Posted on November 22, 2011 in Nose Job, Revision Rhinoplasty, Rhinoplasty
We just updated our San Diego rhinoplasty gallery this past week with additional examples of cosmetic nose reshaping patients who had their nose job performed by Dr. Hilinski. Our rhinoplasty and revision rhinoplasty galleries are among the largest online examples of cosmetic nose surgery in southern California. As an experienced and dedicated rhinoplasty expert, Dr. John Hilinski performs this type of facial plastic surgery on a very regular basis – in fact, much, much more frequently than most plastic surgeons in San Diego. As a result, Dr. Hilinski’s rhinoplasty gallery and revision rhinoplasty gallery are quite expansive demonstrating the wide variety of cosmetic nose procedures that he does. If you look at a good number of board certified plastic surgeon websites here in San Diego, you will likely see a limited number of rhinoplasty patient examples. In most of these cases, this is because that particular plastic surgeon simply hasn’t done a lot of rhinoplasty and, therefore, does not have a very robust portfolio of rhinoplasty examples. When you see over a hundred photo examples of rhinoplasty as in Dr. Hilinski’s San Diego rhinoplasty gallery, you know you are consulting with an expert in cosmetic nose surgery. The latest additions to the rhinoplasty photo gallery include three new cases of ethnic rhinoplasty surgery – two females and one male. These patient examples represent the essence of good rhinoplasty surgery – making very specific changes to the shape of one’s nose without changing their identity. In these three cases, Dr. Hilinski performed ethnic rhinoplasty surgery to get rid of features of their nose that they disliked while keeping harmony with their Hispanic facial features. Unless you happen to perform Hispanic rhinoplasty on a consistent basis, you are unlikely to achieve these type of natural appearing cosmetic nose surgery results. Take a look for yourself and see how this type of plastic surgery on the nose can provide an enhanced facial appearance.
Posted on August 30, 2011 in Facial Plastic Surgery, Nose Job, Nose Reshaping, Revision Rhinoplasty, Revision Rhinoplasty Specialist, Rhinoplasty
Dr. John Hilinski and his staff are proud to announce the launch of SanDiegoRhinoplasty.com – a website dedicated to educating potential rhinoplasty and revision rhinoplasty patients. SanDiegoRhinoplasty.com is intended to complement our main website – drhilinski.com – as a specialized online resource for those considering cosmetic nose reshaping. The new site also contains an online rhinoplasty patient primer that is similar but distinct from our current rhinoplasty tutorial. As an authority and regional expert in rhinoplasty and revision rhinoplasty, Dr. Hilinski felt compelled to develop SanDiegoRhinoplasty.com so that those considering plastic surgery of the nose would have a fully dedicated educational and reference guide. We hope you enjoy the new site!
Posted on May 10, 2011 in Nose Job, Nose Reshaping, Revision Rhinoplasty, Revision Rhinoplasty Specialist, Rhinoplasty
I happen to get several inquiries a week regarding possible injection rhinoplasty. Injection rhinoplasty is a term that was introduced years ago into the plastic surgery world to imply reshaping of the nose by injecting one of many different biocompatible materials. This primarily implied use of injectable fillers to reshape the nose – such as Restylane, Juvederm, Perlane, Radiesse, and Artefill. There is some controversy out there on the merits of injection rhinoplasty or lack thereof. But I wanted to post this plastic surgery blog entry on a different type of ‘injection rhinoplasty’ that is much less popular in the world of rhinoplasty and revision rhinoplasty. This involves the injection of a steroid solution, such as Kenalog, to reshape the nose. Over the years my San Diego rhinoplasty and revision rhinoplasty practice has grown increasingly larger to the point where we are considered one of the regional referral clinics for performing advanced, complex cosmetic nose reshaping surgery. Along the way, I have become quite comfortable using injectable steroids like Kenalog as an adjunct to surgical techniques used during rhinoplasty and revision rhinoplasty. The following case example of a San Diego revision rhinoplasty patient highlights the potential benefits of using steroid injections to help reshape the nose.
