Rhinoplasty

Dr. Frank Agullo performs open and closed rhinoplasty and revision rhinoplasty at his El Paso practice, using VECTRA 3D imaging for pre-surgical visualization. The procedure addresses overall nose size, bridge width, dorsal humps, tip projection and definition, nostril dimensions, and alar flaring. Open rhinoplasty uses a small columellar incision for direct visualization of the nasal framework; closed rhinoplasty keeps all incisions endonasal. Recovery involves one week with nasal tape in place, with swelling reducing over two to twelve weeks and final results in some patients taking up to one year.

Rhinoplasty at Southwest Plastic Surgery in El Paso is performed by Dr. Frank Agullo, who brings both surgical precision and an eye for facial harmony developed over more than a decade of international practice under the brand 'Dr. Worldwide.' Pre-surgical planning uses the VECTRA 3D imaging system, which generates a three-dimensional model of the patient's face and nose to allow simulated visualization of anticipated outcomes before any operative decisions are finalized — providing a reference point for discussion and alignment of patient expectations with surgical possibility. The open rhinoplasty technique involves a small incision placed at the base of the columella (the narrow bridge of skin between the nostrils), which connects bilateral marginal incisions inside the nostrils. This allows the skin envelope to be elevated entirely off the cartilaginous and bony framework, providing direct binocular visualization of the entire nasal anatomy — the upper lateral cartilages forming the middle vault, the lower lateral alar cartilages forming the tip, the nasal bones forming the bony dorsum, and the septal cartilage occupying the midline. This level of exposure is preferred for complex primary cases, cases requiring significant structural modification, cartilage grafting, or tip refinement, and for revision cases where altered anatomy and scar tissue demand the clearest possible operative field. The closed (endonasal) rhinoplasty confines all incisions to within the nostrils, preserving the columellar skin bridge entirely and avoiding the small external scar. It requires greater technical experience to achieve precise modifications through a more limited exposure but offers reduced external swelling and bruising in the early recovery period, and is appropriate for patients requiring more limited modifications with adequate existing structural support. Common aesthetic concerns addressed include reduction of a prominent dorsal hump through conservative rasping or osteotomy, refinement of a broad, boxy, or bulbous nasal tip through suture reshaping techniques or cartilage modification, reduction of alar base width through conservative alar base resection, and correction of nasal asymmetry through differential osteotomies and cartilage-shaping manoeuvres. Revision rhinoplasty — one of the most technically demanding subspecialties in plastic surgery — requires a thorough assessment of what was changed in prior surgery and what structural support (cartilage, bone, soft tissue) remains before planning graft requirements. Ear cartilage and rib cartilage serve as donor sources when additional structural support is needed. El Paso patients are advised to plan for one week of initial recovery with nasal tape in place, with progressive swelling reduction over two to twelve weeks and some patients experiencing residual tip swelling for up to one year as the nasal soft tissue envelopes remodel fully.