# John Hilinski, M.D.

> Contact: alert+old@findlocalcompany.com

### Posts

#### #1 Coolsculpting Team
Contact our office today to schedule a personalized Coolsculpting consult with San Diego's best team of fat freezing specialists. Our Coolsculpting team is led by Dr. John Hilinski who is board certified in plastic and reconstructive surgery. Dr. Hilinski has formulated one of the best teams in San Diego when it comes to non-surgical fat reduction and non-invasive fat loss techniques. This includes our aesthetic nurse, Kellie Hartmann, who has been expertly trained by Zeltiq to give you the best outcome possible when it comes to Coolsculpting.

#### 5 Common Myths About Botox
There are so many myths out there regarding Botox and Dysport that it would be exhausting to post about all of them here. But let's review - and debunk - 5 of the most common myths about Botox and Dysport injections for unwanted wrinkles and creases.

 	Your face will be frozen from Botox and Dysport. If done well, Botox and Dysport will smooth out unwanted wrinkles and lines, but should leave you with some degree of animation and movement - preserving a natural look.
 	Botox and Dysport are toxic and dangerous to your body. Botox and Dysport - as I say to so many of our San Diego med spa patients - are some of the safest drugs I have ever seen in the world of medicine. In my experience, the chances of you having a negative reaction to Botox or Dysport injections are literally lower than well-known drugs such as ibuprofen and aspirin. Although Botox and Dysport are, indeed, neurotoxins - the form and dosage used in cosmetic treatments are incredibly safe.
 	Botox and Dysport injections are really, really painful. Although there is a pinching feeling that is felt by many patients undergoing Botox and Dysport treatment, it is much less painful than many other types of injection. Plus, we try and use a vibratory device that helps distract you from the needle entering the skin. Topical ice application can further help. Application of numbing medicine in advance can also reduce discomfort, but this requires nearly 45 minutes to truly work.
 	Botox and Dysport are one-time treatments. Botox and Dysport last, on average, 3 months before the muscle movement starts to really return. The effects of the Botox and Dysport gradually fade away over that 3rd month. It doesn't just stop working one day! Most new patients who try Botox or Dysport love the results so much, they return almost every three months to the office for repeat injections. This is part of the reason our office has become so popular here in San Diego when it comes to Botox and Dysport injections. In fact, we got so busy doing Botox and Dysport that we couldn't squeeze patients in last minute who were coming up on their 3 month mark. This then forced us to implement an automatic reminder system to notify Botox and Dysport patients that they are soon due up for another treatment and should call to schedule an appointment in advance.
 	Botox and Dysport will fill in lines and creases. Botox and Dysport work by stopping muscles from moving excessively - leading to relaxation of these muscles and less wrinkling. In many cases, these unwanted wrinkles and lines will smooth out over time. But Botox and Dysport do not fill in the lines and creases. Injectable fillers, such as Juvederm, Restylane, Radiesse and Bellafill, will actually fill in lines by adding volume under the skin to plump the wrinkle out.

#### A New Face For Our New Office
The Hilinski Clinic would like to welcome Ronnie, our new front office clinical coordinator. Ronnie comes to us with an extensive background in the world of plastic and reconstructive surgery. She looks to be a valuable resource for you, your family members and any friends considering facial cosmetic enhancement!

#### Abdominal Etching in Fit Male
Can Coolsculpting be done to help patients who are already fit and in shape? Absolutely. For example, take a look at this male patient from San Diego who is already in great shape from working out regularly. He desired to have Coolsculpting to target some residual fat along the upper abdomen region. Dr. Hilinski's Coolsculpting experts helped him out with just a few simple sessions of fat freezing. The result was some nice abdominal etching to highlight his underlying musculature just a bit. Not bad for a non-surgical, no downtime, no needle procedure performed while surfing the internet or watching television!

#### Abnormal Smile After Rhinoplasty?
One concern I hear quite often from my rhinoplasty patients relates to smiling during the early recovery process. It is quite normal for many rhinoplasty patients to experience a 'stiff upper lip' in the early weeks to months of recovery. This is especially true if I have done a lot of work near the columella region of the nose. The swelling that can develop in this area often times leads to the feeling of having a stiff upper lip where your natural smile is hindered. I recommend you not trying to 'overcome' this feeling as it is completely normal. Plus, smiling in this early period of rhinoplasty recovery can sometimes damage the surgical reconstruction that was performed - leading to a suboptimal result as time goes on. Therefore, you will often times hear me telling my rhinoplasty patients to show only a 'Mona Lisa' smile - where there is minimal movement and tension on the bottom part of the nose.

#### Accepting Nostril Asymmetry Following Rhinoplasty
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.

#### Achieve Fuller Lips with a Lower Lip Advancement
When it comes to lip enhancement, most people think of injectable fillers — but there are surgical options that offer long-term, natural-looking results without the need for ongoing maintenance. One advanced technique is the lower lip advancement, a specialized procedure that enhances volume and contour using your own tissue.

At John Hilinski, M.D. Plastic Surgery in San Diego, patients can achieve a fuller, more balanced lower lip through this subtle yet highly effective surgical method.
What Is Lower Lip Advancement?
The lower lip advancement procedure uses a technique called a V-Y advancement flap, which rearranges tissue from inside the lower lip (the mucosal surface) to create a fuller outward appearance.

Dr. Hilinski performs lower lip advancement using a technique known as the V-Y advancement flap. A small, V-shaped incision is made on the inner lining of the lower lip — completely hidden inside the mouth. The underlying tissue is then carefully advanced outward and upward to create a fuller, more defined lip contour.

As the incision is closed in a Y-shaped pattern, it adds natural volume to the lower lip without the need for implants or fillers. Since all incisions are internal, there are no visible scars, making this procedure a discreet and permanent solution for lip enhancement.

This technique allows for precise, tailored enhancement, offering a natural boost in lip volume that is permanent and requires no synthetic implants or repeated filler sessions.
Why Choose Dr. John Hilinski in San Diego?
Dr. John Hilinski is a Harvard-educated, double board-certified facial plastic surgeon with an exclusive focus on facial procedures. His reputation for surgical excellence and precision has made him a trusted name in lip enhancement and facial contouring throughout San Diego and Southern California.

By focusing solely on the face, Dr. Hilinski ensures that every patient receives highly specialized, anatomically informed care that is tailored to their unique aesthetic goals.
Frequently Asked Questions (FAQs) About Lower Lip Advancement
Considering a lower lip advancement procedure but still have questions? You're not alone. At John Hilinski, M.D. Plastic Surgery in San Diego, we believe informed patients make the best decisions. Here are answers to some of the most common questions about this advanced lip enhancement technique so you can feel confident exploring your options.

What makes lower lip advancement different from fillers?

Unlike dermal fillers, which provide temporary results and require repeated treatments, lower lip advancement is a surgical solution that offers permanent enhancement. It also avoids the risk of overfilled or uneven results common with injectables.
Will there be any visible scars?
No. One of the greatest advantages of the V-Y advancement technique is that all incisions are made inside the mouth, meaning no visible scars on the outside of the lip.
What is the recovery time?
Most patients experience some swelling and mild discomfort for the first 3–5 days. Full healing usually occurs within 1–2 weeks, and patients can return to work or social activities relatively quickly.
Who is a good candidate for lower lip advancement?
This procedure is ideal for anyone seeking a fuller, more defined lower lip without relying on fillers. It’s especially suited for patients who want a permanent, natural result and have realistic expectations about the outcome.
Ready to Enhance Your Lower Lip?
If you're seeking a refined, long-term solution for a fuller lower lip, lower lip advancement may be the perfect option. With no external scarring and results that last a lifetime, it's a discreet yet powerful way to enhance your facial harmony.

Contact John Hilinski, M.D. Plastic Surgery in San Diego, CA, today to schedule your consultation and explore how this advanced lip technique can help you achieve the look you’ve always wanted.

#### Advantages of Dysport Over Botox?
Many patients ask if there are any advantages to using Dysport instead of Botox.

For years and years, Botox was the only neurotoxin available here in San Diego to treat unwanted facial wrinkles and creases. Fortunately, in 2009 Dysport was approved by the FDA for cosmetic use to effectively treat facial wrinkles and lines in between the eyebrows. Ever since Dysport came out, patients have been asking why switch to Dysport if I have been using Botox for so long?
Dysport Over Botox
The reality is that Dysport and Botox are so close to one another that any cosmetic doctor injecting either of these two neurotoxins would see they are very comparable. So much so that you can really think of them as being interchangeable.

But if hard pressed, Dr. Hilinski will tell you that he thinks Dysport potentially has three purported advantages when compared with Botox cosmetic injection. These include:

 	Faster onset of action in many patients.  In many Dysport patients, a faster onset of action can be seen. Whereas Botox may take, on average, 2-3 days before the full cosmetic effect is noticed, Dysport patients may see full effects within 1-2 days.
 	Less pain during Dysport injection in many patients In many patients who have had both neurotoxins, they will say that Dysport hurt less during the actual injection process.
 	Longer lasting results in many patients In many cases, patients who have Dysport injection done will see results lasting upwards of 4 months - compared with an average of 3 months in Botox patients.

Now keep in mind that with all of the medical studies published, there is no consensus that the above noted advantages are consistent and reliable. These opinions are really more derived from anecdotal experience performing thousands of injections and listening to patients' feedback.

#### African American Ethnic Cosmetic Rhinoplasty
I recently added another case example to our growing online rhinoplasty tutorial. This latest addition is focused on African American ethnic rhinoplasty surgery using a male patient as an example. This chapter highlights the considerations necessary when thinking of cosmetic reshaping of the African American nose. I hope this helps any African American rhinoplasty candidates out there considering cosmetic ethnic nose reshaping surgery.

#### African American Nose Job Rhinoplasty Tutorial
Come learn more about African American rhinoplasty surgery - also known as African American nose job surgery - in the latest additional to the San Diego rhinoplasty tutorial developed by expert cosmetic nose surgeon Dr. John Hilinski. This latest chapter in the growing library of rhinoplasty discussions focuses on management of the African American nose. If you are African American and considering cosmetic rhinoplasty surgery, click here to learn more about this type of ethnic rhinoplasty surgery.

#### African-American Nose Job
Learn more about African-American cosmetic nose job surgery through this latest case example of ethnic rhinoplasty. African-American rhinoplasty is a very specific and challenging subset within the world of cosmetic nose surgery that demands advanced surgical training and expertise. I happen to think this particular patient has an absolutely beautiful outcome - with a nose that is much more defined and fitting for her face. Let me know what you happen to think of her results!

#### Alar Base Reduction Following Rhinoplasty
Many patients online have inquired about whether or not they can undergo alar base reduction (narrowing) following rhinoplasty. The answer is - yes. In many cases of rhinoplasty and revision rhinoplasty, patients can benefit from having the base of the nose narrowed at the same time other areas of the nose are being reshaped. There are cases, however, when narrowing the alar base is considered a borderline decision. In these types of rhinoplasty and revision rhinoplasty patients, I will usually not do the alar base reduction or narrowing at the time of the surgery. Instead, I reshape the nose and perform all other maneuvers without touching the alar base. After several months of healing, you can usually begin to see if additional alar base narrowing would add to the cosmetic improvements. If so, alar base reduction can typically be performed in the office setting under local anesthesia with minimal downtime. You might be asking why not just perform the alar base narrowing at the time of the rhinoplasty or revision rhinoplasty? The answer is because alar base reduction or narrowing can be somewhat unforgiving. Meaning, it is incredibly difficult to reverse this process once done since you are removing a segment of soft tissue from the nose and altering the natural curvature of the nasal base. For example, look at the attached photo of a patient who consulted with me for possible revision rhinoplasty following surgery (including alar base narrowing) by another plastic surgeon. If you look at her alar base, there is significant scarring, which happens to be quite asymmetric. Unfortunately, in cases like this, it is incredibly difficult to restore a natural appearing contour in this region. If there is an obvious indication to narrowing the base, such as in many ethnic rhinoplasty patients, then by all means this should be done at the time of the surgery. But in my opinion, you are much better off taking a conservative approach to reshaping the nasal base if it is a borderline situation. Keep this in mind when consulting with your rhinoplasty surgeon.

#### Am I a Good Candidate for a Facelift?
A facelift is designed to reduce visible signs of aging, including facial wrinkles, sagging skin, and jowling. After the procedure, patients typically look years younger, enjoy a rejuvenated and rested appearance, and experience a boost in confidence. With so many benefits, facelift surgery is one of the most frequently requested facial plastic surgery procedures performed in the United States. If you are considering facelift surgery, a consultation with a board-certified plastic surgeon will determine if you are a good candidate for the procedure.

During the consultation, your plastic surgeon will discuss your cosmetic goals, review your medical history, and perform a physical examination to make sure a facelift is the best option for you. Men and women in good overall health who have unwanted loose, sagging, or excess skin on the mid and lower face as well as the upper neck are ideal candidates for facelift surgery. Since a facelift does not address nasolabial folds (sometimes referred to as smile lines), patients who wish to smooth this area may benefit from dermal fillers. If your primary concern is sagging skin at the jawline and upper neck, a mini facelift may suit your needs without the recovery time associated with a traditional facelift.

Dr. John Hilinski will thoroughly outline the benefits of your facial rejuvenation options during your consultation and help you decide which procedure may help meet your expectations. To learn more about facelift surgery, or to schedule an appointment, please contact our office today.

#### Am I a Good Candidate for Rhinoplasty?
Rhinoplasty is one of the most popular plastic surgery procedures performed each year. The purpose of the surgery is to improve the appearance and/or function of your nose, while maintaining a natural look that is harmonious with the rest of your facial features. Men and women with varying physical needs and aesthetic goals can benefit from rhinoplasty. It is a highly customizable procedure that Dr. John Hilinski is highly skilled and experienced in performing.

If you are unhappy with the nose you were born with or changes that have occurred with age, you may be a good candidate for rhinoplasty. Specific problems that can be addressed with nose reshaping surgery include:

	Increase or decrease the size of your nose
	Alter the angle or shape of your nasal tip
	Correct a crooked or abnormally high bridge
	Improve a structural problem causing difficulty breathing

In addition to these abnormalities, it is vital that you have realistic expectations regarding the outcome of your surgery. Overall, you should strive for improvement, not perfection. When you come in for your consultation with Dr. Hilinski, he will help you understand if you are a good candidate for rhinoplasty, as well as what you can expect from the procedure.

#### Am I Able To Have Rhinoplasty At 18 Years Old?
This question or a variation thereof is commonly asked in online rhinoplasty forums. The answer is that I frequently perform rhinoplasty on female patients 17-18 years of age. In fact, I have done rhinoplasty on a female patient here in San Diego who was 15 years old (although there were extenuating circumstances). Females in this age range have typically reached a plateau in terms of their nasal shape and size. Males usually take a little longer to reach such a plateau, therefore, we normally wait until male rhinoplasty patients are 18 years of age. Hope this helps you younger patients out there considering possible rhinoplasty, or reshaping of the nose.

#### Am I Too Old To Have A Facelift Procedure In My 60s?
The answer is hopefully not! As facial plastic surgeons, we get asked this question all the time from patients considering facelift surgery in their 60s. The reality is that some patients are going to be considered great candidates to have this type of facial rejuvenation procedure while others might not be such good candidates. Much of this depends on how your skin has aged over the years. If your skin still has reasonable elasticity (a rubber band like quality where your skin snaps back into position when pulled or pinched), then you are more likely to be considered a good candidate for a facelift, or face lift, procedure.
San Diego Facelift Photos
The adjacent photo of one of my San Diego patients who wanted a facelift is a great example of this exact topic. This very pleasant lady consulted with us regarding her lower face and upper neck region. She wanted to look more refreshed and rested. On examination of her face and neck, she was found to have some excess skin but fairly good elasticity. Meaning, when I pinched her skin slightly, it rebounded back into position more readily than many facelift candidates her age. We discussed in detail her option to undergo a rhytidectomy procedure - which is the technical term for a facelift and necklift procedure. Although she was in her 60s and her skin wasn't like some facelift patients in their 40s or 50s, she was still considered a good candidate to have this type of facial rejuvenation procedure performed.
San Diego Before and After Facelift Photos
Below are her before and after photos following the facelift procedure. As you can see, she still looks like herself, which is typically the goal when performing facial rejuvenation surgery like this. What you do see, however, is that she appears more rested and youthful, especially on her profile (or side) view where her sagging jawline and neckline were most visible before the facelift. You also get a good appreciation of how well the facelift incisions can heal in your typical case like this. Her facelift incisions are fairly well hidden just in front of the ear where it junctions with the face. Note how her jawline is now more defined and her neck no longer sags down as it did before the face lift. So if you are in your 60s and considering having a facelift procedure, come by our San Diego office for a complimentary plastic surgery consultation to see if you are a good candidate for this type of facial rejuvenation procedure. Don't let your age determine whether or not a facelift procedure is right for you!

#### Amazing Eyelid Rejuvenation
Check out these amazing eyelid rejuvenation results obtained by one of San Diego's leading blepharoplasty surgeons, Dr. John Hilinski.

This female patient in her 40s wanted to have the heavy eyelid skin removed to give her a more rested look. As you can see in her preoperative photos, there is a significant amount of excess, weighted, loose eyelid skin that literally drapes over her eyelashes.

Dr. Hilinski recommended an upper blepharoplasty (pronounced blef-R-O-plasty) to carefully trim away the unwanted eyelid skin. This was performed under local anesthesia, which helped to avoid any issues related to 'going under' for the operation. The incision for this type of eyelid lift is hidden in the natural eyelid crease. This is usually a well-defined crease, but in her case it is not readily seen because the crepey skin was concealing it. The procedure took just over 1 hour to complete and involved very little discomfort during the recovery period.
Eyelid Lift Results
The results of this effort are seen here below where you can readily appreciate just how much improvement was made in terms of opening her upper eyelids up. No longer does she have the drooping upper eyelid skin that was hanging over her lash line. She now looks much more rejuvenated and rested - yet natural looking without obvious signs of having had cosmetic face surgery.

#### Amazing Neck Lift Results!
Check out these amazing results from Coolsculpting's Cool Mini treatment to help lift the neck. If you happen to have unwanted neck fat and/or a double chin deformity, CoolMini fat freezing may be the answer for you! This younger lady was bothered by excess fat accumulation under the chin and wanted a more defined neck and jawline. But she wasn't really interested in undergoing a surgical procedure.

She consulted with San Diego's best Coolsculpting medspa team, headed by plastic surgeon Dr. John Hilinski. CoolMini, the only FDA-approved treatment to freeze fat away while tightening skin, was recommended to her as the best option to rejuvenate her neck.

The treatment was done in our relaxing Coolsculpting treatment room - with all the creature comforts, including a wide screen television to help the time pass. But fat freezing sessions like CoolMini only take 45 minutes of your time. And there are no needles involved, no surgical incisions and no downtime to worry about following treatment.
CoolMini Neck Lift Results
The results shown here represent changes in her chin and neck just 5 weeks after one (1) session of CoolMini fat freezing. So you can imagine how much more improvement she will see once she completes the recommended second session of Coolsculpting! As a result of CoolMini, you can readily see how her neck is now more angulated and her jaw now appears more defined.

One bonus of having your fat frozen away is the skin tightening effects that can be achieved with Coolsculpting. In fact, this revolutionary cosmetic treatment is FDA approved to help tighten loose skin in the neck region at the same time it freezes the stubborn fat away.

CoolMini Versus Kybella
Many patients wonder if they can achieve results like this with Kybella injection. The answer is - maybe. But you have to keep in mind that Kybella absolutely requires a series of injections - not just one injection - in order to realize any significant improvement in the neck contour. And a series of Kybella injections can cost you upwards of $3500-4000 in many clinics. So the price for Kybella will often times exceed the price to have CoolMini performed on your neck.

Plus, Kybella injections definitely involve some degree of downtime - including some swelling, redness, hardness and discomfort - each time you have an injection. Since many patients end up undergoing 4-5 Kybella injections to get a similar type of outcome, this can total up to quite a bit of healing time with Kybella treatment of the neck.

When you analyze the cosmetic results of CoolMini to Kybella - and take into consideration the additional costs and recovery time - there is just no comparison in our opinion. Opt for Coolscultping's CoolMini fat freezing treatment for your unwanted neck fat and/or double chin deformity.

#### Amazing Neck Skin Tightening Results!
More and more you will be hearing about the amazing cosmetic improvements that patients are seeing from plasma pen treatment. This revolutionary medical spa procedure is also known as fibroblast skin tightening since the fibroblast cells within the skin are key to the success seen with this treatment.

Here is a great case example of how the plasma pen was used to smooth out and tighten the neck skin in this female patient from San Diego. This particular patient was bothered by the deep, coarse neck wrinkles that can be seen in the pre-treatment photo to the left. Having researched the fibroblast skin tightening technology, she opted to undergo the procedure with Dr. Hilinski's medical spa staff.

Using just topical numbing cream applied to her skin for about 45 minutes prior to the appointment, plasma pen resurfacing was done across the upper to lower neck region. For several days she noted some brown and black dots overlying the reddened skin surface. But as the healing process unfolded, these discolorations just simply fell off and disappeared.

The end result was neck skin that was much smoother overall with less wrinkle formation and coarse lines. Anyone can readily see that here in her before and after plasma pen photos where her neck skin looks markedly better. And the patient was ecstatic with the results!

If you have coarse neck wrinkles and lines that you would like smoothed out, contact our office today to schedule your plasma pen appointment with our medical spa nurse, Kellie Hartmann.

#### Amazing Results After One Treatment!
Want to know how powerful Coolsculpting can be for many patients? Look at these amazing results of a female patient in her 30s who underwent just one treatment session with our aesthetic RN, Kellie Hartmann. This patient opted to go with a non-surgical treatment to get rid of unwanted fat around the abdomen and flank. The area around the abdomen is also referred to as the peri-umbilical region - which is essentially the area of the abdomen surrounding the belly button. This tummy fat is a difficult thing for many patients to get rid of even with vigorous exercise and a healthy diet. Liposuction is an option if you are willing to undergo an invasive surgical procedure - that includes incisions, scarring and recovery time. If that is something you are not willing to undergo, then Coolsculpting should be your first choice in terms of a non-surgical fat reduction treatment.

After just one treatment with our advanced Coolsculpting technology, this young lady was seen back in 4 weeks. Photos taken at that time are shown here and reveal a notable improvement in her tummy and flank contour.
Coolsculpting Before & After
As you can see here, her tummy looks flatter and tighter on this frontal view. This same improvement can be seen on both the left and right anterior oblique (angled) views as well. On her flank (back angled) views, you can also readily appreciate how the flank fat crease is now virtually gone after the fat was frozen away.
   

Coolsculpting Consult in San Diego
If you have unwanted tummy and flank fat - and are interested in getting rid of these extra contours with a non-surgical, non-invasive treatment - contact our office today to consult with our team of Coolsculpting specialists.

#### Amazing Upper Lip Transformation
Just saw this patient back in the office. She underwent an upper lip lift by Dr. Hilinski nearly 4 years ago. You can see how well she has healed and how little scarring there is under the nose. You can also readily appreciate what beautiful changes the lip lift made for her. She has a shorter upper lip, which translates into much better proportions and balance. She also has more upper lip 'pink show' - meaning there is more visible redness to her upper lip now that it has been curled out a bit. This gives the appearance of fuller, plumper lips - but on a permanent basis. Along with this, you can see how her vermillion border and cupid's bow are more defined. Granted, she has makeup on in her postoperative photo. But even taking this into consideration her whole mouth region looks better as a result of the upper lip lift.

Dr. Hilinski is the most experienced upper lip lift plastic surgeon here in San Diego - and has been performing this transformative procedure for many, many years. In fact, he was doing upper lip lifts long before it became a more en vogue cosmetic lip procedure. That is why so many patients seek him out - even from the Los Angeles and Orange  County area - to have their upper lip and mouth region cosmetically enhanced. Take a look at our online gallery of incredible lip lift results to see the type of outcomes Dr. Hilinski is able to achieve on a regular basis.

#### An Even Better Body
Coolsculpting isn't just for people who are 'out of shape' as they say. Coolsculpting is actually even better for people who are already in shape - and just want an even better body. The fat freezing experts that work for Dr. Hilinski happen to see a lot of patients who work out regularly, eat healthy and watch their weight. Even these patients will inevitably have a bothersome area of fat that just doesn't respond to the above measures and behaviors. This is precisely where Coolsculpting can help. What areas do these include?

The following is a partial list of commonly addressed areas targeted with Coolsculpting:

 	Arm fat
 	Neck fat
 	Abdominal fat
 	Flank fat
 	Back fat
 	Thigh fat

To learn more about the best non-surgical method to get rid of unwanted fat, contact San Diego's #1 Coolsculpting office today at 619-296-3223 to schedule your complimentary consultation.

#### Anatomy of a Female Facelift Necklift Patient in San Diego
This is a very pleasant lady who underwent a lower facelift and upper necklift procedure in our San Diego facial plastic surgery office. She presented to our demonstrating excess sagging neck skin. As with many facelift and necklift candidates, there was a notable amount of excess fatty tissue underneath the skin that contributed to the problem. In these patients, you cannot, unfortunately, just liposuction the neck. If you do so and remove the unwanted extra fat, the overlying skin is likely to just sag down further. This is because the skin has lost much of its elasticity, or rubber band like quality, and won't just shrink wrap upward. As a result, you are forced to remove the extra fatty tissue but then have to elevate or lift the face and neck skin.
Relevant Facelift Necklift Anatomy
Below are her photos before having the facelift and necklift procedure. As you can see by the white arrows, she has a moderate amount of sagging neck skin that was most bothersome to her. Behind the skin, anatomically, was a fairly thick layer of excess fat that was contributed to the heaviness through her neck region. She actually did not have much in the way platysma (the muscle layer that courses from the clavicle across the neck to the jawline) banding, which is where the muscle hangs down and causes the appearance of a thick vertical cord along the neck. Based on these preoperative photos, I suggested a procedure to liposuction the neck and lift the lower face/upper neck skin.

Targeted Area in Facelift and Necklift Surgery
The facelift and necklift surgery was performed under a general anesthetic in the outpatient setting. After liposuctioning to thin out the neck line, I performed a standard facelift procedure. As in nearly all facelift surgeries, this involved tightening and lifting the SMAS layer to provide a strong, sustained elevation of the facial skin and soft tissue. On her lateral view (see diagrammed photo), you can see the area of the neck that we really tried to target with the combined facelift and necklift. If we were able to lift this portion of her neck and jawline, we would essentially be repositioning her lower face and upper neck skin to mimic their position a decade earlier.

Facelift and Necklift Surgery Results
Here are this patient's before and after facelift/necklift surgery results. As you can appreciate, she has a fairly significant improvement in terms of her upper neck and lower face contour. We were successful in lifting her neck skin and improving her jawline to provide her with more definition and less heaviness. Overall, she looks quite natural and more rested. As you can also see, her ears are still in their native position without undesirable pulling of the ear lobe - a common concern in facelift candidates. If you are considering a lower facelift and upper necklift, we hope this case example provides you with some visual confirmation of what might be possible with facial plastic surgery by The Hilinski Clinic.

#### Anesthesia Choices for Facelift
Many candidates for facelift, or face lift, surgery inquire about the type of anesthesia that is required for the procedure. In my own practice here in San Diego, I typically do a facelift, or face lift, under an IV sedation (twilight anesthesia) or general anesthetic. I also only use a board certified anesthesiologist to put you to sleep. I firmly believe that your safety, care and comfort are of the utmost importance during a facelift procedure. Toward this end, I would much rather have an anesthesiologist taking care of you while I have my own job to do. With an IV sedation anesthetic you are awake and breathing on your own but do not feel any pain or discomfort. Some patients prefer to this type of anesthesia for their facelift, or face lift, since they are not 'completely out' as some people say. Others choose the general anesthetic since they prefer not to be awake and would rather be completely out. With either method of anesthesia, we are able to accomplish our goals in terms of the facelift providing a rejuvenated facial appearance. Under either anesthetic we can also perform the necessary neck work needed to do a formal neck lift, or necklift, at the same time. A subset of patients ask whether or not the procedure can be done under just local anesthesia. Although this is possible in some cases, it does limit the amount of work that can be done in terms of the facelift, or face lift, procedure. When it comes to a limited mini facelift, or mini lift, procedure some patients can get away with just local anesthesia. In my current practice, I would say this is definitely the exception rather than the rule. Hope this helps.

#### Another Gauge Piercing Repair
This is another great example of what gauge earring (gauge piercing) repair surgery can look like. This patient from San Diego, CA desired to have her gauge piercings repaired to make the earlobe appear more natural looking. I performed her surgery under local anesthesia, which took about 1.5 hours altogether. She had minimal discomfort following the gauge earring correction. These photos represent her surgical results at only one week out from surgery. I provide these here mostly so prospective gauge earring repair patients can get a better appreciation of what they might look like themselves at one week. If you are interested in having your gauge earring defects corrected by a San Diego specialist in this particular procedure, contact our office today.
Before & One Week After Gauge Repair

#### Another Very Happy San Diego Otoplasty Patient!
Dr. John Hilinski, board certified facial plastic surgeon, presents another very happy ear pinning, or otoplasty, patient from San Diego, CA. This young male desired to have his ears pinned back because they were overly prominent for his liking. Like many otoplasty patients, his ears were asymmetrically enlarged with his left ear sticking out further than his right. Dr. Hilinski recommended ear pinning under just local anesthesia and an oral sedative pill in our own Hilinski Ambulatory Surgery Center. The procedure took about an hour to complete with minimal discomfort to the patient. Both ears were able to be reshaped from behind, leaving essentially no visible scarring. As you can see from hisbefore and after ear pinning photos shown below, there is an obvious esthetic improvement in the shape and position of his ears. And most importantly, he doesn't look as if he had cosmetic ear surgery! The patient is extremely happy with the cosmetic ear reshaping results and is no longer preoccupied with the appearance of his ears. To see one of the largest ear pinning, or otoplasty, photo galleries in all of San Diego, use this link here. To learn more about ear pinning and otoplasty surgery visit our online discussion of cosmetic ear surgery and our online patient primer for otoplasty.
Before and After Cosmetic Ear Pinning

#### Appearance 1 Day After Otoplasty
Many ear pinning patients wonder what the ears may look like in the early healing process after otoplasty surgery. So I decided to post this blog to give those a visual idea of what to expect in the average case. As I discuss with all my cosmetic ear pinning patients, the ears will appear overcorrected initially. I overcorrect the ear pinning because the ears have a certain amount of cartilage memory - where they want to 'spring' back to their original shape after surgery. If a facial plastic surgeon does not overcorrect during the otoplasty surgery, the ears will spring back as the healing process unfolds - leaving the ears more lateral (sticking out) than desired. I normally try to overcorrect by several millimeters to account for this spring. Consequently, your ears should appear almost too close to the head in the early healing period. The photo series below demonstrates this visually. This is one of my actual otoplasty patients. On the left is his preoperative appearance. As you can see, 1 day after otoplasty surgery, the ears are now positioned closer to the surface of the head. In fact, the ears appear too close to the head because of the overcorrection I performed during the actual cosmetic ear pinning surgery. On the right side, you can see his long-term otoplasty results. As you can appreciate, the ears have sprung back compared to the 1 day postoperative position. But, overall, when compared to his preoperative photo, the ears are greatly improved in terms of shape and position. If you are looking to have ear pinning surgery, do not hesitate in contacting my office today to schedule a personalized consultation with me.