San Diego Revision Rhinoplasty Candidate
This male San Diego rhinoplasty patient presented to our office noting a moderate amount of scar tissue along his nasal bridge following prior nose job done in Los Angeles nearly 20 years ago by a different rhinoplasty surgeon. He had consulted with many rhinoplasty specialists over the years but was unable to find someone to reshape his nose in a non-invasive fashion. He finally consulted with us here in San Diego after learning of our vast experience in revision rhinoplasty surgery. During his revision rhinoplasty consultation, he was noted to have rather dense scar tissue that could be felt along the bridge region as seen in the adjacent photos. On his frontal view of the nose, you can see he had excess volume and fullness along the right side of his nose (white arrow). This contributed to asymmetry of his front view. On the side view, his nose had a ‘stepoff’ deformity (white arrow) – meaning the upper bridge was a different height than the remainder of his bridge. As you can, the upper portion was several millimeters higher than the middle portion of his bridge. His desire was to achieve more symmetry on frontal view and a straighter profile view. However, this particular patient was not interested in undergoing a formal revision rhinoplasty surgery to accomplish his goals.
Nasal Steroid Injections & Rhinoplasty
He specifically searched out our San Diego rhinoplasty practice online and discovered that I had extensive experience in managing noses using steroid injection. We had a lengthy conversation about his nose and decided this would be a reasonable option to help attain the desired cosmetic nose appearance. We started off with a modest amount and concentration of Kenalog injection into the nose. The injections were targeted to try and reduce the upper bridge and side wall of the nose. Going into this, the patient was fully aware that steroid injections typically involve a series of injections rather than just one treatment. As in many rhinoplasty and revision rhinoplasty patients, there was only a mild change that was seen after the first steroid injection into the nose. But after a series of steroid injections (spaced apart 6-8 weeks), we both began to see a real obvious change in the shape of his nose. Eventually we were able to attain the desired cosmetic nose shape and size. This can be appreciated in the following before and after ‘non-invasive’ revision rhinoplasty photos.
Before & After Injection ‘Revision’ Rhinoplasty
Technically speaking, he did undergo cosmetic nose reshaping or rhinoplasty, but not via a comlex surgical procedure. We were able to accomplish the following simply by injection rhinoplasty using steroid injections into the nose. As you can see, his nose is now more symmetric. In addition, the bridge height is now more uniform with a straighter profile compared to before. He is quite please with his revision rhinoplasty results and is even happier that this type of revision rhinoplasty outcome could be achieved without surgery!
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 May 5, 2011 in Nose Job, Nose Reshaping, Revision Rhinoplasty, Revision Rhinoplasty Specialist, Rhinoplasty
This San Diego revision rhinoplasty patient was thought to be a great example of revisionary cosmetic nose surgery and a good platform to discuss some of the details involved in this type of highly specialized surgery. She presented to our facial plastic surgery office with a request to have her nose reshaped further. Her history was significant in that she had undergone two prior nose jobs by other plastic surgeons. When you looked at her nose, it actually was not that bad overall. She is an attractive female who had some issues with the appearance of her nose, but it did not distract significantly from her overall look. However, she was bothered by some residual contour abnormalities with the nose and was willing to undergo further revision rhinoplasty surgery to get it to the point where she was happy. She chose to come to our office given my reputation as a San Diego revision rhinoplasty specialist. It just so happens that we revise a good number of previously unsuccessful rhinoplasty surgeries. When it comes to this type of highly complex, challenging surgery, there is no substitute for having experience and skill in performing revision rhinoplasty on a regular basis.
Revision Rhinoplasty Evaluation – Frontal View
On examination of her nose, the following were the features that we discussed and agreed would likely benefit from the revision rhinoplasty. On her front view, she was still a little wide for her liking. The red curved lines indicate the asymmetric (crooked) position of the nasal bones, which were positioned out to the side more than desired. We also discussed how she was slightly too wide at the upper portion of the nasal bridge as indicated by the blue horizontal line. In addition, she desired to have her tip a little bit narrower to give a more feminine overall look to her nose.
