Posted on February 8, 2012 in Nose Job, Nose Reshaping, Rhinoplasty, Septal Reconstruction
I recently saw a new patient in my office for evaluation of his nose following an injury sustained while playing soccer. Immediately following the nose injury, he was seen and evaluated in a local emergency room. X-rays were taken and confirmed an obvious nasal fracture. While in the emergency room, he was told that he needed to have the nasal fracture repaired by a nose specialist. Unfortunately, he was also told that he would never be able to play soccer again! This comment from the emergency room staff prompted an immediate phone call to me via this patient’s family member who was a personal friend. Fortunately, I was able to calm their nerves by clarifying his true prognosis. The reality is that once repaired and once healed, a vast majority of patients who sustain an injury to the nose are able to resume essentially all of their normal activities – including playing sports. It is a rare case where a patient suffers a nose injury that is so severe that future participation in sports would be prohibited. If you have questions or concerns about repair of your nose following an injury, feel free to contact one of San Diego’s experts in nasal fracture repair – Dr. John Hilinski.
Posted on February 3, 2012 in Face Lift, Facelift, Facial Plastic Surgery
Wondering what a typical facelift patient looks like in their 50s-60s? This latest blog entry by San Diego face expert, Dr. John Hilinski, highlights a female patient in this particular age range who desired cosmetic face enhancement to turn back the clock. Dr. Hilinski discusses the thought process and evaluation of your typical patient who has these type of concerns. Dr. Hilinski performed a combined facelift, neck lift, eyelid lift and chin implant to provide this patient a more rested, youthful appearance – all without looking like she had a surgical lift! To learn about this type of facial enhancement surgery performed by San Diego facial plastic surgery expert Dr. John Hilinski, use this link here.
Posted on January 28, 2012 in Facial Reconstruction, Nose Reshaping, Rhinoplasty, Skin Cancer Surgery
As a San Diego rhinoplasty and revision rhinoplasty expert, Dr. John Hilinski utilizes much of this expert knowledge and experience in nose surgery to help patients who require repair of nasal defects following removal of skin cancer. This is often times referred to as MOHS surgery of the nose, where skin cancers are carefully removed most commonly by dermatologists. In many of these patients, the defect or hole that is created from removal of the skin cancer can be quite extensive. In these situations, dermatologists will frequently refer these cases to Dr. Hilinski to repair the resulting defect. This case example provided here in the latest blog entry focuses on repair of a fairly extensive defect involving the nasal bridge in this female patient from San Diego who had MOHS surgery by a local dermatologist. She was then referred to Dr. Hilinski to help in the repair process because of his widespread reputation as one of the finest nose surgery experts in the region. Learn more about nasal reconstruction following MOHS surgery of the nose by linking here.
Posted on January 26, 2012 in Facial Plastic Surgery, News, Rhinoplasty
Facial Plastic Surgeon in San Diego Discusses Rhinoplasty Recovery
According to the latest statistics from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the most popular cosmetic surgical procedure in 2010 was rhinoplasty, with an average of 54 procedures performed per surgeon. Dr. John Hilinski, a facial plastic surgeon in San Diego who performs well over 100 procedures each year, says because of its popularity, rhinoplasty is subjected to several misconceptions regarding recovery and the surgical process. Dr. Hilinski discusses important factors for patients to consider when weighing the gravity of a surgical procedure such as rhinoplasty in San Diego.
San Diego facial plastic surgeon Dr. John Hilinski says rhinoplasty is the most common procedure he performs at his practice, with an average well over 100 procedures each year. While well above the average, this statistic is reflected in the most recent study from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which states that an average of 54 procedures were performed per surgeon during 2010.