#### Appearance After Blepharoplasty (Eyelid Lift)
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

#### Appearance of Ear After Rhinoplasty With Auricular Grafting
Rhinoplasty and revision rhinoplasty patients commonly ask what their ear is going to look like following nasal reshaping procedures where a portion of the ear is used for grafting purposes. In my practice, which emphasizes rhinoplasty and revision rhinoplasty, ear cartilage grafting, or auricular cartilage grafting, is done on a routine basis. The cartilage is taken from the ear and used to help reconstruct and reshape the nose in cases where the existing cartilage of the nose is insufficient to provide the desired shape. In primary rhinoplasty cases, this is often times in patients who have moderately thick skin and/or in those who desire elevation of the bridge height. In revision rhinoplasty cases, auricular cartilage grafting is frequently done in patients who had too much cartilage removed during their previous nasal reshaping surgery. When I take cartilage from the ear for grafting purposes, I use an incision made behind the ear. In this manner, there is no visible scarring that might be seen from the front or the side. If you take the central portion of the ear cartilage and preserve just the right amount, there really is no change to the shape of ear. Many patients undergoing this type of rhinoplasty procedure inquire whether or not their ear is going to look the same still. The answer is that most patients will have great difficulty seeing any real change in the shape of their ear following auricular cartilage grafting. The attached photo is a revision rhinoplasty patient of mine from San Diego who underwent ear cartilage grafting as part of her reconstructive nose surgery. As you can see in the photo, which was taken 5 days after surgery, there is barely any sign I was ever there! One can see some mild discoloration from the bruising, but the ear looks quite natural without any obvious stigmata of having had surgery.

#### Are The Changes From A Facelift (Face lift) Permanent?
This is a question that is commonly asked by San Diego facelift, or face lift, patients looking to achieve a more youthful, rested facial appearance. In short, the answer to this is - yes. Patients undergoing a facelift procedure to lift and tuck the lower face and upper neck are undergoing a permanent change in their appearance. By definition, lifting the facial skin, then tightening the SMAS layer, followed by removal of the excess skin, is considered a permanent change to the face. Perhaps a better question to ask is 'how long should my facelift results last?' Because the reality is that facelift patients will resume the aging process at the moment I place the last suture during their procedure. Assuming you continue to age at an appropriate rate and take care of yourself, most facelift patients can enjoy 5-10 years before having to consider another lift or tuck. In many cases, patients undergo a facelift procedure and never elect to have any further surgery down the road. But the changes that are made during a facelift procedure are definitely considered a permanent change in the anatomy of the face.

#### Are There Visible Incisions With Otoplasty (Ear Reshaping)?
In essentially all cases of routine otoplasty for prominent ears the incisions (skin cuts) are hidden completely behind the ear. Although some plastic surgeons still make incisions in front of the ear, I have been quite successful with keeping our incisions behind the ear. My otoplasty technique involves an incision made in parallel with the attachment of the ear to the scalp. This type of approach provides me sufficient exposure to reshape the entire ear without having to make an incisions on the front. Therefore, there are no scars or visible signs of otoplasty having been performed.

#### Arm Fat Reduction
Bat wings, arm fat? Our CoolAdvantage Petite applicator is specifically designed to help you freeze away unwanted arm fat that can be so unsightly. Don't be embarrassed any more about lifting up your arms. Coolsculpting is FDA approved for freezing fat away without any surgery, needles or downtime.

Our team of Coolsculpting specialists here in San Diego are ready to help you get summer body ready. With Dual Sculpting - two Coolsculpting machines being run at one time - your treatment time can be cut in half compared to offices that only have one machine available for arm contouring.

If you have excess arm fat that you want to get frozen away, call our office today to schedule your Coolsculpting session.

#### Artefill – Permanent Dermal Filler Update
We have had a lot of inquiries lately about the return of the only FDA-approved permanent dermal filler on the market in the United States – Artefill. I am excited to report that Artefill is officially back as of several months ago. Artefill was previously manufactured and distributed by Artes Medical before they went bankrupt. Many patients were concerned about this development and mistakingly thought it may be due to something about the actual Artefill product. Fortunately, this is definitely not the case. Artes Medical, unfortunately, made a series of poor business decisions that contributed to the demise of the company. This had essentially nothing to do with the merits of the Artefill product and, in fact, some say occurred despite having one of the most promising dermal fillers on the market.

Artefill has now reemerged and is being manufactured and distributed by Suneva Medical out of San Diego, CA, with a whole new business model and phenomenal leadership at the helm. Because my practice is located in proximity to Suneva, I have been fortunate enough to see all the latest Artefill developments first hand. In fact, last month I joined several facial plastic surgery colleagues of mine from Beverly Hills down to San Diego for an exclusive visit to the company. We toured the manufacturing facilities and had an in depth group discussion about using Artefill for a variety of cosmetic uses in the face. This product, which contains finely engineered polymethylmethacrylate (PMMA) beads, is the only non-absorbable dermal/soft tissue filler that has undergone the scrutiny of the FDA and received approval for this particular use. It is currently FDA approved for use in the smile line region (nasolabial fold augmentation) but has had great success in other areas of the face like the cheek and prejowl regions (off label uses). Patients do require a skin test 7-14 days before injection to make sure they do not react to the collagen paste contained in the syringe (which only acts as a carrier for the permanent PMMA).

If you are a current Juvederm or Restylane patient or even someone who has never had a filler but desire a more permanent dermal filler option, I would strongly recommend you consider Artefill.

#### Artefill Medical Advisory Board
The Hilinski Clinic is proud to announce that Dr. Hilinski was chosen to be on the Suneva Medical Advisory Board for the upcoming year. Suneva Medical is the maker of Artefill, the only FDA-approved non-resorbable, aka permanent, dermal filler on the market. Dr. Hilinski is looking forward to becoming more involved with Suneva in advancing the use of Artefill in the field of facial plastic surgery.

#### Asian 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.

#### Asian Rhinoplasty in San Diego, CA
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.

#### Asian Rhinoplasty Surgery
Asian rhinoplasty is a form of ethnic rhinoplasty that involves a much different approach compared to the standard rhinoplasty surgery. First off, Asian rhinoplasty patients typically present with complaints about their bridge being too low, which often translates into the frontal appearance being too wide. A frequent comment from Asian rhinoplasty candidates is that they actually have difficulty wearing eyeglasses and sunglasses because their bridge is too low to actually support the glasses. In addition, they commonly note that their tip is wider than desired. I have included some photos of one of my own San Diego Asian rhinoplasty patients as an example of what we commonly do and the results. As you can see in her preoperative photo below left, her bridge appears somewhat wide and washed out on this frontal view. In addition, her tip is slightly rounded and wide. The overall goal was to provide her with more definition along the bridge and tip. Her particular rhinoplasty procedure involved augmenting the nasal bridge, or building it up, as indicated by the photo diagram. This elevated the bridge height to give improved shadowing on frontal view, thus creating a more narrowed look. In addition, we did grafting of her tip region as shown in the photo diagram. This was done to push her tip out and give it more shape and definition. The end result of this Asian rhinoplasty can be seen below right. Notice how her frontal view looks more narrow and defined now while the tip appears better defined. Also note, however, that her nose still looks ethnically consistent with her face without real obvious signs that she had had a rhinoplasty performed.

#### Asian Rhinoplasty Surgery Examples Dr. Hilinski
I recently added another online case example of cosmetic nose reshaping - this time focusing on Asian rhinoplasty surgery, a certain type of ethnic rhinoplasty. We hope you enjoy this latest addition to our online rhinoplasty patient tutorial that focuses on Asian patients seeking rhinoplasty surgery.

#### Avoiding A Hollow or Sunken Eye Look With Blepharoplasty
One of the most common concerns among potential eyelid lift, or blepharoplasty, patients is having a hollow or sunken look to their eyes following surgery. The hollow or sunken look can be seen in some patients who had an eyelid lift by a plastic surgeon who removed not only skin but also underlying muscle and fat. When too much soft tissue is removed from the upper eyelid, for instance, the eye begins to look sunken. Although the eye now looks different (and has less skin redundancy), it is far from looking youthful and more rejuvenated, which is the goal of an eyelid lift. I think that many plastic surgeons forget to realize that the esthetically ideal eye does indeed have some volume  between the eyelid and the eyebrow. If you look at any famous model out there, you will appreciate there is a nice convex shape (not flat or hollow) going from the upper eyelid crease toward the eyebrow. What most blepharoplasty patients are after is removal of just the excess skin that drapes over their natural eyelid crease that detracts from a more pleasing appearance. In order to avoid this type of look following blepharoplasty, I try and preserve much of the underlying eyelid muscle and even fat. If there is some excess fat that warrants removal, I do this in a conservative fashion during the eyelid surgery. I will also even contour the eyelid muscle a bit but fall short of actually resection (or removal) of the muscle in a majority of cases. For the most part, though, I try and preserve much of the normal, native underlying anatomy. The adjacent photos of one of my San Diego eyelid lift patients highlights much of what I am trying to explain above. This particular female blepharoplasty patient was most concerned about the excess skin along her upper eyelids. As you can see from the photos, she has upper eyelid skin that is draping down almost over her actual eyelashes. Although she was fairly young in age, her upper eyelids were giving her the appearance that she looked much older and tired. I performed an upper eyelid (and lower eyelid) lift to remove essentially just skin from both sides. I did minimal contouring of her upper eyelid muscle and even less work on the fat. The red shaded area in the photo shows essentially what was removed from the upper eyelid. As you can see in her postoperative photo, there is a marked improvement in the shape of her eye now. We fully preserved her natural, almond shape of the eye and provided her with a much more youthful, rested look. All this was able to be accomplished without risking a hollow or sunken look. Hope this helps any of you San Diego blepharoplasty, eyelid lift candidates considering surgery.

#### Avoiding the Spock Look
We here this all the time from new Botox and Dysport patients coming to our San Diego office. 'I don't want Spock eyebrows' they say. Well, no reputable cosmetic doctor wants to create the Spock eyebrow look. But, unfortunately, it can and does still occur when Botox and Dysport is injected by doctors and nurses who don't have a lot of knowledge and experience with forehead muscles and facial movement.

The Spock eyebrow is an overly arched eyebrow that shows its peak out to the side of the forehead. The reason this occurs is because your doctor injected the central part of the mid to upper forehead - without injecting any Botox and Dysport along the sides of the forehead.

To really understand why Botox injections can do this, we recommend you first read our blog entry regarding Botox and forehead movement.

The adjacent Botox diagram shows the Spock issue more visually. The green area represents where Botox or Dysport is injected in the brow elevators. That means this area of the forehead will be paralyzed and stop moving. But the sides of the forehead still have muscle movement since Botox or Dysport was not injected in these areas. And those muscles along the side of the forehead work to pull the eyebrow upwards as is shown by the arrows. The end result cosmetically is that the eyebrow arches unnaturally out to the side - much like Spock's eyebrow.

So how do you avoid this Spock look from Botox and Dysport? Your doctor should also inject these red zones with a small amount of Botox or Dysport so this area of the forehead muscle stops moving enough to provide a more natural looking, softly arched eyebrow.

 

#### Avoiding the Stigma of Male Cosmetic Surgery
This is a great case example of what great facial plastic surgery can do - while avoiding the stigma of male cosmetic surgery. One of the most compelling reasons male patients choose not to have plastic surgery is the fear of looking 'surgically done' to family and friends. This is a male patient of mine who underwent a lower facelift and neck lift to give him a more rested, youthful look. Notice how he still looks like himself - just a more refreshed version. And I was able to accomplish this without making him look surgically done.

#### Baby Botox?
So what is this new talk about 'Baby Botox'? Fortunately, it has nothing to do with injecting Botox into babies!

Baby Botox is a new term that has been recently used to describe a technique for Botox and Dysport injections. This technique, however, is not really new. Dr. Hilinski and other Botox experts have been talking about 'Baby Botox' for years - but have often referenced this as 'micro Botox' injections.

Simply put, Baby Botox and micro Botox injection involves using smaller dosages of the Botox to treat certain areas of the face where unwanted lines and wrinkles are forming. So why use less Botox or Dysport in these areas? So people can more safely avoid that dreaded frozen look that can result when too much Botox or Dysport has been injected. Unfortunately, this still occurs in many other offices in and around San Diego, Orange County and Los Angeles. Dr. Hilinski and his staff are quite careful about avoiding this look - even with standard dosages of Botox and Dysport.

Baby Botox and micro Botox injections involve using 1/3 or 1/2 of the usual number of Botox and Dysport units. To better understand how units work, use this link here to Dr. Hilinski's online resource for Botox and Dysport patients. The thought behind this is that the muscles will be slowed down - but not completely stopped altogether. Therefore, you can preserve some normal animation lines and movement without looking too frozen from Botox or Dysport. In essence, you are getting a more subtle result from a Botox or Dysport treatment session. Is it for everyone? No. But in the right patient Baby Botox and micro Botox injection can be just what they need!

#### Back Fat Reduction
Have unwanted back fat? Check out how the only FDA approved fat freezing treatment, Coolsculpting, can help you get rid of that excess fat without surgery, without needles and without downtime.

This male patient wanted a little help getting rid of his excess upper and lower back fat. He researched the various non-surgical options and ultimately decided to have Coolsculpting done. The upper and lower back fat was treated with Coolsculpting's famous fat freezing technology.

Dr. Hilinski's medical spa staff targeted the areas where you could see the most obvious fat folds in his before photo. In addition, he had the lower back and hip fat treated with Coolsculpting to help slim his waistline.

His actual results are shown here.

As you can easily see, there has been a nice reduction in the amount of back fat that was previously noted. If you look, in particular, at the fat folds along the mid to upper back you will readily appreciate the flattening and reduction that has taken place from Coolsculpting. And if you look at his waistline, there has also been a nice narrowing effect following Coolsculpting. Would more fat freezing sessions get him even more results? Very likely. It is, in fact, not uncommon for patients to have multiple Coolsculpting treatment sessions over a period of 4-6 months, which gives them even more cosmetic improvement in terms of their shape and size. And all of this can be achieved with no surgery, no needles and no downtime.

#### Beautiful Facelift and Neck Lift Results!
Here is a wonderful example of how a facelift procedure can take 10-15 years off of your appearance!

This very pleasant lady came to San Diego desiring to have some sort of cosmetic surgery to make her look more rested and rejuvenated. Her main issues - like many patients looking to have a facelift - centered around the jawline and upper neck. In particular, she was bothered by the excess fatty tissue under her chin and the sagging skin along the upper neck. Together, this anatomical issues caused a visible disruption of her once youthful jawline. Despite taking good care of herself and her skin, these type of changes became more and more obvious as the aging process started taking place. It was at this point that she decided to seek out a board certified plastic surgeon who could help her turn back the clock just a bit.

After consulting with Dr. Hilinski, she was recommended to undergo a lower face and upper neck lift procedure combined with liposuction or lipocontouring of her neck. In addition, Dr. Hilinski recommended other ancillary cosmetic procedures that would complement the facelift and necklift. This included transferring fat from her abdomen to her face. This was done to help restore some lost facial volume while targeting some areas of unwanted shadowing that were present through her midface region (under the eyes and in the mid cheek). As we say in the world of plastic surgery - volume is a sign of youth! In addition, she wanted her nose reshaped to take some attention away from it.
Facelift 'Rhytidectomy' Surgery
Dr. Hilinski ended up performing that precise combination of procedures. The lower face and upper neck lift was done to provide her with a more youthful jawline and neckline. This required removal of excess fat underneath her chin. If we stopped there, her neck skin would just hang down - making her look even older in some sense. Therefore, Dr. Hilinski performed a classic lower face and upper neck lift - often times referred to as a 'rhytidectomy' in plastic surgery terms. Rhytid means wrinkle. So rhytidectomy implies cutting out the wrinkles or removal of wrinkles by way of lifting the skin and pulling it back.

It should be noted that many people use the word 'facelift' without really knowing what this term implies. In the world of plastic surgery, the term facelift implies a cosmetic surgical procedure that targets the lower face and the upper neck at the same time. In fact, when a plastic surgeon performs a facelift, it is very difficult to lift the lower face without lifting the upper neck at the same time. This is because the face and neck have multiple layers of tissue that are - to a great degree - a continuation of each other in the two different areas. So, for example, in the face there is a critical layer of tissue called the SMAS. The SMAS is an acronym for superficial musculo-aponeurotic system. This basically describes a thickened layer of tissue that runs along the lower face which separates (and connects) the deeper structures from the skin layer. This same SMAS layer continues into the upper neck and blends together with the platysma muscle, which spans a good portion of the entire neck. Since these two layers of tissue are essentially blended together, when you pull up on the SMAS layer of the face you will also be pulling up on the neck platysma muscle. That is why you will, to some degree, get a neck lift when you attempt to do a facelift procedure. So when you go to consult with your plastic surgeon about getting facelift surgery, keep in mind that your neck will be reshaped to some degree whether you like it or not!

As is done in most facelift cases, an incision was made along the front border of the ear. This incision is shown in the attached photo diagram as a red line that starts in the temporal hair tuft before going along the junction of the face and ear. The reason facelift surgeons place the incision in this manner is because the scar will ultimately hide much better once it is finally healed. Go ahead and take a look at her scars in the photos shown below and you can see for yourself how well this scar heals in most patients.

The incision allows Dr. Hilinski to lift up the skin along the mid to lower face extending into the upper neck region. A second incision was made in her case just below the chin. This second incision was needed in order for Dr. Hilinski to remove the excess fat in this area using liposuction technique. The SMAS layer of tissue and platysma - previously mentioned above - were then lifted up in a more superior direction as is indicated by the arrows in the adjacent photo diagram. In doing so, her lower face and upper neck were literally lifted up and anchored into a more youthful position.

So what happens to the excess, redundant skin that was moved during the facelift? This is the only tissue that is cut out. The deeper SMAS and platysma muscle layers are lifted and repositioned, but they are not usually cut out. They are just sutured down in their new location. The redundant face and neck skin, in contrast, are actually cut out. In fact, the excess skin is trimmed in the exact pattern as the red incision outlined in the photo diagram. The cut edges are then very carefully sutured together, which results in the scar that is left behind.
Best Facelift Results
Results of facelift surgery are typically seen as early as 2 weeks after the procedure. But at this point in the healing process, patients are still swollen and have moderate distortion of the tissues as a result of the facelift surgery. As time goes on, the skin and deeper SMAS and platysma layers will fully heal into their new, more youthful position. Keep in mind that nearly all facelift patients will see some degree of 'settling' in terms of their skin. Although plastic surgeons can lift and reposition skin into a more youthful location, the one thing they cannot account for is the patient's skin elasticity - or rubber band quality. If the skin doesn't have good 'snap' to it like a new rubber band, there will inevitably be some relaxation as the skin stretches a little bit. This skin relaxation may lead to more visible skin laxity than is desired - but is not the fault of the plastic surgeon. It is more a reflection of the patient's inherent skin quality - or lack thereof. Despite this, most facelift patients will still enjoy a nice improvement that gives them a more rested, rejuvenated appearance as a result of the surgery.

In this case, the patient also went through some degree of skin relaxation after her facelift and neck lift. But fortunately for her, this was not to a significant degree. In fact, here are her before and after facelift surgery photos showing a beautiful, sustained rejuvenation nearly 1 1/2 years after her surgery by Dr. Hilinski. As you can readily appreciate, she looks so much younger and more rested as a result of surgery. If you look specifically at her jawline, you will easily appreciate how her jowls are now markedly improved. As you inspect her jawline in even more detail, you can see how much more defined it is as she turns her head to the side. Whereas her jawline was previously disrupted, it is now much sharper with more uniform shadowing. And when you peek at her neckline, the excess fat is now gone having been removed by liposuction. Her redundant neck skin was then lifted up and back to give her a tighter looking neckline, which is now much closer to a 90 degree angle than it was before facelift surgery.

And overriding all of these amazing improvements is the fact that she still looks very natural after facelift surgery by Dr. Hilinski. In fact, if you just stare at her 'after' photos, you could hardly tell that she has had any cosmetic face surgery. She just simply looks younger and more vibrant. There are no stigmata of being pulled too tight and/or looking stretched and fake. She still looks like the woman she was before she came to Dr. Hilinski - just a more refined, defined and beautiful version of herself. And after all is said and done, this is the essence and measure of incredibly good facial plastic surgery.

#### Beautiful Lip Implant Results
Lip implant surgery is one of the few methods available to us facial plastic surgeons when it comes to providing permanent lip augmentation for our patients. This young lady from San Diego was simply tired of getting repeat Juvederm lip injections over the past several years. She researched her options and discovered that I was a local expert in performing permanent lip augmentation using lip implants. After consulting with me, she opted to go with the Surgisil PermaLip implants for both the upper and lower lips. The procedure took about an hour under local anesthesia. Here are her before and after photos showing what I happen to think are beautiful, natural looking results for her upper and lower lip. They now look more volumized and plump with improved overall shape. This includes with smiling and animation as can be seen here. And these results will not disappear like Juvederm injections will!
Before & After Surgisil Lip Implant

#### Bellafill Leading Expert
Did you know that Dr. Hilinski is one of San Diego's and Orange County's leading experts when it comes to Bellafill use? Although there are many different cosmetic physicians in San Diego offering Bellafill injection, Dr. Hilinski is one of only a handful of doctors in San Diego who has been using Bellafill from the very beginning.
Bellafill History
Bellafill is the current name of the well-known injectable filler that everyone loves because it is essentially permanent. But Bellafill was not always called Bellafill. In fact, when this product first came to market as the only FDA approved non-absorbable filler - it was called Artefill. It was also being sold by a different company - called Artes Medical - that was based here in San Diego. Artes Medical eventually became Suneva Medical - the new company that took over the manufacturing and sales for Artefill. After several years, Suneva Medical then changed the name of Artefill to Bellafill. To this day, the product is still made here in beautiful, sunny San Diego - not too far from Dr. Hilinski's office.

Throughout this journey, Dr. Hilinski has consistently used Artefill and Bellafill as a great option for his patients who desire a much longer lasting filler than what Restylane and Juvederm can do. In fact, Dr. Hilinski has even co-authored papers and book chapters along with other leading Bellafill experts. And Dr. Hilinski continues to lecture regularly around San Diego and Los Angeles on Bellafill use for facial rejuvenation.

So if you want to have a true expert inject your Bellafill - contact our San Diego office today to schedule a personalized consult with a doctor who has been using Artefill and Bellafill since the beginning!

#### Best Fat Freezing Team | Mission Valley | Downtown
Got excess tummy fat? Have a little belly pooch that you can't get rid of with diet and exercise? Afraid of having body liposuction? We have the best non-surgical answer for you - Coolsculpting!

Just take a look at these amazing results of this younger patient who wanted some help getting a flatter, more toned tummy. Like so many of our San Diego patients, she was bothered by her belly pooch, which was reflective of excess, unwanted fat around the abdomen. Although liposuction was an option for her, a surgical procedure along with its attendant risks (scarring, recovery etc) was just not in the cards. Looking for other options, she discovered that Coolsculpting could possibly get her the results she wanted without making any incisions and without any downtime. Eventually, she was referred to Dr. Hilinski's office and his top-notch team of Coolsculpting experts.

She elected to have the tummy fat frozen during an office-based treatment session where she literally relaxed while talking with family and friends. A mere 45 minutes later and her Coolsculpting was complete. Like all patients, she was able to get into her car and drive home.

As the days and weeks went on, she began to notice the effects of Coolsculpting as her frozen fat was gradually dissolved away by the body. Within 3-4 weeks, you could readily appreciate an obvious change in her tummy contour.

The results shown here are only 1 month out from a single session of Coolsculpting around the tummy. That's right, these incredible Coolsculpting results were attained after just one (1) treatment session! Can you see any scars? Of course not! That's because Coolsculpting is entirely non-surgical. You can only imagine what type of cosmetic improvement she would see in her mid section with additional Coolsculpting sessions!
Coolsculpting Transformation

Coolsculpting in San Diego
If you are looking to reduce your belly pooch and don't wish to have surgical liposuction, reach out to San Diego's #1 office for Coolsculpting treatment - the medical spa of Dr. John Hilinski.

#### Best Microneedling in San Diego
Thinking of getting microneedling treatment to enhance your skin's appearance? Why not come to the best microneedling office in San Diego? Our microneedling experts - guided by board certified facial plastic surgeon, Dr. John Hilinski - use the only FDA-approved microneedling pen - the SkinPen - to get you the best results possible. Microneedling is a fantastic office-based, minimally invasive cosmetic treatment that can rejuvenate your skin in a few, short sessions with minimal downtime. Microneedling is a great choice for patients looking to smooth out fine lines (as seen here), improve acne scarring, reduce age spots and pigmentation, tighten loose skin and improve irregular, sun-damaged skin texture. If you are seeking the #1 microneedling specialist in San Diego - look no further. Contact our office today to schedule your complimentary microneedling consultation.

#### Bigger Lips With Filler
Some people wonder how much filler do we typically place in somone's lips? The answer is - usually 1 syringe of Restylane or Juvederm - or less. However, there are definitely patients out there who desire more volume than that to give them even fuller, plumper lips. Most of these Restylane and Juvederm filler patients tend to be on the younger side. This is a great example of what it looks like when lips are filled with more and more volume. This patient happens to be one of my office staff members. On the left side of the photo is her appearance prior to having any lip filler placed. I then added about 1 syringe of filler to produce the results seen in the middle photograph. Personally, I really like this size and shape when it comes to lip filler. You can see that her upper and lower lip are plumper and more shapely with a great balance between the upper and lower. But that wasn't enough for her! She wanted more - especially in her upper lip. So I added another syringe of filler to create the result seen in the right photograph. Now this one clearly has a much bigger, poutier lip. Not exactly what I prefer - but she is utterly happy with her new, much bigger lips!

#### BioCorneum® Available Online!
Did you know that you can now purchase BioCorneum® online directly from our office? BioCorneum® is a physician-only dispensed topical silicone gel that is America's #1 recommended topical treatment to help aid in scar management. BioCorneum® works beautifully for both surgical and traumatic scars. Applied daily to the scar, BioCorneum® can help improve the cosmetic appearance during the healing process. Most patients will use BioCorneum® topically for upwards of 3-4 months to attain optimal results. In some cases, however, it is recommended that BioCorneum® be used for upwards of 9-12 months.

No matter where you live in the United States, you can purchase BioCorneum® right here right now! Just use the links provided to be taken to our online product store. BioCorneum® is now only a few clicks away.

#### Bizymoms Online Interview With Dr. Hilinski
Dr. John Hilinski was recently featured in an online interview with Bizymoms.com discussing rhinoplasty surgery. Bizymoms.com is a website that caters to moms of all ages and covers a wide ranging of topics, including plastic and reconstructive surgery options. Click here for a link to Bizymoms and Dr. Hilinski's rhinoplasty interview.

#### Blepharoplasty Eyelid Lift Cold Compresses
I just saw one of my blepharoplasty or eyelid lift patients back in the office. She is doing quite well and gave me a quick suggestion that I thought would be helpful to pass on to my other patients. For years now we have recommended our eyelid lift patients use Karo syrup, or corn syrup, as a cold compress to reduce swelling and bruising after surgery. It can be placed in sandwich bags and put in the freezer to create a very cold yet pliable compress that molds around the eye. She suggested that adding in some frozen peas helps even further in terms of efficiency. So for all you eyelid lift patients out there, give this a try.

#### Bone Resorption After A Chin Implant
I see this topic as a point of discussion on many plastic and cosmetic surgery forums. The reality is that almost everyone who gets a chin implant has some degree of bone resorption following the surgery. But this fact should not be something that is a great source of anxiety over having a chin implant procedure. The bone resorption that most cosmetic chin augmentation patients get following the implant placement is fairly minor. In fact, most patients, once healed, don't even really notice there has been any resorption. So, although there is some resorption of bone after chin reshaping with an implant, almost everyone gets it and this typically does not detract from the cosmetic chin enhancement results.

#### Botox by Dentists?
Would you go to your dentist for Botox or Dysport treatment? Probably not is what most people say. But the reality is that some dentists here in San Diego and Orange County now offer Botox and Dsyport injections for cosmetic indications. There are dentists that have injected Botox and Dsyport for TMJ problems - which really does fall into their primary line of work. But for cosmetic wrinkle reduction? A handful of these dentists are also offering to do filler injections, like Juvederm and Restylane at the same time!

Personally, I think that Botox and Dysport treatment for wrinkle reduction should be left to doctors whose primary education and training focused on cosmetic treatments like these. It really does take years of education and training to get to the point where a doctor truly understands the nuances of Botox, Dysport and dermal filler injections to enhance someone's facial appearance. And board certification in something like Facial Plastic and Reconstructive Surgery shows the general public that a certain doctor has passed rigorous training and examination specific to that area of practice. With so many other types of doctors offering cosmetic treatments like Botox and Dysport, it is highly recommended you find someone who is board certified in plastic surgery and doesn't just do this type of thing on the side.

#### Botox for Men
What percentage of Botox patients are men? In our practice, it is about 20%, but rising every year! That is because Botox and Dysport treatment has become less and less taboo for men seeking to reduce unwanted fine lines and wrinkles in their face. If women can do it, why not men, right?

The fallacy has been that Botox and Dysport will make a male face look 'off' somehow or another. But, the reality is that Botox and Dysport can be done where it simply enhances the rugged look of a typical male patient. Normally this means not putting in too much, which is a good policy in general when it comes to cosmetic treatments. This includes avoiding over injection of the forehead region where the eyebrows could potentially  rise up - almost feminizing a male face.
Common Areas for Male Botox

 	Horizontal wrinkles in the forehead
 	Frown lines in between the brows
 	Crow's feet surrounding the eye

In the right, trained hands of cosmetic experts like Dr. John Hilinski and his aesthetic RN staff members, men can expect to see a nice improvement in the appearance of their face as a result of Botox and Dysport. They should still look rugged and masculine - just with less wrinkling and deep lines across the face.