Revision Rhinoplasty Evaluation – Oblique View
On her oblique, or angled, view of the nose you can begin to see some issues she had with the bridge height. The white arrow indicates a notched scar that she had developed from her original rhinoplasty surgeon. The last facial plastic surgeon who did her rhinoplasty tried to improve the scar and was able to do so, but it was still in need of additional revision work. On this oblique angle, you can also see the red curved line along the upper dorsum, or nasal bridge, that indicates it is too high for her facial proportions. Ideally, the bridge height would be lower down to give her nose a more feminine, softer look.
Revision Rhinoplasty Evaluation – Side View
On the side, or profile, view of her nose, you can better appreciate what I was alluding to in the oblique view above. You can see that her bridge height is just a little too high for her nose and you can see the shadow from her notched scar. This happens to be a soft tissue depression along the area where her columellar incision was made previously to open the nose. Her nasal tip was also slightly ‘over projected’ still – meaning, it stuck out from her face a little too far. This latter finding was not real obvious to the untrained eye, but was something we had discussed in her revision rhinoplasty consultation.
Revision Rhinoplasty Recommendation
Once again, overall this wasn’t a terribly bad looking nose. As a revision rhinoplasty specialist, I have certainly seen noses in much worse shape following prior rhinoplasty reshaping by other plastic surgeons. In many peoples’ opinion, this was a rhinoplasty result that is fairly acceptable given the known complexities and challenges associated with nasal reshaping surgery. And, after all, her nose definitely had the potential to look worse with another revision rhinoplasty surgery. But the patient in this case was still bothered by her nasal appearance and wanted to have more reshaping of the nose. And I felt quite confident in my abilities as a revision rhinoplasty specialist that I could help her out. In the end, I recommended she undergo another revision rhinoplasty surgery to address many of the issues we just reviewed.
The Revision Rhinoplasty Surgery
We elected to perform another open revision rhinoplasty approach since one of the goals was to correct the notched columellar scar. In the process I was able to cut out her old scar and realign the edges so that the final result would be less visible. I then reduced her upper bridge height by sanding it down to achieve a more pleasing nasal profile. This was followed by a maneuver to break the nasal bones on both sides in an effort to reposition them. In doing so, this portion of the revision rhinoplasty procedure helped to narrow the nose as best seen on the front view. This also helped us to achieve more symmetry when looking at her nose front on. The revision rhinoplasty also included some nasal tip reshaping. This primarily involved reduction of her tip cartilage and an attempt to bring the nose back closer to her face.
Before And After Photos Revision Rhinoplasty
Here are her before and after revision rhinoplasty results. As you can tell, she has a nice overall improvement in the shape of her nose. Once again, she did not start off with a nose that was all that bad. I would consider this a type of ‘finesse revision rhinoplasty’ procedure since we altered the shape of her nose a little here and a little there to create a more enhanced nasal appearance. Her upper bridge is now thinner and shadows better plus her nasal bones are more narrow. This translates into a more feminine and symmetric frontal view. Her oblique angle now shows a more elegant looking nose with a softer appearance after revision open rhinoplasty. And her side view of the nose now shows a more fitting shape with better proportion compared with the rest of her facial features. We were also able to improve the notch underneath her nose.
San Diego Revision Rhinoplasty Specialist
For anyone interested in learning more about why an expert revision rhinoplasty specialist may make a difference in your rhinoplasty repair procedure, use this link here. To see more photos of nose reshaping patients by one of San Diego’s best revision rhinoplasty specialists, click 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 April 13, 2011 in Revision Rhinoplasty, Rhinoplasty, Septal Reconstruction, Septoplasty
I wanted to post a plastic surgery blog entry focusing on rhinoplasty imaging as it relates to achieving realistic results in nose reshaping. This particular San Diego rhinoplasty patient had suffered trauma to the nose when he was actually stepped on after falling to the ground. As you can see on his frontal rhinoplasty view, he had severe trauma to the bridge of his nose with collapse. You can see his frontal view looks ‘washed out’ – meaning, he has very poor shadowing on both sides of his bridge. In addition, you can appreciate that his nose was collapsed asymmetrically, or differently on both sides.
