Your first rhinoplasty is not a mistake. Choosing the wrong surgeon for it can cost you a great deal the second time around.

I have performed over 1,000 rhinoplasties and do both primary and revision surgery. In this episode, I pull back the curtain on what I find on the operating table in revisions and why the process is so much more complex the second time. Scar tissue, altered cartilage, changed vascularity, and the emotional weight of having already been through it once all come into play. I address the revision rate honestly, quoting the industry figure of up to 20% and sharing my own range of 5 to 10%.

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Key Takeaways

1. Revision rhinoplasty is more physically and emotionally demanding than a primary procedure. Patients have already gone through the full year-long healing process, placed trust in a surgeon, and now face doing it all over again with a more complicated surgical field.

2. The revision rate in rhinoplasty is real, quoted at up to 20% industry-wide. Dr. Sturm's own rate falls between 5 and 10%, and she is transparent that the exact number across the field is difficult to pin down precisely.

3. Scar tissue from a prior procedure changes the surgical landscape. Cartilage may be removed, warped, or shifted, and vascular changes require more careful handling of the skin throughout the operation.

4. Misaligned expectations are a leading driver of revision surgery. Surgeons who do not use computer imaging may leave both parties with different pictures in their heads, and a nose that is technically well-executed may still not be the one the patient wanted.

5. Revision surgery takes longer, costs more, and rarely achieves the same level of precision as a primary procedure. The goal is always perfection, but the starting conditions make it harder to reach, and patients deserve that honest context before deciding to move forward.

Timestamped Overview

00:00 Speaking about rhinoplasty volume and why it's both primary and revision patients in her practice

00:00:30 The question most people do not ask during consultations: what happens if the result is not what you wanted

00:01:16 How healing over the first year to year and a half changes the nose and what patients are evaluating before deciding to revise

00:01:32 The emotional difficulty of trusting again after a previous result fell short of expectations

00:02:15 Why revision surgery is more complex: scar tissue, altered cartilage, changed vascularity, and increased operative time

00:02:52 The most common causes of revision, including expectation misalignment, healing variability, and technical factors

00:03:10 How computer imaging creates a shared visual goal and reduces the expectation gap

00:03:40 How asymmetry, small irregularities, and subtle issues sometimes emerge with healing even after a technically sound surgery

00:04:09 What surgeons encounter in the revision field and why shooting for perfection in a compromised tissue environment is genuinely harder

00:04:48 What to look for in a surgeon's training and approach before committing to revision surgery

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What happens when work and family truly mix?

Art Severand spent years in orthopedics before joining our practice as a laser specialist, learning new skills and balancing family life along the way.

- You’ll hear about the shift from orthopedics to aesthetics

- Why 2020 changed the way people sought out treatments

- The role of laughter in making patients feel comfortable

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Book your appointment with Aesthetic Specialists of Houston HERE.

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Key Takeaways

1. The conversation introduces Art Severand as Dr. Sturm’s significant other and laser specialist at the practice. Their collaborative dynamic—blending personal and professional life—helps strengthen the practice, supporting both patients and each other. This emphasizes the value of assembling a team with complementary personalities and skills.

2. Art shares his journey from a decade in orthopedics to joining the aesthetics field during the pandemic. The shift was driven by family needs and industry changes (such as the surge in aesthetic demand during 2020), highlighting how adaptability and responding to life circumstances can lead to meaningful new directions in one's career.

3. He and Dr. Sturm emphasize a patient-centered approach, with Art bringing humor and comfort to treatments often seen as unpleasant (like Morpheus). The focus is on making experiences positive, even for more challenging procedures, demonstrating that technical skill and emotional intelligence together can transform patient care.

4. Art acknowledges the importance of mentorship, specifically learning a "delicate touch" from Dr. Sturm, transitioning from the rougher world of orthopedics to the more finesse-driven field of aesthetics. This points to the significance of continuous learning and being open to growth—even from those close to you.

5. Their discussion covers how both have developed grit and determination, shaped by upbringing and past experiences. Art highlights viewing challenges not as problems but as disconnects to solve, underscoring the value of persistence and a solutions-oriented mindset in both personal and professional life.