 

#### Botox for Sweating
Did you know that Botox is commonly used for excess sweating? Most of our Botox patients in San Diego come to our office for treatment of unwanted face wrinkles and creases. This is far and away the most popular use for Botox (as well as Dysport). But, Botox is also regularly used for treatment of excessive sweating that can involve the armpits - also referred to as the axilla in medical terminology. Many patients, for example, develop sweaty armpits during speeches or even in the course of a normal business meeting with colleagues. This is known as hyperhidrosis and can sometimes be quite embarrassing  due to the staining that is commonly seen. Fortunately, there is an effective answer - and it is in the form of Botox injections that can be done in our San Diego office by board certified plastic surgeon, Dr. John Hilinski. No longer is Botox used to just treatment wrinkles and creases - it is also one of the best treatments for sweaty armpits! Call our office today to schedule your consult.

#### Botox Getting Even More Popular
Popularity of Botox
Yesterday we posted on how popular rhinoplasty had become in 2017. But, according to a recent NewBeauty publication, the most requested procedure overall in cosmetic offices is still Botox and Dysport injection.
Botox Use Going Up

Since 2012, both Botox and Dysport treatments have gone up nearly 33%. That is a huge increase in popularity for these two wrinkle fighting treatments. Here in San Diego, Botox and Dysport remain at the top in terms of most commonly requested office-based cosmetic treatments. Dr. Hilinski and his team of cosmetic specialists continue to see more and more new patients - especially millenials - coming in for Botox and Dysport to reduce unwanted wrinkles and creases around the face. We suspect as 2018 unfolds, that our San Diego office will see an even higher uptick in Botox and Dysport appointments. In fact, so much so that we have even considered bringing on an additional provider to start doing Botox and Dysport injections alongside Dr. Hilinski.

#### Botox Versus Dysport Units
In 2018, Botox and Dysport continue to be the most popular and effective wrinkle fighting agents that we use in our San Diego office. Both treatments are quite effective in reducing unwanted wrinkles and lines - and can be considered fairly equivalent when it comes to delivering cosmetic results.

But Botox and Dysport are fairly different in terms of how potent each 'unit' is in controlling muscle movement. One (1) unit of Botox is about equivalent to three (3) units of Dysport. This means that Dr. Hilinski will need to use three times as much Dysport to get the same effect in wrinkle reduction as he would get with Botox. So, for example, if you normally get 25 units of Botox to treat your forehead wrinkles and creases, you would need 75 units of Dysport to get the same cosmetic effect.

The good news is that Dysport is also priced accordingly - so it is 1/3 of the price of Botox in our San Diego office. That means, from a price perspective, Botox and Dysport come out to be the same cost for you. Now it is just a matter of choosing which wrinkle reduction treatment you prefer better - Botox or Dysport!

#### Brotox for Men
Here is an example of what Botox or Dysport can do in the average male patient - often times referred to as Brotox. This male patient disliked the wrinkle formation around the eyes (the crow's feet area) and in between the eyebrows (the glabella region or frown lines). Dr. Hilinski injected Dysport into both of these areas to help smooth out the wrinkles. Notice how he still looks quite natural - and masculine - following the non-surgical wrinkle reduction treatment!

#### Bullhorn Upper Lip Lift
This is another example of how surgery can help enhance the appearance of an elongated upper lip - a cosmetic concern that is more common than you would imagine. Shortening the upper lip using a bullhorn incision upper lip lift technique is gaining in popularity and has become one of the more regular procedures I perform. Take a look at this patient's upper lip region and see how an upper lip lift has provider her with a nice cosmetic improvement while still allowing her to look herself. Let us know what you think of her results!

#### Can An Upper Lip Lift Improve Your Facial Balance?
Board-certified facial plastic surgeon John Hilinski, MD explains how an upper lip lift can effectively help balance facial proportions.
 
Unfortunately, the overall appearance of the face can be dramatically impacted when just one area of the face looks unbalanced. Our upper lip lift patients are generally men and women looking to achieve more harmonious and balanced facial proportions. People with a disproportionately long, or elongated, upper lip are often good candidates for an upper lip lift procedure.
 
The “upper lip” is the space between the bottom of the nose and the vermillion border of the upper lip (where the pink of the lip begins). For most patients, an upper lip that is around 12-14 mm long will look proportionate. Many patients who elect to undergo upper lip lift surgery typically have an upper lip length of 18-20 mm or even longer. Other patients have appropriate length, but very poor volume in terms of the pink portion of the upper lip (appearing almost flat) and are also considered good candidates for this procedure.
 
Since the lower third of the face plays a significant role in the balance of the face, an upper lip lift procedure that targets this zone, in particular, can have a large impact by improving overall facial harmony. For some patients, shortening the upper lip and removing the excess skin allows the pink or red portion of the lip to appear fuller and become more visible. As an additional benefit, many upper lip lift patients find that the procedure increases the visibility of their upper teeth when smiling, creating a more vibrant and healthy look.
 
Check back soon for a follow-up blog post in which Dr. Hilinski will discuss upper lip lift techniques and which treatments can be combined with the procedure.
 
To learn more about Dr. John Hilinski and how an upper lip lift may benefit you, please contact our office today.

#### Can Blepharoplasty Improve My Vision?
As we age, the skin of the upper eyelid can begin to droop and may eventually impair the field of vision. Although many upper blepharoplasty (eyelid surgery) patients seek to eliminate this excess skin and fat for cosmetic reasons, some patients can also significantly improve their vision with this commonly performed procedure.

If your eyelids sag or droop to a degree that impedes your natural line of sight, upper blepharoplasty can restore your field of vision. When the upper eyelid begins to descend, the skin can begin to encroach upon your vision or push your lashes in front of the eye, blocking peripheral vision and narrowing your overall eyesight. An upper blepharoplasty can reverse these effects. As an additional benefit, some patients find they can more easily insert contact lenses after the procedure.

Depending upon your insurance plan, the cost of an upper blepharoplasty may be completely covered. A visual field test conducted by your ophthalmologist is typically the first step in determining your eligibility for this coverage, since this test can reveal if your upper blepharoplasty can be classified as a medical necessity. To learn more about blepharoplasty, or to schedule a consultation with our board-certified plastic surgeon, please contact us today.

#### Can Ear Reshaping, or Otoplasty, Be Performed on a 10-Year-Old?
The answer to this question is - absolutely. In fact, many patients who have ear reshaping or otoplasty done for prominent ears have it done at 5-6 years old. Cosmetic reshaping of the ears can be done as early as this age because the ear is essentially fully formed by that point. It is also good timing because many parents do not want their child subject to any unwanted attention as they become integrated into schooling and more social interaction. So 10 years old is just fine to consider having otoplasty for prominent ears. To learn more about San Diego otoplasty or ear reshaping, link here to our online otoplasty tutorial.

#### Can I Afford Rhinoplasty?
The cost of rhinoplasty (or a nose job) can vary according to several factors. While cosmetic procedures are often not covered by insurance providers, a rhinoplasty that is intended to improve breathing functionality may be covered since it is reconstructive in nature. In addition to your insurance, the following factors may influence the total amount you can expect to pay:

	Anesthesia
	Surgical facility
	Medical tests
	Post-surgery garments and medications
	Expertise of the surgeon

Although cost is often a major concern when considering a plastic surgeon, we stress the importance of not selecting a rhinoplasty specialist based on price alone. It is important that you seek a board-certified facial plastic surgeon who is experienced in performing nose surgery and can offer a wide variety of before-and-after pictures of previous patients’ results.

When you come in for a consultation with Dr. John Hilinski, you can learn about his extensive training and expertise on the procedure, as well as get a better understanding of how much you can expect to pay. Should you need financial assistance to make your rhinoplasty more affordable, we can help you apply for financing to make the surgery possible.

#### Can I Do An Upper Eyelid Lift In The Office?
Many patients seeking an upper eyelid lift, or blepharoplasty, are pleasantly surprised to hear that they can undergo the procedure in the office setting. An upper eyelid blepharoplasty is one of the most gratifying procedures for both patient and surgeon. The procedure can have quite dramatic, yet natural appearing, results that provide a significant improvement in terms of looking more rested and youthful. Plus, upper eyelid blepharoplasty can usually be done in the office using local anesthesia (injection of numbing medicine). If desired, a low dose of oral Valium can also be given to provide more relaxation during the procedure. Most cases are completed in under an hour. Another huge advantage of doing this in the office is that patients avoid the additional costs associated with facility and anesthesia fees. In addition, there are no concerns with reacting to general anesthesia. The ability to achieve this type and degree of cosmetic enhancement under local anesthesia in the office makes upper eyelid blepharoplasty one of the most popular procedures we perform.

#### Can I Reduce the Size of My Ears?
Many patients who undergo surgery for their ears are concerned with how much the ear protrudes from the side of the head. Otoplasty surgery is commonly used to “pin” the ears back to cosmetically improve their natural position. However, some patients have ears that are disproportionately large compared to the size of their head, even when the ears are otherwise positioned close to the scalp. Macrotia ear surgery is designed to reduce the height and width of the ear’s surface for a more balanced, harmonious aesthetic.

Most patients who seek to reduce the overall size of their ears find that the upper portion of the ear is significantly taller and wider than the lower half. For the average adult, the width of the ear is about 50-55% of the length at its widest point. As the ear grows beyond this ratio, the ear can appear overly large. Macrotia ear surgery typically focuses on reducing the size of the upper half of the ear and concealing the incision within the outermost fold of the ear (the helical rim). To discover if you might be a good candidate for macrotia ear surgery, or to schedule a consultation with our board-certified plastic surgeon, please contact us today.

#### Can Men Benefit from Neck Liposuction?
As our culture evolves, so do perceptions of masculinity and personal grooming. Many men are considering cosmetic procedures to improve their appearance and regain their confidence. One such procedure that has gained popularity among men in recent years is neck liposuction.

Dr. John Hilinski, a leading plastic surgeon based in San Diego, CA, has extensive expertise in this area and helps guide his male patients through the transformative journey of neck liposuction.
Understanding Neck Liposuction
The American Board of Cosmetic Surgery says neck liposuction is a minimally invasive surgical procedure designed to remove excess fat from the neck area, enhance the jawline and contour the neck. The procedure involves making small incisions through which a thin cannula is inserted. This tube removes unwanted fat deposits, resulting in a slimmer and more defined neck.

Neck liposuction is particularly appealing to men who may struggle with submental fullness—commonly referred to as a “double chin”—which can occur due to genetics, weight fluctuations or aging. Dr. Hilinski utilizes advanced techniques tailored to men’s unique anatomical features to ensure optimal aesthetic results.
Why Should Men Consider Neck Liposuction?
The American Society of Plastic Surgeons affirms that, “In the last decade or so, we have seen a growing presence of men pursuing plastic surgery to maintain and enhance their appearances.”

What can neck lipo do for men?

 	Enhanced Jawline Definition: One of the most compelling benefits of neck liposuction is the ability to create a more pronounced jawline. For many men, a well-defined jawline is synonymous with youthfulness and vitality. Removing excess fat can elevate the appearance of the neckline and jaw, giving men a stronger and more masculine visage.
 	Improved Confidence: A common reason men seek liposuction is dissatisfaction with their appearance, which can impact self-esteem. Reshaping the neck and jawline can restore confidence and help men feel more comfortable in social and professional settings.
 	Targeted Fat Removal: Men often find it challenging to lose stubborn fat in the neck region through diet and exercise alone. Neck liposuction offers a targeted solution, enabling individuals to achieve desired results without the frustration of traditional weight loss methods.
 	Quick Recovery: Compared to more invasive surgical options, neck liposuction tends to have a shorter recovery time. Most men can expect to return to regular activities within a week or two, making it an appealing choice for busy professionals and fathers who may not have the luxury of extended downtime.
 	Long-Lasting Results: Neck liposuction results can be long-lasting when combined with a healthy lifestyle. As fat cells are permanently removed from the treatment area, maintaining weight will help preserve the newfound neck contour.

The Neck Liposuction Procedure
At John Hilinski, M.D. Plastic Surgery, the neck liposuction process begins with a comprehensive consultation. Dr. Hilinski takes time to discuss the patient’s goals, evaluate their neck structure and determine if they are a suitable candidate for the procedure.
Pre-operative Evaluation
During the initial consultation, Dr. Hilinski will assess various aspects of your neck, including skin elasticity and fat distribution. He will also review your medical history to ensure your safety during the procedure.
Anesthesia
On the day of the surgery, you will be administered anesthesia, ensuring you remain comfortable throughout the process. Depending on the extent of the liposuction and your preferences, this may include local anesthesia with sedation or general anesthesia.
Incision and Fat Removal
After the anesthesia takes effect, Dr. Hilinski will create small incisions beneath the chin or behind the ears. He will then carefully insert the cannula to dislodge and suction out excess fat.
Recovery and Post-operative Care
Following the procedure, patients can expect some swelling and bruising. Dr. Hilinski will provide specific post-operative instructions, including instructions on how to manage discomfort and when to return for follow-up visits.
Neck Liposuction FAQs
Am I a good candidate for neck liposuction?

Good candidates are generally healthy individuals who struggle with localized fat deposits in the neck area. To maintain the results, it’s essential to have realistic expectations and engage in a healthy lifestyle.

How long does the procedure take?

The length of the procedure varies depending on the extent of fat removal, but it typically ranges from 1 to 2 hours.

Will I have noticeable scarring?

Incisions for neck liposuction are small and strategically placed to minimize visibility. Most scars will fade significantly over time.

What can I expect during recovery?

In the initial days following the procedure, patients can expect some swelling, bruising, and discomfort. However, these symptoms usually subside within a week, allowing most patients to return to work and leisure activities shortly thereafter.

How long do results last?

The results of neck liposuction are designed to be long-lasting as long as you maintain a stable weight and healthy lifestyle.
San Diego CA Neck Liposuction
Neck liposuction can be transformative for men seeking a more contoured neck and jawline. Dr. Hilinski’s commitment to patient-centered care and exceptional results has made him a trusted choice for individuals seeking facial cosmetic enhancements in San Diego. Whether you are motivated by personal confidence or aesthetic desires, exploring neck liposuction might be the step to achieve your goals.

If you’re interested in learning more, don’t hesitate to schedule a consultation with Dr. Hilinski at his practice, where he will be happy to discuss your options in detail.

#### Can You Alter The Nose Height & Length At The Same Time?
This is a question I have seen on some online rhinoplasty forums and decided to answer with a patient example. This patient was recently seen in follow-up evaluation in our office and was thought to be a good case example of altering nasal height and length at the same time. His main complaint on presentation was the convexity, or bump, as seen best on his profile view. In addition, he had ptosis, or drooping, of the nasal tip region. On frontal view this translated into a somewhat flattened appearance when looking at the lower half of his nose. We had a long discussion regarding possibilities with undergoing a rhinoplasty procedure. Specifically we discussed reducing the height of his bridge in concert with elevation of his nasal tip region. All the while, we emphasized the need to maintain a strong, masculine bridge along with an ethnically consistent look. He decided to proceed with the surgery, which was performed nearly a year and a half ago. As you can see from the diagrams below, we were able to reduce his bridge height at the same time as shortening his nose by repositioning his nasal tip. With regard to the latter, I was able to detach his lower lateral cartilage on each side (red outlined cartilage) and reorient their position to achieve the desired tip shape. This was done primarily to shorten the nose and erase signs of the drooping tip. On side view, you can see that the angulation of his nose was altered to create more of a 90 degree angle between his nose and upper lip. In addition, the bridge height was reduced sufficiently (blue line) to allow a nice natural transition from his bridge to the tip. Overall, he has a significant improvement in his nasal appearance with a nose that is more refined yet one that still fits into his remaining facial features. To see this patient's full rhinoplasty photo series in color, click here for a link to our rhinoplasty gallery.

#### Case Example of Hanging Columella Revision Rhinoplasty
I recently saw one of my postoperative revision rhinoplasty patients in follow-up and it reminded me of several discussions that have taken place online regarding a hanging columella. This particular patient had prior rhinoplasty surgery by another plastic surgeon. One of her remaining concerns following surgery was the position and shape of her columella. The columella refers to the column of soft tissue and cartilage that divides the two nostrils. In her particular case, it was simply too heavy and brought unwanted attention to this area of her nose. Many people with this particular problem inquire whether or not this type of revision rhinoplasty can be done under local anesthesia. The answer is - yes. Over the years I have performed many revision rhinoplasty procedures for this exact indication and have successfully done this under local anesthesia or local anesthesia with very light sedation.

This particular patient here had hers done in under 45 minutes using a closed approach. This means that there were no external incisions made on the nose. An incision was made on each side of the columella to allow adequate exposure of the underlying anatomy. I then tucked up the cartilage and soft tissue with permanent sutures. The end result of this type of revision rhinoplasty was a subtle yet noticeable improvement in her tip and columella. Her nose now looks much softer overall and she is quite happy with the change.

To see other photos from her revision rhinoplasty, use this link here: https://www.drhilinski.com/gallery/revision-rhinoplasty/patient-39#content

#### Cast After Rhinoplasty or Revision 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.

#### Cast Falling Off After Rhinoplasty - What Should I Do?
What should I do if my rhinoplasty cast keeps falling off?

I have seen this question posed on other sites and forums related to cosmetic rhinoplasty. My advice to patients that ask this question is to call your rhinoplasty specialist and ask them what to do first.

I can tell you from experience that it is extremely uncommon for the nasal cast to simply fall off after having undergone cosmetic rhinoplasty or revision rhinoplasty. My normal routine is to apply a medial adhesive to the skin of the nose prior to placing my nasal bandages and the cast. As you can see in the attached photo of one of my own primary rhinoplasty patients, the dressings and cast fit very tightly over the nose. In fact, so tightly that it is highly unlikely the cast would fall off during the first week of healing. I even have to use some degree of effort when I go to remove the nasal cast in my office. So when I hear that the cast fell off 'on its own' I immediately question what the patient might have done to precipitate this. Usually there is some explanation - such as accidentally getting the cast wet or incidentally hitting the nose.

Some surgeons might have you try and replace the cast at home (since it should already be molded properly to your nose) and reinforce it with tape across the midface region. Others might just tell you to leave it off. Keep in mind the cast is intended to keep the nasal bones in position following reshaping of the nose during the rhinoplasty. If the bones happen to drift or shift a little during the early post-operative period, your rhinoplasty surgeon can show you how to do nasal, or digital, exercises to put the bones back into the desired position. So not all is lost if the cast does 'happen' to fall off!

#### Cephalic Orientation of Cartilage
Our most recent addition to San Diego's best and ever-expanding online rhinoplasty tutorial focuses on a special problem related to the bulbous nasal tip - cephalic orientation of the lower lateral cartilage. This is a relatively common problem in many patients seeking cosmetic nose work. Take a closer look to find out more about a highly specialized technique that can be used to provide a natural looking, more feminine nose in this group of rhinoplasty patients.

#### Chin Augmentation/Implant Consultation
I wanted to quickly discuss the topic of chin enhancement or chin reshaping using a chin implant for augmentation. Many potential chin implant patients inquire about sizing of the actual chin implant. They often ask, "How do you know what size implant I need to enhance my chin and jawline?" The answer is - I measure it!
My 'Old' Approach To Chin Implant Placement
When I went through my facial plastic surgery training, I was taught that you should use what are called 'implant sizers' when performing chin enhancement surgery. Basically, you have a general idea of what size chin implant you want to use to get the desired chin shape and size. Once in surgery, you then place a chin implant sizer into the area where the real implant will ultimately sit. The chin implant sizers are replicas of the real implant but come in a range of sizes and shapes. The sizers are intended to guide your plastic surgeon with the proper choice of chin implant. With the implant sizer in place, you make a visual assessment of the patient's chin to see if you need to go up or down in size with regard to the implant. Once you decide on the appropriate size, you remove the implant sizer and place the real chin implant and complete the surgery.
The Problem With Chin Implant Sizers
Unfortunately, when using a chin implant sizer to determine the appropriate choice of implant for chin augmentation, there is one considerable hurdle - swelling that occurs during the surgery. Despite very careful surgical technique and gentle handling of the tissue, some chin implant patients will develop swelling of the area as the operation is ongoing. In these patients, there can be considerable inaccuracies when measuring whether or not the chin implant sizer is the correct choice for reshaping the jaw. After all we dealing with changes to the shape and size of the chin that are on the order of millimeters. So even moderate swelling during the chin augmentation surgery can lead to the wrong choice of implant for that particular patient.
My 'New' Approach To Chin Implant Placement
Because of this very issue, years ago I decided to take a new approach to chin enhancement surgery with an implant. I simply began measuring my San Diego chin implant patient's deficiency in terms of chin projection before we actually went to surgery. During either the initial chin implant consultation or preoperative visit, I photograph my patient holding a ruler as shown here. By drawing a vertically line down from where their current chin ends, I can determine more accurately how many millimeters are needed to augment the chin. And this measurement is being done without confounding factors such as surgical swelling that are present with the old approach. Based on this actual measurement, I can choose a chin implant with the shape and size that is just right for my patient. Looking back over time, I feel quite strongly that this new approach to chin implant surgery to enhance the jawline and lower face has resulted in much improved esthetic outcomes for all of my San Diego chin implant patients.

#### Chin Implant Placement and Stabilization
A common question asked during consultation for chin augmentation with a chin implant relates to chances of the implant moving after placement. As I tell all my chin implant patients, there is always a chance the implant can shift or move slightly after placement. It is, however, very unlikely the implant will move to a significant or visible degree once placed properly.

I normally place my implants from under the chin since we are often doing liposuction or platysma muscle tightening at the same time. But even in those cases of isolated chin implant placement, I still prefer this approach. By virtue of going under the chin I can create a very short and direct path to where the implant will ultimately rest. In addition, I avoid the risk and concern of infectious complications that come about when implants are placed through the mouth (intraoral route). Once I expose the lower border of the jaw bone, I create precise pockets or tunnels under the periosteum, which is a thick, dense covering immediately over the bone. Chin implants typically have tapered tails that extend from the middle on each side that allow natural blending with your native jaw bone. These tails are tucked under the periosteum almost like your arm fits into a sleeve. In doing so, the chin implant becomes quite stable in terms of position and is inhibited from moving left or right and up or down. At this point in the operation, it is actually quite difficult to remove the implant even with surgical instruments. I also happen to fixate the implant with a single absorbable suture placed just under the jaw bone. This provides added stability until the implant area is fully healed.

Using this technique I have been highly successful in placing chin implants for augmentation of the jawline.

#### Chin Implant to Enhance Facial Harmony and Balance
This young female patient from San Diego is a great example of how a chin implant can significantly enhance facial harmony and balance without looking surgically 'altered' or 'done' as some people fear. This particular patient had what we would describe as facial plastic surgeons was poor chin projection. Meaning, her chin simply too small for her lower face and did not project outward sufficiently to be in balance with the mid to upper face. In most cases, we evaluate chin projection and position by looking at the side view, or profile.This is shown in the adjacent photo diagram of this patient taken prior to chin implant surgery. An imaginary vertical line is typically drawn straight down from where the red and white lip meet. Ideally, the chin in a female patient should project forward to within millimeters of this line on average. As you can see, the most prominent point of her chin, as seen from the side view, sits several millimeters behind what is considered ideal.
Chin Implant For Facial Enhancement
In this case, the patient opted for augmentation of her chin using a chin implant, which is clearly the most common method of chin enhancement in my practice. By going from underneath her chin, I was able to hide the scar quite nicely. In addition, this approach allowed for more accurate placement of the chin implant and less likelihood of her getting an infection (compared with placement done through the mouth). Overall, you can see from her before and after photos that her lower face is now in much better balance and harmony with the mid and upper face regions. Her chin contour has been notably enhanced and she has improved definition of her jawline. Arguably most important is the fact her jaw and chin still look very natural for her facial features. Although we know she has a chin implant, this is not something that is readily picked up by someone walking by her on the streets of San Diego.

Chin Implant Consultation in San Diego
If you have an underdeveloped chin and/or desire enhancement of your chin projection, feel free to contact our San Diego office today for a complimentary consultation for chin implant surgery.

#### Chipmunk Cheek Treatment
Do you have chipmunk cheeks that detract from having a sculpted, defined face? Are your cheeks excessively round and puffy? If so, you might be a good candidate to undergo buccal fat removal by one of San Diego's leading plastic surgeons, Dr. John Hilinski.

Buccal fat is the layer of fatty tissue sitting inside of the cheek that contributes to fullness of the face. If the buccal fat pad is excessively large, the cheek will look fuller than desired and make the face appear rounder. Many patients worried about their buccal fat pad note that their face lacks definition. Men, in particular, feel like their excess buccal fat takes away from having a chiseled look.

Fortunately for those patients with too much buccal fat, there is a procedure to help called buccal fat reduction. Buccal fat removal is done by making an incision inside of the cheek just opposite the gum line. Dr. Hilinski then carefully dissects down into the buccal space where the fat is situated. He then teases out the buccal fat to reduce the unwanted volume. Dr. Hilinski will usually take out about a walnut or golf ball size amount of buccal fat, which is enough to make a visible change while leaving behind a sufficient amount to keep the face looking natural. The end result is a cheek that is more sculpted and defined because it is now less rounded and full.

If you live in San Diego and have chipmunk cheeks - and want a more sculpted face, reach out to our San Diego office today to schedule your buccal fat removal with Dr. John Hilinski.

#### Choosing Your Botox Doctor
Why is it so important to choose the right medspa office for your Botox and/or Dysport injection? Because not all injectors of cosmetic neurotoxin and filler are equal.

Over the years, we have heard so many of our patients talking about getting Botox, Dysport, Juvederm and Restylane injections done elsewhere in San Diego by various medspas - only to find out that there is much more to the art of cosmetic injectables than just sticking a needle into someone's face.

For example, there are a number of so-called medspas in and around San Diego that were started by doctors who were never really trained in the core specialty of plastic surgery (or dermatology).

This includes doctors who were trained as the following:

 	Obstetricians-gynecologists
 	Anesthesiologists
 	Pain doctors
 	Family practice physicians

But why, you may ask, would these doctors - who were trained in something completely separate from cosmetics - be doing Botox and injectables? Given the state of medicine - in terms of lower and lower insurance reimbursements to doctors - many of them decided to start getting into the cosmetic industry to make more money. They end up learning online how to do Botox, Dysport and injectable fillers. Or they go to a 'weekend warrior' course to try and learn the art of cosmetic enhancement over a 2-3 day period. Then they turn around and open their new cosmetic practice somewhere in San Diego to begin offering facial fillers and Botox. Unfortunately, often times patients who don't know any better assume that these 'cosmetic physicians' are just as well trained as the plastic surgeon or dermatologist across the street. The cold hard truth is that they simply are not as well trained in the field of plastic and cosmetic surgery. There is no substitute for a doctor who completed years of training versus someone who took a few hours or days.

Do yourself a huge favor and take the extra steps to see if your chosen Botox and filler doctor is actually fully trained in this highly specialized field. There are dangers and complications from all cosmetic treatments - including Botox, Dysport, Juvederm and Restylane. What is so important besides knowing how to minimize adverse events is how to manage the complication if it does arise in those rare cases. That is where so many of these so-called non-core (not trained in the core teachings of plastic surgery) doctors are at an additional and significant disadvantage - and so are you.

#### CO2 Laser for Rhinophyma
Here is yet another happy patient of Dr. Hilinski's who underwent CO2 laser for rhinophyma! This middle-aged male traveled to San Diego to have Dr. Hilinski evaluate his nose for possible rhinophyma treatment. Rhinophyma is a skin condition that involves overactive sebaceous glands in and around the nose that can lead to unwanted excess skin thickness. Indeed, this is precisely what Dr. Hilinski noted in this patient here. As you can see in the photo to the left, his nose skin is much thicker than the average individual. In addition, the surface contour is very rough and cobblestone-like. Rhinophyma like this is usually correlated with underlying rosacea, a very common skin disorder. As rosacea progresses over the period of years, it can then lead to more exaggerated changes in the skin thickness as is noted here - and then it is referred to as rhinophyma.
CO2 Laser for Rhinophyma
In this case, Dr. Hilinski recommended CO2 laser treatment for his rhinophyma. The CO2 laser is considered one of the 'workhorses' for rhinophyma because it is so effective at vaporizing away the thick, sebaceous tissue while also tightening and smoothing the nose skin. In addition, the CO2 laser is very effective at reducing bleeding during the actual procedure.

Most rhinophyma patients have CO2 laser treatment done while under at least IV sedation, if not asleep completely. This simply makes the experience much more comfortable and tolerable.

Dr. Hilinski normally will do what he calls is sequential planing of the rhinophymatous skin. This means that he uses the laser to go layer by layer over the thicker, sebaceous nose skin. As he does this, the diseased skin and tissue are vaporized away in a sequential manner. Eventually, Dr. Hilinski lasers down to somewhat normal appearing skin, which is where the treatment stops. In the process of doing CO2 laser on the nose, the rhinophyma is treated and the underlying skin undergoes simultaneous tightening.

At the completion of the rhinophyma laser treatment, a balm or ointment is placed over the surface of the treated skin. Patients are instructed in how to care for their skin over the following week, which is about the amount of time it takes your body to generate a new skin layer. At this point the nose is still quite red and puffy, but many patients are able to resume a public appearance around 1o days after rhinophyma laser treatment.

As the weeks and months go by, the nose skin settles down and starts to achieve a more normal color and texture.
Rhinophyma Laser Results
Here are the actual results of this patient's CO2 laser procedure intended to treat his rhinophyma. As you can see, the appearance of his nose is markedly better! He literally appears as if all the rhinophyma has been eradicated. The nose skin is so much smoother and tighter - and now looks like a normal nose! We are so happy and excited to be part of this transformation for this patient.

Rhinophyma Consult
If you are suffering from rhinophyma, don't hesitate in contacting one of the most experienced plastic surgeons in all of California who specializes in treating rhinophyma - Dr. John Hilinski.

#### CO2 Laser Rhinophyma Treatment
This is one of my favorite procedures to perform - CO2 laser treatment for rhinophyma. As an expert rhinoplasty surgeon, performing cosmetic reshaping of the nose never gets old. This is a unique type of nose that has excessive glandular activity creating the classic look of rhinophyma. I used a CO2 laser to actually sculpt and reshape this patient's nose - restoring what is essentially a normal look. These results demonstrate what typical rhinophyma patients look like after about 2-3 months of healing from the laser procedure. If you see his nose from the bottom view, you can also appreciate how rhinophyma surgery can actually open the nostrils in some cases. Let me know what you think of this rhinophyma surgical outcome!
Rhinophyma Laser Surgery Results

#### Columella Scar Following Rhinoplasty
Many rhinoplasty candidates inquire about the appearance of the columella scar following an open rhinoplasty approach. As I tell most patients considering an open rhinoplasty, the scar generally heals quite nicely with minimal visibility. In fact, we intentionally create a geometrically broken line incision so that we fool the naked eye when it comes to visualization. The incision is also strategically placed under the nose, across the columella that divides the two nostrils. So even if it were partially visible one would have to be looking from under your nose to see it. Attached below are typical examples of my own rhinoplasty patients from San Diego showing how well the scar tends to heal. Go ahead and see if you can locate their incision lines.