Imaging in Rhinoplasty
We consulted with him in our San Diego office regarding reconstructive rhinoplasty surgery, which included a discussion of cadaveric rib cartilage grafting. Using a computer imaging program, we provided him with a visual idea of what his nose might look like following nasal reshaping surgery. Below are his preoperative rhinoplasty photos and the corresponding imaged view of what his nose might look like after nose reshaping. This imaging represented rebuilding his bridge back up and repositioning his nasal bones to their original orientation. On his side view you can see just how much his bridge was collapsed. With the computer imaging program, we were able to demonstrate visually how rebuilding his bridge back up might look following rhinoplasty.
Computer Images From Rhinoplasty Consultation
Actual nose preoperatively on left side, computer imaged/enhanced photo on right showing possible changes with planned rhinoplasty or nose job surgery.
Reconstructive Rhinoplasty With Rib Grafting
I ended up taking this patient to surgery and performed a complex open reconstructive septorhinoplasty. As part of the nasal reshaping process, I also performed a cadaveric rib grafting procedure. This was needed to rebuild his bridge height and restore and more normal looking nose.
Actual Rhinoplasty Before And After Photos
Here are his before and after rhinoplasty (nose job) photos. As you can see, we have now restored a more symmetric frontal view of his nose with improved shadowing. His nose no longer looks flattened across the front. On his profile view, rhinoplasty has provided restoration of a masculine profile view through elevation of his bridge height. Also compare his true post-rhinoplasty result with the computer imaged rhinoplasty photos shown above. As you can see, his actual rhinoplasty results are better than what we imaged in his rhinoplasty consultation before surgery. This is, in fact, my goal with all rhinoplasty patients. My personal approach to the rhinoplasty consultation involves ‘under-imaging’ and ‘over-delivering’ in terms of the nasal reshaping process. I would much prefer to show you computer images that are sufficiently enhanced to make you satisfied as a rhinoplasty patient, yet realistic and achievable. If you are content with the surgical goals using a computer image that is under enhanced, you should then be even happier when the actual rhinoplasty results surpass the anticipated imaging. This particular San Diego rhinoplasty patient is a prime example of our routine use of computer imaging in nasal reshaping surgery.
To see this San Diego rhinoplasty patient’s complete photo series, use this link here to our online rhinoplasty gallery.
We just updated our San Diego rhinoplasty gallery this past week with additional examples of cosmetic nose reshaping patients who had their nose job performed by Dr. Hilinski. Our rhinoplasty and revision rhinoplasty galleries are among the largest online examples of cosmetic nose surgery in southern California. As an experienced and dedicated rhinoplasty expert, Dr. John Hilinski performs this type of facial plastic surgery on a very regular basis – in fact, much, much more frequently than most plastic surgeons in San Diego. As a result, Dr. Hilinski’s rhinoplasty gallery and revision rhinoplasty gallery are quite expansive demonstrating the wide variety of cosmetic nose procedures that he does. If you look at a good number of board certified plastic surgeon websites here in San Diego, you will likely see a limited number of rhinoplasty patient examples. In most of these cases, this is because that particular plastic surgeon simply hasn’t done a lot of rhinoplasty and, therefore, does not have a very robust portfolio of rhinoplasty examples. When you see over a hundred photo examples of rhinoplasty as in Dr. Hilinski’s San Diego rhinoplasty gallery, you know you are consulting with an expert in cosmetic nose surgery. The latest additions to the rhinoplasty photo gallery include three new cases of ethnic rhinoplasty surgery – two females and one male. These patient examples represent the essence of good rhinoplasty surgery – making very specific changes to the shape of one’s nose without changing their identity. In these three cases, Dr. Hilinski performed ethnic rhinoplasty surgery to get rid of features of their nose that they disliked while keeping harmony with their Hispanic facial features. Unless you happen to perform Hispanic rhinoplasty on a consistent basis, you are unlikely to achieve these type of natural appearing cosmetic nose surgery results. Take a look for yourself and see how this type of plastic surgery on the nose can provide an enhanced facial appearance.
