Posted on May 22, 2011 in Ethnic Rhinoplasty, Nose Reshaping, Rhinoplasty
As a San Diego rhinoplasty specialist, I see quite a few cosmetic nose reshaping patients who mistakenly ask to have their nose shortened. What they really are asking is to have the nose ‘deprojected’ or brought closer to the face. Projection of the nose refers to how far the nose sticks out from the face. To gain a better visual understanding of this, please refer to our San Diego Rhinoplasty Tutorial section on nasal analysis. In cases where the nose projects out too far, we can reshape the nasal tip to bring it in better balance with the surrounding facial features. This is what we call deprojection since we are decreasing the projection of the tip. This can be done with or without changing the rotation of the nasal tip (which does impact whether or not the nose is shortened or lengthened). To clarify this concept of deprojection of the nasal tip, I have provided the following case example of a San Diego reconstructive rhinoplasty patient of mine.
Overly Projected Nasal Tip
This rhinoplasty patient from San Diego desired reconstructive nose surgery. As you can see in this preoperative profile photo, his nasal tip was overly projected off of the face. In other words, the nasal tip looks like it stuck out too far. In many cases, this can be a very subtle finding in a rhinoplasty patient. In this particular rhinoplasty candidate, it was not grossly over projected but nonetheless still visible and bothersome. This patient also had slight under-rotation of the tip – meaning the nasal tip drooped down just a bit.
Deprojection in Rhinoplasty
As part of this patient’s reconstructive nose surgery, we deprojected his nose to bring the tip closer to the face. We also rotated the nasal tip slightly (shortening the nose), but the deprojection is what is most appreciable in terms of the nose reshaping. This can be seen in the adjacent rhinoplasty photos. On the left you can see by the colored lines the projected position of the nasal tip in two different locations before the rhinoplasty. On the right is the new position of the nasal tip with the same two colored lines showing the subtle improvements that were made. As you can appreciate, not every nose has to undergo dramatic transformation or significant reshaping in order to realize a more esthetically pleasing result.
Posted on May 8, 2011 in Ethnic Rhinoplasty, Nose Job, Nose Reshaping, Revision Rhinoplasty, Revision Rhinoplasty Specialist, Rhinoplasty
Dr. John Hilinski, rhinoplasty specialist in in San Diego, CA, has added another chapter to one of the most informative rhinoplasty resources online – the San Diego Rhinoplasty Tutorial. Dr. Hilinski is widely respected as one of the regions best rhinoplasty surgeons. This includes expertise in cosmetic rhinoplasty and revision nose reshaping as well as functional nose procedures to improve breathing. The latest rhinoplasty tutorial chapter discusses the nuances of nasal exercises following rhinoplasty and revision rhinoplasty. This is particularly important when it comes to management of the nasal bridge after cosmetic reshaping of the nose. To learn more about nasal exercises in rhinoplasty, use this link here.
Posted on April 16, 2011 in Asian Rhinoplasty, Ethnic Rhinoplasty, Nose Reshaping, Revision Rhinoplasty, Rhinoplasty
We at the Hilinski Clinic of Facial Plastic Surgery are quite proud of the fact that our San Diego nosejob patients love their rhinoplasty results. However, there is always the issue of whether or not patients should be smiling after a rhinoplasty procedure. I like to tell my rhinoplasty patients that they should refrain from smiling after their nosejob for at least 6-8 weeks. Instead, I suggest they try what I like to call a ‘Mona Lisa’ smile. When patients animate excessively after rhinoplasty surgery and have a wide grinned smile, they are putting unwanted tension on the bottom portion of their nose. If there was reshaping of the nasal tip and/or base, which is common in my San Diego rhinoplasty practice, this type of unwanted tension can detract from the final surgical outcome. This tension pulls on the nose and can disrupt the normal healing around sutures or grafts that were placed to reshape the nose. Therefore, rhinoplasty patients are recommended to minimize this type of facial movement until the nose can heal adequately. At 6-8 weeks out from a nosejob procedure, there is obviously still a good amount of healing that needs to take place. However, sufficient healing has taken place by this point in time such that you can begin smiling a little wider and showing just how much you love your rhinoplasty results! Happy healing. Dr. Hilinski
Posted on February 17, 2011 in Asian Rhinoplasty, Ethnic Rhinoplasty, Nose Reshaping, Revision Rhinoplasty
I just saw of one my many San Diego nose job (rhinoplasty) patients in the office today to take off her cast following nose reshaping 5 days ago. She was doing quite well with minimal bruising and very little swelling despite a full reshaping of the nose. She was pleasantly surprised how little of a recovery was involved with her rhinoplasty procedure. In addition, she was quite happy that her pain levels following the nose job were significantly less than she had envisioned prior to the rhinoplasty. As I told her and all my other San Diego nose job patients, there is a misunderstanding out there about pain levels following a rhinoplasty procedure. Most of my San Diego cosmetic nasal reshaping patients are on low dose narcotic pain medication, such as Vicodin, for about 2-3 days after their rhinoplasty or revision rhinoplasty surgery. In fact, there are many of my San Diego rhinoplasty patients who have recovered without taking any narcotic medication at all! The bottom line is that rhinoplasty patients are typically uncomfortable following nasal reshaping of the nose. However, significant pain requiring narcotic medication is quite uncommon following rhinoplasty performed at The Hilinski Clinic of Facial Plastic Surgery.