According to the AAFPRS study, rhinoplasty was the most popular cosmetic surgical procedure performed in 2010, particularly among men where it was nearly twice as popular as any other surgical procedure. Dr. Hilinski says with the popularity of San Diego rhinoplasty comes a number of misconceptions patients need to be cautious of when considering the procedure. Because rhinoplasty affects both the cosmetic appearance of a central point in one’s facial symmetry, as well as essential airway passages and breathing structures, he says patients should be sure to discuss the entire surgical process and recovery with a board-certified facial plastic surgeon before undergoing any nasal reshaping surgery.
While the typical rhinoplasty procedure takes anywhere between an hour and a half to three hours to perform under general anesthesia, Dr. Hilinski says most patients expect the recovery process to be quick. However, because of the intricate nature of rhinoplasty, he says full healing and final shape of the nose may not occur until anywhere between six months to two years after surgery, depending on whether patients undergo an open or closed procedure. Dr. Hiliniski says many patients feel publicly presentable after 10-14 days, but rhinoplasty recovery is an ongoing process and patients need to be prepared for swelling, bruising, and puffiness that may realistically require a significant amount of healing before the final desired results take shape.
“In a majority of open rhinoplasty procedures, nearly 70-80% of the swelling has gone away by 2-3 months out from surgery. That leaves nearly 20-30% of the swelling that still has to go away over the next 1-2 years. This is a point that many rhinoplasty patients often times forget. Even at 9 months out from surgery, when patients think they are looking at the final result, the reality is they still have a decent amount of healing to go before the shape of the nose finally plateaus. In patients who have had a closed rhinoplasty procedure, it may take the final shape as early as 6-9 months out from surgery since there is less swelling involved with this type of rhinoplasty technique. Over this time they should see a progressive trend where the nose is taking on its new shape and size. However, rhinoplasty patients need to keep in mind that there may be periods of time (days to weeks) when the nose looks more swollen or puffy than it did previously.”
Dr. Hilinski says patients considering rhinoplasty must take into account all factors before deciding to undergo a procedure. He stresses the level of commitment patients need to prepare for with such a cosmetic enhancement and recommends talking about the options with an experienced and personal facial plastic surgeon so as to ensure the highest quality results, safety, and patient satisfaction are achieved.
“I think one of the most important things that patients need to realize about rhinoplasty surgery is the healing process can be quite extensive when compared with other plastic surgery procedures (such as breast augmentation or eyelid surgery). Many patients are under the mistaken perception that their nose will be essentially healed 2-4 weeks out from surgery. When someone considers undergoing a rhinoplasty procedure, they are committing themselves to a long-term healing process that can take upwards of 1-2 years before the nose ultimately settles into its final shape and size. This is quite a commitment when it comes to surgical healing and one that needs to be considered very seriously by any potential rhinoplasty patient.”
About John M. Hilinski, MD
Dr. John Hilinski earned his medical degree from Harvard Medical School in Boston, after which he completed a General Surgery Internship followed by a Head and Neck Surgery residency at the University of California, San Diego (UCSD) Medical Center. He also completed a Facial Plastic and Reconstructive Surgery Fellowship at the University of Illinois, Chicago Medical Center and a National Institutes of Health Research Fellowship at the UCSD Cancer Center. Dr. Hilinski has served as a staff surgeon at Sharp Memorial Hospital and Scripps Clinic and Green Hospital, as well as a Clinical Faculty Instructor in Facial Plastic and Reconstructive Surgery at the UCSD Medical Center and Veterans Administration Medical Center. He is board-certified in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery. Dr. Hilinski is also a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology-Head and Neck Surgery, the California Society of Facial Plastic Surgery, and the San Diego County Medical Society, in addition to having been published in several book chapters and medical journals.
Located at 3720 Fourth Avenue in San Diego, CA, Dr. Hilinski’s practice can be reached at (619) 296-3223. He can also be contacted online via the website www.drhilinski.com or www.facebook.com/drhilinski.
