Colorado’s own Heidi Montag Pratt of The Hills MTV reality series now in its sixth season underwent comprehensive plastic surgery earlier this year generating endless news feeds and paparazzi coverage. “This situation should not be perceived as reality,” says Jeffrey Raval, MD, FACS. “Reputable plastic surgeons do not engage in performing surgery to gain notoriety.”

While undergoing 10 plastic surgery procedures performed in one day – a mini brow lift, Botox injections, a nose job, fat injections in her cheeks and lips, a chin reduction, liposuction to her neck, her ears pinned back, buttocks augmentation, liposuction to her waist and thighs, and revision breast augmentation—Montag had the surgeries taped purportedly to use in a future reality show.

Post-surgical photos of Montag reveal a Barbie-shaped physique. “Truly, the responsibility of any cosmetic surgeon is to vet elective surgery options with a patient prior to surgery. Consults with the doctor would routinely identify what surgical procedures are indeed going to enhance an individual’s lifestyle and improve their health. A perceptive plastic surgeon will be able to assess whether an individual is seeking surgery for all the wrong reasons, i.e. to please a partner or to gain notoriety. From the outside, it would appear that this particular celeb pursued surgery to generate media attention rather than to correct physical flaws.”

Dr. Raval has gained a reputation among fellow surgeons in the Rocky Mountain West of being The Nose Doc, particularly proficient at revision rhinoplasty surgery, repeat nose jobs that are more complicated than first-time nose surgeries because of the scar tissue that develops in any surgical area.

Dr. Raval pioneered the use of Dermamatrix in nose surgeries resulting in a smoother, more natural shape to the nose. Introduced in 2006, this dermal matrix is preferred over others because of its uniformly soft and pliable consistency and its increased tensile strength.

To see a video on the benefits of Dermamatrix, go to www.ravalmd.com/rhinoplasty.html.

Upper Airway Resistance Syndrome disturbs sleep patterns, but can be remedied

It may not be your mattress that’s keeping you from having a good night’s sleep. It could be Upper Airway Resistance Syndrome (UARS), according to Jeffrey Raval, MD FACS, located at 250 Steele St., Denver, CO. While sleep apnea has gotten a lot of press in the last few years, UARS is a more recent diagnosis. It’s so new, in fact, that the equipment used in some sleep clinics is not geared up to diagnose the problem the way that an ear-nose-throat surgeon can.

Sleep apnea affects men far more frequently than women. However, older women suffer from UARS than do any other demographic group, says Dr. Raval, an American Board Certified Facial Plastic Surgeon and Ear/Nose/Throat/Head Neck Surgeon. Curiously, UARS is often diagnosed after nasal surgery to correct crookedness or surgery for a deviated septum.

“We have women patients who report back to us that they had spent years of restless, sleepless nights chalking that up to stress, menopause or insomnia. They’ll tell us they never made the connection between breathing well and sleeping well…until after their surgery to correct the nasal obstruction,” Dr. Raval says. Frequently women who suffer UARS have severe nasal airway obstruction. Simple nasal airway reconstructive surgery such as straightening the septum, called a septoplasty, can vastly improve their life by allowing them to sleep throughout the night.

UARS differs from sleep apnea in that many people suffering from sleep apnea are overweight, while those diagnosed with UARS share the opposite condition of a thin face, a small or narrow jaw and a thin neck. When taking his patient’s health histories, Dr. Raval has found that it’s not uncommon among this group of UARS patients to have had orthodontia as a child to correct overcrowded teeth-one of the defining characteristics of the thin face and small or narrow jaw.

Otolaryngologist Steven Park, M.D. released a book in 2008 called “Sleep Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (Jodev Press), on the topic of UARS. His findings in the book are consistent with those Dr. Raval has witnessed among patients who complain of cold hands and feet, low blood pressure, and the inability to sleep on their backs comfortably.
European studies (one study of French women) show that almost half of the women with chronic insomnia and resulting daytime fatigue have UARS-a sleep disorder caused by resistance to air flow through the nasal passages.

Breathing strips (Breathe Right is one such product) do help some patients with UARS. Others see improvement using nasal dilators such as Nozovent or a saline nasal spray. Over-the-counter Claritin can remedy congestion from allergies. When either of those remedies doesn’t solve the problem, an ENT can prescribe a nasal spray containing itraconazole (Sporanox), xylitol, mupirocin (Bactroban) and dexamethasone. In other cases, Dr. Raval has had success prescribing dental devices that push the jaw forward preventing it from blocking the throat opening. And a special nasal mask called a Continuous Positive Airway Pressure (CPAP) can be recommended to deliver air to the airway while preventing the nasal passages from collapsing during sleep.

“A good night’s sleep is one of the best things a person can do to maintain their health,” adds Dr. Raval. “Now that we understand UARS, we have solutions that can help.”