Posted on February 11, 2011 in Asian Rhinoplasty, Blepharoplasty, Ethnic Rhinoplasty, Facial Plastic Surgery, Nose Reshaping, Revision Rhinoplasty, Rhinoplasty
San Diego rhinoplasty specialist, Dr. John Hilinski, has just completed another chapter for his online rhinoplasty tutorial that helps current and prospective nasal reshaping patients better understand the entire process of nose surgery. This latest rhinoplasty chapter focuses on the use of nasal steroid injections in management of the nose surgery patient. To learn more about this rhinoplasty topic, click here to learn about our nasal reshaping tutorial on steroid injections for rhinoplasty patients.
Posted on February 9, 2011 in Asian Rhinoplasty, Ethnic Rhinoplasty, Nose Reshaping, Rhinoplasty, Septal Reconstruction
One rhinoplasty topic that I see commonly discussed online is the issue of persistent nostril asymmetry following rhinoplasty. I think this is a topic that deserves some mention and clarification. Many rhinoplasty and revision rhinoplasty patients note some degree of nostril asymmetry following their nasal reshaping procedure. This is certainly more the rule than the exception. The real question is whether or not the persistent nostril asymmetry noted is easily visible on frontal view of the nose. Meaning, can people notice this when looking directly at you? Or is it just noticeable when looking from underneath the nose (called the base view)? Of course, all rhinoplasty experts and revision rhinoplasty specialists aim to achieve as much symmetry as possible. This includes creating a nose that is balanced and proportional from all views. However, the reality is that you are never going to have ‘the perfect’ nose even after a well performed rhinoplasty or revision rhinoplasty surgery. Given this fact, most rhinoplasty experts will prioritize their efforts when it comes to reshaping the nose. One of the top priorities in nasal reshaping surgery is to achieve as much symmetry and harmony as possible on frontal view since this is where most people see you. Obviously if you can correct the nostril asymmetry at the same time as achieving the desired frontal symmetry, then that would be ideal. But in some cases you simply cannot have both. There are definitely those rhinoplasty and revision rhinoplasty patients out there whose anatomy just doesn’t allow you to have perfectly symmetric nostrils as seen from below, unless you sacrifice symmetry of the nose on frontal view. What I tell many of my own San Diego rhinoplasty and San Diego revision rhinoplasty patients is that our main goal is to create as much symmetry as possible on the frontal view. If we achieve symmetry of the nostrils on base view that is great. But the priority is definitely the frontal view.
Case Example of Rhinoplasty Nostril Evaluation
Attached is a quick case example of rhinoplasty surgery as it relates to nostril asymmetry. This particular rhinoplasty patient presented with asymmetry of her nose including the nostrils as seen on frontal view. As you can see from her before rhinoplasty photo diagram (red arrow), her right nostril was much more narrow due to a segment of cartilage that was protruding into the nostril opening. This not only created asymmetry of her nostrils on base view, but also impacted her frontal view. I performed a closed rhinoplasty procedure on her to create more symmetry (as well as to improve her nasal breathing). My priority was to create a nose that looked more symmetric on frontal view. Although I definitely attempted to create nostril symmetry at the same time, I was not going to sacrifice her frontal appearance just for the sake of gaining more equivalent sized nostril openings. As you can see from her before and after rhinoplasty photos noted below, she has a nice overall improvement in her frontal view. Her bridge is more balanced and her nostrils and nasal base look more even now. I was able to remove the excess protruding cartilage without compromising her tip support. Overall, her frontal appearance looks quite symmetric. On base view, you can also see an improvement with better symmetry related to her nostril size and shape. I am the first to admit that she still has some degree of nostril asymmetry. However, in this particular rhinoplasty patient I would not have achieved as much symmetry in her frontal appearance had I attempted to do more work on nostrils as seen from below. It came down to a matter of priorities and being realistic when it comes to rhinoplasty results. I hope this helps in clarifying some of the debate and discussion ongoing out there in the rhinoplasty world regarding persistent asymmetry of the nostrils following nasal reshaping procedures.