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Posted on January 22, 2012 in Ear Pinning, Ear Reshaping
We are seeing an increasing number of patients with gauge earlobe piercing holes who desire to have the problem repaired. As has been noted in prior blog entries on gauge earlobe repair, this type of plastic surgery of the ear requires relatively specific training and experience in cosmetic ear surgery. Although there may be a number of board certified plastic surgeons in your particular area, not all of the surgeons have the required expertise in this niche surgical procedure to deliver consistently successful results. Because my practice focuses on facial plastic surgery and cosmetic enhancement of the face and neck, I happen to perform this type of ear plastic surgery on a more regular basis than the average surgeon out there in San Diego, CA. The patient featured in today’s blog entry is another great case example of gauge earlobe repair that shows what I would consider a medium sized hole looks like before and after repair. This very attractive young female patient decided to stop wearing her gauge earrings and sought out opinions to repair the holes that resulted from years of stretching the earlobe. The only viable option in this type of scenario is surgical closure of the gauge earlobe hole. She decided to proceed with the surgery, which was performed under local anesthesia in the office setting. In order to repair the gauge earlobe defect, it was necessary to borrow tissue from an adjacent area in the ear in order to close the hole. Put in simple terms, the soft tissue just behind the hole was cut in the shape of a peninsula, thus allowing it to move forward while filling in the gap of the hole. Very carefully the different layers of the skin were then sutured, or stitched, together to create a scar that was minimally visible to the naked eye. As you can appreciate in the before and after gauge earlobe repair photos below, she now has a relatively normal earlobe with very little remaining signs of having had a prior stretched earlobe piercing. Yes, her earlobe is smaller now, but, unfortunately, there are very few other options when it comes to repairing gauge earlobe holes. In this particular scenario, you can only work with the limited amount of soft tissue that is remaining in the surrounding area of the earlobe in order to close the defect. The most important point to emphasize is that her earlobes now look much more normal and do not draw unwanted attention following the cosmetic surgical procedure. If you have gauged earlobe holes and are considering surgical repair to close them, contact our San Diego facial plastic surgery office today for a complimentary consultation.
Posted on January 17, 2012 in Facial Plastic Surgery
What is the youngest age when it comes to performing cosmetic rhinoplasty surgery in San Diego, CA? In general, the youngest age for female patients is around 16-17 years old and for males around 17-18 years old. These age ranges are chosen because it is around that point in their development that growth of the nose (inside and out) has begun to stabilize. Because of this, surgical reshaping of the nose can be undertaken through rhinoplasty surgery without a significant risk of disrupting the normal growth pattern. That being said, I have performed rhinoplasty surgery on female patients as young as 15 years old in certain situations. For instance, a young female patient who was only 15 years old had seen me for rhinoplasty reconstruction of the nose because she wanted to have a smaller looking nose. In a scenario such as this where we would be attempting to make the nose smaller, the risk of disrupting further growth of the nose is not as much of a concern. Her rhinoplasty was performed with excellent results that look very natural for her face. But as a rule of thumb, you can consider those age ranges noted above as a guideline for consideration of rhinoplasty surgery in your teens.
Posted on January 13, 2012 in Neck Lift, Neck Liposuction, Platysmaplasty
Many patients seek out plastic surgery of the neck because of what is often times referred to as a double chin deformity. A double chin simply refers to an excess prominence or fullness underneath the chin due to unwanted fat. 