My nose is slightly disproportionate, but not so bad that I need surgery. In fact I don’t think most people can tell my nose is off-kilter unless I’m looking at them straight on and not moving, not even talking. Now that I’m staring into the eyes of my fiancé, I’d like to think he thinks I’m perfect. Is there anything that can be done besides a full-blown nose job?

Clarice—28 years old, Englewood, CO resident engaged to be married in the fall of 2008.

Dr. Raval: Clarice, everyone’s nose is slightly asymmetrical. In cases like yours when a nose isn’t necessarily oversized but is just a little uneven, the newest advancement is simply injecting filler into the smaller side of the nose to plump it up slightly to the same shape as the other side. This works too for small bumps on the bridge of the nose. You just want your nose to look even and not detract from the rest of your face.

The 15 minute nose job uses injectables like Perlane to fill in where needed. Any dents or creases can be eliminated and both sides can be made equal. We numb you up a little prior to treatment with a topical anesthetic ointment and in only 15 minutes, your nose will be ideally balanced. The nice thing about Perlane is that it lasts up to a year and because it’s hyaluronic-based there’s no risk of an allergic reaction.

Call our office for an appointment to see if this isn’t the first option you should consider before weighing a full-blown nose job or rhinoplasty as it’s called in medical terms. Our office number is 303.381.FACE (3223).

Q: I have considered plastic surgery on my nose before, but now at age 27 I broke my nose in a charity powder puff football game. Yes, it was brutal. And not only is it crooked, but I can’t breathe the same. What do I need and what do I tell the Doctor when I go in for a consultation? I want it functional and aesthetically pleasing and I’d like to convey that without saying, “Hey Doc, how ’bout a nose job?”

A: Good question.  Any type of plastic surgery on the nose is generally called rhinoplasty. Granted, this can be discomforting considering the mental image conjured by the word “rhino.” But fret not, rhino means nose and plastic surgery on the nose ranges from full cosmetic reconstruction to noninvasive out-patient procedures to help sinuses.

The new nose guide.

Do you have a humped nose, crooked nose, tension nose, traumatic nose or saddle nose?

Rhinoplasty is for you if…

Form:

You don’t like how your nose looks.  It could be too big, too pointy or have an unwanted bump.  A rhinoplasty can correct it and improve the look of the whole face.

An injury changed your nose and your appearance.  Simply realigning nasal bones that may have been fractured and removing crushed cartilage can correct the nose.  Even if the nose appears twisted or flattened, it can be corrected in approximately two hours.

Function:

You have trouble breathing. A deviated septum can be corrected and nasal passages can be enlarged to ensure breathing with ease.

You suffer from sinusitis. A special type of rhinoplasty called balloon sinuplasty can clear your nasal passages in order to allow sinus drainage.  Headaches, facial pain and congestion are among the symptoms that can be alleviated.

Slightly reshape the nose:

Closed rhinoplasty is the way to go. Incisions are made within the nose and it is slightly rearranged to achieve desired shape. This is done by removing bone and cartilage and then reshaping skin and tissue around the structure. This can typically be performed in 1 to 2 hours

Completely reshape the nose:

An open rhinoplasty is required. The incisions are made on the strip of skin separating the nostrils. Then the bone and tissue is rearranged to the desired shape and the incisions are closed immediately. Following the procedure, an external splint will need to be worn for 6-8 days to ensure proper healing. This procedure takes less than two hours.

Clear sinusitis:

This cutting-edge procedure does not require incisions. A balloon is inserted into the nostrils by using a wire catheter and the balloon is only inflated up to a quarter inch when inside the nasal passages in order to clear them. This is only a 30 minute procedure that typical needs less than 24 hours for full recovery.

Google Jennifer Aniston and 18,900,000 results pop up in less than 19 seconds, among them teasing headlines like “Aniston and John Mayer caught kissing again” to a report by Fox News in 2007 that Aniston has had a second nose job by Indian plastic surgeon Raj Kanodia, the second one to correct a first surgery for a deviated septum done a dozen years ago. The surgeon is also reportedly the plastic surgery solution to Jessica Simpson and Cameron Diaz, the article by Catherine Donaldson-Evans on the FX website, owned by News Corp. the parent company to FOX News.

Repeat rhinoplasty or nose jobs aren’t uncommon, reports Dr. Jeffrey Raval of Denver, CO, who is known as “The Nose Guy” for his exceptional surgical capabilities in repeat nose jobs. “The issue with a repeat nose surgery is always the scar tissue,” says Dr. Raval, F.A.C.S. and triple board certified facial plastic surgeon with American Board certifications in head and neck surgery, otolaryngology and plastic surgery.

Patients frequently seek out Dr. Raval for their repeat nose job when they’re not happy with the surgery performed by another plastic surgeon. Sometimes these patients come from states away, says Dr. Raval who is not afraid to tell a potential patient who wants unreasonable surgery that they’re not a good candidate for cosmetic surgery.

