Hello everyone, my name is Alexandra Garcia and today I will be presenting to you my ISM final

presentation. Before I begin, I would like to show everyone my ISM online portfolio. This website

contains everything pertaining to this mentorship from pictures of my mentor and I to various

assignments given to me throughout the semester. Some of the assignment I have are a mentor

interview essay that gives you more information about my mentor and multiple journal entries. The

journal entries are short responses to questions regarding our mentorships and our different

experiences throughout the semester. Now, I will begin my presentation. My final presentation is on

rhinoplasties, but before I start talking about my product, I would like to begin by describing what ISM is.

ISM is a class at our high school, Clear Horizons Early College High School, and it stands for independent

study mentorship. The class is focused on finding a mentor in our field of interest and then shadowing

and observing first-hand the different experiences and tasks done in our field. ISM is such a unique

experience in that we are exposed to so many different scenarios, preparing and building up our soft

skills such as our communication and interpersonal skills. With that, for my mentorship, I decided to

look in the medical field because I have always been interested in this field – especially now when this

field is changing and growing every day, I can’t wait to see what medicine is going to be like by the time

I’m a medical student or even by the time I am a doctor.

My mentor this semester, Dr. Garcia, is a plastic surgeon. The reason why I chose plastic surgery

is because I wanted to learn more about plastic surgery itself. I wanted to learn what it really consisted

of behind the cosmetic side of nose jobs and tummy tucks we so often hear about. A little education

background on Dr. Garcia is he attended the University of Puerto Rico where he earned his Bachelor of

Science degree in biology while also minoring in chemistry and math. After this, he went to the

University of Puerto Rico School of Medicine for medical school, and later went to Baylor School of

Medicine for his General Surgery Residency and UTMB for his Plastic Surgery Specialty. And although she

technically was not my mentor, Mrs. Sylvia Rodriguez, my other evaluator today, I do consider to be my
second mentor as she has helped me so much throughout this entire mentorship and I have learned so

much from her.

When creating my final product, I wanted to make sure I focused on creating a product that not

only benefited patients, but also students like myself. In order to do this, I decided to create two

different Rhinoplasty models – one displaying the bone and cartilage structures of the human nose and

the other displaying a nose after a rhinoplasty procedure has been done. When researching for this

product, I read an entire chapter out of a medical textbook that described step-by-step the surgical

order of a rhinoplasty. This textbook really taught me so much and helped me overcome my biggest

obstacle – not being able to see a rhinoplasty done in person. I also was able to find information in

pamphlets given to patients undergoing a rhinoplasty found in Dr. Garcia’s office. Though I learned so

much through my research and observing Dr. Garcia, I did have obstacles and struggles to face. One of

the struggles I faced was trying to figure out how to make this product. I am not an artist so figuring out

the different materials needed to make my models was difficult but ultimately attainable. Having these

models physically in front of a patient, could help put them at ease by showing them exactly what is

going to be done to them during their surgery. On the other hand, I feel that my product will benefit

students in a way that it gives them a tangible diagram of the body structures they are learning about.

Similarly, I feel that by having something directly in front of them, it will be easier to learn about the

many complexities that come with this surgery.

While doing my final product, I was able to reflect on all that I had learned from Dr. Garcia. I

remembered that when I had my first interview with Dr. Garcia, he had asked me what kind of surgeon I

wanted to be, and I replied explaining how I wanted to be an oncological surgeon. He immediately shut

down my response saying that it’s one of the hardest fields because you are literally dealing with

patients who are dying and more than likely will not survive. I had thought about his words for a while

afterwards, but it only now hit me how important they were. As a surgeon you want to do whatever it
takes to save a life, but with oncology, a lot of times you are working on a “lost cause”, but with plastic

surgery you will always make your patient happy because you’re doing what they want. I learned that

plastic surgery is one of the most important specialties as it has so many different impacts physically but

also emotionally. I also learned just how intimate surgery really is. These patients, who, at first, are

complete strangers to surgeons, are trusting them with their life. Surgery is an art form; the patients are

the willing canvases and the surgeons are the artists. Dr. Garcia is such a perfectionist and never gives

his patients anything less. He so meticulous with his work and just observing him do his job is incredible,

seeing first-hand, the care and attention he gives each patient.