This is visually demonstrated in the adjacent photo diagram of an actual patient. As you can see, her normal chin contour is outlined in red. Her ‘double chin’ refers to the second prominence seen just behind the first as outlined in yellow. The reason the double chin is considered undesirable is because it detracts from an, otherwise, well-defined youthful jawline and neck. Many patients who have a double chin are actually in fairly good shape and are not considered overweight. This small pocket of fat under the chin is just a tough area to target with continued weight loss and exercise. In some patients, no matter what you do physically to get in shape, this prominence under the chin may persist. In fact, this is the best type of candidate to undergo a liposuction or liposculpture procedure – someone who has worked very hard to get in shape but simply cannot achieve the results desired through exercise and diet. In these instances, surgical reshaping of the chin and neck region is a viable, recommended option. In patients like this, cosmetic reshaping is performed to reduce the unwanted fullness under the chin while also trying to create more definition along the jawline. Sometimes this requires liposuction alone where the fat is removed with specialized surgical instruments. In other cases, liposuction is combined with tightening of the muscle under the chin – termed a ‘platysmaplasty’ (the muscle is referred to as the platysma). In the current patient example, the latter procedure was performed to help reshape her neck and jawline to provide a more rested, youthful appearance. Her before and after neck liposuction photos are shown here. As you can see, her frontal view does not change significantly, but she does have an improvement in the definition of her jaw as seen on from this angle. When you start looking at her oblique (45 degree angle) and lateral view, there is a more obvious improvement that can be seen in terms of the area under the chin and along the jaw. Look specifically at the diagrammed photo comparison of the oblique view that highlights in blue how her jawline has now been brought out into view following the procedure. The beauty with this type of cosmetic enhancement procedure is that the incisions (scars) are hidden under the chin and behind the ears with minimal visibility following surgery. As is demonstrated in this photo series, this particular female patient from San Diego, CA has an obvious yet natural looking cosmetic improvement from combined liposuction and platysmal tightening of the neck. If you are interested in undergoing a similar type of cosmetic surgical procedure to improve your upper neck and jawline, feel free to contact one of San Diego’s experts in facial plastic surgery, Dr. John Hilinski, at 619-296-3223.
Posted on January 8, 2012 in Nose Job, Nose Reshaping, Rhinoplasty
A common concern among rhinoplasty and revision rhinoplasty patients in San Diego, CA is their appearance in the short-term following cosmetic nose reshaping. This blog post here attempts to shed some light on this issue using a real patient example. This particular San Diego rhinoplasty patient happens to be a familiar face – she is the front office staff member of San Diego Face and Neck Specialties – Christine! This past month Christine underwent a cosmetic rhinoplasty procedure to reshape her nose. Specifically, she had her nasal tip lifted up and the bridge of the nose reduced slightly while being narrowed. These photos represents what our typical rhinoplasty patient looks like just 2 weeks out from surgery. As you can see, there has been an obvious change in the shape and size of her nose. In addition, you can appreciate that she still has swelling of the soft tissues of the nose that contribute to the nose still looking puffy. But overall she is quite presentable to the public eye at just 2 weeks out from surgery. In fact, she is already back to work here at the office! You can also see that she has minimal signs of bruising around the nose and eyes – something that often times concerns potential rhinoplasty patients who are having their nose broken like Christine did. It also helps that Christine was very compliant with her recovery process and post-rhinoplasty instructions. Hopefully this series of photos provides some further insight into the early healing period for anyone considering cosmetic rhinoplasty surgery here in San Diego and the surrounding regions.
Posted on January 4, 2012 in Nose Job, Nose Reshaping, Rhinoplasty
Dr. Hilinski continues to expand on one of the largest rhinoplasty photo galleries in San Diego with the addition of the latest example of finesse rhinoplasty surgery. This young female from San Diego desired cosmetic nose reshaping surgery to simply make her nose look more refined for her face. 
