Why You Should Choose Dr. Reagan of San Diego
Surgeons are not all equally trained, nor are they equally proficient at all surgeries. And surgeries are not all equally challenging. Rhinoplasty(Nose job) is one of the most exacting procedures performed in plastic surgery. The nose, centered in the middle of the face, commands much attention. Millimeters matter, and even the most minimal of deformities can be noticed. Deviations in nasal anatomy, either congenital or acquired from trauma or disease, can lead to difficulties in breathing. At True Beauty San Diego, Dr. Reagan is truly an expert in performing Rhinoplasty. Dr. Reagan trained at one of the premier centers for learning rhinoplasty at The University of Texas at SouthWestern in Dallas, recently voted the top plastic surgery program by the U.S. News World Report. UT SouthWestern is also home of the annual Dallas Rhinoplasty Symposium where surgeons come from all over the world to improve their rhinoplasty skills. It was here, under the guidance of the nation’s top experts, that Dr. Reagan developed his superior skills for Rhinoplasty. A published author on the topic (Dallas Rhinoplasty, Nasal Surgery by the Masters, 1st Edition), Dr. Reagan continues to lecture about Rhinoplasty. (About Me)
Common Indications For Rhinoplasty
- Dorsal Hump : a bump on the bridge of the nose, usually made of cartilage and bone. Can either be congenital (hereditary) or acquired (trauma).
- Long Nose : The nose projects too far from the face. The length of the nose needs to be reduced, often requiring reduction of both the septum and tip structures.
- Boxy, Bulbous, or Wide Tip : Deformities of the cartilaginous paired tip structure (lower lateral cartilages.) Suture technique will correct these deformities nicely.
- Droopy Tip : Tip of nose hangs down, especially when smiling. Often associated with long nose. Tip needs shortening and elevation, sometimes requiring a graft (columellar strut).
- Wide Dorsum : Wide nasal bridge. The bones need narrowing (see Osteotomies).
- Wide Nostril/ Nostril Base : Overly wide nostrils, requires resection of soft tissue on lateral aspect of nostrils (see Alar Resections)
- Deviated Tip : Rotation of the nasal tip, often associated with deviated septum. Tip structures need to released from scar tissue, straightened, and often reinforced with suture or cartilage grafts.
- Asymmetry of Nose : Usually traumatic in origin. Structures need to be released from scar tissue, straightened, and re-inforced when necessary.
- Difficulty Breathing : Often from Inferior Turbinate Hypertrophy (allergies) or Deviated Septum (traumatic)
Surgical Technique: Open Vs. Closed Rhinoplasty
Open Rhinoplasty – The Best Approach!!
There exists two fundamental approaches to performing rhinoplasty, the open vs. closed technique. Open Rhinoplasty involves placing a small incision across the columella, then continuing with incisions inside the nose. The external skin/subcutaneous tissue is lifted off the underlying cartilage and bone. These structures can then be more precisely manipulated and repositioned to yield a more predictable result. Also, more complex cases involving grafts are more easily performed with the open approach. Given the demanding nature of rhinoplasty with a premium on precision, Dr. Reagan strongly prefers the open approach.
Occasionally the columellar incision from an open rhinoplasty needs to be revised ( 5%). In addition, nasal tip swelling tends to be greater and more prolonged with open rhinoplasty compared to closed rhinoplasty. Even with this in mind, most patients look presentable after 2 weeks.
The closed approach is the original approach made popular in the 1950’s. All incisions are inside the nose, but these incisions are often much longer to allow visualization and more destructive to the cartilaginous structures. The closed approach does not re-attach structures, simply relying on approximation during healing. In Dr. Reagan’s experience, the classic “over-resected nose” with collapsing nostril is more often the result of the closed approach. Dr. Reagan appreciates that ultimately it is the skill of the individual surgeon, and not the surgical approach, that will determine the surgical outcome.
The nasal bones usually require narrowing at the time of Rhinoplasty. This is achieved by fracturing the bones in a controlled fashion with narrowing. Dr. Reagan performs percutaneous osteotomies using a small stab incision along the lateral nasal wall. A small (2mm) instrument is introduced to produce the controlled fracture.
The septum is a single, mid-line cartilaginous structure that supports the nasal tip and nasal vault. External trauma can cause septal deviation, which in turn, can lead to tip deviation and difficulty in breathing (nasal obstruction). A septoplasty usually involves removal of the deviated portion of the septum. Sometimes grafts are used to support repositioning of the septum.
Inferior Turbinate Resection
There exist three selves on the lateral aspect of the nasal cavity that function to warm the air prior to entering the lungs. These shelves are lined with mucosa which is highly vascular and sensitive to external stimuli. The mucosa will swell to certain allergens, causing narrowing of the airway at the inferior aspect. Thus, inferior turbinate hypertrophy is the most common cause of airway obstruction. This turbinate is often reduced (submucosal turbinate resection) at the time of rhinoplasty.
Alar Wedge Excisions
It is not uncommon for the nostrils to flare at the time of shortening nasal tip. To correct this, a wedge of soft tissue is excised in the alar groove. This excision can be carried into the nasal sil if nostril reduction is desired.
The patient will awake with a nasal splint on the external portion of the nose, and packing within the nose. The eyes will become swollen and bruised. Sutures will be present along the columellar incision. The patient should be prepared to keep the head elevated 30 degrees. The eyes will be iced every few hours for the first 2-3 days. Arnica Montana and Corticosteroids are used to reduce bruising and swelling.
The packing comes out day 3, sutures and the splint are removed day 7. Dr. Reagan might leave tape on the nose, or even re-apply the splint, for another week.
Most patients are presentable at week 2 post surgery. Certainly by 6 wks the majority of bruising and swelling will be subsided. Final results, especially of the tip, will take 6-12 months.