What I Learned After My Second Surgery Due to Body-Focused Repetitive Behavior

Back in October 2016 I wrote my first Mighty story To the Parents With Kids Who Pick Their Noses (Hint: That’s Everyone) as a way to reach out to people and introduce the idea of the truly damaging effects of dermatillomania (skin picking) and rhinotillexomania (nose picking). I was not ready to be “The Face” of either of these conditions, but I was ready to share my story. I was overwhelmed with the positive response my story received not only from readers but from the body-focused repetitive behavior (BFRB) community. My story about rhinotillexomania was one of the first that many had ever read, as it is such a shameful topic for our society.

As I detailed in my original story, I was scheduled for my second surgery to attempt to repair my septum for October 31, 2016. In September 2017, I was finally cleared by my plastic surgeon as fully healed from that surgery. My nose took 11 months to heal from surgery, but the effects on the mind will last indefinitely.

My surgery went as planned for the most part. Except the part that didn’t.

The original plan, as outlined in my story from October 2016, was the surgeon would borrow tissue from my scalp just above my chewing muscles and insert that tissue into my damaged septum. He would attach the tissue to a dissolvable plate and use some of my own nasal tissue to patch it up (like a graft). While he had my nose open (required stitches to close it up) he discovered that the structure of my nose was far weaker than he expected. My surgeon ended up cutting my ear from top to bottom (50 percent detached) in order to borrow cartilage from my ear and insert it into the tip of my nose. See photos of my post-surgery below.

Looking like Wilson the volleyball from Castaway after surgery:

Unfortunately the topic of my “facial reconstruction” (as I call it) come up frequently in unusual circumstances — like when discussing how I cannot bring myself to get a COVID-19 test or I can’t go cliff jumping into the sea. It’s a very awkward topic to try to explain when people ask “oh what happened to your nose?” I come up with interesting lies about a deviated septum or an accident as a teenager.

All of this because I picked a hole through my septum after 28 years of nose picking.

Recovery from this surgery took far longer than expected. I was bedridden for about two weeks. I didn’t eat solid food for two weeks. I wasn’t allowed to carry or lift more than 10 pounds for a month. About three months after surgery I nearly choked after part of the dissolvable plate decided it didn’t want to be in my body and pushed its way out of my septum (leaving a small hole behind it) and getting stuck where my nasal passage meets my throat. I saved myself by calmly walking to the bathroom (I was at work), breathing through my mouth and gently gargling the lodged plate out of my throat. I spit it into my hand, put it in a zip lock bag, and made an emergency visit to my surgeon in a crying mess. I cried, a lot. I went through a lot of pain medication. I felt like Mr. Potato Head for at least four months.

The view of my disassembled Mr Potato Head ear:

The sensation in my ear and nose took a long time to come back, so in the absence of sensation it always felt like my ear or nose could just pop right off my face. People stared intently at me on the street, wondering what had caused me to look so beat up. A woman walking down the street stopped to hug me (with my consent) and told me I was beautiful even though I was swollen and covered in bandages and staples.

My surgeon and I had discussed what help I was going to get to prevent me from ever putting my finger up my nose again. The trauma of surgery was enough it seemed. Part of my daily regiment involves cleaning my nostrils and applying a healing ointment (non-antibiotic and non-antibacterial) to the inside of my nose using a cotton swab. No more pinky fingers with their picking urges. I now carry a small box in my purse full of cotton swabs and ointment. Because my daily routine does not involve my finger, then there is no urge to pick anything that might be crusting or floating around in my nose. On the down side, I go through a 500 count box of cotton swabs almost every month.

Now for the negative results of my surgery.

After the first surgery on my nose (detailed in my original post from October 2016) I was right back to my normal life fairly quickly. I went back to my martial arts training. I was applying ointment inside my nose using my pinky finger. Life basically returned to normal. Not with this second surgery. The stress, anxiety and trauma of my October 2016 surgery caused me to begin fearing anything that might come near my nose. I never returned to my martial arts training after this second surgery. I was too afraid of an elbow to the face during class. But not only that, I now have hesitancy and stress related to the following every day activities:

• Kissing. For about two years after surgery, it could never be spontaneous anymore. After surgery my boyfriend at the time had to learn a new way to show spontaneous affection for me. Gone were the days of “leaning in for a quick peck on the cheek.” I would recoil in terror at the sight of anything coming near my nose (his nose, so that his lips could contact mine). Only planned, intentional and forewarned kissing was approved those days. Now over four years later, I can handle most spontaneous kisses — but I still warn men I am dating of my general anxiety about this.
• Using a tissue. I never realized how much I would miss blowing my nose. After surgery, I never wanted to risk picking my nose again so I refused to put my finger or pinky in there to clean out mucus (like when I have a cold or I have recently cried). I was also very afraid to blow my nose. My surgeon told me right after surgery I should do rinses in my nose but to use the ones with gravity, and not the ones where you squeeze a bottle to push the rinse through. He didn’t want that kind of pressure traveling through my nose. He wanted a gentle environment. As a result, I was terrified to blow my nose. I didn’t think I would ever feel comfortable blowing my nose ever again for fear I would just blow out the graft and everything that is patched and holding my nose together. However, after about three years I began feeling comfortable to blow my nose using a Kleenex. These days I don’t blow, but I will gently wipe out my nose with the tissue.
• Crowds. Not that I had a distinct love for crowds to begin with. A few summers ago over the 4th of July I went to a bar to listen to a band with a friend of mine. It was a really small bar and a really popular band. At the beginning of the night, there was room to move and folks were generally sober. I was sober as the designated driver. By 1 am, it was back to back in this bar and everyone was drunk. I was no longer enjoying the music because all I could focus on was elbows flying by my face as people reached for something at the bar, reached to tap a friend on the shoulder or generally flailed their arms to the music. I tapped my friends shoulder and said I would wait the remainder of the night outside and to come find me when everyone was ready to leave.

I used to take all of these activities for granted.

Martial arts. Kissing. Blowing my nose. Going to concerts or crowded bars. Now they are old memories that trigger a lot of stress and anxiety for me, so I avoid them if I can. Four years later I still have nightmares that my nose disintegrates and falls off, leaving gaping holes into my face. The thoughts running through my head when I’m awake are that I will damage my nose again, or the repairs will fail, and I will either have to have surgery a third time or that my nose will have irreparable damage done to it and I will live the rest of my life with a collapsed nose.

The unintended purpose of this post is to remind people to never take the little things in life for granted (like spontaneous kissing and blowing your nose). The intended purpose of this post is to share how life-changing nose picking can end up being for one person. I hope people may better recognize their own nose picking problem or better recognize it in their children or other loved ones. Seeking help early, and not treating nose picking as a phase that a child will grow out of, may save someone from having a traumatic relationship with their face like I do.

I also hope this post shares a good tip for people who face a nose picking problem — using cotton swabs to clear any mucus out of your nose and applying moisturizer (or healing ointment) inside your nose once or twice a day can help keep your nose from drying out. This discourages picking of dried up mucus by removing the skin contact sensation that can trigger the pick for a lot of us.