Specifically, her nasal bridge was too wide as seen from the frontal view (and she had a small bump on the bridge). If you look at the adjacent photo shown here, you can appreciate that her nose was too wide for her face. Overall, she is an attractive female, but her nose was out of balance with her surrounding facial features. This is shown in the diagrammed photo where the red lines indicate the actual width of her nose and the blue lines indicate the approximate desired width that would provide a more refined nasal appearance. Dr. Hilinski, an expert in finesse type of rhinoplasty surgery, performed the nose reshaping procedure to provide her with a nice cosmetic enhancement including narrowing of the nasal bridge. The rhinoplasty surgery was done in this case with a closed approach – where no incisions are made externally on the nose. Her nasal bridge was reshaped by gently sanding it down while the bones were moved inward. These rhinoplasty maneuvers were performed using a finesse technique so there was not a dramatic change in her appearance. In many ways, this type of finesse cosmetic nose surgery is actually more difficult than performing rhinoplasty where a significant hump, for instance, is reduced. This is predominantly because the margin of error is markedly less in someone with a face and nose like hers. Because of this, only finesse changes can be tolerated to create a nose that looks more shapely, yet natural looking. You can see in the before and after rhinoplasty photos in this case example how the nose now appears more narrow and refined on the frontal view. Look specifically at the width of her nasal bridge – she now has a more attractive nose that shadows much better than it had prior to rhinoplasty reshaping. This type of change is largely a result of the osteotomies that were performed during surgery – where the nasal bones are intentionally broken in a controlled manner and narrowed appropriately. As you can see in the photos, she still very much looks like her old self. But she now has a nose that is more in balance with her facial features with improved definition. If you have a nose that you think might benefit from finesse rhinoplasty surgery like this one, feel free to contact one of San Diego’s finest rhinoplasty surgeons today!
Posted on December 16, 2011 in Face Lift, Facelift, Neck Lift
Over the past several weeks we have consulted with a number of San Diego patients seeking to have cosmetic surgery to enhance the appearance of the lower face and upper neck region. A good percentage of these patients have asked what the difference is between having a lower facelift and an upper neck lift. Because this inquiry has arisen during many of these consultations, I thought it would be helpful to post my answer here on our blog for any future facelift/neck lift patients considering this type of facial plastic surgery. In general, when facial plastic surgeons use the term ‘facelift’ to describe a procedure, they are really talking about the lower one-third of the face as well as the upper one-third of the neck region. But when patients initially think of the term facelift, they often times conjure up images of lifting the entire face from the jawline to the forehead. So you can see where the misunderstanding arises when discussing what a facelift procedure does. 
A good example of this is shown visually in the adjacent patient. This is a middle-aged female from San Diego, CA who consulted with our office desiring a procedure to help make her look more rested and youthful. As you can see from this profile view, she has excess, sagging skin folds along the lower face continuing into the upper neck region. As is noted in the photo diagram, the dotted line distinguishes where the lower face comes to an end (yellow arrow) and the upper neck begins (red arrow). So, as you might imagine, pulling up on the soft tissue of the lower face is also going to elevate the soft tissue of the upper neck. And, in fact, this is precisely what a ‘facelift’ procedure does – both the lower face and upper neck. During the operation, we lift up the skin going from in front of the ear across the face, down into the neck and behind the ear. Once this is done, the deeper tissues of the face (referred to as the SMAS layer) are used to perform the actual lifting. The excess, or redundant, skin is then removed and the incision line is closed very carefully. The end result should be a more rejuvenated, rested looking face and neck. Now there are certainly other procedures that are also referred to as ‘neck lifts’ – but these are isolated neck lifts that are intended to tighten the area from under the chin. Unlike what we refer to as a facelift, these type of lifts do not do much for lower face enhancement.
A good example of a facelift procedure is shown here. This is obviously the same patient featured above. In the before and after facelift photos, you can appreciate the overall improvement in her jawline and neck region. On the frontal view, you can see that her neck has been tightened and the jawline has now been refined. But she doesn’t look pulled or stretched. This is especially true around the mouth area where many facelift patients are concerned they will look like the joker! And as pointed out above, you can see that the facelift targeted the lower one-third of the face and upper one-third of the neck. 
On side view of this patient, you can now see after surgery that her jawline is much more visible without the excess skin folds previously noted. In addition, you can now see a clear division between her lower face and upper neck. Overall, you will also appreciate that she still looks like the same person – just a more rested, youthful version of herself. And that is the essence of doing good facelift work – that you provide the patient with a nice, natural looking enhancement without altering their identity.