“I make a point of taking the time to discuss with the patient their concept of what the surgery will do for them,” says Dr. Raval. “If they’re scheduling surgery to please someone else or expect their lives to become altogether different, new and improved because of a surgical procedure, they will not be pleased with the outcome, even when the surgery is flawless.”

No surgical procedure makes everything about one’s life perfect, Dr. Raval adds.

Take, for instance, Jennifer Aniston. Even though she had a first nose surgery, she still ended up divorced from her husband, Brad Pitt. And although she underwent a subsequent corrective nose job to trim the wideness of her nose, she still suffered heartbreak, falling in and out of love. She was incessantly  pursued by the paparazzi. Reports about Jennifer’s every move, whether it was true or not, were widely circulated, particularly when she was expected to be at the same event as her ex, Brad, and his new wife Angelina Jolie.

Nose jobs are done for many reasons, not the least of which is to simply correct the appearance of the nose. Other reasons for nose surgery include restoring breathing function in the case of a patient whose breathing is limited because the inside of the nose is crooked (called a deviated septum). Many patients have noses that are outsized like their parent or other family member, consistent with their DNA of origin. Surgeries to minimize the size of a nose or to correct a bump on the nose are often performed on teens in their mid-teen years.

“The outcome for a teen patient who has been ridiculed or teased because of the size or shape of their nose is almost always highly positive,” says Dr. Raval. “A good nose job eliminates the object of this ridicule and torment. Now if a teen has a big nose and a repulsive attitude or other offensive behavior, chances are nose surgery won’t do a thing to endear others to him/her or to make the teen feel better about him or herself.”

“That would be a case where I would suggest to a parent that the child be seen by a counselor who could help the teen work through his or her emotional issues to better understand what is causing issues in interaction in the first place,” Dr. Raval says.

In his years in practice, Dr. Raval has had many, many patients who’ve had nose jobs tell him that the surgery has improved their lives.

Sometimes patients combine surgery to correct a deviated septum along with surgery to correct the appearance of the nose. When Dr. Raval is minimizing a nose or removing a bump, his overriding concern is that the nose be consistent with the rest of the patient’s facial characteristics. “In the ‘60s patients who came in wanting a nose job might want theirs to be made into a small pixie nose. But those days thankfully ended when the objective of cosmetic surgery became more focused on making a patient look natural as well as beautiful, absent exaggerated change or an over-surgerized noses,” says Dr. Raval.

The decision to opt for a nose job is one that requires a patient to take appropriate time off rigorous activities to recover. Following rhinoplasty, the nose is packed with dressings that must remain in place for several days. Then for about a week to 10 days, the patient is advised to not sniff their nose or blow their nose. Instead they’re instructed to gently dab at any discharge with a tissue. Once the nose has begun to heal, the mucous plug, that at first functions as a sort of protective cover, will naturally dry up and release from the inside walls of the nostrils. Follow-up visits to the doctor will check to confirm that the healing process is going as is expected and the swelling and tenderness that occurs will minimize as the nose heals completely.

“Just because you like the noses the celebrity twins Mary-Kate and Ashley Olsen breathe out of, doesn’t make that same nose ideal for you,” cautions Dr. Raval. “By the same token, it can be tough on a child to have a nose that attracts attention for all the wrong reasons.”

Dr. Raval can be reached at 303-744-2300 or visit his website at www.ravalmd.com

Okay, here’s the bad news. Not only does your skin wrinkle and sag as you age, but your nose drops too.

Here’s the good news: there is a solution in the case of a nose that drops significantly adding years to the appearance of one’s face.

Dr. Jeffrey Raval, board certified facial plastic surgeon, has raised the noses of aging patients surgically and in doing so has eliminated years from their appearance. Often this type of surgery is in companion with other facial surgery, i.e. facelift or brow lift, addressing all at the same time.

“The nose ages, dropping as we gain years,” explains Dr. Raval, who is also a board certified facial plastic surgeon. For patients who have a particularly elongated nose, the advancement in years means their nose grows disproportionately long for their faces, aging their appearance unnecessarily.

Known as The Nose Guy, a credit given to him by fellow surgeons who apprise his nose jobs as being exemplary, Dr. Raval is able to turn back the clock in a patient’s appearance by elevating the nose just enough to look more attractive and youthful while retaining its full and necessary function for breathing.

That’s another plus to Dr. Raval’s capabilities: he’s board certified in both ENT and facial plastic surgery so that he understands both the aesthetics and function of the nose inside and out and can perform surgery to address both aspects—both very necessary aspects—of the nose.

“He’s got your eyes,” joyful grandparents coo at the infant they cradle in their arms while seeing in their memory their own son, father to this baby. While an infant may resemble his mother’s or father’s baby pictures at birth, the likelihood of the child manifesting other inherent traits, like a large nose, are likely to show up as the child gets older.

