Posted on March 5, 2010 in Facelift, Facial Plastic Surgery
I often times get asked what type of facelift technique do I prefer to do on my patients. The answer to this is – it depends on the type of facial anatomy that I am presented with and the desired change. Essentially any facelift procedure done today involves some type of lifting of the SMAS layer (also known as the superficial musculo-aponeurotic sytem). This is the thicker fibrous layer of tissue that sits below the skin and above the muscles of the face. In order to effectively lift the face and get a long-term esthetic improvement, one has to involve the SMAS layer in one or another. The main differences between the various facelift techniques mostly relate to if and how far below your surgeon dissects the SMAS to lift the face. Some facial plastic surgeons go quite deep, therefore, the term deep plane facelift. Others go a short distance under the SMAS and some don’t even lift the SMAS at all. Instead, they tighten the SMAS layer with permanent sutures to get a similar result. The MACS facelift technique has gained increasing popularity recently and is a variation of the SMAS suture tightening technique. The MACS lift (which stands for minimal access cranial suspension) involves placing a series of suture loops anchored to the deep fibrous tissue above the ear. By strategically placing these suture loops, the surgeon can effectively lift the lower face and upper neck to achieve a nice cosmetic improvement. All of these facelift techniques have been used by surgeons to achieve great cosmetic outcomes over the years. In many cases, patients aren’t even aware of what technique was used in their particular case. Not that it really matters as long as your surgeon is comfortable with their chosen technique and has enjoyed safe, successful outcomes over time. Dr. Hilinski.
Posted on in Blepharoplasty, Facial Plastic Surgery
One of the more frequently asked questions is what will my eyes look like after an upper blepharoplasty, or eyelid lift, procedure? Or what can I expect at one week out from my eyelid lift? Within the first 72-96 hours your eyes will swell and might even bruise. We always recommend ice compresses (or Karo syrup bags) to the eyes during this period to minimize swelling and discoloration. Within 5-6 days, I will see you in our office to remove the sutures. The sutures are fine threads placed along the upper eyelid crease to bring the skin edges together very carefully. There are some additional sutures along the outside of the eyelid in some cases where the patient has ‘hooding’ of the skin to the side. You may still look puffy that day when the sutures come out but within a few days to weeks will begin to look more and more presentable in the public. One of our San Diego rhinoplasty patients who had an upper eyelid blepharoplasty is shown in the attached photo 5 days out from surgery on the left showing what the average patient looks like at this point. Notice the fine blue sutures along the upper eyelid. On the right is the same patient within a few weeks. Happy healing. Dr. Hilinski
Posted on in Facial Plastic Surgery, Revision Rhinoplasty, Rhinoplasty
Question: Why do some plastic surgeons only show the lateral or profile view of the nose following rhinoplasty or revision rhinoplasty?
Answer: This is a great question. In my opinion, plastic surgeons should provide at least two views of the nose in their before and after photos. Nasal reshaping is such a 3-dimensional process that I don’t a single lateral view can represent an accurate outcome of the surgery. Plastic surgeons should always try to provide before and after rhinoplasty photos of at least two views – preferably a frontal and side view. Sometimes the oblique or 45 degree angle view also helps in demonstrating an accurate change. Many plastic surgeons will post only the lateral view of the nose showing how, for instance, a hump has been removed or how the tip was elevated. That is great to see this view but the real question is how does that nose look from the front? Getting the frontal view symmetric and refined is the real challenge in rhinoplasty and revision rhinoplasty. Without the frontal postoperative photo, I personally don’t think that one can accurately judge how good of a rhinoplasty was performed. My humble opinion. Dr. Hilinski
Posted on in Otoplasty
Question: Is it normal to have my ear look like it is overcorrected after having an otoplasty?
Answer: The answer to this is – yes. It is entirely normal and even expected that the ear(s) looks much closer to the surface of the head early on after otoplasty, or ear reshaping. The cartilage of the ear has what is termed ‘memory’ that gives it a tendency to go back to its original position. This is what accounts for the ears ‘relaxing’ weeks to months after otoplasty. In order to compensate for this relaxation, the otoplasty procedure is done with a certain amount of overcorrection. That is precisely why your ears might look too close to your head in the early recovery period after otoplasty. Just give it some time and they will relax. Best regards, Dr. Hilinski
Posted on in Facial Plastic Surgery, Revision Rhinoplasty, Rhinoplasty
Question: Do you always put a cast on the nose following rhinoplasty or revision rhinoplasty?