#### Combined Laser Peel
It is quite common to see cosmetic patients who need combined fat transfer with laser peeling of the lower eyelid skin. Most of these patients present with complaints that they look tired and aged. Nearly all of these patients state they don'l feel tired. They just look tired - and are sick of having to answer questions from others about whether or not they got enough sleep the night before.

This case example provided here shows some of the more common signs that many of these patients demonstrate on examination. The main issue is that there is a lack of volume, or a volume deficiency, seen across the lower eyelid as it junctions with the cheek. Because of this volume deficiency, the lower eyelid will shadow a bit more than desired - making this area look darker than it should. This, in particular, can make the lower eyelid appear prematurely aged and tired. In addition, though, so many of these patients also have skin wrinkling involving the lower eyelid region. You see this here where the patient's lower eyelid skin almost looks crepey - described as such because it mimics the appearance of wrinkled crepe paper. When these two issues are combined - volume deficiency of the lower eyelid with crepey, wrinkled skin changes - it can be quite obvious that the patient looks excessively tired and aged.
Lower Eyelid Fat Transfer
So how do you address this issue with cosmetic surgery? The first thing is helping to restore lost volume along the lower eyelid. Although this is done all the time in our San Diego medical spa with absorbable fillers like Restylane and Juvederm Vollure, a longer-term solution is fat transfer. Fat transfer involves taking fat from somewhere else in the body, such as the abdomen or flanks, and repurposing the fat by injecting it into the face. In doing so we are essentially robbing Peter to pay Paul - we are just using fat as our method of currency.

Nowadays, we are so much better at performing fat transfer - even more so than we were just 5-10 years ago. This is mostly based on scientific studies that have helped guide our understanding of fat transfer to new levels. For example, we now recognize that fat can be transferred to the face from the body using various types/forms of fatty tissue. For instance, in the lower eyelid region we would transfer fat that has been processed a bit differently than fat that we would put in the lips. And both of these may be processed even differently than fat that we would transfer to the mid-cheek or jawline of the face. We typically refer to these various types of fat transfer as micro-fat, milli-fat, and nano-fat transfer techniques. If your plastic surgeon isn't aware of these newer, more advanced techniques and doesn't have the proper instruments to process fat, you may not end up with an optimal result from fat transfer surgery.

When fat transfer is performed in the proper manner - where the actual fatty tissue is processed differently for specific areas of the face - the success rates for restoring lost facial volume go up significantly. Now does all the fat that is transferred to the face stay there? No, absolutely not. There is some loss of fat in the transfer process - meaning some of the fat cells die off when moved from one location of the body to another. But a good majority of the fat that is transferred from the abdomen, for example, will get new blood supply in the new location (the face) and, thus, become a part of the facial soft tissue. In doing so, the transferred fat will provide the patient with a long-term volume enhancement to replenish that which was lost from the aging process.
Lower Eyelid Laser Peel
So the fat transfer can help in filling out the lower eyelid hollows, which can replenish the volume deficiencies. But what about the crepey skin changes? In some patients, just doing fat transfer alone will help the appearance of the lower eyelid skin. This is because fat transfer also allows for recruitment of valuable growth factors and stem cell attractants, which help to improve the viability and cosmetic look of the skin. But to be more certain about improving the lower eyelid skin, we often times will recommend combining fat transfer with a laser peel.

Dr. Hilinski's favorite laser to use for lower eyelid crepey skin changes is the CO2, or carbon dioxide. The CO2 laser is widely considered the workhorse for laser skin peels in the world of cosmetics. When used properly by trained professionals, such as facial cosmetic surgeons, the CO2 laser can result in marked improvement in the appearance of lower eyelid wrinkles. The way CO2 laser peels work is as follows for the lower eyelid. The laser first evaporates away the outermost dead skin. The laser is also used to penetrate deeper into the skin down to the level of the dermis. In doing so, the more superficial, aged, wrinkled skin is effectively removed. That is why the area being lasered looks so raw and inflamed after a laser peel. But as the new skin starts to grow in from below, the old, crepey skin is replaced with new, rejuvenated tissue - which is smoother and tighter in appearance.

By combining the CO2 laser with fat transfer to the lower eyelid region, the lost volume is replenished and the skin is rejuvenated at the same time. This can be a very powerful combination in patients who have aged and tired looking lower eyelids.
Fat Transfer and Laser Peel
Here is a real-life example of how fat transfer and a laser peel can work in combination to restore a more youthful looking lower eyelid. Dr. Hilinski ended up taking fat from the abdomen region - right around the belly button. The fat was processed appropriately to generate a source of milli-fat that could be injected into the lower eyelid to fill out the hollows. Once this was done, Dr. Hilinski then used his CO2 laser to peel the lower eyelid skin. In doing so, he was able to smooth out many of the wrinkles that criss-crossed the eyelid skin. Was he able to get all of them? No, that is not realistic and should be understood by patients seeking out this type of cosmetic treatment. But, the laser can produce a substantial improvement in the crepey skin changes that so often affect patients' lower eyelids. And this is precisely what can be seen here - a very nice cosmetic enhancement in this patient's lower eyelid region - to the point where she now looks much more rested and youthful without looking as if she had plastic surgery.

#### Combining Chin Implant with Platysma Muscle Tightening
We have had several patients consulting with us over the past few months for chin augmentation with placement of an implant. Many of these patients were seeking an increase in projection to achieve more definition along the jawline and upper neck. In several of these patients, it was noted that tightening of the platysma muscle would also prove beneficial in their surgical outcome so I decided to post a quick blog regarding this combination procedure. The following case example highlights some of the more pertinent points. This patient from San Diego desired improved definition of the jawline with a stronger looking chin. We consulted with him and decided that a chin implant would help him achieve this type of change. However, during consultation I also pointed that his neck was poorly defined and might benefit from additional work beyond just a chin implant. We decided that his neck could also be contoured by tightening the muscle just underneath the chin, called the platysma muscle. The procedure, termed a platysmaplasty, would help provide him a longer horizontal neck line, which would also further improve definition of his jaw. The photo on the left below shows his profile view before any surgery. The next photo over shows his actual postoperative result following combined chin implant and platysmaplasty. As you can see in the diagrammed photo below, the chin implant was able to provide further definition as indicated by everything in front of the red curved line (his original chin contour traced out). Had we just performed the chin implant, this would have been the only improvement realized. The platysmaplasty portion of the procedure was able to eradicate the excess fullness under the chin as indicated by everything shadowed behind the blue outline. Had we only performed the platysmaplasty, this is the only improvement that would have been seen. Using the diagram for comparison, one can easily appreciate how combining the procedures can dramatically increase the results. If you are considering chin augmentation with a chin implant and think you might benefit from this type of combined procedure, give our office a call to schedule a complimentary consultation. We look forward to meeting you in person. Sincerely, Dr. Hilinski

#### Combining Chin Implants with Rhinoplasty for Improved Results
Many times, patients coming in for one concern can achieve even better results when an additional area is addressed as well. While the decision is ultimately up to the patient, Dr. John Hilinski may recommend combining procedures to help patients achieve more balanced results. One such combination that he has found provides a beautiful outcome is chin augmentation and rhinoplasty.

A common reason patients seek facial implants and rhinoplasty is because they have a weak chin and a prominent nose. While undergoing one of these procedures alone can improve the facial aesthetic, Dr. Hilinski may recommend combining the two for a better harmony of features. By altering both the nose and chin at the same time, he can determine the extent of work that needs to be done to each to achieve optimal results.

When a patient comes in for their consultation, Dr. Hilinski will perform a thorough examination to determine the best course of treatment to help them reach their ideal outcome. If the patient has any additional concerns, such as facial aging, they can be addressed at this time. To schedule your consultation with Dr. Hilinski, please contact our practice today!

#### Combining Facelift Surgery With Otoplasty (Ear Reshaping)
I just finished two surgeries in the last two days with both patients undergoing combined facelift surgery with otoplasty (ear reshaping). It just so happens that both of these patients from San Diego desired reshaping of their ears as well as facial rejuvenation of the lower face and upper neck. In both cases, we were able to easily reshape the ears in the midst of the face lift procedure. When performing a facelift surgery, we have to make incisions around the ears to lift the face. During this exposure, the ears are quite accessible to cosmetic reshaping. In one of the patients we also reduced the size of the earlobes as part of the cosmetic ear reshaping. Although not a common combination in facial plastic surgery, it can definitely be done as evidenced by my last two days in surgery!

#### Combining Fat Grafting and Skin Laser
So many patients seek out Dr. Hilinski because of the natural results he is able to attain. Here is a classic example of just that - a patient who desired to look younger and more rejuvenated without looking like she had plastic surgery performed.

When Dr. Hilinski examined her, he noted the usual signs of aging he sees in many middle-aged patients living in San Diego. Much of this had to do with sun exposure and damaged skin from being outside. This typically consists over skin wrinkling and age spots. In her case, you can see signs of this, particularly around the mouth and the jowl region where the resting wrinkle formation was most pronounced.

The other issues she had were more related to regions of volume loss where the fat in her face had started to atrophy, or shrink away. This is also a very common problem in patients her age. As the aging process sets in, people begin to lose volume in their face from the fat starting to shrink down. When we lose this volume, some areas of the face start to look deflated and begin to shadow a bit more than desired. Collectively, the wrinkled skin and fat loss give the appearance of being prematurely aged.

So what are the answers to these problems? For the former issue of aged skin, laser resurfacing is still one of the best options. Dr. Hilinski mostly uses a carbon dioxide (CO2) laser to help rejuvenate skin. Like many of the lasers on the market today, ours is able to be fractionated - which simply means that the laser beam is broken up into micro fractions. This translates into only a fraction of the full laser beam hitting the skin in any one place. In doing so, this allows preservation of micro-sized islands of skin that do not get touched by the laser - which allow for more rapid healing from the procedure. This is why fractionated CO2 laser skin resurfacing treatments are so much more popular today. In essence, the laser is used to 'wipe away' the outer layers of skin to allow a new, fresh layer of skin to grow in that is more youthful and vibrant.

The latter issue of volume loss from fat atrophy is addressed by simply replenishing the face with more fat. This is precisely what fat transfer, or fat grafting, does in the world of plastic surgery. If one takes fat from one area of the body, for example, the abdomen, and transfers it as a graft to a different region, the body will typically allow the fat to live in the new location. In the process of grafting the fat, a certain percentage of it will not survive the transfer process. But a good percentage of the fat will survive once it gets a new blood supply in the new location. Once this occurs, the fat now has a new home and will live in the new location just as if it was always there. Nowadays, techniques for fat grafting have been thoroughly refined to the point that we have been able to effectively increase the percentage of fat that survives the transfer process. This translates into better cosmetic outcomes and results with fat transfer.

So back to this patient. This combination of skin laser and fat grafting is what was recommended to her. She underwent the combined procedure while awake using just local and topical anesthesia. The fat was harvested from the abdomen region and used to restore lost volume in various regions of the face. This included the area under her eyebrows (where she had too much hollowing), the cheeks and the lower face. Once this was done, the CO2 laser was used to resurfacing her facial skin.
Fat Grafting and Skin Laser Results
The results of the procedure are shown here several months into the healing process. Overall, you can tell that she just looks more rested and rejuvenated. But the beauty is that you can't pinpoint precisely what she had done and where it was done. That is because her results are so natural looking. Overall, you can readily tell that her skin is smoother with less wrinkle formation - especially around the mouth region. In addition, she has improved volume where her face just looks fuller with less shadowing. The patient was quite happy with the outcome of her fat grafting and laser skin resurfacing procedure and has recently referred one of her friends for the exact same treatment!

 

#### Complimentary Vial of Sculptra Aesthetic®!
*Actual Sculptra® Patient.

Complimentary vial of Sculptra®? No, that's not a typo!

Our office is currently running a promotion that can save patients up to $745 off of their total Sculptra® treatment!* - that's about the cost of an entire vial!

When purchasing a full course of Sculptra® treatment, patients may qualify for the following discounts:

 	$150 off 1st treatment
 	$175 off 2nd treatment
 	$200 off 3rd treatment

Be sure to sign up for Aspire Rewards® in order to fully take advantage of this promotion, in addition to many other offers!

*Total discount of $745 reflects in-office promotional coupons plus applicable patient Aspire Rewards®.
Contact Us
For more information and to take advantage of this limited time Sculptra® promotion, please contact us today or call (619) 296-3223. We look forward to seeing you soon!

#### Composite Ear Graft Surgery
The latest addition to our ever-growing online rhinoplasty tutorial for rhinoplasty and revision rhinoplasty patients focuses on a specific technique to correct excessively arched nostril rims - the composite ear graft. Take a look using the link provided here to learn more detailed information about correction of alar retraction or arched nostril rims.

#### Considering A Facelift: What Should I Expect?
Our double board-certified facial plastic surgeon, John Hilinski, MD, explains what you can expect during facelift treatment.
 
Our facelift consultations entail a physical examination coupled with a thorough discussion to determine each patient’s specific aesthetic goals. I consider any patient who seeks a more youthful, rested appearance of the lower face and upper neck regions - while maintaining realistic expectations - a good candidate for this procedure. I also utilize a second follow-up consultation to give patients some time to consider our initial conversation, discuss any questions or concerns that may have arisen during the meantime. This second consultation also gives me an opportunity to go into more detail regarding the necessary preparations leading up to surgery.
 
The day of surgery, our patients will check into our own private ambulatory surgery center. Then, the anesthesiologist will interview the patient and come to a decision regarding the exact type of anesthesia that will be used during the facelift (IV sedation or general anesthesia). Next, I will perform my pre-operative markings on the face and neck, just like you would see on television where purple marks are placed [along the face]. The total time for facelift procedures is typically 3-4 hours.
 
Immediately afterward, patients are instructed to remain fairly sedentary. I usually see patients within 24-48 hours of their surgery to ensure that they are healing well. My patients typically begin to resume somewhat normal daily activities after 7 days and many return to work within 10-14 days. Although it can take several more weeks for patients to feel “like themselves” again, the majority of my patients feel well enough to be in public after 2 weeks.
 
To learn more about Dr. John Hilinski and our facelift treatment options, please contact our office today.

#### Cool Mini Double Chin Treatment
Here is a great video that highlights just how effective Coolsculpting can be when it comes to contouring the neck and giving the appearance of having a neck lift - just without the surgery! Many people refer to this problem as having a double chin. This younger female patient was bothered by the excess, unwanted fat under her chin - and desired to have something done to give her a better jawline and neckline. After consulting with San Diego's premiere office for facial cosmetic enhancement, she opted to go with a non-surgical option. Specifically, she opted for Coolsculpting's Cool Mini, which is intended to freeze away neck and chin fat with no needles, no surgery and no downtime.

Keep in mind that not all Coolsculpting offices offer the Cool Mini neck contouring procedure. Dr. Hilinski and his team of fat freezing specialists are among a select group of Coolsculpting practices that have the specially designed Cool Mini device. The Cool Mini was engineered to help treat the submental region (the area of the upper neck that is under the chin) while getting rid of excess fat. You can't use any of the other Coolsculpting devices to accomplish this. Because Dr. Hilinski is one of San Diego's foremost experts when it comes to Coolsculpting, naturally he has the Cool Mini so he can offer his patients the absolute best in treatment options.

This patient underwent Cool Mini treatment of her neck - performed by one of Dr. Hilinski's highly trained registered nurses - Kellie Hartmann. The Cool Mini was performed in under one hour - and she was then on her way home with literally no recovery involved. It was only a matter of time before her results began to be noticed in terms of an improved neck and jawline. As the weeks and months unfolded, her submental fat slowly dissolved away after having been frozen by the Coolsculpting technology. After just two months, she saw quite an improvement - and was already happy with the outcome of her Cool Mini treatment.

Fortunately for her, the results just kept getting better! In fact, one thing that makes Cool Mini such an incredible option for neck contouring is that it has FDA approval as a treatment that will actually tighten the skin. And you can see what we are talking about in the accompanying video - where you can watch her neck contour improve over several more months of healing. But even more interesting is how her skin literally tightens up under the chin as the four month mark of healing comes around. For example, take a close look at the moles on the side of her upper neck and note where they are located before the Cool Mini treatment. As her neck undergoes the amazing transformation, you can track how her skin tightens up based on movement of those moles. After four months, you can see how much better her neck contour is as a result of the Cool Mini Coolsculpting treatment. She now has much better definition and improved angularity to her neck and jawline. Look, in particular, at how she now has more shadowing under the jaw - an indirect sign that her excess fat has been removed and the skin has tightened up along the upper neck region.

#### CoolMini Better Than Kybella
Learn here from San Diego's #1 Coolsculpting practice why CoolMini is so much better than Kybella for that pesky double chin deformity. A double chin is also commonly known as excess submental fat - where sub = below and mental = chin - so under the chin.
The Truth About Kybella
Let's start off with the truth about Kybella treatment.

This was an incredibly popular medspa treatment that was highly touted when it first hit the U.S. market as the next best treatment for a double chin. It was marketed as a minimally invasive, office-based injection (or shot) that would simply melt fat away - helping to get rid of excess fat in the upper neck region without any surgery.

Unfortunately, keen marketing helped establish and perpetuate the notion that Kybella could get rid of a double chin in just one injection treatment session - which was not the case. Any facial plastic surgeon who had performed mesotherapy at some point in their career knew very clearly that Kybella treatment would require an actual series of injections to effectively treat a double chin deformity - not just one session. Yet, most of the Kybella ads seen out there gave prospective medspa patients an inaccurate impression of how the treatment really worked. Based largely on these ads, patients were flocking to medspas and doctor's offices to get their magical Kybella injection to get treat their double chin. Does Dr. Hilinski offer Kybella? He does - but he only recommends this after a true discussion has taken place with the patient regarding the truth about Kybella.

The reality was that Kybella truly needs 4-5 treatments in order to get any substantial improvement in a double chin deformity. Yes, that is right, Kybella requires 4-5 different office visits that are each separated by 4-6 weeks. If you look back at the clinical trial data for Kybella, you will see that more than half of the patients required 4 or more sessions to get a substantial reduction in their double chin. Do some patients get improvement in their double chin after 1 or 2 Kybella injections? On occasion, yes, you will see some patients see a visible reduction in the neck fat after just a couple of Kybella shots. But that is not the norm - and it is not the recommendation by most medspas performing Kybella treatment.

You also have to keep in mind that these are Kybella injections. Yes, we said injections. Meaning a needle is used to puncture your submental skin as the Kybella is deposited into the double chin fatty layer. Although a real tiny needle is used, there are between 10-20 actual injections done at each Kybella office visit. This can add up if you aren't a big fan of needles - and, after all, who is?

In addition, many patients weren't aware of the fact that there really is some downtime with Kybella double chin treatment. For example, wherever the Kybella is injected, you will likely notice some burning sensations and discomfort that may last for several days. Furthermore, the tissue injected with Kybella can become somewhat dense and hard. We call this induration in the world of plastic surgery. What that translates into is an area under the chin that can look swollen and lumpy where the Kybella was placed. In some cases, this can be somewhat dramatic for certain patients. And this visible swelling can last several days after your Kybella injection before beginning to soften up. So there is some 'recovery' from Kybella treatment. Although it isn't like a surgical healing, it nonetheless may limit your public appearance for even a few days. And this happens after each and every Kybella treatment session! So as you start to add up the true recovery from Kybella, you must multiply the number of treatments that are really being done (4-5) by the number of days of true downtime.

Let's also not forget the economics of Kybella double chin treatment. Since you can't just get one Kybella injection and get rid of your double chin, you need to calculate the real cost by multiplying the number of treatments by the expense for each session. On average, Kybella treatments can cost about $1000 per office visit. If you ultimately need 4-5 sessions to get rid of your double chin, that can be upwards of $5000 in total for Kybella. This figure has to be weighed against the costs (and recovery, or lack of recovery) of other treatment options, such as CoolMini.
CoolMini Over Kybella
Like Kybella, CoolMini is an FDA-approved medspa treatment for treatment of a double chin. Meaning, both are established, effective options to get rid of unwanted fat under the chin. However, you have to look more in-depth into the nuances of CoolMini to understand why it has so many more advantages over Kybella.
No Needles With CoolMini
First off, CoolMini truly is non-invasive. This means there are no needles and no skin puncture at all with CoolMini - which also means no pain from needle pokes. Instead, the CoolMini device (as shown above in the graphic) is gently placed under the chin and secured in place with a strap. The CoolMini treatment is then performed and you are done! That's it. In fact, our Coolsculpting room is set up so that patients can comfortably get treated while watching television and/or playing on their phone. Is there pain associated with CoolMini? Some patients note a mild, fleeting cold sensation as the temperature drops quickly to freeze the unwanted fat. The submental area then does numb. But beyond this there is no comparison to the multiple needle injections required for each Kybella treatment session.

Now, not all Coolsculpting practices offer CoolMini - since this is a specially designed adapter that was developed specifically for freezing submental fat. Dr. Hilinski and his medspa staff do, in fact, have the CoolMini adapter and treat the double chin deformity on a very regular basis. This is yet one more reason why you should choose the #1 office in San Diego for Coolsculpting services.
No Downtime With CoolMini
Another big advantage of the CoolMini is the fact there is really minimal downtime with double chin fat freezing. Immediately after getting CoolMini with our expert medspa staff, you may see some pinkness or redness in treatment area. But this quickly subsides. And compared with Kybella, CoolMini has much less swelling. In fact, CoolMini patients can resume public appearance immediately after treatment with no real restrictions in terms of physical activity.
CoolMini Treatment Sessions
How about the number of CoolMini treatment sessions versus Kybella? In most patients seeking double chin fat reduction, CoolMini is done over two (2) office visits to achieve a notable visible improvement. The two CoolMini office visits are spaced apart by 4-6 weeks typically.

So compared to Kybella, it takes less than half the number of office visits when getting CoolMini done. Do some CoolMini patients elect to do more than those two treatments? Indeed, we do have patients who want to get even more reduction in the double chin deformity and choose to get more CoolMini treatments. But even including these patients, the average number of office visits is less with CoolMini versus Kybella.
Costs of CoolMini
Comparing the costs against Kybella, CoolMini is clearly the economic winner. For two CoolMini sessions, retail cost is about $2000. Even if you elect to undergo four (4) CoolMini treatments, you will likely end up paying less than you would for 4-5 Kybella injection sessions. Is there special pricing and promotions that can drive this cost lower? On occasion, yes, you can find some really great specials on CoolMini that can make it even more financially attractive as a treatment for your double chin. Contact Dr. Hilinski's medspa staff today to see about special pricing offers on CoolMini, in particular.
CoolMini Skin Tightening
One more significant reason to choose CoolMini distills down to the actual results you may get from freezing double chin fat. Most patients with a double chin don't realize that the skin is also an important factor in the equation. Yes, getting rid of the submental fat is key. You can get rid of the unwanted double chin fat with a variety of methods as described. But if the skin in the submental area does not 'shrink down' as desired, it may leave you with a sagging neck that can look even worse.

Fortunately, CoolMini is FDA-approved to tighten the double chin skin at the same time as it is freezing the fat away. In some patients, you can just look at the neck after CoolMini and visibly see in the photos how the skin has tightened up very nicely. Take a look for yourself at the CoolMini photo examples shown before - that are proof that CoolMini can make a huge improvement in your double chin deformity.

This is a huge bonus when it comes to choosing CoolMini for your double chin deformity.

CoolMini Better Than Kybella
At the end of the day (and the comparison!), you can readily see how and why we recommend CoolMini as the better option for treating your double chin in San Diego. So now that you clearly know the benefits of CoolMini over Kybella, it is just a matter of scheduling your complimentary consultation with San Diego's best Coolsculpting team - headed by Dr. Hilinski and his medspa staff.

#### Coolsculpt Away Your Belly Fat
One of the most commonly requested Coolsculpting treatments is freezing away unwanted belly fat. This is an area of the body that is difficult for people to contour even with regular exercise and a strict diet. This is true for both men and women. If you have some belly fat that can be squeezed between your fingers - you are likely a very good candidate for Coolsculpting as offered by Dr. Hilinski and his team of specialists.

Can liposuction help to get rid of this fat? Absolutely. But so many patients would rather do something non-surgical - meaning, without needles and with no downtime. The only FDA approved procedure that allows this to be done by freezing fat is Coolsculpting! So what are you waiting for? Contact our office today at 619-296-3223 to schedule a consult with our expert aesthetic nurse, Kellie Hartmann, R.N.

#### Coolsculpting for Men?
Coolsculpting non-surgical weight loss is a great option for men who are trying to get a more sculpted body. Freezing fat with Coolsculpting is the only FDA-approved technique available here in San Diego to help men get rid of those extra, unwanted pounds. Thousands and thousands of men are challenged by reducing excess fat in certain areas of their body - despite keeping to a healthy diet and regular exercise. For this population of men, Coolsculpting has been a huge blessing as the only non-invasive method that allows that extra fat to be frozen away.

Areas of excess fat in male patients that are commonly treated with Coolsculpting include:

 	Love handles - one of the most common areas in men that is hard to get rid of in the gym
 	Central abdomen - the classic 'beer belly' that haunts so many men
 	Double chin - that stubborn area under the chin that detracts from an otherwise strong, male jawline

Although men are often bothered by other regions with excess fat, these are the 'problem areas' that drive so many male patients to seek out Coolsculpting as offered by Dr. Hilinski and his expert team here in San Diego, CA. Call our office today to see about any specials that are available to men seeking to freeze that fat away!

#### Coolsculpting Summer Body!
Looking for ways to get that summer body? Contact San Diego's best Coolsculpting office to schedule your non-surgical, no downtime body contouring treatment.

With 'dual sculpting' body reshaping, you can get your Coolsculpted body twice as fast! Our two Coolsculpting machines means that you can get your treatment session done in half the time. Coolsculpting is the only FDA-approved non-surgical method for freezing fat away to give you the shape and curves that will get you ready for your summer beach body.
Common Coolsculpting Sites

 	Arms
 	Abdomen
 	Love handles
 	Bra and back fat
 	Neck
 	Inner thighs

Coolsculpt Experts
Dr. Hilinski and is expertly trained Coolsculpting staff are ready to help you get rid of that pesky, excess fat in no time. Call our office today to schedule a personalized consult.

#### Coronado Botox Treatment
Do you live on Coronado island and get Botox treatment? Don't want to leave the comforts of the island just to get your Botox wrinkle reduction treatment? You are not alone!

That is why Dr. Hilinski and his med spa staff are starting to cater to Coronado residents and workers who want a little Botox treatment. Dr. Hilinski is double board certified facial plastic surgeon and graduate of Harvard Medical School - making him one of the most qualified cosmetic physicians in all of San Diego. That same training, experience and expertise is now coming to Coronado!
What Can Botox Do for Me?
Although most people know about Botox and understand Botox helps to stop wrinkle formation, many people aren't fully aware of how Botox cosmetic can be used in specific areas of the face and body. Here is quick summary of what Botox can do for patients.
Forehead Botox
The most common area that our med spa aesthetic team treats is the forehead region. This includes the horizontal wrinkles that are created when someone tries to raise their brow as well as the glabella wrinkles that are created when you frown. The latter wrinkles are often referred to as the 11's or 11 lines that form in between the eyebrows. An example of this type of Botox treatment is shown here in this younger female patient who disliked the excess wrinkle formation across her forehead. Following Botox injection, you can see how much smoother her forehead became, even with attempted elevation of her eyebrows.
Crow's feet Botox
The crow's feet refer to those pesky radial lines, or wrinkles that form around the sides of the eye, particularly when smiling. The crow's feet are commonly injected at the same time as the forehead is treated with Botox because the results you see in one area can enhance the others - especially when it comes to giving you a little chemical brow lift from Botox!
Masseter Botox
The masseter muscle is one of the muscles involved in chewing and sits off to the side of the face. Injecting Botox into the masseter muscle can sometimes help thin out someone's face if the muscle is making the face appear too wide from the front view. In female Botox patients, this can be particularly nice in creating a more feminine, slimming facial appearance. Another reason why the masseter muscle is injected with Botox is to help reduce symptoms of TMJ. In some patients, clenching of the jaw can make TMJ symptoms much worse. If Botox is injected properly, this can help reduce the pain and discomfort associated with TMJ.
Chin peau de orange Botox
A funny area that many patients don't really think about for Botox is the chin. In many patients, the chin muscles can create unwanted wrinkling of the skin - mimicking the surface appearance of an orange. This is why it is commonly referred to as peau de orange, or orange peel. A little Botox injection into the chin can really help reduce this peau de orange.
Bunny lines Botox
Bunny lines are those wrinkles created when people scrunch their nose. These animation lines can bother some patients. Fortunately, Botox can effectively smooth out these wrinkles.
Nefertiti Botox
Nefertiti was an Egyptian queen known for her beautiful neckline. When Botox is injected into strategic areas of the jawline and neck, it can help give a chemical neck lift to patients - sometimes referred to as the Nefertiti neck lift.
Arm pit Botox
Botox is well-known for its ability to slow down activity of sweat glands when injected very superficially into the skin. When Botox is injected into the arm pit, or axilla, in this manner it can help dramatically reduce unwanted arm pit sweating.
Botox Treatment in Coronado
If you live or work in Coronado and think you might want Botox for any of the indications noted above, contact our office today to schedule your treatment with of our incredible med spa staff experts.

#### Cosmetic Ear Reshaping Otoplasty Incision Placement
During many of my otoplasty (cosmetic ear reshaping) consultations in my San Diego, CA office, patients commonly ask about the incision placement. Obviously, one of the concerns when undergoing cosmetic ear surgery is the visibility of scarring. Fortunately, I happen to use an otoplasty technique where my incisions are kept essentially entirely behind the ear. I do this specifically so that I can hide the ear incisions and scars from being visible. The photos here demonstrate this point precisely. As you can see, this male otoplasty patient from San Diego presented with asymmetric looking ears (where his left ear stuck out much further than his right side) that were excessively prominent. I performed otoplasty surgery to pin his ears back so that they were in a more natural position. In addition, we wanted to make the ears more symmetrical. Although there is no one out there that has perfect symmetry of the ears, creating more symmetrical ears was a realistic goal in this case.

Before and After Cosmetic Ear Surgery

As you can see from his before and after cosmetic ear surgery photos below, his ears are markedly better now. The ears are clearly less prominent and the right and left ears are now much more symmetrical in appearance. I provided a view from behind his ears to visually demonstrate how all of this can be accomplished from entirely behind the ears. Notice the scars are barely visible when looking from behind him. Go ahead and click on the photo to see a close-up of how nicely the scars can be hidden during cosmetic otoplasty surgery. With additional time and healing, these scars become even less obvious to the point where they are blended very nicely with the surrounding skin.

