deeper and for more time, I could already breathe better although more by the left side than the right one. By nightime I ate pastry containing white cheese, it was my first solid food since the surgery, and sleeping became something so-so instead of horrible. I slightly bumped my nose by accident but it did not hurt much. I could listen to music and clean my eyes and teeth in a veeeery light way. Although I was using the prescribed medicine by the doctor to protect my stomach from the other medications, at day 4 I started to feel some pain and it lasted for many days. I was also able to for the first time have a bath with soap. Other thing I did which the doctor did not prescribed but which helped was to clean the inside of the nose with saline solution at the body temperature, gently inserting it at each side of the nose using a syringue without the tip (obviously) and rotating my head in a way which made the liquid come out by the other side of the nose. I learned which it would help me to breathe better and also protected me against some airborne virus and bacteria.

Day 5

At day 5 I already felt good enough, I could touch gently my nose and still feel something instead of nothing or some discomfort. I could cook my own food: fried fish without too much spices. Once more I did a nasal washing and this time it came out a lot of mucus from the left side while a lot of dried blood came out from the right side. I could go to the bathroom for "number 2" for the first time since the surgery, and my intestines were still adapting to once more eat solid food. I had a lot of gas from sleeping for so long with my belly up due to my nose, and that led me to feel pain at my back. I hoped which my digestion would improve with the decrease in medications quantity, but it did not. I could already do a lot of things by myself and I could even sneeze to clean my nasal airways sometimes without touching the nose. I would just force air out of my lungs by just one side of my nose, inclining the head if necessary. I could resume my shower baths being very careful to not wet my head.

Day 6

By day 6 it started to come more mucus at the right side than dried blood, which was a good sign. I could breathe normally by the left side and almost nothing more came out during the nasal cleaning. I did not slept well at night very probably because I ate curry udon, a spice which actually made sleeping harder at night. So, take care with your food while recovering. I had a medical appointment with my surgeon and for my suprise he said which he would already remove the external and internal casts from my nose and also part of the stitches. I did not like surprises, but at the same time I was happy which the doctor said I was recovering well, besides the decreasing bleeding at my right side. He said I cleaned my nose too well, which I should not clean too much the crust above the injuries otherwise I would end up with ugly scars. Perfectionism has its merits. Now about taking the inner casts... it was one of the worst pains in my life. I usually do not cry, but I did while I squirmed. People talk about plastic surgery as if it was like buying new clothes, but it was not. It was as if my nose cartilage would break and come out together with the cast, but it was just a sensation. The inner cast did came out with dried blood and opening still not fully healed minor wounds, and it was done twice for each side. The outer cast in comparison did not hurt, and as for the stitches, the pain was smaller but more concentrated of putting a sharp scissor inside a small wound to pull out the surgery thread and cut it.

He cleaned both sides with hydrogen peroxyde and swabs, and it was needed to drain with a tube the blood clog formed at the right side of my nose, but he could not take all of it out at that moment. After that, although I was still not breathing well, I was breathing better than my whole life. A rhinoplasty is not only aesthetical, it improves also breathing issues if you have them. He made new bandages, softer, and warned me to not wet them. In case they get wet I should use a hair drier at the cold setting to dry it. That new bandages were still helping me to shape my nose.

Day 7

At day 7 the medic advised me to not clean the nose by 24 hours when it bleeds. I was still using antibiotics and the medication to protect my stomach.

Almost 4 months

My breathing remained not so good, always harder from the right side than the left. During the nasal cleaning it came out twice, once for each side, a big dry mass in a yellowish color followed by a small amount of liquid blood. One of them even ended up going down my throat instead of coming out by the nose, making it harder to breathe for a while until I managed to swallow that without choking. I spoke with my medic and he said it was a mixture containing a medical resin which he used inside my nose to prevent further bleeding during the surgery, which it was normal for it to come out with time. Sometimes it came out with dried blood and surgery stitches. Although a little painful, I also removed the remaining stitches by myself; they had already been cut by the medic before, and then he said I could remove them after some time as they would be only lightly stuck inside my nose.

After that I could breathe better by the left side, but I still cannot fully breathe at the right side. Currently, I still do the nasal washing with the saline solution, but the mucus already come out without that, only by forcing air out of my lungs through one side of the nose. I caught H3N2 in december, and my nose was already healed enough to endure it. Every time I use my mask to protect myself and others concerning the COVID, my nose gets swollen, taking many hours or days to look pretty again. The longer I use the mask the worst, it does not matter if it has a metallic clip or not, the pressure is enough.

I also started to smell a strong stink coming from inside the nose, but it was usually not strong enough for people to also smell it most of the time. I talked with the doctor and he said which perhaps it was because the cartilage had become exposed after the surgery, but which tissue would once more cover it with time. Washin the nose improved the smell, but it always returned, albeit weaker with the passage of the months. I a saw a green mucus, and it is usually associated with infecction; and with time it became yellow then white. I commented with my surgeon about how the shape of a side was different from the other, and he said it was still needed many months of healing; but time passed and the shape difference remains... perhaps I need a "revision surgery"? It would be something quicker and easier as most of the job was already done. He also said to me which I still had the deviated septum, it just was smaller.

Would the current perceived issues caused by the medic? Was it how my body reacted to the surgery? Was it the result of a single event? I do not know, but I can say the following: If you are restricted to Brazil, or even worse, the Brazil northeast, I recommend the medic but not the hospital which he had chosen, it is awful. The thing is which if you choose him you will most likely have to do at that hospital. If you can, do it outside Brazil.



Last Updated: 2022/02/14

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