Answer: The answer is – no. I will only place a cast on the nose if I have performed osteotomies (breaking the nose) during the rhinoplasty procedure. The cast, like for a broken arm, is intended to keep the bones in position during the early healing process. Unlike with your arm, however, we take the cast off within the first week. Dr. Hilinski.
Posted on March 4, 2010 in Facial Plastic Surgery, Revision Rhinoplasty, Rhinoplasty
Question: If I just want to narrow my nose by reducing the width of the base, do I have to undergo an anesthetic?
Answer: The answer to this is ‘no’ if that is all you want done in terms of a limited rhinoplasty or revision rhinoplasty. We have several patients every year that only want to narrow the base of the nose where the nostrils attach to the cheek and lip. There are a variety of methods used for base narrowing of the nose and essentially all of these can be done in the office under local anesthesia and sometimes an oral sedative medication. In most cases, this simple limited type of nasal reshaping can make a significant improvement in the appearance of the nose.
Posted on in Facial Plastic Surgery, Septoplasty
Many patients inquire about septoplasty for nasal obstruction, or difficulty breathing through the nose, and ask whether I perform suture technique to straighten the septum. The answer to this is ‘no’ in terms of my primary surgical technique for septoplasty. The reason for this is that the cartilage of the septum has what we call ‘memory’, which means that it has a tendency to go back to its original shape if given the opportunity. Conservative methods of straightening the septum like just suturing the cartilage are highly prone to failure because the cartilage memory overrides the suture tension. The end result is that the cartilage bends back to its original crooked shape. In order to effectively straighten a deviated septum, the surgeon normally has to cut the cartilage at the very least to permanently reshape it. By cutting the septum in strategic locations one can completely erase the memory issue and provide a long-term improvement.
Posted on in Dermal Fillers, Facial Plastic Surgery, Revision Rhinoplasty, Rhinoplasty
I just completed an interview today with an independent journalist here in San Diego who was researching the topic of injectable filler use for the nose. This idea has actually been around for many years but has been gaining increasing media attention. It has been called among other things the non-surgical nose job as well as injection rhinoplasty and lunchtime rhinoplasty. These names and labels all refer to the technique of injecting a dermal filler (like Restylane, Perlane and Juvederm) into the nose to reshape and contour. It is not a bad option in those patients who want to bridge the gap and buy time before they ultimately undergo an actual rhinoplasty or revision rhinoplasty. We have had many rhinoplasty patients over the years here in San Diego opt for this procedure and then end up having their rhinoplasty performed after the filler has gone way (6-9 months typically for the temporary fillers mentioned).
Posted on March 3, 2010 in Asian Rhinoplasty, Ethnic Rhinoplasty, Rhinoplasty
Question: What is Asian rhinoplasty and how is it different from standard rhinoplasty?
Answer: Asian rhinoplasty is quite different than the average rhinoplasty procedure. The reasons for this are multiple but primarily involve the desired endpoint in terms of esthetic outcome and the unique underlying anatomy. With regard to the desired esthetic outcome, any experienced rhinoplasty surgeon is going to agree that you cannot reshape an Asian (or any ethnic nose) the same as you would in a Caucasian rhinoplasty. Although the bridge is typically augmented and the tip is made more defined in Asian and ethnic rhinoplasty, the end result has to remain in balance with the rest of the facial features. Since there are such distinct differences in Asian and ethnic faces, your rhinoplasty surgeon must respect these unique characteristics and avoid performing ‘westernization rhinoplasty’ in this population. Only rarely do I have Asian rhinoplasty patients who truly desire to move away from their ethnic look. With regard to the anatomy of an Asian nose, there are very clear anatomic variances that warrant a different technical approach to the nose. For instance, the combination of thicker skin and weaker underlying cartilage in the Asian rhinoplasty patient means that your rhinoplasty surgeon has to alter their surgical technique to compensate for these variables. For these reasons and more, you need to make sure that your chosen rhinoplasty surgeon is experienced and versed in performing Asian rhinoplasty on a regular basis. Sincerely, Dr. Hilinski.
Posted on March 2, 2010 in Facial Plastic Surgery, Revision Rhinoplasty, Rhinoplasty
One of my San Diego revision rhinoplasty patients was just in and asked what many patients ask regarding nasal exercises. Is it normal to have pain with the exercises? The answer is absolutely. In fact, if you are not pushing hard enough on your nose to elicit some degree of pain, you are likely not pushing hard enough! In order to effectively move the nasal bone after we perform an osteotomy (fracture or break the bone) you have to push to the point where pain is felt. Many rhinoplasty patients worry about over correcting the bone, but this is essentially unheard of when performing nasal exercises. Happy healing. Dr. Hilinski.