San Diego Otoplasty Consult

If you have overly prominent ears and are considering cosmetic otoplasty surgery, contact my office today for a complimentary consultation.

#### Cosmetic Facial Mole Removal in San Diego, CA
One of the most common office-based procedures we perform involves facial mole removal. This is a fairly straight forward cosmetic surgery procedure that can wipe away memories of an unwanted facial blemish. For instance, this patient from San Diego, CA, presented to our office complaining of a large mole along the side of her cheek. There was no history of skin cancer - as in many patients, this was simply for cosmetic reasons. As you can see in her preoperative photograph, there is a large, raised, dark mole along the right cheek area. The mole measured approximately 6-7 mm in width. We discussed in detail with the patient how mole removal can be used as an option to improve the esthetic appearance of her face. She opted to have the scar excised, or removed, rather than shaved off. The resulting defect, or hole, was then meticulously closed with precise plastic surgery technique. The end result is noted below showing her before and after cosmetic mole removal photos. You can appreciate that there is very little evidence of where the incision was made. She has a fine scar in the area, but this is barely perceptible to the human eye. And this is in light of the fact her skin is natively quite dark, which is always more difficult to work with when trying to hide surgical incisions. Overall, this patient is quite pleased with her procedure and results. If you are considering cosmetic mole removal, contact our office today.
Before and After Cosmetic Mole Removal

#### Cosmetic Injectables: How Long Do Results Last?
One of the most common concerns that my patients express during one-on-one consultations is regional volume loss throughout the face. While in the past patients were more focused on a single line or crease, more and more patients are now seeking to restore lost volume across an entire region, such as the cheek mound. The injectables Sculptra® Aesthetic and Bellafill® are highly beneficial for improving both concerns due to their history of successful results. Although I still treat individual lines and creases here and there, I find myself restoring regional volume loss with these products far more often.

Depending upon the individual patient’s goals, Sculptra® Aesthetic may be a better choice than hyaluronic acid (HA) fillers. With Sculptra® Aesthetic, I can restore lost facial volume in a much broader manner, almost like painting with a wider brush. As an added benefit, Sculptra® results can last for upwards of two years – nearly twice as long as many of the HA fillers.

Bellafill®, on the other hand, has one major advantage over all other dermal fillers: it is the only long-lasting filler on the market. For an experienced patient who has acquired “filler fatigue” and is tired of making maintenance appointments every year, Bellafill® can be a great option to consider for facial contouring.

In the end, the best way to determine which cosmetic injectable is best for you is to discuss your cosmetic goals with an experienced plastic surgeon who will take the time to listen carefully and design a treatment plan that can meet your expectations.

- Dr. John Hilinski
Contact Us
If you would like to learn more about Sculptra® Aesthetic or Bellafill®, please contact our practice today to schedule your consultation.

#### Cosmetic Nose Reshaping Without Altering Facial Identity - Finesse Rhinoplasty
I have a significant number of patients who consult with us at our San Diego facial plastic surgery practice regarding what I like to call a 'finesse' rhinoplasty procedure. These patients are seeking some type of nasal reshaping procedure to provide them with a cosmetic enhancement in the appearance of their nose. However, a good majority of these patients state they are afraid of looking too different from their rhinoplasty procedure. As I try to emphasize to all of my San Diego nose job patients, the essence of great rhinoplasty surgery is to provide an enhanced look while maintaining a natural facial appearance. As much as we can as rhinoplasty specialists, the aim should be preservation of the overall facial appearance while reshaping the nose to be in balance with the surrounding features.
Another Example of Finesse Rhinoplasty
I have posted other patient examples of finesse rhinoplasty, but thought this was a good example to refresh the topic. This is a very pleasant young female from San Diego who desired cosmetic nose reshaping. She specifically did not wish to have a dramatic overhaul of her facial features. She simply wanted to have the nose reshaped so that some of the distracting features were minimized. On initial consultation with her, I noted a dorsal hump, or bump, on the bridge as well as a slightly rounded looking nasal tip. These features can be seen in the preoperative rhinoplasty photos shown below. Overall, not a bad looking nose, but one that could benefit from some finesse reshaping.

San Diego Finesse Nose Job
We agreed that a finesse nose job would be an appropriate choice for her case. She was taken to the operating room and underwent cosmetic reshaping of the bridge to reduce the height. In addition, I narrowed her nasal tip to provide improved contour and shape. We very specifically did not wish to reduce her bridge height too much as we were trying to maintain a very natural look for her. We also did not do an aggressive reshaping of her nasal tip as we simply wanted to reduce the round, more prominent features of the nose. The end result of this type of finesse nose job, or finesse rhinoplasty, is seen below. As you can easily appreciate, there is a definite change in the appearance of her nose. However, take note that she still looks like herself. But her nose is now more shapely and defined. Her nasal bridge has been reshaped to appear more feminine and her tip is now narrowed sufficiently to provide better definition without being too excessive. Could more have been done with this nose? Certainly, but in this particular case for this specific face with her distinct desires, it was not warranted. Keep in mind that not all nosejob patients want a drastic change in the appearance of their nose. In fact, a majority of rhinoplasty consultations I have absolutely do not want to go in this direction. This rhinoplasty patient now looks better in terms of her nose, which is in balance with her remaining facial features while still looking quite natural, as if she could have been born looking like this. You cannot ask a whole lot more than that when it comes to cosmetic rhinoplasty outcomes. To learn more about cosmetic rhinoplasty, nosejob surgery and nasal reshaping, click here for a link to our rhinoplasty tutorial.

#### Cosmetic Reshaping of the Crooked Ethnic Nose
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

#### Cosmetic Rhinoplasty At 77 Years Old!
For any of you cosmetic rhinoplasty patients out there in San Diego and beyond who think you might be too old for some nasal enhancement - I just saw a 77 year female who wants to have her nose reshaped! So why at 77 years old is probably what you are asking (which is precisely what I was asking). She stated that she had actually been unhappy with her nasal appearance dating back several decades, but just never had any cosmetic reshaping of the nose. A few months back she suffered nasal trauma that caused additional widening of her bridge. Unfortunately, this amplified the features of her nose that she didn't like from before. On top of this, she is going to her 60th high school reunion later this year. She remembers from past reunions that her identifying feature to classmates was her nasal profile. This time around, she wants to be remembered for something else besides her nose. So go figure. There really isn't an age limit when it comes to cosmetic rhinoplasty to reshape the nose.

#### Cosmetic Rhinoplasty for a Bulbous Wide Tip
This is one of the latest additions to our online rhinoplasty tutorial intended to help anyone with a bulbous nasal tip learn more about corrective nose job surgery. See how cosmetic rhinoplasty helped transform this young lady's nose including complete reshaping of her bulbous, wide nasal tip. Let us know what you think of her rhinoplasty results!

#### Cosmetic Rhinoplasty Updates in San Diego, CA
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.

#### Cosmetic Surgery to Shorten the Lip?
Yes - there is actually a cosmetic surgical procedure to shorten the upper lip. The procedure is called a subnasale (under the nose) upper lip lift surgery. This highly specialized surgery is intended to shorten one's upper lip in cases where it appears too long. This most recent addition to our San Diego facial plastic surgery website discusses the nuances of this procedure in detail - focusing on one of my recent upper lip lift surgery patients. Let me know what you think!

#### Creating An Inconspicuous Well Healed Facelift Incision
Many facelift patients inquire about how inconspicuous their scars will be once healed. Well here is a photo example of one of my San Diego facelift patients demonstrating how to conceal a facelift incision. This patient underwent a lower facelift along with tightening of her upper neck line. As you can see from the photos she has a nice rejuvenation and looks much more rested. Arguably more importantly she does not look like she has had any surgery performed in the sense that she looks quite natural. If you look at her close-up photos, you can see that her facelift scars are well healed and barely visible to the naked eye. Her hairline has been preserved and her ears are not malpositioned following the facelift procedure. This is precisely what we aim for when performing this type of cosmetic facial enhancement surgery. Interestingly, this particular patient specifically searched out board certified plastic surgeons in San Diego who showed her close-up photos of their facelift patients' incisions as this was a major consideration for her. To see the remainder of her before and after facelift photos use this link here.
Before and After Facelift Surgery

Well Healed Facelift Incisions
These photos show a well healed facelift incision can heal. The blue lines in the photo below right outline the actual incision used in this San Diego facelift patient.

#### Current Restylane, Perlane & Dysport Specials!
San Diego's The Hilinski Clinic of Facial Plastic Surgery is pleased to announce our current specials on the Medicis line of products - Restylane, Perlane and Dysport treatments! Restylane and Perlane now contain lidocaine (novacaine) within the gel preparation, making the injection process much more comfortable for everyone. These new products, now known as Restylane-L and Perlane-L, are a significant improvement over previous injectable fillers that did not contain the numbing medication. Dysport is the only true alternative to Botox cosmetic and is used for the same purpose - to treat unwanted facial wrinkles & creases from excess muscle movement. Dysport treatment is a great alternative to give you that more rested, youthful look from a simple, office-based procedure.
Current Restylane, Perlane and Dysport Specials
The Hilinski Clinic of Facial Plastic Surgery is now offering the following specials for all San Diego patients.

Restylane-L Receive $100 back when you purchase two (2) syringes of Restylane for treatment of unwanted facial wrinkles and creases

Perlane-L Receive $60 back when you purchase one (1) syringe of Perlane for treatment of unwanted facial wrinkles and creases

Dysport Receive $50 back when you purchase Dysport for treatment of undesirable frown lines and facial wrinkles

These offers are good from now through March 31, 2011 at The Hilinski Clinic - San Diego's dedicated facial plastic surgery clinic.

Call us today at 619-296-3223 to schedule your consultation and treatment session.

#### Define Your Face with Facial Liposuction
For those looking to achieve a more sculpted, defined facial appearance, facial liposuction offers a precise and effective solution. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we specialize in facial liposuction to help patients reduce excess facial fat, contour their features, and reveal a slimmer, more refined look. Facial liposuction is ideal for patients who have stubborn fat deposits around the cheeks, jawline, or neck that do not respond to diet and exercise, giving you the facial definition you’ve always wanted.

How Facial Liposuction Works

Facial liposuction is a minimally invasive procedure that targets and removes pockets of unwanted fat from specific areas of the face and neck. Using a small, thin tube called a cannula, Dr. Hilinski carefully removes excess fat, sculpting and contouring areas such as the cheeks, chin, and jawline. Unlike body liposuction, which typically removes larger volumes of fat, facial liposuction is a delicate procedure that focuses on small, precise areas to create a naturally refined and youthful appearance.

Areas Facial Liposuction Can Improve

Facial liposuction can address several key areas of concern, creating a more balanced and defined facial structure:

Cheeks: For patients with “chubby cheeks” or excess fat in the midface, liposuction can slim the cheek area, bringing out the cheekbones and enhancing overall facial structure.

Double Chin: Excess fat beneath the chin, often referred to as a “double chin,” can make the face appear heavier and less defined. Facial liposuction in this area helps create a more contoured profile, giving a slimmer appearance to the neck and jawline.

Jawline: A well-defined jawline is a hallmark of youthful, attractive facial contours. By reducing fat around the jawline, facial liposuction can improve definition and create a more chiseled look.

Neck: The neck is another area where fat can accumulate, causing sagging and blurring the distinction between the face and neck. Liposuction in this area can help refine the neck’s shape and provide a smoother transition to the jawline.

Benefits of Facial Liposuction

Facial liposuction offers a range of benefits, including:

Enhanced Facial Contours: By removing excess fat from targeted areas, facial liposuction reveals the natural contours of your face, bringing out cheekbones and defining the jawline for a more sculpted look.

Improved Profile and Neck Contour: Reducing fat under the chin and along the neck improves your side profile, enhancing the transition from the face to the neck and making you look younger and more energetic.

Permanent Results: Unlike temporary cosmetic solutions, facial liposuction removes fat cells permanently, meaning the results can be long-lasting if you maintain a stable weight and healthy lifestyle.

Minimally Invasive: Facial liposuction is less invasive than traditional surgical procedures, requiring only small incisions. Patients typically experience minimal downtime and a quicker recovery.

Is Facial Liposuction Right for You?

Facial liposuction is an excellent option for individuals with good skin elasticity who are looking to refine their facial structure by removing localized fat deposits. Ideal candidates are generally those who are near their ideal weight but struggle with areas of stubborn fat on the face or neck that don’t respond to diet or exercise.

It’s essential to have a consultation to determine if facial liposuction is the right approach for you. During your consultation with Dr. John Hilinski, he will discuss your goals, assess your facial structure, and create a customized treatment plan tailored to achieve the most natural, aesthetically pleasing results.

Achieve a Defined, Sculpted Face with Dr. John Hilinski

At John Hilinski, M.D. Plastic Surgery in San Diego, we are dedicated to helping you achieve your ideal appearance with advanced facial contouring techniques. Dr. Hilinski’s expertise in facial aesthetics ensures you will receive personalized care with precision and artistry, giving you a naturally enhanced look.

If you’re ready to reveal the definition and contour of your face, contact our San Diego office to schedule a consultation and explore how facial liposuction can help you achieve the look you desire.

#### Do Hair Grafts Look Natural?
Do hair grafts look natural? Absolutely! Modern day techniques for hair transplant have advanced considerably compared with the days of hair 'plugs' as they were called. Nowadays, hair restoration surgery can provide you with a new hair line that blends very naturally with your native hair. This is in great part due to expert hair transplant surgical technique that allows us to use the finest, delicate micro grafts in recreating lost hairlines. In doing so, the transplanted hairs are oriented and carefully placed by Dr. Hilinski and his team of hair restoration specialists in parallel with the surrounding hairs. The actual hairline itself is also slightly staggered or jagged to help mimic a natural border of hair. In combination, these type of hair transplant techniques aid in giving you the most natural looking hair grafts as possible. If you have unwanted hair loss and are considering hair transplant surgery, don't hesitate in contacting our San Diego office today to discuss you options for a beautiful, natural hair restoration.

#### Do I Have to Be Careful With My Ears All my Life Following Otoplasty?
We get this question from potential otoplasty, or ear reshaping, patients quite commonly. Do I need to be careful with my ears for the rest of my life following the surgery? The answer is no. Fortunately, otoplasty is done using permanent sutures to reshape the ear. Once the healing process is completed around 3-4 months out, there is sufficient scar tissue to maintain the shape of the ear permanently. It will take upwards of one year for the scar tissue to fully mature, but the ears are quite stable in the meantime. Thereafter, otoplasty patients rarely have to worry about their ears again.

#### Do You Pack The Nose After Rhinoplasty or Septoplasty?
One of the most common fears following rhinoplasty and/or septoplasty is the possibility that the surgeon is going to pack the nose. This means the surgeon places gauze or similar material inside the nasal passages to put internal pressure on the tissues. This is done to minimize chances of bleeding as well as to promote stable healing of the internal lining (called the mucosa). Unfortunately, nasal packing after rhinoplasty/septoplasty is extremely uncomfortable. Not only is packing painful, it also inhibits patients from breathing thru the nose during the early recovery period. Because these issues can be so anxiety provoking for some patients, I stopped packing noses on a regular basis nearly 6 years ago. Instead, I use an absorbable suture to stabilize the internal tissues that also helps minimize bleeding. Doing this also allows patients to have at least some degree of breathing thru their nose in the early recovery period. If I do place anything in the nose after surgery, it might be a small piece of absorbable gel-like material that dissolves with use of salt water spray in the nose. Either way, I avoid having to pack the nose in the traditional manner, leaving my patients with a much more comfortable recovery.

#### Does Coolsculpting Actually Work?
We get asked all the time from prospective patients - does Coolsculpting actually work? Can you really freeze fat away without having liposuction surgery? It almost sounds way too good to be true. But it isn't! Just take a look at this case example provided here, which visually demonstrates to you that Coolsculpting actually does work to freeze fat away - and can do so with fairly dramatic improvement.

This 77 year old female from San Diego consulted with our medical spa about unwanted fat around her mid section that she wanted to address. As you can readily see, she had a significant amount of extra fat. In cases like this, it is not only a matter of appearance, but it also affects how patients subjectively feel - particularly with how certain clothing fits on their body.

At her age - although she is still quite vibrant and healthy, she wasn't really interested in undergoing extensive surgical liposuction or lipo-contouring to get rid of the extra tummy fat. When she discovered that we offered Coolsculpting, she jumped at the opportunity to undergo fat freezing treatment because it was non-invasive and did not involve any real downtime.

Was this patient a good candidate for a single treatment using Coolsculpting? Absolutely not. She was told up front by our Coolsculpting expert, Kellie, that she would need several treatments in order to achieve any substantial improvement through her mid section. Understanding this, the patient opted to have a series of Coolsculpting treatments over several months.
Before & After Coolsculpting
Here are her actual before and after photos following the series of Coolsculpting treatments. As is easily seen, she has had quite a bit of reduction in the fat around her mid section. In fact, this would be considered a fairly dramatic reduction in fat as a direct result of the Coolsculpting sessions. Just look at her belly button alone and you can see how much anatomical change has occurred now that the fat has been frozen away. Does she have some residual skin laxity following the fat freezing? Admittedly, yes. But overall she has quite a bit of cosmetic improvement - and the mild skin laxity that has appeared is a welcome trade off in most cases - especially in someone who is 77 years old. Plus, she feels much better when it comes to her clothing and simply moving around on a day-t0-day basis now that the fat in her mid section has been reduced so nicely. And all of this was accomplished using Coolsculpting technology with no needles, no surgery, and no downtime!

#### Does Insurance Pay for Septoplasty?
The short answer to this question is – yes, if you have symptoms of nasal blockage that are not improved with medications. If you are found to have evidence of a deviated septum, or crooked septum, on examination by a facial plastic surgery or otolaryngology specialist, they will likely recommend surgical repair. In order for your insurance company to cover these services, your surgeon will submit paperwork documenting their opinion and recommending septoplasty surgery. If preauthorized (meaning the insurance company offers preliminary approval), then most patients proceed with the septoplasty and have the expenses covered by their insurance company. Of course, as the patient, you should be well aware of any and all restrictions and responsibilities related to your healthcare policy. Hope this helps. Dr. Hilinski.

#### Does My Neck Get Lifted With A Facelift?
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.

#### Double Chin Cool Mini
Have a double chin that you have struggled with over the years? Do you exercise like crazy and keep a strict diet - only to still be bothered by unwanted neck fat that gives you a double chin? Come see San Diego's #1 team of Coolsculpting and Cool Mini experts to undergo treatment for your double chin deformity.

Dr. John Hilinski and his staff of certified Coolsculpting experts are San Diego's leading team when it comes to non-surgical double chin treatment. This includes their use of Cool Mini to target fat under the chin in an attempt to create a more defined and sculpted neck line.

This young lady from San Diego in her 20s desired to get her double chin treated in a non-surgical manner. She ended up consulting with Dr. Hilinski's Coolsculpting team and elected to undergo treatment with the Cool Mini adapter. This is a specially designed adapter for the Coolsculpting machine that allows the upper neck fat to be specifically targeted during the fat freezing process.

Following just one treatment session, a fairly significant improvement was noted in her double chin issue. You can see for yourself in the before and after photos shown below. These confirm that the extra fatty pocket under her chin has been greatly reduced - providing her with much better upper neck and jawline shape and contour. And all of this was the result of just one simple Cool Mini session that took less than one hour to undergo while sitting comfortably surfing the internet in the treatment room. Could she get even better results with more Cool Mini treatment? Absolutely! To a certain point, more treatment sessions will provide you with even better cosmetic results.

If you have a double chin that you have a hard time getting rid of, contact San Diego's #1 Coolsculpting team led by board certified facial plastic surgeon, Dr. John Hilinski.
Double Chin Frontal View

Double Chin Oblique View

Double Chin Lateral View

#### Double Chin Liposuction in San Diego, CA by Dr. Hilinski
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.

#### Double Chin Treatment
One issue we see frequently here at our San Diego office is a double chin deformity. This is essentially too much fat contour in the area under the chin. Although we offer Kybella injection and liposuctioning of the chin, one great option to get rid of this fat is freezing it away with Coolsculpting. This is especially true for those patients who are simply not ready for surgical liposuction. With our CoolMini Coolsculpting hand piece, getting rid of your double chin is easy as can be. With essentially no downtime associated with the Coolsculpt treatment, you can be back to your normal daily activities in no time - with improved neck and jaw contouring. CoolMini neck reshaping takes about 45 minutes to do in the office and you will need two (2) Coolsculpting treatment sessions to get an ideal result. If your double (or triple) chin is bothering you - and you don't want to have Dr. Hilinski perform liposuctioning - give CoolMini a chance to create a new look for you!

#### Downtime After Rhinoplasty
I often get asked, “What is my downtime going to be following rhinoplasty?” The answer can certainly vary among different patients. However, in general, the first week you will have tape and possibly a cast on the nose. I usually remove sutures around 5-6 days out from surgery along with the tape and cast. On that day, your new nose will be ‘revealed’ but don’t expect it to look like the finished product. It will be moderately swollen and look quite large. By 10-14 days out from surgery, there will be a significant decline in swelling and bruising to the point where you will look what is termed ’supermarket presentable’ in public. Meaning, you and I will still recognize a certain degree of swelling but most people in line at the supermarket will not think twice when they see you. The swelling continues to decrease incrementally week by week and month by month. People with thin skin will typically see quicker resolution of the swelling compared to those with thick skin. Overall, expect a gradual decline with periods of time (days to weeks) where the nose may look more swollen. This can be affected by excess salt in your diet, warmer weather and even increased activity levels. Ultimately it does take a year or longer for your nose to heal completely. In the meantime, I will recommend regular follow-up visits to ensure that we maximize any opportunity to optimize your recovery.

#### Dr. Hilinski Among Three Rhinoplasty Surgeons Recognized In This Region
Dr. John Hilinski was selected by the Association for Medical Ethics as one of three rhinoplasty experts in this region who met the ethical and surgical standards established by the Association. Dr. Hilinski is proud of this recognition and honored to be one of only three rhinoplasty and revision rhinoplasty specialists selected. For many years now, Dr. Hilinski has put forth enormous effort in building his reputation as a rhinoplasty and revision rhinoplasty expert. He appreciates the recognition from the Association as well as the countless numbers of grateful patients that have allowed him to be involved in their care.

#### Dr. Hilinski In the News: UCSD Rhinoplasty Lecture
Dr. Hilinski Participates in Plastic Surgery Symposium at UCSD

According to a recent online survey conducted by RealSelf.com, consumer interest in cosmetic enhancement is up, with nearly 70% of Americans stating they would pursue plastic surgery, such as breast augmentation or rhinoplasty, if money were not an issue. As interest in plastic surgery grows, the School of Medicine at the University of California in San Diego is playing a role in enhancing the field as they recently hosted a plastic surgery symposium to welcome a number of regional plastic surgery experts. Dr. John Hilinski, participated in the event, and focused on his personal approach to facial plastic surgery.

A recent online survey conducted by RealSelf.com found that nearly 70% of their online visitors would be interested in cosmetic enhancement if cost was not a consideration. Dr. John Hilinski, a board-certified plastic surgeon, is doing his part to educate this growing population of Americans interested in plastic surgery, specifically as it relates to his specialization in facial plastic surgery. The University of California in San Diego School of Medicine recently hosted a plastic surgery symposium that covered a broad spectrum of surgical cosmetic enhancement procedures, including a lecture from Dr. Hilinski’s perspective, which focused on rhinoplasty and revision rhinoplsty.

The audience was comprised of staff from the UCSD Division of Plastic Surgery, as well as some of the most respected plastic surgeons in San Diego and Los Angeles. Dr. Hilinski gave a lecture that focused on his expertise and personal approach to the nuances associated with managing the rhinoplasty and secondary rhinoplasty patient population. Dr. Hilinski says one area in which audience members expressed a particular interest in was his post-operative management of cosmetic nose surgery. He added that rehabilitation after a rhinoplasty procedure is a complicated process, and requires an extensive amount of experience to ensure each patient’s goals and expectations are met.

Dr. Hilinski says he enjoys participating in lectures and other plastic surgery events such as conferences and continuing education courses. He adds that he believes maintaining a public presence provides validity to his reputation as an expert in rhinoplasty in San Diego, and helps the general population better understand the reasoning behind pursuing cosmetic enhancement.

About Dr. Hilinski

Dr. John Hilinski earned his medical degree from Harvard Medical School, and completed his general surgery, and head and neck surgery residencies at the University of California, San Diego Medical Center. He also completed a facial plastic and reconstructive surgery fellowship at the University of Illinois, Chicago Medical Center, as well as a National Institutes of Health Research Fellowship at the UCSD Cancer Center. Dr. Hilinski is a member of the American Board of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology, the California Society of Facial Plastic Surgery, and the San Diego Medical Society.

Dr. Hilinski’s Facial Plastic Surgery practice is located at 3720 Fourth Ave. in San Diego, CA 92103, and can be reached at (619) 296-3223, or found online at https://www.drhilinski.com, or the Dr. John Hilinski Facial Plastic Surgery Facebook page.

#### Dr. Hilinski Lectures at UCSD on Nasal Tip Refinement
Our experienced facial plastic surgeon recently had the honor of speaking at the University of California, San Diego (UCSD) at the Medical Center Division of Plastic Surgery Grand Rounds. Dr. John Hilinski focused his lecture on rhinoplasty, discussing the various surgical techniques for achieving the desired nasal tip shape. In his lecture, which was titled, “Nasal Tip Refinement: Tips and Techniques,” he shared the technical details and various challenges that come with cosmetic nasal tip reshaping. He presented his reasoning for performing his preferred techniques on certain shapes, noting his ultimate goal is to achieve a refined, yet natural appearance.

Considering the amount of experience and training he has undergone with nose surgery, Dr. Hilinski strives to educate fellow surgeons on what he has found to be the most beneficial methods. By doing so, he hopes his audience will return to their practices with more knowledge on the subject to provide their patients with an enhanced level of surgical results.

Reflecting on his most recent lecture at UCSD, Dr. Hilinski says, “If I can help succeed in positively influencing even a few surgeons in the audience, the entire field will benefit.”

For more information, or to schedule a consultation with Dr. Hilinski, please feel free to contact us.

#### Dr. Hilinski on NBC News Discussing Botox Injections
San Diego botox injection specialist, Dr. John Hilinski, was interviewed today by the local San Diego NBC news station regarding his opinions on botox injections. The topic of discussion focused on the 8 year old young girl in Northern California was injected with botox by her mother for cosmetic reasons. Dr. Hilinski was chosen because of his expertise in facial plastic surgery and botox treatments for unwanted facial wrinkles. Dr. Hilinski discussed the cosmetic indications for botox use and why this story raised so many eyebrows. Stay tuned tonight on NBC channel 7 at 6:00 pm PST for Dr. Hilinski's interview.

#### Dr. Hilinski Presents Latest on Cosmetic Injectables
In October, I was invited by Dr. John Vartanian to speak at The Ultimate Aesthetic Training Workshop that took place at The Luxe Hotel in Beverly Hills. In my presentation on filler injection, I focused on the use of microcannulas, or blunt-tipped cannulas, as well as facial contouring with Sculptra® Aesthetic and Bellafill®. I felt honored to be invited by other experts in the field of cosmetic and plastic surgery to provide my personal insights regarding these dynamic treatment options.

During my presentation, I spoke in detail regarding the use of Sculptra® for facial contouring and Bellafill® for cosmetic enhancement of the face. At this point in time, not all offices offer Sculptra® to their patients. I wanted to let the audience of other plastic surgeons know the real merits of offering this volumizer as an option. Not only can Sculptra® deliver an amazing liquid facelift, but it can last nearly twice as long as fillers like Restylane® and Juvederm®. Bellafill® also has its own unique advantage: it is the only FDA-approved permanent filler currently on the market. However, it is important to note that using it requires a much more conscientious approach to each patient’s personal wants as well as a plastic surgeon who has a great deal of expertise in facial contouring.

My hope is that the audience could learn the techniques used in my injection practices and bring that information back home for the benefit of their own patients. With my extensive experience in using fillers for cosmetic face enhancement, I feel I can help quicken the learning process for other surgeons just getting started in the field.

- Dr. John Hilinski
Contact Us
For more information about our cosmetic injectable offerings, or to schedule a consultation with Dr. Hilinski, please contact us today.

#### Dr. Hilinski Published in JAMA for Gauge Earlobe Repair
Our team is proud to announce that Dr. John Hilinski has recently been published in the Journal of the American Medical Association (JAMA) for his work in facial plastic surgery. Dr. Hilinski was co-author of the article, “Reconstructing the Gauge Earlobe Defect,” along with Jessica Collins, MD, FRCSC and Joshua Harvey, BS. The article details the assessment and reconstruction of earlobe deformity caused by gauged earrings - a popular trend that gradually stretches the earlobe until the desired size.

Within the case study, Dr. Hilinski provides an overview of the three gauged earlobe classifications: small, medium, and large. The greater the gauge is in size, the more complex the procedure must be to provide the most natural-looking reconstruction results possible. The specific surgical techniques for each gauge classification detailed in the case study all concluded with excellent results six months following the procedure.

Dr. Hilinski performs earlobe reshaping at his practice for a variety of concerns, including earlobe laceration, gauging, and enlarged earlobes. He encourages anyone suffering from one of these problems to contact our practice to schedule a consultation, where he can recommend the best solution for their needs.

#### Dr. Hilinski to Discuss Rhinoplasty at Upcoming Plastic Surgery Symposium
Dr. Hilinski was invited to be a featured speaker at the upcoming University of California, San Diego, Division of Plastic & Reconstructive Surgery Symposium this coming Saturday. Dr. Hilinski was asked to present his personal approach regarding rhinoplasty and revision rhinoplasty to an audience of San Diego plastic and reconstructive  surgeons. Dr. Hilinski was invited largely based on the fact he is a regional expert in complex, challenging rhinoplasty and revision rhinoplasty cases.

#### Dr. Hilinski to Give Lecture on the Ethnic Rhinoplasty Procedure
On Wednesday, August 14th, our very own Dr. John Hilinski will be speaking at the UCSD Medical Center in La Jolla, California. He was invited by the faculty to speak as part of the UCSD Division of Plastic Surgery lecture series, and is excited to present his lecture entitled "Updates in My Ethnic Rhinoplasty Practice." 

Dr. Hilinski believes it is important to participate in lectures and continuing education, as it helps him improve and share his knowledge for the betterment of others. As a facial plastic surgeon and regional specialist in rhinoplasty and revision rhinoplasty, Dr. Hilinski says his lecture on the complex ethnic rhinoplasty procedure is a way for him to pass along helpful information on techniques to other doctors in the community. When discussing the procedure, he emphasizes the importance of enhancing the appearance of a person’s nose while maintaining their ethnic characteristics. By preserving these features consistent in the patient’s heritage, Dr. Hilinski believes the procedure should result in a very natural appearance.