So, what exactly is a rhinoplasty? Essentially, it is surgery done to the nose to correct and

reconstruct the form, restore the function, and aesthetically enhance the nose. Those of us who aren’t

doctors commonly hear it called a nose job. Now that we know what the procedure is, I will now begin

to explain what to do before the surgery, what happens during the surgery, and what to do after the

surgery. So of course, before the surgery, a patient is going to want to begin their surgical journey by

getting a consultation done by a board-certified plastic surgeon. Once the consultation, and the surgical

plan have been determined, when the night before your surgery comes, there are a couple things you

should do to prepare. The first thing is you should avoid eating or drinking for at least 7 hours before

your surgery. You should also arrive at the hospital early to sign any remaining papers needed and just

to get yourself situated and relaxed for your surgery. Upon arrival, you want to make sure your face is

clean of any makeup, moisturizers, or lotions, for the surgeon to have a clean canvas to work on. And

finally, although it is not a mandatory step, I think it would be beneficial to the patient to fill any

prescriptions prescribed and gather any supplies that may be necessary for your post-op care just so

that the patient will have a peace of mind knowing that they are completely prepared for their surgery.

Once the patient has entered the operating room, the anesthesiologist will then administer the

appropriate amount of anesthesia – after about 10-15 minutes, the patient is asleep and ready for
surgery. When the surgeon arrives, he will begin by drawing the incision lines he is going to cut with a

marker. The first step is the initial incision which is done in the shape of an inverted-v on with wings on

either side, on the columella – the columella is the little strip of skin between our nostrils. Once the

incision is made, the columella to tip needs to be exposed. In order to do this, the skin will be retracted

in three different directions as the surgeon begins to detach the outer layer of skin from any underlying

structures with angled converse scissors. With the columella to tip exposed, next comes the septal

exposure which is done using a Transfixion Approach. This exposure elevates the mucosa and

perichondrium through an anterior tunnel. The extramucosal tunnels come next to drop the lining of the

mucosa allowing the dorsal hump to be fixed. At this point of the surgery, the surgeon will take a

“surgical timeout” to assess the nasal anatomy in front of him. Because no one has the exact same body,

everyone’s nose is a little different, this results in the surgeon just having to double check and make sure

his surgical plan is still viable. Additionally, as the surgeon is reviewing his surgical plan, he should now

know how much bone and cartilage to remove to attain the desired profile. The next excision that is

done is removing a portion of the cephalic lateral crura to reduce the nasal tip. After this begins the

critical part, the dorsal modification. To begin modifying the dorsal hump, the surgeon will go in with

two different tools – a rasp for the bone and scissors for the cartilage. He will then use the Incremental

Dorsal Reduction method to slowly reduce the hump making sure to check the profile to avoid taking

out too much bone or structure. With the dorsal hump finally reduced, next the caudal septum and

anterior nasal spine is looked at. There are three different kinds of changes that can be made at this step

depending on the patient. The first change that can be made is to rotate the tip, the second is to shorten

the nose by resecting the lower half, and finally the third change could be to deepen the anterior nasal

spine to define the lower nasal contour. Following this, the septal harvest is done to correct ant septal

body deviation. This is done to correct any breathing impairments that may be present or may have

occurred during the dorsal reduction. The next step is the osteotomy; this is where the commonly heard
stigma that during a nose job they break your nose. Essentially, that is what’s being done in order to

narrow the base width because as you reduce the dorsal hump, the nose begins to get wider so to

achieve the narrow nose most patients desire, osteotomies are done to narrow the nose. Getting

towards the end of the surgery the next couple steps are done all to fix the aesthetic appearance of the

nose. Inserting spreader grafts help restore the normal dorsal width of the septum while also helping

avoid deformities and any asymmetries. Tip grafts can also be added to refine the tip of the nose until

getting the surgeon’s desired nose profile. In the same way, alar width is modified with three different

methods – one is a nostril sill incision to reduce nostril show, the second method is an alar wedge

excision that reduces nostril flare, and the last method is a combined sill/wedge excision to reduce both

flare and width. Finally, all incisions are sutured and depending on the surgeon, a patient may be given a

cast. Although the cast is optional, Steri-strips will be added to the nose to assist in tip molding and skin

compression. Now that the surgery is done, it is important to take certain measures to ensure proper

healing of your nose. The first thing a patient needs to do is make sure the post-op dressings and sutures

are kept clean to prevent infection and ensure immediate healing. As a second measure to prevent

infection, it is also important for the patient to take any antibiotics prescribed as that will help their

body heal itself. And of course, with any surgical procedure comes follow-up appointments. With this

procedure, a follow-up appointment should be expected the following day to make sure everything

made it through the night and is still intact. As time goes on, the follow-up appointments will gradually

get further apart, only checking to make sure the nose is healing properly and maintaining proper

structure.

At this point, I’d like to say thank you to Dr. Garcia, Mrs. Sylvia, and my ISM teacher Ms. Kahlich

for giving me this great opportunity. Dr. Garcia, thank you so much for allowing me to shadow you and

being so willing to teach me and answer all my questions. I’d like to open the floor to any questions or

comments as I am done with my presentation, thank you again.