That inherent propensity along with the fact that the first thing that’s noticeable when you see someone’s face is usually their nose when they’re younger and their eyes when they’re older, make nose jobs a real consideration today for young people with outsized noses.

Dr. Jeffrey Raval prefers to postpone nose surgery on a child until they are past puberty and their nose has reached the size it will remain.

But some unique cases call for surgery before that time.

Take for example the case of the young teenage girl who had a natural stage presence and loved to act. In elementary school and junior high, she’d found her niche. But when she got to high school and was as anxious to star in the school play, a thoughtless boy had ridiculed the size of her nose. It was humiliating enough to the girl that she withdrew from acting and increasingly retreated to being a solitary child, keeping to herself.

Her parents were aware of the ridicule their daughter had suffered by her classmate and sought out Dr. Raval to assess their daughter’s candidacy for a nose job. She was a fit for surgery, Dr. Raval determined.

“This was a case that surgery totally changed a life,” says Dr. Raval. “I could see an entire revision of her self-esteem and personality.”

The young lady regained her confidence and reinvested herself in participating in stage plays, regaining her stage presence because of her innate talent, only now without the embarrassment of having a naturally outsized nose. Hollywood will likely chronicle her story years from now.

“It’s this kind of surgery that is so rewarding,” adds Dr. Raval.

Sometimes a first-time nose job does not result in the nose a patient wants.

That’s where Dr. Jeffrey Raval has gained his stature among fellow physicians in Colorado and the entire western region in revision rhinoplasty. He’s even known as The Nose Guy among surgeons.

The revision rhinoplasty is the toughest nose surgery of all to perform, explains Dr. Raval. “There is a lot of scaring after the first nose surgery. You [the surgeon] never know quite what was done in the initial surgery. Oftentimes, the nose needs to be rebuilt because the biggest problem the second surgeon encounters is that too much of the nose—bone and cartilage—was removed the first time.”

One doctor who sought out Dr. Raval for his repeat nose surgery actually shed tears upon completion of the second surgery. Tears of happiness, because the nose job that had gone so wrong at the hands of a different doctor previously, was corrected to exactly the look the he wanted with his revision rhinoplasty by Dr. Raval.

In the years he’s been in practice in Denver, Dr. Raval has seen his patient base for nose jobs extend to cover many states in the western region. Patients have come to him from as far away as Wyoming, Idaho and Nebraska, having heard he’s the go-to surgeon for the most well done first-time and repeat rhinoplasty surgeries.

Maybe you know someone who has had surgery for a deviated septum. Their nose, they tell you, was crooked on the inside.

The thing is everyone has some level of deviation of their septum. Whether that deviation is big enough to warrant surgery versus not, is largely dependant on the functionality of their nose.  If the patient has a difficult time breathing through their nose from a deviated septum then their septum may need to be straightened.

“No one has a perfectly shaped nose,” explains Dr. Raval. “When the shape of the nose creates a functional breathing problem is when the nose may require surgery.”

Many times evidence of a deviated septum on the inside of the nose is reiterated by the poor shape of the outside of the nose—with the patient having suffered an injury or just by the genetics he or she inherited.

Dr. Jeffrey Raval is board certified in ENT (ear, nose and throat) and in facial plastic surgery and reconstructive head/neck surgery. The training he has in both the outward appearance of the nose and the inner functions give him an advantage surgically in understanding the necessary function as well as the beauty of how the nose works and looks.

It used to be that nose jobs, rhinoplasty, in the ‘60s, 70’s and 80’s resulted in a lot of upturned pixie noses. Large noses were minimized into dramatically smaller ones, upturned at the tip. The problem with this, explains Dr. Jeffrey Raval, is that the aesthetic and function didn’t work in concert for the patient.

One of the missing parts about nose jobs like this is the reason for newer techniques in nose jobs today. “When we take something out of the nose, we realize we weaken it and we have to put something back,” says Dr. Raval.

Yes, even in the case of making a nose smaller, a new application of cartilage is necessary to help reshape the nose to be most natural looking and better functionally.
The cartilage can be harvested from one’s own body—like from the nose itself or the ear—or is readily accessible from surgical suppliers.

In the case of a person who has had nose injuries—one or more—in athletics, especially, the need for additional cartilage is apparent because the inside of the nose has collapsed, leaving a flattened or mashed look. Inserting bone and/or new cartilage will remedy that.

Another thing that happens after a person has suffered an athletic injury to the nose, or even in a car accident, is that the nasal cartilage may be lost and has to be replaced. This is also true in the case of a revision rhinoplasty—repeat nose surgery when a first nose job has been a failure.

Dr. Jeffrey Raval is known among fellow physicians as The Nose Guy for his expertise in revision nose surgery.