In order to consistently achieve great results, Dr. Hilinski explains how doctors who perform ethnic rhinoplasty must have repeated experience performing the procedure. Having performed numerous ethnic rhinoplasties, Dr. Hilinski says the upcoming lecture is also a way for him to reflect on his own practice and techniques, looking back critically at his results and helping him continuously get better. 

If you are interested in rhinoplasty or other procedures available at our facial plastic surgery practice, please contact us today for more information, or to schedule a consultation with Dr. Hilinski.

#### Dr. John Hilinski Answers Frequently Asked Questions About Ear Surgery
Recently, the American Society for Aesthetic Plastic Surgery (ASAPS) released statistics revealing that 30,358 otoplasty procedures were performed across the United States in 2012, making ear surgery the 10th most popular cosmetic surgery performed last year. In light of the procedure’s popularity, we sat down with our double-board-certified facial plastic surgeon, Dr. John Hilinski, to learn a bit more about cosmetic ear surgery at our San Diego facial plastic surgery practice. Below are Dr. Hilinski’s responses to some frequently asked questions regarding otoplasty.

 

Question: What is the main benefit of otoplasty?

 

Dr. Hilinski: The main benefit is that patients who are born with poorly developed, overly prominent ears can achieve a more natural appearance with less undesired attention being drawn to their ears. This type of cosmetic ear surgery is considered a permanent correction to their congenital abnormality.

 

Q: Who is a good candidate for otoplasty?

 

DH: The best candidates for otoplasty, or ear pinning surgery, are patients who have overly prominent or excessively large ears and wish to have them reshaped to appear more proportionate to their overall facial features. These patients typically have ears that stick out too far from the side of that head. For instance, one of the most prominent features of a poorly developed ear is the fact the surface of the ear can be easily seen when looking directly at the patient. Normally, a majority of the ear surface cannot be visualized when seen from the frontal angle. If the ear is not fully developed, it does not have an opportunity to fold in closer to the head. Consequently, it remains further out.

 

In the photo to the left, this underdevelopment is represented by the yellow line indicating how the ear nearly sticks out at a 90 degree angle from the plane of the head. In many cases, this is because the conchal bowl, the cup in the center of the ear, is much larger than average. Another common feature of a poorly developed ear is a much flatter surface. The normal, well-developed ear has a number of undulations and creases that collectively form a natural contour. When the ear is absent of these hills and valleys, it looks flat and underdeveloped. This is usually from a poorly developed antihelix, which is the long ridge naturally present in the normal ear. Other frequent findings in otoplasty candidates include a taller than normal ear - as shown by the red line in the adjacent photo - as well as a lobule, the fleshy bottom portion of the ear, that sticks out too far.

 

Q: Are there any age restrictions for ear pinning surgery?

 

DH: It is recommended that surgeons wait until the ear has stopped growing before performing otoplasty surgery. In most patients, this is around age five to six years old. Anytime after this period, patients can undergo otoplasty surgery without any significant concerns about future ear growth complicating matters. It also just so happens that patients begin to start their schooling around five to six years of age, and we all know how mean other children can be, so to a certain extent, getting the ears pinned back and corrected before children start the schooling process to prevent teasing can be a huge advantage psychologically.

 

As far as an upper age limit, there really is not one when it comes to otoplasty surgery. Usually patients who go 40 to 50 years with overly prominent ears are not going to entertain the idea of cosmetic surgery given the fact they are typically accepting of their appearance by this age. However, there are certainly many exceptions to this rule. For example, just last year I performed otoplasty surgery on a 72 year old male who flew out from Hawaii to have me perform his ear pinning surgery!

 

Q: How do you perform an otoplasty procedure?

 

DH: During otoplasty surgery, the abnormal features of the ear are sequentially addressed until a more natural looking ear has been achieved. In my chosen technique, I use incisions that are completely hidden behind the ear, near where it attaches to the surface of the scalp. In this manner, I can hide the scars from direct view. Some of the skin considered excessive is removed, and the underlying cartilage is then reshaped. This usually involves removing some of the excess cartilage first. Once the framework of the overly prominent ear has been weakened, it can be reduced in size and shape. The ear is brought closer to the head using a series of sutures or stitches. The flat portion of the ear is then reshaped to create a natural-looking antihelix ridge. Finally, the lobule is then brought closer to the head as necessary.

 

Q: How long does the procedure typically take to complete?

 

DH: It normally takes me one to two hours to perform cosmetic ear pinning surgery. The good news is that young adults and older patients can have it done under just oral sedation with something like Ambien. Younger patients, and those adults who are more anxious, typically have otoplasty done while under a deeper IV sedation anesthesia.

 

Q: What makes your otoplasty technique different from others?

 

DH: My technique involves making incisions that are contained entirely behind the ear so that scarring is not visible. There are still many plastic surgeons in 2013 who continue to make incisions, and scars, on the front side of the ear, which continues to perplex me. I have one of the busiest otoplasty practices in all of San Diego and haven’t had to make an incision on the front of the ear yet to accomplish the desired goals for my standard otoplasty patients.
Contact Dr. John Hilinski
For more information about otoplasty, or to schedule an ear pinning consultation, please contact Dr. John Hilinski today.

#### Dual Sculpting Arm Fat
Did you know that you can get Coolsculpting for your unwanted arm fat and get it done in half the time it takes many other offices to do the same procedure? That is because San Diego's #1 Coolsculpting practice - headed by Dr. John Hilinski - has two Coolsculpting machines that can be used at one time. This is termed dual sculpting in the world of Coolsculpting.

Dual sculpting is particularly great for patients who have unwanted arm fat, or flabby arms, and desire a more toned, slimmer look. Shown here is one of our Coolsculpting patients getting an actual treatment done for her arm fat using the dual sculpting technique. As you can see, she has two different Coolsculpting machines attached to her while freezing her arm fat simultaneously. As you can also appreciate, she is smiling because Coolsculpting treatment can be quite relaxing in many regards. You are sitting comfortably in an ergonomically designed treatment chair while watching TV in our specially designed Coolsculpting treatment room. In a short 40-45 minutes, your entire treatment is over and you can be on your way!

If you have flabby arms and are looking to get a bit toner and slimmer for the upcoming springer and summer seasons, contact the best Coolsculpting team in San Diego for your complimentary consultation. When it comes to arm fat, dual sculpting is the only way to go!

#### Dysport Is Back And On the Rise!
Interestingly, our office has seen several patients recently who have requested to have Dysport instead of Botox for their unwanted facial lines and wrinkles. Botox is still very much in demand and is definitely the more popular treatment option. But Dysport has clearly made a lasting impression on many of our patients when it comes to addressing those frown lines and crow's feet. Because of this, The Hilinski Clinic is now back to carrying both Dysport and Botox. We look forward to providing you with a choice during your next visit.

#### Ear Grafting (Auricular Cartilage Grafting) and Revision Rhinoplasty
Many patients who are scheduled to undergo revision rhinoplasty require ear cartilage grafting (also known as auricular cartilage grafting) as part of their surgery. This is commonly done when we need to add structural support and/or additional contour to the nose following prior rhinoplasty where too much cartilage or bone was removed. Patients often wonder what the ear is going to look like after the cartilage has been removed from their ear. As I tell any of my patients having this type of procedure, the ear should look essentially the same as it did before I took the cartilage. I use a hidden incision made entirely behind the ear and leave behind a sufficient amount of ear cartilage to maintain a normal shape. The ear tends to hurt a little more than the nose does, but this is managed with low dose pain medication during the first week. I have attached a photo below of one of my San Diego revision rhinoplasty patients who had ear grafting to the nose just one week prior. You will notice that her ear looks almost entirely normal without any obvious evidence that we were there.
Appearance of Ear One Week After Surgery

#### Ear Lobe Reshaping Otoplasty Surgery in San Diego, CA
Learn more about otoplasty surgery in San Diego offered by Dr. John Hilinski by reviewing this latest addition to our online otoplasty resource and primer. Dr. John Hilinski is considered one of the busiest and best otoplasty surgeons in San Diego due to his dedicated experience in performing plastic surgery of the ear. This most recent addition to our online education resource focuses on a San Diego patient who desired to have his earlobes (ear lobes) reshaped to appear less rounded. Although not considered a real common form of cosmetic otoplasty surgery, this type of plastic surgery of the ear requires someone with specialized expertise in performing otoplasty surgery. This case example includes diagrammed photos as well as before and after photos highlighting the cosmetic ear lobe changes that were made.

#### Ear Lobe Reshaping/Reduction
I had a patient consult with our office recently who inquired about ear lobe reduction/reshaping. This happens to be a niche procedure that not a lot of plastic surgeons actually perform on a regular basis. Given the fact that my practice focuses on facial plastic surgery here in San Diego, ear lobe reduction is something that I have done fairly consistently over the years. It is actually a variation of a limited otoplasty, or ear reshaping. Most patients present with a chief complaint that their ear lobes simply look too large. Others note that the ear lobe is too thick in appearance. In some instances, this can impact whether or not the patient can wear certain types of earrings. Most patients looking to have ear lobe reduction desire a smaller, thinner ear lobe that simply is not distracting to the eye. The photos below demonstrate a case of ear lobe reduction in one of my patients from La Jolla. As you can see from her preoperative photo, below left, she had fairly thick, wide ear lobes that were particularly distracting to her. Now some people looking at her would likely not notice anything abnormal. However, she was definitely bothered by their appearance and desired to have them reduced in size. We performed the limited otoplasty ear lobe reduction under straight local anesthesia in the office setting. Her incisions were hidden nicely to minimize any sign of me having been there. As you can see from her postoperative photo, below right, her new ear lobes now look smaller and thinner as well as more feminine. Yet, they still look natural. If you are considering ear lobe reduction surgery, simply contact my office today to schedule a consultation.

#### Ear Pain Following Complex Rhinoplasty
Question: I had an ear graft done as part of a complex revision rhinoplasty. Is it normal for my ear to hurt more than my nose?

Answer: Thank you for your inquiry. The answer is yes. It is quite normal to have more attention drawn to the ear as a result of discomfort and pain. The ear is quite sensitive being innervated by many sensory nerves. Therefore, it is expected to hurt more than the nose does following rhinoplasty. In most cases of rhinoplasty and revision rhinoplasty when there is no ear grafting, pain is actually very mild and usually requires only a few days of low dose Vicodin or equivalent. Best regards, Dr. Hilinski.

#### Ear Pinning (Otoplasty) in San Diego, CA
Dr. John Hilinski, board certified facial plastic surgeon in San Diego, CA, discusses another example of ear pinning (also known as otoplasty or ear reshaping). This female patient from San Diego presented to the office complaining of prominent ears. She was found to have overly developed ears that were asymmetric - meaning one stuck out further than the other. In this case, the patient's left ear was more prominent than the right. We discussed in detail the possibility of undergoing ear pinning surgery to make her ears smaller in size. The otoplasty surgery was done under local anesthesia in the office setting. The procedure involved making an incision behind the ear so that all scars would be hidden from direct view. The ear cartilage was reduced in size and brought closer to the head. This was able to be done while maintaining a natural look and shape overall. Her before and after ear pinning photos are shown below.
Before and After Ear Pinning
As you can see based on these before and after ear pinning photos, she has an obvious improvement in the shape and size of her ears. The ears are now more appropriately positioned closer to the surface of the head and are clearly less visible as seen on the frontal view. From below, you can also appreciate how the ears were previously more angulated out from the side of the head. Following ear pinning, or otoplasty, the ears are now more properly angulated.

Ear Pinning (Otoplasty) Consultation in San Diego, CA

If you or someone you know has been bothered by the appearance of their overly prominent ears, contact our San Diego, CA office today to schedule your otoplasty (ear pinning) consultation. To see other photos of Dr. John Hilinski's patients who have undergone ear pinning surgery, use this link here to be taken to the main otoplasty photo gallery.

#### Ear Pinning Example (Otoplasty) in San Diego
One of the most commonly performed surgeries here at The Hilinski Clinic of Facial Plastic Surgery is ear pinning to help reshape an overly prominent ear. This is a plastic surgery procedure involving the ear that is listed on many plastic surgeons' websites. Unfortunately, many board certified plastic surgeons, even those that are well-established in the community, simply do not do ear pinning on a regular basis. What sparked this plastic surgery blog entry is a discussion I just had with a San Diego patient looking to have ear pinning surgery. We were both commenting on how many plastic surgeons here in San Diego 'offer' ear pinning surgery as part of their practice. But only a small percentage of these plastic surgeons have a good number of patient photo examples to show potential ear pinning candidates their actual surgical results. You have to ask yourself why this is the case? The answer is likely because they simply haven't done the surgery often enough with successful results to have developed a photo library of this particular plastic surgery procedure. What else would explain this?
San Diego Ear Pinning Sampling
Because of this most recent ear pinning consultation, I conducted a quick, informal sampling of San Diego plastic surgeons offering ear pinning, or otoplasty, surgery online. I did this to get an idea of how many photo gallery examples were provided. Out of six plastic surgeons' websites here in San Diego, there was an average of 1-2 ear pinning photos showing their work. Granted, this isn't a very scientific method. But, in my personal opinion as a board certified facial plastic surgeon, I think you would have more patient examples to show if you were doing ear pinning surgery on a regular basis. Just makes sense, doesn't it?

#### Ear Pinning Expert
Who does more otoplasty, or ear pinning, than any other facial plastic surgeon in San Diego? Our guess is that Dr. John Hilinski performs ear pinning surgery more frequently than all other plastic surgeons here in town. If you look, for example, at his online photo gallery of otoplasty results, you will find that Dr. Hilinski has more real-life examples of ear pinning compared with most doctors in San Diego.

Here is just one of those phenomenal results. This young lady presented with a chief complaint of having ears that were simply too prominent for her face. When Dr. Hilinski examined her, he quickly noted that her ears just stuck out too far from the side of her head. Although Dr. Hilinski also performs a lot of macrotia ear reduction surgery, that was not the issue in this particular patient. She was recommended to undergo cosmetic ear pinning so that her ears could be folded back - and in the process become less obvious.

The otoplasty was done under straight local anesthesia - meaning, just an injection of numbing medication so that she could not feel any pain. Going from behind the ears, Dr. Hilinski was able to pin the ears back closer to the side of the head. The whole surgery took about 2 hours. She was instructed to wear a bandage for about 4-5 days continuously and then was recommended to wear an athletic sweatband at night for about 6 weeks.

Her actual surgical results are shown below - which visually demonstrate a beautiful and natural looking otoplasty outcome. Her ears are now clearly much closer to the side of her head and no longer stick out excessively. Yet, she looks like she could have been born this way - with ears that are smaller looking and less prominent. If you have ears that stick out too far and you desire cosmetic ear surgery - contact one of San Diego's best ear pinning experts - Dr. John Hilinski - right now!

#### Ear Pinning for Kids
Did you know that Dr. Hilinski performs more otoplasty, or ear pinning surgery, than most plastic surgeons in practice? In fact, we would go so far as to say that he does more cosmetic ear surgery than any other plastic surgeon here in San Diego. Testimony to this is his incredibly vast photo gallery of amazing ear pinning results. Just take a look for yourself and you see that he has example after example of otoplasty patients that he has operated on over the years.

The latest success story involves this young girl whose parents brought her to Dr. Hilinski because of her prominent ears. Simply put, they thought her ears stuck out too far and desired to have them pinned back to appear less prominent.

That is precisely what Dr. Hilinski did in this case - he performed cosmetic ear pinning surgery to bend the ear structure back closer to the side of her head. In doing so, he had to remove some of her excessive cartilage in combination with making her ear fold more defined.
Before and After Ear Pinning
The results of her surgery after 4 months are shown here. As you can see, her ears are no longer as prominent and look very natural positioned on the side of her head. And you can see just a hint through the pixelation that she is now smiling!

#### Ear Plastic Surgery Reshaping
One of the most dramatic views to compare when looking at before and after ear plastic surgery photos is this base view. It is always nice to confirm just how much change in the shape of the ear has been accomplished with otoplasty. For instance, this San Diego ear reshaping patient had ears that were fairly prominent in terms of sticking out from the side of the head. On this base view of her ears, you can see how the auricle is angulated nearly 90 degrees from the scalp surface. Otoplasty, also known commonly as ear pinning and ear reshaping, was able to be done from completely behind her ears. By reshaping the ear and bringing the entire auricle closer to the head (essentially pinning the ears back), her ears now look much less prominent. In fact, you don't even pay attention to her ears when looking at her now following ear plastic surgery. The patient is also much less self-conscious now about her ears. Of course, the frontal view before and after ear reshaping surgery is always the one patients and plastic surgeons care about most commonly. But this base view is also nice to visually compare really how much the ears can be reshaped in many otoplasty patients.

#### Ear Reduction Experience
Want to know what it is like having your large ears made smaller in size? Have you been bothered by excessively big ears your whole life and now want to consider ear reduction surgery? Maybe your journey and experience are similar to Manny's when it comes to having big ears. Take a look here and enjoy his candid discussion.

https://youtu.be/Ixyr2rqXEGI

#### Ear Reduction Expert
Here is a fantastic macrotia ear reduction case that vividly demonstrates how Dr. Hilinski can make large ears much smaller in size.

This is a patient who - like so many of our cosmetic ear reduction patients - discovered Dr. Hilinski online in her attempt to find someone who could shrink her large ears down in size. Now Dr. Hilinski has been performing this exact operation for many years now. But despite this, patients with excessively large ears were challenged in finding our website given the fact that so few plastic surgeons offered this procedure. Fortunately, this trend has shifted as Dr. Hilinski has become increasingly more well-known as the 'go-to' plastic surgeon when you want your ears made smaller in size. That is largely because he is one of less than a handful of board certified plastic surgeons in the world who has documented experience in actually making large ears smaller in size. In fact, he is one of the only cosmetic ear surgeons out there who has a robust gallery of before and after photos that show how he can make someone's large ears smaller in size. As a result, more and more patients with large ears are now discovering Dr. Hilinski online from all over the world - further contributing to his international reputation as the guy who can make you a 'designer ear' in about an hour.

This very pleasant lady from Chicago finally found our macrotia photo examples on the web and immediately reached out to consult with Dr. Hilinski in the hopes he could help her with ears that were excessively large in size. In her own words, she was bothered by the appearance of her ears for decades - often times doing everything in her power to keep them hidden from view. This followed many years of schooling where she admitted to being bullied by classmates who readily made fun of the shape and size of her ears. Unfortunately for her, when she researched options to reshape her ears to be smaller in size, she constantly came across otoplasty, or ear pinning. Although otoplasty surgery is a great option for ears that stick out too far from the side of the head, pinning and ear back does very little to help in the situation where the ear is too large in size and/or is abnormally shaped. In fact, a sizable percentage of Dr. Hilinski's macrotia ear reduction surgery patients have already undergone attempted otoplasty - only to find out that the surgery didn't fix their perceived problem. Why? Because the ears were still too large or unusually shaped. When you look at this particular case example, you can easily see from this oblique view just how abnormal the ear appears. The diagrammed photo provided here literally points to the main problem with scapha enlargement - where the top portion of the ear is overly developed and looks as if it extends up and back too far. If you follow the outer border of the ear (called the helical rim), you will quickly notice that there is almost an 'outpouching' where the normal, rounded curvature of the ear has been replaced with an area that seems to extend or protrude beyond where the natural curve should be. This was precisely what bothered this patient - and so many others - and prompted her to consider making the ears smaller in size.
Making an Ear Smaller in Size
Dr. Hilinski performed his famed macrotia ear reduction surgery to help make the ear smaller in size while restoring the helical rim contour to a more natural shape. In addition, he recommended a slight reduction of the earlobe to make it appear less bulky. The overall goal was to make the ears look smaller in size so this combination was a perfect fit for her.

The actual surgery took less than 2 hours to perform under local anesthesia. This means that the ear reduction surgery did not require a general anesthetic where she would have been put to sleep. Once Dr. Hilinski injects the local anesthetic, the ears go completely numb and the patient feels no pain. A huge advantage of making smaller ears with this approach is that patients are not exposed to the risks of having general anesthesia and recover much quicker after the surgery.

A fairly light head wrap is placed around the ears to help reduce initial surgical swelling. And since this is in place, there is really no wound care on the patient's behalf during these first few days. Once the wrap is removed, we do ask that you clean the incisions properly with specific instructions provided by our office.
Large Ear to Small Ear
This patient needed to get back to Chicago a little sooner than planned, so she ended up seeing Dr. Hilinski for her 1st postoperative visit just 36 hours after macrotia ear reduction. Fortunately, he was able to remove her ear bandages and the swelling was very mild as was the bruising. In fact, here are her early results at only 36 hours out from surgery. As you can see, she now has a much smaller ear that has a more natural shape. More specifically, the helical rim curve has been reshaped to look totally normal now that the extra scapha cartilage and skin have been removed. No longer does she have that extra extension coming off the top of her ear. Instead, she now has an ear that is overall smaller in size, shorter in height, and simply more proportional. Over time the suture lines will slowly fade as the scar softens and become less visible to the naked eye. But even at this point, the patient would gladly exchange some scarring for an ear that has been reduced in size and has just the right curvature!

#### Ear Reduction Healing
See what early healing looks like following macrotia ear reduction surgery performed by Dr. John Hilinski. Macrotia ear reduction surgery, or scapha reduction surgery, is an unusual type of cosmetic ear surgery that is intended to actually make an ear smaller in size - not just pinning the ear back closer to the head. Dr. Hilinski is one of the nation's few experts in macrotia ear reduction. Learn more about this by using this link here.

#### Ear Reshaping (Otoplasty) Immediate Recovery Period
I wanted to post a quick blog entry visually demonstrating what otoplasty patients might look like immediately following ear pinning surgery. This young gentleman from San Diego desired reshaping of his ears (ear pinning) to address overly prominent auricles. As you can see from his preoperative otoplasty photos below, his ears stuck out to the side of his head bilaterally. As is the case in most patients undergoing ear pinning, one side stuck out farther than the other side. In this particular ear pinning patient, his left ear was slightly more prominent than his right ear. We recommended a bilateral (both sides) ear pinning procedure using plastic surgery technique to reshape the ears so they would be closer to the head and less prominent overall. As with most otoplasty patients his age and older, this was performed under a local anesthetic in our outpatient surgery center in San Diego. The entire surgery was done from behind the ears to reduce the excess cartilage prominence and sew the ear closer to the surface of the head. He tolerated the procedure well.
Before Ear Pinning Photos

Immediate Post Otoplasty Photo
This photo was taken within minutes of completing his ear pinning surgery. As you can appreciate, his ears are slightly overcorrected from the otoplasty. This is done intentionally so that, once the ears relax, there is still a nice correction in the shape and size of the ears. As you can also see in the photo, there is very little swelling or bruising immediately after the ear pinning.
Ear Pinning Bandage
Within a minute of the above photo, a standard compression wrap was placed around the ears to keep them in position while trying to minimize swelling that would inevitably occur over the following several days. This bandage is comprised of an inner layer of cotton to help gentle push the ears against the head with an outer layer of 'coban' - one of the more common dressings used in facial plastic surgery. This is probably the most uncomfortable part of the ear pinning surgery since the bandage can be fairly tight. Unfortunately, it is a necessary evil when it comes to cosmetic ear reshaping. The good news is that we normally remove this bandage within 1-2 days, replacing it with a more tolerable dressing.
4 Days Out From Ear Pinning
The adjacent photo represents the same patient 4 days out from having his ears pinned back. As you can easily see, he looks fairly good in terms of being publicly presentable - and it has only been 4 days! Compare this photo with his preoperative photo above and you can really get an appreciation for how much improvement can be seen following ear pinning surgery. Stay tuned for additional postoperative photos coming in the next few weeks to months. We also have a great video chronicling his recovery from ear pinning surgery that we will post as soon as we can. In the meantime, I hope this helps provide any potential otoplasty candidates a realistic view of what they might be able to expect following ear reshaping surgery in our San Diego office.
Additional Otoplasty Information
To see more before and after photos of ear pinning patients done in our San Diego office, click here. To learn more about the actual ear pinning surgery for cosmetic reshaping of the ears, use this link here for our online San Diego Otoplasty Patient Primer.

#### Ear Reshaping/Otoplasty Debate Over Dissolvable Versus Permanent Sutures
I have seen this issue arise in a number of online forums regarding otoplasty, or ear reshaping. My personal opinion as a facial plastic surgery expert is that permanent sutures are a better choice when it comes to a majority of the ear reshaping process. Cartilage has what we call 'memory' in that if you reshape the cartilage with a temporary measure (or absorbable suture) it is likely to go back to its original shape or at least try to during the healing process. That is largely why some ears will tend to return back to their original size, shape and position following otoplasty done with absorbable sutures. Even when using a permanent suture in otoplasty, the ears have to be shaped such that your surgeon overcorrects to a certain degree since this memory issue will arise despite having the permanent sutures in place. Don't get me wrong. There are times when I will place an absorbable suture in the process of reshaping the ear. However, I only use these in areas where I am less concerned about cartilage memory and I use PDS suture, which lasts 6 months or so under the skin before dissolving away. In the meantime, there is plenty of scar tissue formation to allow for long-lasting stability in terms of the changes made to the ear. To learn more about San Diego otoplasty, ear reshaping and ear pinning use this link here for our online otoplasty tutorial page.

#### Earlobe Reduction Surgery
Take a look at this patient's earlobes that were reduced in size. This patient came to me desiring to have a more normal sized earlobe. Ultimately, I performed a cosmetic reduction procedure to remove the excess earlobe tissue. In the end, he was given a much more natural looking earlobe that was considerably smaller than the original size. And if you look real closely, you might be able to see where I made the cuts. Let me know what you think of his results!

#### Ethnic Revision Rhinoplasty
This patient was seen in our office today for follow-up evaluation, prompting me to post a blog regarding her ethnic revision rhinoplasty case (Asian and African American nose). She originally had a septorhinoplasty by another rhinoplasty surgeon here in San Diego. She was unhappy with how her nose looked following the nasal reshaping process and also had difficulty breathing through her nose. As you can see from her before photos below, her nose appears asymmetrically collapsed across the middle of the bridge. Her nose is also canted, or deviated, to her right side. I performed an open revision rhinoplasty on her, including reconstruction of her middle vault (mid portion of her bridge) with spreader grafts. As you can see in her post-op photos, she now has much more symmetry as seen on the frontal view. In addition, her nose functions much better than it did before. Make note of how we were able to give her a nose she was quite happy with while maintaining her ethnic appearance and balance with the remainder of her face. Most importantly, it would be very difficult to tell that this particular patient has undergone two fairly complex nasal reshaping procedures!

#### Ethnic Upper Eyelid Enhancement in San Diego, CA
I tell patients all the time that one of the facial plastic surgery procedures that provides the most 'bang for the buck' is upper eyelid lift surgery. This particular case example highlights this point precisely. This male patient from San Diego, CA presented to our clinic with a desire to have his upper eyelids enhanced. He simply wanted to have more definition along the upper eyelid region along with improved symmetry. As you can see from the adjacent preoperative photo diagram, his right upper eyelid was more droopy than his left. We often describe this in terms of excess heaviness of the upper eyelid. In some cases, this excess upper eyelid skin can even hang down onto the actual eyelash line, completely obliterating any sign of the normal upper eyelid crease. In this particular case, the patient was an ethnic male who had moderately thick skin. This matters because thicker, ethnic skin does not necessarily heal as quickly and nicely as thin, fair skin does when it comes to facial plastic surgery. But with excellent surgical technique, successful results can be achieved even in ethnic upper eyelid lift patients. We discussed in detail this patient's desire to have more definition along the upper eyelid region as well as more symmetric upper eyelids. This would require an upper eyelid lift procedure, also known as a blepharoplasty (pronounced blef-are-o-plasty). Fortunately, this type of facial cosmetic eyelid surgery can be performed essentially under local anesthesia. Meaning, the only thing necessary is injection of a numbing agent along the upper eyelid region - similar to what is used when going to the dentist. In rare cases we will also provide an oral sedative, but this is only for those patients who are prone to anxiety. The actual upper eyelid lift surgery takes approximately 45 minutes to an hour to be completed. This typically involves taking the excess upper eyelid skin away and carefully sewing the upper eyelid skin together to recreate a nice, new, defined upper eyelid crease. A good majority of the incision (and, therefore, scar) is hidden in the natural upper eyelid skin crease so that there is very little sign of having had and upper eyelid lift. There is some swelling and mild bruising of the eyelid region for about 3-4 days with most patients seeing resolution of this by the end of the week. Most patients will return to their normal daily activities 6-7 days following an upper eyelid lift procedure. The following series demonstrates this particular ethnic, male patient's upper eyelid lift before and after photos. As you can see, he has a nice overall improvement in terms of the upper eyelid region. His upper eyelid crease is now more defined and symmetric when looking at both sides. Taking a step back, you get the sense as well that he is just looks more rested. He still looks like the same person - just a more rejuvenated version of himself. If you are interested in having an upper eyelid lift procedure performed, contact our San Diego facial plastic surgery office today!

#### Evening Out Upper Eyelids
So many patients who undergo upper eyelid lift surgery also have issues with asymmetry. Meaning, one eyelid is usually much heavier than the other and can draw even more unwanted attention to an already concerning area.
Here is a great example of just that - a San Diego patient who had excess upper eyelid skin on both sides but had more droopy skin on her left upper eyelid. She consulted with Dr. Hilinski about a procedure to make her upper eyelids look more rested while also trying to make them more symmetrical, or even. Dr. Hilinski suggested a traditional upper eyelid lift, or blepharoplasty, to remove the unwanted, heavy eyelid skin.

Her eyelid lift was performed under local anesthesia where Dr. Hilinski gently injected the eyelids with numbing medication. Once this was done, the patient felt no pain at all. The excess upper eyelid skin was carefully removed and the skin was sutured back together. The entire operation took less than 90 minutes to perform and involved little recovery time.

Her before and after photos are shown below and confirm a very nice, natural looking cosmetic improvement in terms of the upper eyelids. She now has much less heaviness because the weighted, loose eyelid skin has been trimmed away. In addition, you can see that her upper eyelids now appear more symmetrical in that the right and left look much more similar. That is because Dr. Hilinski was able to remove slightly more skin from her left side to even the eyelids out. More importantly, she still looks like herself! She simply looks more rested and rejuvenated with more youthful eyes.