Timestamped Overview

00:00 Balancing Work and Family Demands

05:30 Resilient Mindset: Just Get It Done

07:31 Morpheus Treatment: Overcoming Fear

09:43 Ready for Next Chapter

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Some patients spend more time planning a vacation than preparing for a surgical consultation. The difference shows the moment they walk in.

Dr. Sturm, double board-certified facial plastic surgeon and founder of Aesthetic Specialists of Houston, can read within the first few minutes whether a patient has done their homework. In this episode, she walks through exactly what a great consultation looks like from both sides of the table: what patients should bring, what they should watch for, and what the surgeon's behavior during that appointment tells them about the relationship they are about to enter. A surgeon who agrees with everything is not a green flag.

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Key Takeaways

1. A consultation that moves straight from before-and-afters to a quote without real dialogue is a warning sign. Patients deserve a surgeon who listens to their goal, offers feedback, and proposes a plan rather than simply agreeing with whatever is asked.

2. The add-on rhinoplasty, where a nose job gets casually appended to an unrelated procedure, reflects a lack of surgical seriousness. Rhinoplasty requires dedicated thought, detailed planning, and its own consultation on its own terms.

3. Bringing inspiration photos is a useful starting point, but the more valuable question is what specifically about that nose appeals to the patient. That conversation reveals the actual goal and gives the surgeon something precise to work toward.

4. Volume matters. A surgeon who performs rhinoplasty two or three times a week has a fundamentally different level of active skill than one who does it a handful of times a year, and a full portfolio of before-and-afters reflects where a surgeon's focus truly lies.

5. The post-consultation reflection is as important as the appointment itself. Patients who felt rushed, held back, or uncertain about whether they were heard should treat that as meaningful information before committing.

Timestamped Overview

00:00 The observation that some patients research a vacation more carefully than a surgical consultation, and why it matters

00:01:04 Why a surgeon who agrees with everything is a red flag, not reassurance, and what real engagement looks like

00:01:30 The add-on rhinoplasty problem and why treating nose surgery as an afterthought signals insufficient planning

00:02:00 How Dr. Sturm uses visual options during consultations to find the endpoint the patient actually wants

00:02:30 The importance of back-and-forth dialogue as confirmation that a surgeon is truly listening and building a plan

00:02:58 How to think through goals before a consultation: what kind of nose, what personality of surgeon, what kind of partnership

00:03:30 Questions to ask during the consultation: board certification, training specialty, volume, and surgical frequency

00:04:20 Why training background matters and why specialty alignment with the procedure is a non-negotiable

00:04:48 How to evaluate the consultation afterward based on how it felt, not just what was said

00:05:12 Why some patients see Dr. Sturm multiple times before moving forward, and why that pace is always supported

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Twelve syringes of filler and you still look tired. The problem is not your face.

Dr. Angela Sturm, double board-certified facial plastic surgeon and founder of Aesthetic Specialists of Houston, addresses one of the most common patterns she sees in new patients: years of filler that have not delivered the results they were promised. She explains why providers who rely on a single tool tend to keep applying it even when it is not solving the right problem, and how patients end up with wide cheeks, puffiness, and an unnatural shape that still does not feel like them. The real issue is often gravitational descent or skin quality, neither of which filler can fix.

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Key Takeaways

1. Overfilling happens when providers treat every concern with the same tool. Filler added to lift the cheeks often widens the face instead of lifting it, leaving patients with an unnatural result and a face that still does not look refreshed.

2. Three distinct processes drive facial aging: volume loss, skin quality changes, and gravitational descent. Each requires a different type of treatment, and confusing them leads to spending significant money on the wrong solution.

3. Filler addresses true volume loss, the hollowing in the cheeks, temples, and around the eyes. For skin texture, brown spots, and fine lines, lasers, peels, and microneedling are the appropriate tools.

4. When lifting is the primary goal and the degree of descent is significant, non-surgical options provide limited improvement. Surgery is the most effective solution for patients who want a meaningful, lasting lift.