Posted on February 2, 2011 in Ethnic Rhinoplasty, Rhinoplasty
So many ethnic rhinoplasty and revision rhinoplasty patients seek consultation stating that they want their nose refined but don’t want it to look real different. I think this is the essence of doing good rhinoplasty when you can provide the patient a refinement without looking like you did. This patient from San Diego was seeking a rhinoplasty specialist to reshape her nose. However, she did not wish to have an entirely new look. There were some features about her nose that she disliked and wanted to target only these issues. We consulted with her including a session of computer imaging of her nose. This gave me a good idea of what direction and degree she wanted to go in with regard to the nasal reshaping. It also provided her with a realistic perspective of what her nose might look like following rhinoplasty.
Pre Rhinoplasty Photos
The photos below represent her pre rhinoplasty nose. She was most concerned about her rounded looking nasal tip as well as the bump on her bridge and the slightly flared nostrils. We discussed how reshaping each of these individually in a conservative fashion would translate into an overall improvement when looking at her nose collectively.
Post Rhinoplasty Photos
This young lady was brought to surgery and had an open rhinoplasty performed. We reduced her bridge height then narrowed her nasal bones. You can see that her bridge is now more narrow looking with better shadowing on frontal view. On side view, she does not look scooped out – instead, she has a nice feminine looking profile now. With regard to her tip region, we narrowed her tip but did not go so far as to create a nose that looked surgically altered. We provided her with tip refinement of the nose but maintained a nice convex shape. Her nasal base was also narrowed with wedge excisions to address the unwanted flaring. As you can see, her scars are well hidden and barely visible. Overall, this patient is quite happy with the direction her nose is going in following rhinoplasty.
Posted on January 21, 2011 in Ethnic Rhinoplasty, Rhinoplasty, Septal Reconstruction, Septoplasty
Wanted to post a quick blog entry on cosmetic reshaping of the crooked ethnic nose. Correcting a crooked nose deformity is arguably one of the most difficult and challenging types of cosmetic rhinoplasty, or nose reshaping, procedures. This young rhinoplasty patient from San Diego presented to my office with a notable crooked nose. As you can see, her nose alignment is shifted to her right side. Like her, most rhinoplasty patients are bothered by the fact that the crooked nose draws unwanted attention to the mid portion of the face and can be quite distracting. Her goal was simply to have a nose that was in proper alignment with her other facial features and one that was smaller. We performed an open cosmetic septorhinoplasty to reshape her nose. This included reshaping her nasal bridge and repositioning her nasal bones. I also performed some tip work to reduce the overall size of her tip and bring it to a more midline position. As you can see from her before and after rhinoplasty photos, she has a nice improvement with better alignment of her nose. The nose also looks smaller, yet not too small for her face. She also has improved tip position and shape. Overall, she now has a much softer, more feminine look that is appropriate for her face.
Before and After Rhinoplasty
Posted on January 11, 2011 in Ethnic Rhinoplasty, Rhinoplasty
Just saw this very nice young lady back in the office today following a closed rhinoplasty procedure. She is good example of correction of a crooked nose deformity using rhinoplasty technique. She was most unhappy with the frontal appearance of her nose. As you can see in her preoperative photo below left, she has an obvious crooked nose deformity. We performed a closed rhinoplasty procedure on her to reshape the nose. The rhinoplasty procedure included breaking her nasal bones to reposition them in a more midline orientation. You can see in the rhinoplasty diagram below where the bone was actually broken (as indicated by the red curved lines – termed medial and lateral osteotomies). Once her nose was repositioned more to the middle of her face, she still had a slight asymmetry where her left middle bridge region was depressed. This is actually quite common in correction of crooked nose deformities. You can straighten the nasal bones and provide improvement in the alignment of the bridge but there may still be some contour abnormalities that need to be addressed. In this case, we performed cartilage grafting of her left side as indicated by the blue shaded area. This corresponds to an onlay cartilage graft that was taken from her septum (inside the nose) and grafted onto the left bridge. This thereby provided even more symmetry on her frontal view. As you can see in her rhinoplasty photo series, there is a marked improvement in terms of her frontal nose alignment with a very nice natural looking result.
Dr. Hilinski, San Diego rhinoplasty specialist, is pleased to announce the release of his new online rhinoplasty tutorial chapter – Asian Rhinoplasty. This latest rhinoplasty discussion focuses on Asian rhinoplasty surgery – a niche cosmetic procedure in the Asian population. Dr. Hilinski discusses the nuances of evaluating the Asian rhinoplasty patient and how cosmetic nose reshaping in Asian patients is much different than performing Caucasian rhinoplasty. To learn more about this particular rhinoplasty topic, please use this link here. We hope you enjoy this latest addition to one of the most comprehensive online educational guides on cosmetic and functional rhinoplasty surgery.