#### Example of Reconstructive Septorhinoplasty
One of the main differences between my practice and other plastic surgeons' practices is that I have additional advanced specialty training in reconstructive work related to the nose. This more commonly involves patients that need a plastic and reconstructive surgeon for functional, or medically indicated, work that needs to be done. This is commonly referred to as a reconstructive septorhinoplasty. This reconstructive septorhinoplasty patient from San Diego was recently seen in our office and was thought to be a good example of how we integrate reconstructive nose work with cosmetic reshaping of the nose. He presented primarily with complaints of difficulty breathing thru his nose. On preoperative examination he was noted to have asymmetry of his nose where the base was different from one side to the other. On frontal view of his nose you can see how it is canted off to his right side and his nostrils are different from left to right. From underneath his nose, you can easily appreciate how his left nasal airway is nearly completely blocked. This was from deviation of his septum, which happens to be a common cause of nasal obstruction. He elected to undergo surgery to help improve his nasal airway function while also providing him more symmetry. His surgery was performed with use of cadaveric costal, or rib, cartilage grafting. This was used in order to have sufficiently strong and plentiful material to reconstruct the nose. A caudal strut graft was used to stabilize the tip while providing more symmetry. In addition, a long strut graft was used along the left side of his bridge to stabilize his dorsal support and contour. Internally, a formal septoplasty was performed to straighten out the deviated septum and improve the internal nasal airway. The end result can be seen in the before and after photos below. Notice how on his frontal view his nose is now much more symmetric and fits his face more appropriately in terms of balance. From below, you can see how his nostrils are now much more even. In addition, his septum is now much straighter. The end result for this reconstructive septorhinoplasty patient is a nose that is more symmetrically shaped for his face and one that is much more efficient when it comes to breathing.

#### Excess Neck Fat
One of the most common procedures performed in all of plastic surgery is liposuction. This procedure is also known as lipocontouring since it utilizes liposuction technique to remove excess fat while contouring the neckline.

This young male patient came to Dr. Hilinski desiring to have a more defined jaw and neck. He was most bothered by the accumulation of excess fatty tissue under his chin and along this jawline. Despite his best efforts to reduce his weight, this area of fatty excess along the neck was quite stubborn.

Fortunately, Dr. Hilinski considered him an excellent candidate to undergo lipocontouring, or removal of the unwanted neck fat. The procedure took approximately one (1) hour to complete under a light sedation. In the process of contouring his neck, Dr. Hilinski made three very small slits in the skin - one behind each earlobe and one under the chin. Using these small access ports, Dr. Hilinski was able to first perform Vaser on the patient. This is a highly advanced technology that is often times used during liposuction procedures, especially in the neck region, to help 'pretreat' the fat using ultrasonic vibratory energy. In this manner, Vaser helps to breakdown the fatty tissues to make them more amenable to liposuction. Some of the Vaser heat energy also helps to tighten the skin and soft tissue from inside out - an added bonus for any patient having liposuction. Once the Vaser portion of the surgery was completed, the excess neck fat was then removed from these same three ports by suctioning it out with very thin cannulas. Not only did Dr. Hilinski remove the neck fat along his jawline, he also reduced the fatty layer along the mid portion of the neck and under the chin.

In patients this young, the skin still has enough 'elasticity' - the rubber band quality that allows skin to snap back - that it will readily shrink down to the new, smaller neck size. This doesn't happen overnight, but does reliably do so over the first several months after Vaser liposuction.
Vaser Liposuction Results
His amazing neck liposuction results are shown below. As you can readily see, there has been a dramatic improvement in his jaw and neckline! Whereas he previously did not have much definition along the lower face and upper neck, he now has marked shadowing due to the fact that his actual jawbone is now visible since the excess fat was removed. This visible improvement is arguably even more substantial when looking at his side view.

If you have unwanted, excess neck fat and desire more definition along your jawline, contact our office today to schedule your Vaser liposuction procedure with one of San Diego's best liposuction surgeons.

#### Exercising After Botox?
If you have been to our San Diego office and had Botox and/or Dysport injections you will likely have heard Dr. Hilinski recommend that you should refrain from exercising for at least 24-48 hours after the treatment. But why is this? Is it because of unwanted bruising after Botox or Dsyport? Nope.

The main reason Dr. Hilinski recommends you avoid exertional activities for 24-48 hours is to minimize your blood pressure and heart rate from going up. If this were to occur right after your Botox or Dysport treatment, you are at risk of 'washing away' the effects of the Botox and Dysport before it really takes effect. In the end, you just won't get as good of a result from the Botox and Dysport. So make sure you schedule your Botox and Dysport office treatments around your workout schedule!

#### Exosomes in Plastic Surgery
We recently had a series of inquiries from prospective patients who wanted to have 'exosome' cosmetic treatment. Given this recent trend (as of late 2020), we decided to post on our blog here to shed a little light on the whole concept of exosome treatment in plastic surgery.
What Are Exosomes?
So what are exosomes? They are microscopic particles that get released from a cell and, simply put, signal surrounding cells to change their biological behavior. Think of exosomes as basically messengers that influence the behavior of cells in the region where they are present by signaling some sort of response. Exosomes include agents like proteins, growth factors, mRNA, cytokines, enzymes, etc. Once released into the surrounding area, exosomes can influence the biological behavior and activity of the surrounding cells - thus they have huge potential in terms of cell repair, rejuvenation and healing.

Exosomes have become increasingly popular as of late because they are a buzzword in the world of 'regenerative' medicine - especially in the arena of cosmetic regenerative medicine. Regenerative medicine refers to any number of varied cosmetic treatments that are purported or intended to help biologically turn back the clock - literally. These include cosmetic interventions that have the potential to regenerate certain cells in an attempt to reverse the aging process or optimize wound healing. So, for example, exosomes are touted as a great option to place on open wounds (such as after a laser skin resurfacing procedure) to help speed up healing and/or make the healing process more ideal.
What About Stem Cells?
So what about stem cells and how do they relate? Exosomes are basically the messengers that get released from stem cells to signal change in other cells. Think of the exosomes as being a more specific type of cell-to-cell targeting while stem cells are more non-specific and generic in their remodeling capabilities.

Stem cells are all the rave right now in plastic surgery (and other fields) because of their potential to help regenerate tissue and reverse aging. But isolating true stem cells is a laboratory process that currently is not feasible to do in your average clinical setting. For example, when fat is taken out of the body there are two main components - (1) the actual fat cells, or adipocytes and (2) what is called the stromal vascular fracture, or SVF. The stem cells are largely contained in the SVF, which has to be isolated away from the adipocytes to generate the stem cells.

So, if you are reading online that a particular plastic surgery clinic is using 'stem cells' to treat certain conditions, it is in all likelihood not exactly true. In most instances, the surgeon is harvesting fat from one area of the body and placing it in another - called fat transfer. Now fat contain a number of stem cells and stem cell attractants, which can help in the healing process. These are sometimes referred to as adipose (fat) derived mesenchymal stem cells. However, when this procedure is being performed, the surgeon is not injecting a concentrated, isolated solution of stem cells - they are just one component of what is being injected or transferred.

Most scientific studies looking at the potential of stem cells to regenerate tissue utilize a concentrated batch of stem cells. And this process requires an elaborate series of steps - usually done in a laboratory - to isolate the actual stem cells. Although fat transfer does contain stem cells, they are not isolated and concentrated as you would find in the laboratory process of deriving stem cells. Therefore, it is very challenging - and inaccurate - to say that undergoing fat transfer stem cell treatment is the same as true stem cell treatment.
Legality of Exosomes
Unfortunately, although the potential for exosome treatment for cosmetic surgery patients has been scientifically proven, the reality is that we still do not have the ability to do this in a predictable - and legal - manner. The use of exosomes does fall under the umbrella of the FDA - which, as of this blog date, has not approved their use. So anything that you read online right now regarding treatments with exosomes to act regeneratively as a cosmetic enhancement is, quite frankly, illegal.

Some plastic surgery clinics and medical spas have skirted this FDA issue by stating that topical use of exosomes - to accelerate healing or to improve skin wrinkle formation - is more or less equivalent to using a cosmetic skincare product. However, the FDA clearly states that this is not the case and that exosomes - and their biological potential to affect skin and soft tissue - have more serious potential implications than a simple cosmeceutical agent.

#### Expert Ear Pinning Otoplasty Surgery
This very pleasant young man was just seen in follow-up today following ear pinning surgery to correct overly prominent ears. As you can see from his before photos, his ears were developed such that they stuck out too far from the side of the head. In fact, his ears nearly stuck out at a 90 degree angle creating unwanted attention. His parents elected to have him undergo cosmetic otoplasty, or ear pinning, surgery to correct the shape and size of the ears. I ended up pinning the ears back closer to the head using incisions that were hidden completely behind the ear. This included reducing the size of the ear cartilage. For a young guy, he was a champ in tolerating the surgery and recovery process. As you can see from these before and after otoplasty photos, there has been a dramatic transformation in the appearance of his ears. As shown, his ears are now much closer to the head with a more appropriate position and shape. Despite all the work that was done, his ears still look quite natural - as if he could have been born with these ears. If you or someone you know could benefit from this type of ear plastic surgery, do not hesitate in contacting our office today.
Before & After Ear Pinning Front

Before & After Ear Pinning - Base

Before & After Ear Pinning - Side

#### Eyelid Enhancement
Here is another great example of how Dr. Hilinski can help rejuvenate your upper and lower eyelids without making you look surgically 'done' as they say.

This patient came to our office seeking treatment for unwanted upper eyelid and lower eyelid bags. Her examination showed excessive, heavy, weighted upper eyelid skin that was literally draped onto her eyelashes. The lower eyelids demonstrated the classic bags that bother so many prospective blepharoplasty patients. In addition, she had some degree of volume loss where the lower eyelid junctions with the cheek. This created unwanted shadowing along the lower eyelid that further exacerbated her bags.

Ultimately, Dr. Hilinski recommended an upper eyelid blepharoplasty - essentially an upper eyelid lift - combined with a lower eyelid blepharoplasty. The latter involved taking some of the excess fat out and then adding some fat below this level to help restore lost volume.

The results of her cosmetic eyelid surgery are seen below. As you can easily tell, she has a beautiful, marked improvement in the upper and lower eyelid regions. Yet - she still looks like herself. She doesn't have obvious signs of having undergone cosmetic plastic surgery. She simply looks more rested and youthful around the eyelid region. This is such a high impact plastic surgery procedure since we all talk to each other by looking into each other's eyes. If you are bothered by excess eyelid skin and/or eyelid bags, contact our office today to schedule your personalized consultation with Dr. John Hilinski.

#### Eyelid Lift and Fat Transfer in San Diego
Check out these amazing, natural-looking results by Dr. John Hilinski who demonstrates the power of combining an eyelid lift with fat transfer.

This middle-aged female patient simply wanted to look more rested and youthful - but she was fearful of looking 'surgical' or 'done' after facial cosmetic surgery. She consulted with Dr. Hilinski who is one of San Diego's best facial plastic surgeons and known for creating very natural appearing cosmetic results.

Her main issue was around the eyelid region - both upper and lower. On examination it was noted that she had excess skin folds along the upper eyelid. This is actually incredibly common and something that Dr. Hilinski sees on a very regular basis. Her lower eyelid region was a bit more complex - having two separate but related anatomical issues. One was the eyelid bags that were readily seen. The excess, bulging fat under the eyelid was contributing to unwanted shadowing in an arc-like manner. But this was combined with a certain degree of hollowing just underneath the bulging fat. So in one location she had too much fat (bulging eyelid fat) and immediately adjacent to this she had too little fat (lower eyelid-cheek junction volume deficiency). When these two issues are present together in the same patient, the appearance of looking tired and aged is even more pronounced.
Eyelid Lift in San Diego
Given the above mentioned findings, Dr. Hilinski suggested she undergo surgery to help provide her a more rejuvenated appearance. One procedure would involve taking the redundant skin away from the upper eyelid margin. This is called an eyelid lift, or blepharoplasty in plastic surgery jargon. The other procedure could be interpreted as a lower eyelid lift, but it really involved taking out the unwanted eyelid fat and filling in the cheek area with new, fresh fat taken from another area of the body. The former is technically a lower eyelid lift and the latter is termed fat transfer. When these two procedures are combined, the result can be quite powerful!
Eyelid Lift Results
Here are her results of the surgery performed by Dr. Hilinski. She is about 5-6 months out from surgery in these pics, which represent a very stable, realistic result. As you can readily see by just glancing at her photos, she looks markedly better overall! When you look even closer, though, you begin to better appreciate the finer details of how Dr. Hilinski provided her with a rejuvenated outcome - yet preserved her natural look and avoided the stigmata of her having had plastic surgery!

Her upper eyelids no longer have excess skin folds that make her look prematurely tired. And her lower eyelid fat pockets have been reduced nicely to help get rid of the under eye bags. In addition, the fat that was transferred to her cheeks has helped restore much needed volume to her face. In concert, these procedures have taken at least 10 years off of her face - making her look so much more rested and rejuvenated!

#### Eyelid Surgery San Diego
This is a great case example of what an upper eyelid lift can do to help rejuvenate your overall facial appearance. This middle-aged female from San Diego desired to look more rested and youthful. In particular, she was bothered by the fact that her upper eyelids had excess skin and appeared heavy on initial glance.

When you look at her left eye (right side in the photo), you can appreciate how there is actually a bit more bunching of skin on this side with more skin folds. We call this 'asymmetry' in the world of plastic surgery, which simply means there is a difference between the two sides. Now everyone has some degree of asymmetry - and will continue to have asymmetry even after undergoing the best plastic surgery out there. However, this amount of asymmetry is more than expected when it comes to the upper eyelid region. And one additional sign of this is the fact that her left brow is being pulled up higher - just look at the amount of arching seen in the brow on her left side. This is a direct reflection of the fact that she has more upper eyelid skin redundancy on this side and she is subconsciously compensating for this by trying to 'pull up the skin' using her eyebrow.

Dr. Hilinski recommended she undergo a classic upper eyelid blepharoplasty procedure - or an upper eyelid tuck - to help remove the excess, redundant skin folds. When performing upper eyelid lifts it is very important that your plastic surgeon leave behind enough skin so that the upper eyelid can actually fully close. So arguably more important than how much skin is removed in an upper eyelid lift is how much skin is being left behind! In addition, a sufficient amount of upper eyelid fat and soft tissue should be preserved so that the eyelid does not appear hollow afterwards. Both of these are part and parcel of maintaining a natural upper eyelid following blepharoplasty surgery.

In this case, Dr. Hilinski ended up making a standard upper eyelid lift incision in her natural skin fold - and extending this out to the side into one of her crow's feet. In doing so, he was able to carefully hide the incision and scar.

And here are the beautiful results of her upper eyelid lift several months later. As you can readily appreciate, her upper eyelids now look much more defined without the excess, redundant skin folds. In addition, you can see how her left eyebrow is not as sharply arched any longer since the extra eyelid skin has been removed - and there is no longer the need to compensate for this by elevating the eyebrow. Her upper eyelids are now nicely rejuvenated with a well-defined eyelid crease now clearly visible - and above all else, she still looks natural. In fact, she now just looks like a more rested version of her old self.

#### Facelift Necklift Rejuvenation
Despite all the latest fillers and laser devices being advertised out there in 2016, there is no substitute for a beautifully performed lower face and upper neck lift. This patient here exemplifies what this type of facial surgery can do to help reverse the signs of aging while providing a much more rejuvenated facial appearance.

You can see from her photos how she had moderate jowling along the jaw line in addition to sagging skin under the chin region. Although she is an attractive female, these issues were making her feel less youthful. I ended up performing a standard lower face and upper neck lift including tightening of the platysma muscle under the chin. All in all this provided her with a much more rested, rejuvenated appearance - while maintaining a natural look. Let us know what you think of her outcome!

 

 

#### Facelift Technique Update
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.

#### Facial Appearance 10 Days After Facelift Necklift in San Diego, CA
Many patients inquire about their short-term appearance following a facelift/necklift procedure. This case example demonstrates what most patients look like at 10 days out from a lower facelift and upper neck lift procedure. This middle-aged female from San Diego, CA desired rejuvenation of her lower face and upper neck due to unwanted sagging skin that was making her look prematurely aged. She consulted with us and was recommended to have a lower facelift combined with an upper neck lift procedure. As with many facial rejuvenation patients, one of her main concerns was looking natural following the surgery. She was also concerned about what she might look like in the early recovery period (first few weeks). We took a series of early postoperative photos to visually show others what they can likely expect at this time point after a similar facelift necklift surgery.
Pre Facelift Images
Her face and neck photos prior to surgery show classic changes consistent with aging. This includes early jowling along the jawline as well as skin bands that are visible under the chin. As you can see, this patient did not have a significant amount of excess fat that needed liposuctioning.

Post Facelift Images
Based on her desires and needs, we performed a standard SMAS facelift procedure to enhance the lower face and upper neck at the same time. These photos represent her recovery around the 10 day mark following surgery. As you can see, there is a notable improvement in her lower face and upper neck contour. She clearly looks more rejuvenated and rested. Despite some swelling that is still present (as expected) around the incision lines, she appears publicly presentable. Even at this point in the early recovery process, her scars are beginning to fade away nicely. Much of this is attributed to the fact that we try and camouflage facelift incisions around the ear as much as possible. Even in patients like her who have more ethnic, darker skin color the facelift incisions can be hidden quite nicely. As you can also appreciate, facelift patients do not have to look like they have been 'pulled' after having a rejuvenation procedure like this. If you or someone you know are interested in having a facelift necklift procedure, feel free to contact our San Diego office today.

#### Facial Filler Facts
Facial dermal fillers, such as Restylane, Perlane, Juvederm and Artefill, are some of the most popular cosmetic office-based treatments I perform on a daily basis. These minimally invasive injection procedures involve careful placement of a gel-like filler substance to correct unwanted facial lines and creases. The results in most cases can be a significant improvement and enhancement of the facial appearance with essentially no downtime, which is why these fillers as so attractive to so many patients. A good number of you out there have likely already dabbled in this arena with filler injections of the smile lines (or nasolabial folds), cheeks and lips - some of the more common areas for filler enhancement. Every so often we see someone in the office for possible filler injection who says something to the effect that they had the treatment in the past, but it didn't work. In most of these instances, I try and educate the patient as to what probably really occurred - a point that I would like to emphasize here today.
Filler Failure? Not Likely
The reality is that there is rarely a 'filler failure' in most plastic surgery offices. Meaning it is highly unlikely that the filler material simply did not do what it was designed to do. What it usually boils down to is the fact that not enough filler was used to treat the area(s) of concern. For example, when someone consults with us for treatment of deep smile lines, also known as the parenthesis deformity, they usually require 1-2 syringes of the chosen filler - whether it be Restylane, Perlane, Juvederm or Artefill. In some patients who are less aged, perhaps one syringe may work to soften or fill both smile lines. In others, their parenthesis deformity is more pronounced with deeper creases that might necessitate using one or more syringes of a filler on each side - so a total of two to four syringes. If the latter patient is only interested in purchasing one syringe (but really needs two or more), they are not going to have as nice of a result as the former patient (who really only needed one syringe). In this instance, the patient who got the one syringe, but really needed more than that, may see their injectable filler result as a failure. In reality though, they simply didn't get enough filler injected for their particular problem. So why did this happen you might ask? The answer is largely economical. Many patients who get injectable fillers are on some kind of budget. Each syringe of injectable filler can range in price from $425 up to $900. If that particular patient was recommended to have two or more syringes of filler, yet only budgeted for one, they are unlikely to attain an ideal result. This is not a filler failure. It is simply an issue that not enough filler was injected for that specific patient.
Multiple Site Injections
A similar scenario arises in cases where injectable filler patients are looking to have multiple sites treated, but only want to purchase one syringe. For example, I had a recent patient in the office who wanted to treat her smile lines, lips and pre jowl area on both sides of the face. However, she was only willing to purchase one syringe of Restylane on that particular day. As I discussed with her in detail, one syringe of Restylane (or Perlane, Juvederm, etc.) was just not sufficient to treat these multiple areas. You can certainly try and use one syringe of a filler and distribute it across all of these injection sites. But the end result will be just slight improvement in each area. This is in contrast to significant enhancement of one particular area if the entire syringe is used to target just one of these regions. To help better understand this concept, you can use the analogy of traveling around the world on a set budget for one week. Think of having a fixed amount of money (filler) and wanting to see certain tourist sites (facial lines and creases). You have to decide if you want to spend in-depth, quality time in just one tourist destination or visit multiple sites each for a short period of time. If you had an unlimited budget, you may choose to spend quality time in a multitude of sites living life to the fullest. But the reality is that most people, and patients, do not have this luxury.
Injectable Filler Consult San Diego, CA
I hope this explanation sheds some light on the reality of having injectable fillers for undesirable facial lines and creases. This doesn't mean you have to necessarily pay more money just to achieve an enhanced facial appearance with Restylane, Perlane, Juvederm or Artefill. It just means that you have to be realistic in what areas you want treated with a certain amount of filler. If you are considering an injectable dermal filler treatment and want more detailed information, contact our San Diego facial plastic surgery office today to consult with Dr. John Hilinski - one of the area's foremost experts in facial enhancement with fillers.

#### Facial Implants Offer Long-Term Solution to Volume Loss Says San Diego Facial Plastic Surgeon
San Diego, CA -- Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, says he has noticed a dramatic increase of patients interested in facial implants at his practice over the past few years. This trend is confirmed by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which finds that the number of facial implants performed on women has risen by 50 percent in the past year. Designed to add volume and fullness to facial contours, Dr. Hilinski says the procedure has rapidly become a sought-after alternative to dermal fillers and injections such as Restylane® and Juvederm® because of its ability to provide longer lasting results. As the procedure continues to grow in popularity, he says keeping patients informed about how the treatment works as well as expectations for recovery and results is an essential step in ensuring facial implants are performed with the highest level of care and patient satisfaction.

As with non-invasive procedures such as BOTOX®, Dr. Hilinski states patients who are considered good candidates for facial implants are those that want to reshape their face by adding volume in very specific areas, such as the chin or cheek region. He adds that patients may feel as if their face is proportionally underdeveloped or unbalanced, a situation that can be remedied through strategic planning and precise placement of the implant. For example, Dr. Hilinski says by placing a chin implant, he can augment the contour of the jawline and provide a much more complete sense of facial harmony.

“Most facial implant patients are simply looking to achieve a more balanced facial appearance,” says Dr. Hilinski. “Many who ultimately undergo facial implant surgery have had prior injectable filler treatments, like Restylane® or Juvederm®, but wish to have a more permanent solution to their problem.”

Although there are a variety of materials that may be used for facial augmentation, Dr. Hilinski prefers a silicone plastic, or silastic, implant at his San Diego facial plastic surgery practice because they offer a much safer and more predictable outcome. Other materials include porex and goretex; however, he says these can often elicit a tissue reaction from the body, which can cause the implant to move or lead to a higher incidence of implant rejection. Dr. Hilinski adds that after years of having used silastic implants, he is much more familiar with the array of sizes and shapes available and how each one can be used to enhance facial appearance.

“Whenever a foreign material is placed into the body, there is always the risk of rejection,” he says. “Fortunately, this risk is minimal when facial implants are placed correctly by board-certified facial plastic surgeons with experience in augmentation of the face with implants. There is also a potential risk of damaging the nerves around the face that provide sensation and/or movement. Again, this risk is quite rare when facial implants are performed by reputable facial plastic surgeons with dedicated experience in this particular area.”

Like other facial rejuvenation procedures such as a facelift or rhinoplasty, Dr. Hilinski says patients should expect to experience a moderate amount of initial swelling during the first few days where the implant is placed, though most begin to see a significant decline by the end of the first week. When performed properly by a board-certified facial plastic surgeon, he says the procedure may still take many more months for the complete healing process to be final, but patients should notice drastic improvement in the fullness and vibrancy of their face almost immediately:

“The huge upside of having a facial implant is the expectation that one should see quite a dramatic enhancement in their facial appearance following placement of a facial implant. And in most cases, facial implants can result in a very natural look as if the patient was born with that particular facial contour.”

About John Hilinski, MD

A graduate of Harvard Medical School, Dr. John Hilinski completed his residency in Head and Neck Surgery at the University of California, San Diego Medical Center, as well as a Facial Plastic and Reconstructive Surgery Fellowship at the University of Illinois, Chicago Medical Center. He is double-board certified in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery, in addition to being a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology, and several other professional organizations. Dr. Hilinski currently serves as a Clinical Faculty Instructor at both the University of California, San Diego Medical Center and the Veterans Administration Medical Center.

Located at 3720 Fourth Avenue in San Diego, CA, Dr. Hilinski’s practice can be reached at (619) 296-3223. He and his team can also be contacted online via the websites drhilinski.com or facebook.com/drhilinski.

#### Facial Mole Shave Removal
This is another great example of how moles can be permanently removed with minimal signs of scarring. This young lady desired to have her facial moles taken off. I recommended a specialized shave technique where the mole is removed without having to use sutures or stitches. You can see from the photo comparison here that the moles have been successfully erased with really no obvious signs of visible scarring. Let us know what you think of her results!

#### Facial Plastic Surgeon Discusses Choosing Cosmetic Procedure
Facial Plastic Surgeon in San Diego on Choosing the Appropriate Procedure

A recent study from the American Academy of Facial and Reconstructive Plastic Surgery (AAFRPS) found that 75% of all procedures performed by facial plastic surgeons in 2008 were nonsurgical in nature. However, San Diego facial plastic surgeon Dr. John Hilinski says his practice is quite different when compared to the AAFRPS statistics. When choosing a procedure, he stresses the need to work with patients to determine which approach will meet their long-term cosmetic enhancement goals and expectations.

While the latest study from the American Academy of Facial and Reconstructive Plastic Surgery (AAFRPS) shows nearly three-quarters of procedures performed by facial plastic surgeons are nonsurgical in nature, Dr. John Hilinski says the breakdown at his San Diego facial plastic surgery practice varies significantly. “In my practice, I would say 50-60% of our procedures are surgical. About 40% of our time is dedicated to performing nonsurgical, office-based cosmetic enhancement procedures.”

Dr. Hilinski says he works with each patient to determine which procedure will provide the best long-term result with the least amount of effort. “In many cases surgical approaches happen to provide a better long-term outcome so we often opt for this pathway.” However, Dr. Hilinski also acknowledges that his patients are concerned with the amount of recovery time and the overall invasiveness of more traditional procedures, and are increasingly interested in nonsurgical options such as BOTOX Cosmetic® or  injectable fillers. “We are in an era of minimal downtime and many patients would rather choose the less invasive option since there is less recovery time involved.”

While Dr. Hilinski says his practice has experienced an increase in noninvasive procedures, he stresses that when it comes to patients considering procedures such as nasal reshaping, there is no substitute for procedures such as rhinoplasty. When trying to find the right surgeon and determine the appropriate procedure, Dr. Hilinski says in addition to choosing a board-certified plastic surgeon that is committed to helping them find the right procedure for their goals, patients need to consider the extent of a surgeon’s experience. “The single most important factor is choosing someone who has dedicated experience in that particular sub-specialty. Why not go to the plastic surgeon who does a particular procedure on a consistent basis.”

About John Hilinski, MD

Dr. John Hilinski earned his medical degree from Harvard Medical School. He then completed his general surgery internship at the University of California, San Diego Medical Center, followed by a Head and Neck Surgery Residency. Dr. Hilinski also completed a facial plastic and reconstructive surgery fellowship at the University of Illinois, Chicago Medical Center, and a research fellowship with the National Institutes of Health. He is a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology - Head and Neck Surgery, and the California Society of Facial Plastic Surgery.

Dr. John Hilinski’s facial plastic surgery practice is located at 3720 Fourth Avenue, San Diego, CA 92103, and can be reached at (619) 296-3223 or found online at drhilinski.com or facebook.com/drhilinski.

###

#### Facial Plastic Surgeon in San Diego Discusses How to Choose the Right Practice for Rhinoplasty
San Diego Facial Plastic Surgeon on Rhinoplasty and Choosing the Right Practice for a Procedure

According to the latest statistics from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), rhinoplasty was the top procedure performed by facial plastic surgeons in 2010, with an average of 54 procedures performed per surgeon. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, says that because of the difficulty involved in successful rhinoplasty, consulting with the proper physician is essential for achieving the best results. Dr. Hilinski discusses the intricacies and complexities of rhinoplasty as well as specific qualifications to look for in a facial plastic surgeon.

At his San Diego facial plastic surgery practice, Dr. John Hilinski says rhinoplasty is the most common procedure he performs. The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) confirms Dr. Hilinski’s observations, reporting in their latest study that an average of 54 rhinoplasty procedures were performed in 2010 per surgeon, followed by facelift with an average of 50 procedures and eyelid surgery with an average of 49. Because of its popularity, Dr. Hilinski says many doctors are choosing to offer rhinoplasty at their practice, but few have the qualifications and experience needed to perform such a complex and intricate procedure. He says rhinoplasty requires specific surgical attention to both the cosmetic appearance and the physiological detail of the nose’s structure, because it impacts both a person’s breathing and their appearance.

“Cosmetic rhinoplasty is arguably the most complex and challenging plastic surgery procedure performed because the nose is truly the centerpiece of the face and plays such an important role in our facial appearance. And, unlike other cosmetic procedures such as breast augmentation and abdominoplasty, less than ideal surgical results cannot be easily concealed from view. Because the stakes are so high in cosmetic reshaping of the nose, choosing your rhinoplasty surgeon can significantly influence whether or not a successful outcome is achieved.”

Dr. Hilinski says that as with any aesthetic enhancement, patients must be sure to consult with the proper surgeon before undergoing a rhinoplasty or secondary rhinoplasty procedure. He also adds that plastic surgeons with specific focus on the face and nose are far more likely to have the experience and surgical ability to perform the procedure successfully and with the highest quality results. Dr. Hilinski says surgeons who have been certified by the American Board of Facial Plastic and Reconstructive Surgery and also the American Board of Otolaryngology-Head and Neck Surgery are preferred because of their dedication to the specific cosmetic and functional structure of the nose and face. “Those with this additional board certification have established expertise in dealing with the actual function of the nose. Such experience can be vital when reshaping the nose for cosmetic reasons, as form and function are inextricably linked when it comes to rhinoplasty surgery.”

Another distinction to look for in a facial plastic surgeon according to Dr. Hilinski is a detailed and expansive portfolio of before-and-after photographs. He says that a surgeon’s ability to display their work extensively signifies an aptitude and consistency in their surgical technique that comes from having an experienced background in performing rhinoplasty and revision rhinoplasty.

Regardless of whether patients are seeking rhinoplasty in San Diego, or another procedure such as eyelid surgery, Dr. Hilinski recommends putting the time into researching thoroughly all options before undergoing any procedure. “Unless your chosen rhinoplasty surgeon meets these all-important criteria, my recommendation is to keep looking. Given the fact that cosmetic nose reshaping is widely regarded as the most difficult plastic surgery procedure to perform correctly, doing your homework way up front can pay huge dividends in the future.”