5. The best injectors know and communicate the boundaries of what filler can and cannot do. A provider who refers to a facial plastic surgeon when the problem exceeds filler's scope is demonstrating the kind of expertise worth trusting.

Timestamped Overview

00:00 The opening scenario of overfilled patients who still look tired, and why the problem is systemic, not personal

00:00:27 How the hammer-and-nail dynamic in practices that offer only one modality drives overfilling

00:01:17 Why the promise of instant, affordable results leads patients to keep spending without addressing the root cause

00:01:55 A practical self-assessment framework: gravitational descent, skin quality, and volume, and how to tell which is driving aging

00:02:48 Mapping treatments to causes: lasers and peels for skin quality, microneedling for texture, filler only for true volume loss

00:03:20 When gravitational descent is the issue and why filler cannot lift what needs to be surgically repositioned

00:03:50 Skin tightening devices and RF microneedling as middle-ground options for patients who want a modest lift without surgery

00:04:15 How to factor downtime, budget, and desired outcome into building a realistic treatment plan

00:04:30 What separates the best injectors from the rest: knowing when to refer and having a trusted surgical relationship

00:04:45 An invitation for patients who have been filling without results to schedule a fresh-eyes consultation

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What draws someone to a career in nursing? How do you find your way from the hospital floor to the world of aesthetics? Chasity Zuniga started out knowing she wanted to care for people, and her journey has taken her through ICU shifts during the COVID-19 pandemic, across Texas as a travel nurse, and finally to a new chapter with Dr. Sturm’s team.

- You’ll hear about childhood experiences that shaped her path.

- Why she chose to dive into the beauty side of nursing.

- Her thoughts on what it means to help others feel good about themselves, inside and out.

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Schedule a consult with Dr. Sturm HERE. Book your appointment with Aesthetic Specialists of Houston HERE.

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Key Takeaways

1. Chasity's journey into nursing was sparked by personal childhood experiences in the hospital. Her compassion for patient care and the influence of supportive medical staff in her early years inspired her to pursue nursing, showing how personal encounters can shape professional aspirations.

2. Chasity has worked in a variety of nursing settings—from intermediate care to ICU to travel nursing—demonstrating versatility and resilience. Her adaptability allowed her to thrive in different environments, including during the COVID-19 pandemic, highlighting the importance of openness to new challenges and flexibility in healthcare.

3. Her background as a makeup artist fueled her interest in aesthetics. Although breaking into the field was challenging, Chasity combined her love for beauty and healthcare by finding opportunities in medical aesthetics, illustrating how diverse experiences can converge into a fulfilling career path.

4. Chasity values the relational aspect of nursing, sharing meaningful moments where small acts of kindness—like gifting a Christmas bracelet—had a significant impact on patients. The theme emphasizes how empathy and thoughtful gestures can greatly enhance patient care and satisfaction.

5. Chasity enjoys providing aesthetic treatments like Morpheus microneedling, Botox, lip fillers, and especially loves using and recommending "Easy Gel" for under-eye improvement. She takes pride in educating and sharing results with clients, underscoring the satisfaction that comes from helping others look and feel their best through innovative treatments.

Timestamped Overview

00:00 Childhood Hospital Stay Inspires Nursing

05:21 "Reluctant to Leave, Offered Jobs"

08:05 "Experiencing Clients' Loyalty"

10:05 Blood-Derived Gel for Skin Rejuvenation

12:43 "Glowy Skin Product Love"

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She was already in the gown, IV in, ready to go. Dr. Sturm canceled the surgery anyway.

Dr. Angela Sturm, double board-certified facial plastic surgeon and founder of Aesthetic Specialists of Houston, shares one of the most important stories from her surgical career: the moment she stopped an operation that was technically ready to proceed because the patient was not. She walks through why the surgeon-patient relationship is never just a transaction, why body language and unspoken hesitation carry as much weight as anything on a consent form, and why a gut feeling, whether the patient's or the surgeon's, is always worth pausing for. The patient eventually returned, had her rhinoplasty in a much better headspace, and was thrilled with the result.

This episode is a guide for anyone preparing for surgery and feeling uncertain about what they are allowed to feel or say. Dr. Sturm is direct: it is never too late to speak up, reschedule, or ask harder questions. She explains what to look for in a surgeon's communication style during the consultation phase, how that dynamic only intensifies as surgery day approaches, and why emotional readiness belongs right alongside medical and physical readiness as a prerequisite. Listeners leave knowing exactly what a trustworthy surgical partnership looks and feels like before they ever step into an operating room.

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Schedule a consult with Dr. Sturm HERE.

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Key Takeaways

1. Once a deposit is paid, a surgery date is set, and a consent is signed, many patients feel locked in. A good surgeon recognizes this dynamic and actively creates space for the patient to communicate doubt or hesitation at any point.

2. Body language, tone, and what a patient does not say matter as much as what they do say. Surgeons who pay attention to these signals and start the conversation protect their patients in ways that go beyond technical skill.

3. Gut feelings in medicine are taken seriously for a reason. When something feels wrong, the right move is always to hold off, because elective procedures can be rescheduled and emotional readiness cannot be rushed.

4. The surgeon-patient relationship in facial plastic surgery spans at least a year and often much longer. Feeling genuinely comfortable asking questions and being honest, even about fear, is a prerequisite for a good outcome.

5. Choosing a surgeon whose personality feels like a real match matters more than it might seem. If communication feels strained at the consultation stage, it will feel more strained as surgery day approaches and even harder in recovery.

Timestamped Overview

00:00 Dr. Sturm opens with the story of canceling a surgery that was already underway and why she would do it again

00:00:15 Why patients feel locked in after paying deposits and signing consents, and the mindset shift required to stay communicative

00:01:21 Reading body language, what patients do not say, and why a surgeon who pays attention changes the entire experience

00:02:10 The specific moment Dr. Sturm recognized a patient was not ready, asked the question, and stopped the procedure

00:02:50 How gut feelings work in medicine and why honoring them is considered a professional standard, not a hesitation

00:03:20 The comparison to walking away from a wedding: deposits, dress, guests, and all, when the inside feeling says stop

00:03:50 How the same patient returned, had surgery successfully, and was in a dramatically better place the second time

00:04:16 What to look for during consultations: how comfort asking questions early predicts how the relationship holds up under pressure

00:04:45 Why holding back during a consultation is a red flag worth examining before moving forward

00:05:00 Dr. Sturm's standard that every patient should arrive at surgery emotionally, physically, and medically ready

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How does experiencing your own surgery change the way you connect with your patients?

Not only has Dr. Sturm performed over a thousand surgeries, she, too, has had a rhinoplasty.

She discovered not only physical benefits, like better breathing and confidence, but also gained empathy for the emotional journey patients experience. Embracing imperfections and the ups and downs of healing became part of her insight.

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Schedule a consult with Dr. Sturm HERE.

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Key Takeaways

1. Dr. Sturm shares that having undergone rhinoplasty herself gave her unique insight into the patient’s emotional and physical journey. Experiencing both roles helps her better understand and empathize with her patients.

2. She discusses how she didn't realize her own self-consciousness about her nose until after the surgery. The procedure improved her confidence and made her feel better about herself, highlighting the significant psychological benefits that can come from cosmetic surgery.

3. Dr. Sturm initially pursued surgery to address breathing difficulties caused by a deviated septum. The surgery dramatically improved her breathing, especially during exercise and sleep, underlining how rhinoplasty can bring life-changing functional benefits, not just cosmetic ones.

4. She emphasizes that it is normal to have mixed feelings, uncertainty, or anxiety after seeing post-surgery changes for the first time. The adjustment process is different for everyone, and support from loved ones can be crucial during this period. Over time, most people come to accept and appreciate their new appearance.

5. Dr. Sturm points out that no result is absolutely perfect—minor asymmetries or imperfections may remain. Learning to accept these and appreciate the overall improvement is important. It’s about loving yourself, being content with realistic outcomes, and not aiming for unattainable perfection.

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