About John Hilinski, MD

Dr. John Hilinski received his medical degree from Harvard Medical School. He completed a General Surgery internship and a Head and Neck surgery residency at the University of California, San Diego Medical Center, focusing exclusively on surgery of the face and neck. Dr. Hilinski also received extensive training through a fellowship in Facial Plastic & Reconstructive surgery in Chicago, IL, where he served as a Clinical Instructor in the Division of Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine. He is double board-certified in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery. Dr. Hilinski is a member of the American Academy of Facial Plastic and Reconstructive Surgery and the American Academy of Otolaryngology-Head and Neck Surgery. He has been published in numerous medical journals and book chapters for rhinoplasty and advanced techniques in scar revision.

Located at 3270 Fourth Avenue in San Diego, Dr. Hilinski’s practice can be contacted at (619) 296-3223 or online via the website drhilinski.com or www.facebook.com/drhilinski.

###

#### Facial Plastic Surgery and Upcoming Holiday Season
We have been quite busy around the office lately, consulting with many of you about a wide variety of facial plastic/cosmetic surgery procedures. As my staff has likely already explained to many of you, we are embarking on a very busy time of year when it comes to facial plastic surgery. Traditionally, this time of year is very popular for plastic surgery since many patients take advantage of holiday vacation time to assist in their recovery. For this reason, I personally take very limited time off between now and the first of the year. So please be patient with us if we cannot immediately honor your scheduling requests – my staff have been instructed to make every effort to accommodate everyone’s needs. On behalf of the staff at San Diego Face and Neck Specialties, I would like to wish you a great upcoming holiday season. We look forward to being part of a bigger and better new year’s celebration with you!

#### Facial Reconstructive Plastic Surgery in San Diego, CA - Forehead Osteoma
Dr. Hilinski has just added another example of facial reconstructive plastic surgery to our ever-growing San Diego facial plastic surgery photo gallery. This latest case involves a female patient from San Diego who developed a bony growth (called an osteoma) involving her forehead region. Not only was the growth becoming more esthetically displeasing, it was also causing her pain and discomfort. Dr. Hilinski ended up performing the reconstructive facial surgery to remove the bony growth through hidden incisions. The end result is shown in our reconstructive facial plastic surgery photo gallery and demonstrates how this type of surgery can provide a significant improvement with very little evidence of having had something done. If you happen to have something similar to this particular patient and require reconstructive facial plastic surgery in San Diego, CA, please do not hesitate in contacting our office today.

#### Facial Scar Revision in San Diego, CA
Over this past week, I have witnessed several traumatic injuries to the face while watching a number of competitive water polo games in Orange County. Many of these injuries occurred around the eyes and forehead region and involved lacerations (cuts). Unfortunately, I was not equipped to offer my services on the pool deck! Most of these injuries were subsequently seen and treated in the local emergency rooms. Although there is great care provided in a good majority of our community emergency rooms, facial laceration repair is one procedure that commonly needs revision by a plastic surgeon. This is a great example of facial scar revision in a female patient from San Diego, CA who was also initially repaired in an emergency room. This particular patient suffered a facial laceration while sledding in the local mountains. The laceration was repaired by staff at a local emergency room without the advise of a plastic surgeon. Unfortunately, the laceration did not heal optimally and she desired scar revision to make it less visible. As you can see in the adjacent photo of her forehead, there is an obvious visible scar that is abnormally shaped running across her mid-forehead. You can also appreciate the fact that the scar has darkened (called hyperpigmentation) and is slightly depressed (sunken in). This latter problem creates unwanted shadowing of the scar and contributes to the scar being much more visible.

The patient elected to undergo facial scar revision with our office to help improve the appearance of the scar. We recommended a technique called excisional scar revision - meaning we planned on cutting out (excising) her old scar and redoing the closure in a more meticulous manner. She underwent the procedure using just local anesthesia to numb the area. We removed her old scar completely then realigned the skin edges in a very strategic fashion. We then let her heal for at least a year, which is about how long it normally takes for scars to mature and evolve to a stable state. In the meantime, she was recommended to use topical healing gels like Mederma and silicone to aid the scar maturation process. Her end results are shown below.
Photos of Facial Scar Revision
As you can see from her before and after scar revision photos, she has a significant improvement in the appearance of the scar. Is it completely invisible? Absolutely not. But the patient and plastic surgeon have to be realistic in terms of what they are trying to achieve with this type of cosmetic enhancement procedure. The goal is to make the scar less visible to the naked eye. It would be completely unrealistic to think that the scar will disappear completely after scar revision. In this particular case, we were able to achieve the goal of making the scar much less visible to the naked eye. The level of the scar is much better and more even with the surrounding skin. The texture and color of the scar have also been enhanced. There has been a clear cosmetic improvement that might be further enhanced by additional techniques like dermabrasion. However, the patient is quite happy with the overall change and is not interested in pursuing any further procedures for the scar. If you are interested in having a scar revised for cosmetic improvement in appearance, please do not hesitate in contacting our San Diego facial plastic surgery office today.

#### Facial Slimming Treatment
Did you know that Botox can be used as a fantastic non-surgical facial slimming treatment? Well, it can be! Many cosmetic patients are bothered by an overly wide face that can be attributed to hyperactive facial muscles. In particular, this is from a masseter muscle that is overly active and bulky. This is especially prominent in some female patients.

In the adjacent photo diagram, you can see this for yourself where this female patient from San Diego desired a slimmer face. She was bothered by her jawline contour that was excessively wide - giving her the appearance of a more squared outline. Anatomically, this was due to a very strong masseter muscle that was causing too much bulky in the area. After consulting with Dr. Hilinski, she opted to go with a non-surgical solution using office-based Botox injections to slim her face. Dr. Hilinski injected the Botox thru the skin into the masseter muscle. After several days, the Botox started to work by stopping the masseter muscle from contracting as much. Just like any muscle that is not active, reducing the ability of the masseter muscle to contract led to atrophy, or shrinkage. The end result was a less bulky masseter muscle and a slimmer looking face and jawline.

If you desire facial slimming by targeting the masseter muscle with Botox injections, contact one of San Diego's best medical spas led by Dr. John Hilinski.
Before and After Masseter Botox

#### Fall Specials on Juvederm at the Hilinski Clinic
The Hilinski Clinic is now offering Juvederm XC for $425 per syringe! Juvederm XC is one of the most popular dermal fillers used to treat unwanted facial creases and wrinkles. This office-based, minimally invasive cosmetic treatment is now even better with Juvederm XC. This latest dermal filler product now comes prepackaged with lidocaine, which helps maximize comfort while minimizing discomfort. Our special is running from now until the end of November so call us today to schedule your appointment and kiss those lines goodbye!

#### Female Middle Eastern Cosmetic Nose Surgery
This is a female Middle Eastern rhinoplasty patient who sought out an expert rhinoplasty surgeon to reshape her nose. Her main issues involve the nasal tip and columella region. More specifically, this particular patient had what is called a hanging columella. This means that the area in between the nostrils hung down too low - giving the appearance that it was drooping off of the nasal tip region. In addition, her nasal tip was poorly positioned. Furthermore, her nasal bridge had a bump, or hump, deformity that she disliked. I ended up performing a rhinoplasty procedure to reshape her nose. Careful thought and planning was required above and beyond your average rhinoplasty surgery. This is because I was dealing with an ethnic rhinoplasty patient who has a Middle Eastern heritage. In these situations, plastic surgeons must be even more careful to create a final result that is natural appearing and balanced with the face. As you can see in the following before and after ethnic rhinoplasty photos, her cosmetic surgery result reveals a nose that is in harmony with the face - and one that looks like it belongs on an Middle Eastern ethnic face.
Before and After Middle Eastern Rhinoplasty

Before and After Female Middle Eastern Rhinoplasty

Middle Eastern Rhinoplasty Consult
If you are interested in cosmetic Middle Eastern rhinoplasty surgery, simply contact our office today to consult with one of the regions most experienced and expert Middle Eastern cosmetic nose surgeons.

#### Fibroblast Plasma for Perioral Lines
Here is another fabulous example of the power of the plasma pen.

This patient was bothered by the wrinkles and lines around her mouth - essentially the upper and lower lip region. These are commonly referred to as smoker's lines by some people even when the patient doesn't have a history of smoking. The point is that these vertical lines (which can come about from repeated pursing of the lips) are aesthetically undesirable because they can make this area look prematurely aged. These coarse wrinkles often times develop disproportionately in this 'perioral' region - meaning around the mouth and lips. Patients often come to the office thinking they need a filler, such as Restylane or Juvederm, to plump these wrinkles out. But fillers are not the ideal treatment for perioral and lip wrinkles.
Louise Walsh Plasma Pen
One of the latest and best options for these wrinkles is the powerful plasma pen. There are a wide range of so-called plasma pens being marketed and advertised online. But a good majority of them are not considered true medical-grade instruments for cosmetic enhancement. Dr. Hilinski and his staff chose the Louise Walsh plasma pen, which is, indeed, considered the best plasma pen available to plastic surgeons and cosmetic dermatologists. The pen is manufactured with the highest standards and has been proven to clinically superior to others when it comes to achieving the best cosmetic outcomes. After extensive research, Dr. Hilinski opted to use the Louise Walsh plasma pen as his instrument of choice.
Plasma Pen Lip Wrinkles
In this particular case, Dr. Hilinski and his registered nurse, Kellie Hartmann, recommended the plasma pen to help smooth out her lip and perioral wrinkles. The beauty of plasma pen treatment is that it can be done using just topical numbing cream. Yes - that means no needles! Patients are recommended to apply a nice layer of numbing cream to the treatment area about 1 hour prior to their scheduled appointment.

Once they come to the office, the skin is cleaned and the treatment begins. Patients will note some degree of heat as the plasma pen is carefully used to treat the skin. The plasma pen does not penetrate into the skin. Rather, it is passed over the surface of the skin. As this is done, the plasma energy is used to create somewhat of an arc between the tip of the pen and the skin. This plasma energy is what tightens the skin and stimulates collagenesis that will make the skin look even more youthful well after the treatment has been completed. As the skin tightens, the wrinkles are smoothed out.
Plasma Pen Results
Here are the results of this patient's plasma pen treatment for unwanted lip wrinkle formation. As you can see, there is a marked cosmetic improvement noted! Her upper and lower lip wrinkles are now much smoother given how the skin was tightened around the mouth region. Even the coarser, deeper vertical lip lines have been nicely tightened. The overall effect is a much more youthful perioral region. And this type of cosmetic result from the plasma pen is noted after just one treatment session! Imagine what it will look like when she completes one more round with the magical plasma pen.

 

#### Finesse Female Rhinoplasty in San Diego
This is a great example of a finesse rhinoplasty procedure that we recently saw back in the office for a follow-up appointment. This young San Diego patient came in with a desire to have a nose job because she felt as if her nose was too wide and looked too big for her face. We discussed with her at length the potential benefits of a cosmetic rhinoplasty procedure to reshape her nose. Specifically, we talked about bringing her bridge height down while narrowing the nasal bones and tip region. She was fairly concerned, like many potential rhinoplasty patients, about maintaining a natural look following nasal reshaping. I outlined for her a surgical plan to help improve the esthetic appearance of her nose largely based on a finesse approach - meaning, doing a few millimeters here and there in certain rhinoplasty patients can translate into a very nice improvement while preserving the overall look of the nose. In the before and after rhinoplasty photos shown below, you can appreciate the changes that are seen in her nose following the finesse nose job. Her front view shows a more narrow bridge and tip without looking fake or surgically done. On the oblique view you can appreciate the finesse changes to her tip shape and bridge height while maintaining a natural curvature from the radix down to the nasal tip. The same can be said on the lateral view of the nose. And on her base view, you can see how her new nasal tip shape looks more triangular following the rhinoplasty procedure. And also keep in mind that this particular rhinoplasty patient had fairly thin skin, making the operation much more difficult overall. If you are considering a finesse rhinoplasty procedure to improve your nasal appearance, contact our San Diego office today - trust your nose to a rhinoplasty specialist.
Before & After San Diego Rhinoplasty

#### First Plastic Surgeon Offering J Plasma
Dr. Hilinski is proud to announce that he is the first plastic surgeon in San Diego to offer the Renuvion J Plasma cosmetic technology. J Plasma, as it is often referred to online, is a revolutionary plastic surgery technology that can help patients realize cosmetic results they never dreamed possible prior to the introduction of Renuvion. The main benefit of J Plasma is to help rejuvenate aged, wrinkled skin to a more youthful, glowing appearance. In addition, it is being used to help literally tighten skin from underneath. This skin tightening includes areas ranging from the face to the neck to the abdomen.

Common conditions where J Plasma skin resurfacing can provide you with marked cosmetic improvement include the following:

 	Fine lines and wrinkles
 	Smoker’s lines (perioral rhytids)
 	Wrinkles around the eyes
 	Sagging skin
 	Discolored skin
 	Sun spots
 	Freckles
 	Rough, uneven skin

Two of the most common areas where J Plasma is being used to tighten skin from underneath include the following:

 	Upper and lower neck - including the J Plazty procedure
 	Abdominal tightening - done in conjunction with Vaser liposuction this can replace the need to do a tummy tuck

J Plasma Renuvion Consult
To learn more about J Plasma Renuvion technology from one of the region's experts, contact our office today to schedule your appointment with Dr. Hilinski.

#### Fixing a Droopy Nasal Tip
Read about correction of a droopy, or plunging, nasal tip in this latest addition to our expanding online rhinoplasty tutorial - one of the most detailed and informative resources online for prospective cosmetic nose surgery patients. This case example reviews the nuances of evaluating a droopy, or ptotic, nasal tip deformity and includes a series of before and after photos describing the changes that have taken place.

#### Fixing Protruding Ears in San Diego
Did you know that Dr. Hilinski is one of the nation's leading experts when it comes to fixing protruding ears? In fact, Dr. Hilinski is actually considered one of the world's foremost authorities on cosmetic ear reshaping - having earned an international reputation with patients coming from all over the globe to get their new ears!
Otoplasty, or ear pinning, for prominent, protruding ears is among the most common surgeries he performs. There are so many patients out there with concerns regarding how their ears look - way more than you would imagine. These patients will often present with longer hair to help hide their ears because they stick out too far.
Fortunately, Dr. Hilinski is here to help with vast experience in correcting protruding ears. If you research otoplasty surgeons in San Diego - and we mean really research them, which includes looking at their gallery of patient examples - you will quickly realize that Dr. Hilinski arguably does more of this surgery than any other plastic surgeon in town. What this means in the world of plastic surgery is that he has more patients seeking him out to fix their prominent ears than other board plastic surgeons. More photo examples of ear pinning equals higher volumes performed - it's pretty simple.

GOALS OF EAR PINNING
When having cosmetic ear pinning surgery, it is important to really understand the true goal of the surgery. It really isn't about creating a 'pretty ear' or an 'attractive ear' in the end. It is more about taking unwanted attention away from the ears. The end goal is to make the ears as least visible (or distracting) as possible. In other words, the aim is to make the ears simply look natural on the side of the head.
Here is an amazing case example of a patient who sought out Dr. Hilinski to have her ears pinned back. As you can see in the before photo, her ears, indeed, were quite prominent. Her left ear stuck out further than her right - but both ears were angled outward excessively. This made her a fantastic candidate for otoplasty ear pinning surgery.
Dr. Hilinski ultimately performed his personalized surgical technique on her - which includes his individualized method of overlapping the ear cartilage to achieve beautiful results that last a lifetime. No longer does he routinely suture the ear back to the surface of the scalp like so many other plastic surgeons do still. Instead, he meticulously reshapes and repositions the prominent ear cartilage to recreate the proper angles needed to make the ears look more vertically oriented as seen from the frontal view. As you can see here in this true life example, otoplasty can have a significant impact on one's appearance when done properly by a true cosmetic ear expert like Dr. Hilinski.
When you see Dr. Hilinski's results of ear pinning surgery, you really do have to ask yourself - why go anywhere else for your cosmetic ear surgery?

BEFORE AND AFTER EAR PINNING

#### Flabby Arms
Transform your flabby arms with the #1 non-surgical fat freezing treatment - Coolsculpting. Dr. Hilinski and his team of Coolsculpting specialists in San Diego offer the best medspa treatment to help tone up and slim your flabby arm fat.
Flabby Arm Coolsculpting
We have quite a number of patients who consult with us from South San Diego to La Jolla to North San Diego County to help in treating their flabby arms. Some of these patients are self-conscious about showing off their arms because they feel the upper arm looks to flabby. Many of these Coolsculpting candidates simply want to wear certain clothing items without worrying about their flabby arms. For instance, some look forward to the day they can put on that spaghetti strap dress. Others are looking to show off that sexy outfit for that special upcoming event. For instance, lots of women will consider Coolsculpting to slim their arms down prior to their big wedding day.

No matter what your motivation is, Coolsculpting can help you get there by targeting the excess fat along the upper arm region.
Coolsculpting for Bat Wings
You might hear some people talking about getting their bat wings Coolsculpted. This is just another way of describing excess, sagging arm fat as it can mimic the silhouette of bat wings where the outline of the arm can be viewed as hanging down. This is noted in the adjacent photo where the arrows help to indicate how the arm fat and skin can appear to 'drape off' the arm when it is held out to the side of the body. This is also the area that can contribute to too much jiggle when some patients move their arms in certain clothing that exposes this zone.

Whether you are discussing bat wings or flabby arms, it is all in reference to the unwanted arm fat that can be effectively treated and improved with Coolsculpting treatment.
Get Rid of Flabby Arms
So how do you get rid of flabby arms and bat wings? Well, the first recommendation is to workout regularly - specifically doing exercises that help target the triceps area of the arms. Eating healthy is also recommended. If both of these fail to help improve your flabby arms, then Coolsculpting is a great option for you.

Can you undergo liposuction for flabby arms? Absolutely. But liposuction is an invasive surgical procedure that necessitates some degree of downtime and recovery. For those people who don't want to risk surgery and don't wish to deal with the surgical recovery of liposuction, Coolsculpting is the best alternative to treat those flabby arms.

Coolsculpting is the only FDA-approved treatment option to simply freeze that flabby arm fat away. In addition, Coolsculpting has been FDA approved to help tighten skin in areas where the fat is frozen. This can be a huge advantage once the fat has been reduced in the arm region. In many cases, nearly a 20% reduction in fat can be consistently seen after just one Coolsculpting treatment session. In patients who elect to do a series of Coolsculpting arm fat reduction sessions, the results can be even more dramatic.
Flabby Arm Coolsculpting Results
Shown below is a typical result that we see with Coolsculpting of the arms. This patient underwent dual sculpting by San Diego's #1 medspa Coolsculpting team - meaning she had treatment of both arms done simultaneously. This means her actual treatment time was cut in half compared to many other Coolsculpting practices in San Diego. The end result after this single Coolsculpting treatment is an arm that has less of a flabby appearance and more tone. The skin also appears tighter after Coolsculpting. In addition, you can now more easily see the outline of her triceps muscle. This is considered a very nice result for a medspa treatment that is done with no needles, no surgery and no downtime in an effort to tone and tighten those flabby arms.

#### Flatter Stomach No Surgery!
So what does it look like when patients get sequential Coolsculpting treatments done? Here is great example of how flat your stomach can get from one and two sessions. This patient from San Diego decided to get Coolsculpted around the abdominal region to achieve a flatter stomach. After just one session, you can see her results here in the middle photo. When comparing her contour and look prior to Coolsculpting, you can see there is a significant overall improvement. Her tummy appears flatter and more tone - and she has a much slimmer waist. She then opted to do a second Coolsculpting treatment several months later to get even better results. The photo on the right shows her evolving results. As you can see, she was able to get an even flatter stomach. And the tone and tightness of her skin around the mid-section is much improved as well. In fact, if you compare her before photo with the latest photo, the results of Coolsculpting are so good, she literally looks like she could have had liposuction or tummy tuck surgery. Yes - freezing fat away without any needles and without any downtime can help achieve cosmetic results that rival surgery!

#### Flatter Tighter Tummy
Another fantastic result from San Diego's best Coolsculpting office! This young lady desired to have a flatter, tighter tummy - but didn't want to undergo an invasive liposuction procedure. Like so many patients out there, she opted to have her fat frozen away without needles and without any downtime. She chose to have Coolsculpting performed by Dr. Hilinski's medspa team of fat freezing specialists - including our graduates from Coolsculpting University. The patient underwent freezing of her lower abdominal fat during a comfortable, office-based procedure where she literally sat in front of a television while the treatment was completed. An hour or so later and she was able to drive away - with no recovery involved. Results shown here are about  3-4 months out from just that one Coolsculpting treatment session. As you can see for yourself, there has been quite an improvement noted in her lower abdominal region - with a much flatter, tighter tummy thanks to freezing of the fat. Are you looking for some help to flatten your tummy? Call San Diego's #1 medspa for Coolsculpting fat freezing treatment!

#### Flatter Toned Tummy | Downtown | Point Loma
It's not too late to still get that summer body! Especially in San Diego where the sun is out most of the year. Take a close look at these amazing Coolsculpting results courtesy of the medical spa staff of Dr. John Hilinski. This young lady wanted to tone up and get rid of some extra fat, which was resistant to regular exercise and a healthy diet. As a past patient of our office, she entrusted the team of Coolsculpting specialists that Dr. Hilinski has built to help patients just like her. Like so many patients considering Coolsculpting, her first choice was to have something done without all the risks of surgery - nor the recovery involved with liposuction and lipocontouring.
Want a Flatter Tummy?
Her main concern - which is one of the most common complaints amongst our patients - was the excess fat around the tummy region. What we are really talking about is the area circumferentially around the belly button - or the umbilicus as it is officially known to plastic surgeons. She, by no means, was considered overweight, but she did desire to be a bit more toned with a flatter stomach. And although a steady diet and vigorous exercise can help many patients, there is a good percentage of people who simply won't get their tummy any flatter without additional help.

This is where the world's #1 fat freezing technology - Coolsculpting - comes in to save the day. Undergoing surgical liposuction is definitely an option - and one that a lot of people ultimately choose to have done. But what if you don't want surgery? What if the thought of making scars around the tummy is not something you are willing to do at this point? Fortunately, Coolsculpting is entirely non-surgical and can help patients achieve cosmetic results that can rival what they might see with surgical lipo-contouring. And this is done without making any cuts - so no scarring. And there is essentially no downtime associated with fat freezing.

It will take a few weeks to months in order for you to start seeing a flatter tummy from Coolsculpting. And the results usually get better over the following 3-4 months.

In many cases, our patients elect to have a second or even third Coolsculpting treatment done in order to get an even flatter tummy.
Coolsculpting Results
So what about this patient's Coolsculpting results? Here they are below! You can now see - especially on her oblique views - just how much reduction in fat was accomplished with Coolsculpting. And these results are after just a single treatment session. Her tummy is now much flatter - which is easily appreciated in just two dimensions on her frontal view. And when you start to turn her to the side, you can readily see a beautiful new figure with a more toned abdomen region. Imagine what she would look like if she had 1-2 more fat freezing sessions.

Coolsculpting in San Diego
Do you have unwanted tummy fat? Do you want a more toned, flatter abdomen region? Don't want surgical liposuction? Call the office of Dr. John Hilinski today to consult with San Diego's #1 Coolsculpting team.

#### Flatter Tummy
See what Coolsculpting was able to do for this San Diego woman who desired a flatter tummy! This patient underwent an initial Coolsculpting treatment that provided her with a significant improvement in fat reduction around the tummy and hips. She then elected to undergo a second fat freezing session with San Diego's best team of Coolsculpting specialists. Shown here is her progression through the treatments. After just one Coolsculpting session, she had a very nice result. But, like many patients who love the changes from Coolsculpting, she wanted even more! You can see here what that second session of freezing fat did - giving her an even flatter, more shapely tummy. As we talk about all the time, you can also see that the skin even looks tighter from freezing the fat. In fact, many plastic and cosmetic surgery experts will tell you that Coolsculpting outcomes like this rival tummy tuck results - just without the scarring, invasive surgery and intense recovery. If you live in the greater San Diego area and have unwanted fat around the tummy and hips that is bothering you, contact our office today to consult with the best Coolsculpting specialists around.
Flatter Tummy Results

 

#### Flatter Tummy Over Time
See how Coolsculpting results can improve over time long after the treatment has been completed! This female from San Diego desired non-surgical body contouring with Coolsculpting to help target unwanted belly fat. She really desired to have a flatter tummy since this was one area that continued to bother her despite eating healthy and maintaining a reasonable exercise regimen. But she didn't want to have liposuction given the more invasive nature of surgical fat removal. After researching her options, she decided to go with Coolsculpting as offered by Dr. Hilinski and his incredible medical spa staff.

She underwent 2 different treatment sessions that were done to help sculpt her tummy fat. The procedures were performed in our Coolsculpting treatment room, which is set up to make patients feel comfortable and relaxed as their fat is frozen away. The treatments took about 90 minutes each with literally no downtime. In fact, this patient is a registered nurse and was back to work the following day without any complaints at all and no disruption in her work schedule. This is pretty typical for our patients seeking non-surgical fat reduction - regardless of what area is being treated. Her Coolsculpting treatments were separated by about 6-8 weeks in order to allow her body to process the fat that was frozen away during the 1st session.
Coolsculpting Progress
So here is her result approximately 1 month after the 2nd Coolsculpting treatment. As you can see on these oblique photos of her tummy, she has quite a nice improvement. Her tummy fat is definitely reduced and her abdomen looks flatter. Does she still have some residual excess tummy fat? She certainly does. However, there is a marked improvement as you can readily see. And if you asked the patient, she was quite excited about the cosmetic improvement in her abdomen noted at this point.

The good news is that many Coolsculpting patients will continue to see more cosmetic improvements in their body months after the initial changes are seen - including this patient here. The key is to make sure you are continuing to maintain a healthy diet along with regular exercise. If you gain any significant amount of weight after Coolsculpting the improvements seen may not be noticed at all - which is precisely the same thing that happens when you have surgical liposuction. So as long as you don't change your daily habits considerably - meaning you eat healthy and exercise, the cosmetic enhancements from the fat freezing session(s) should continue to get better.

To prove this point, we have provided a series of photos of this same patient several months after she completed her abdominal Coolsculpting. And as you can readily appreciate, her tummy is even flatter 2 months later without any intervening treatment being done! This is because some of the fat that was frozen during Coolsculpting was still getting absorbed away by the body when the 1 month after photos were taken. In addition, her skin was still shrink wrapping down to the new smaller waistline that Coolsculpting was able to provide her. These physiological processes can take upwards of several months in most patients, which is why we usually reserve judgement on Coolsculpting results for this period of time. So if you look at this case example 3 months after her fat freezing was completed, her tummy is even flatter than it was at 1 month.

Before and 3 Months After
And if you directly compare her Coolsculpting results from before to 3 months after, there is even more of a distinct improvement seen. In fact, this type of non-surgical cosmetic enhancement really does rival what some patients get from surgical liposuction of the tummy - but without the incisions, scars and risks!

#### Flatter, Tighter Stomach in Your 40s
Want to get a flatter, tighter stomach without surgery? Get Coolsculpted today by Dr. Hilinski's team of fat freezing specialists! Coolsculpting is an incredibly effective, non-invasive, no downtime cosmetic fat reduction treatment that allows you to contour down unwanted stomach fat to achieve that shape you always wanted.

This patient shown here is in her 40s and had some problem areas, including her stomach/abdominal region. She elected to undergo Coolsculpting by our team of experts. This included freezing her fat around the abdominal region. After just one treatment, you can see a fairly marked improvement in the stomach region - with flatter, tighter abdominals. If you look even closer, you can easily appreciate how the skin around her belly button looks even tighter. And all this improvement was realized after just one Coolsculpting treatment! No downtime, no needles and no recovery was involved.

If you are in your 40s, workout regulary, eat healthy and still want a flatter, tighter tummy - contact our office today to see one of our Coolsculpting specialists to freeze that fat away!

#### Follow Us On Facebook!
Dr. Hilinski and his staff welcome everyone to check us out on Facebook! You can find the latest patient stories, office specials and lots of other great insider news! Be sure to share with your friends and we look forward to seeing you there!

#### Follow Us on Instagram!
Dr. Hilinski and his staff invite you to follow us now on Instagram at drhilinski! We look forward to adding new photos on a regular basis to keep you updated on office happenings as well as upcoming specials. And don't forget to 'like' those photos you think deserve it!

#### Forehead Lift Suspension For Crooked Eyebrow Position
Many patients inquire about crooked eyebrow position, also known as asymmetric eyebrow positioning, and whether or not a browlift might help. What they are referring to is the actual position and shape of the eyebrows. In a good majority of people, the eyebrows naturally sit differently on both sides of the forehead - one side is usually higher than the other. Most of us are simply born this way. In most social situations and conversational environments, however, this difference in eyebrow position is not really obvious to others. There are definitely patients, though, who are bothered by the fact their eyebrows have a different shape when comparing the two sides. In fact, so much so, they seek out a facial plastic surgeon to help enhance the symmetry in the eyebrows. This particular patient is one such example and is presented here.
Eyebrow Lift Patient Presentation
This patient was unhappy with the fact her left eyebrow was lower and flatter than her right eyebrow. Again, many patients might look at this and not put too much emphasis on this natural difference between the two eyebrows. However, there are a good number of patients who present to us facial plastic surgeons each year seeking correction of crooked eyebrows. One option that is quite common is using botox injections to help create more eyebrow symmetry by lifting the one side. Unfortunately, many patients, like this one, are looking for a more permanent surgical correction. In this particular patient, we recommended an eyebrow lift, which is also known as a brow lift or forehead lift (suspension). This is a cosmetic eyebrow procedure intended to lift the brow region to reposition and reshape the lower forehead. This can be done using what is called an open brow lift approach where incisions are hidden in the hairline to perform the forehead suspension. Alternatively, an endoscopic brow lift can be done (also called an endobrow lift) where limited incisions are made and small surgical telescopes are used to perform the forehead lift. Each one has its own advantages and disadvantages that will be reviewed with your facial plastic surgeon to determine the best choice for your individual case. In this particular patient, she chose to have the open approach brow lift surgery.
Eyebrow Lift Surgery Photos
Her before and after eyebrow lift photos are shown here. As you can appreciate there has been a notable enhancement in her eyebrow position and shape on her left side. This side of her forehead was lifted more preferentially to try and achieve the desired symmetry. Using meticulous surgical technique and permanent sutures, her left eyebrow was lifted and repositioned in a higher location to create a more feminine arch-shaped eyebrow. As is noted in the photo diagrams, her left eyebrow was previously quite flat across as is indicated by the blue line. Following the forehead lift, or brow lift, it was more arched to match her right side as indicated by the red curved line. Certainly some people may look at this and think - subtle change. But in many cases of facial plastic surgery, this is precisely what is desired and needed - a visible cosmetic improvement in an area without looking surgical altered. And in the case of an eyebrow lift, avoiding that unwanted surprised look that so many patients fear.

San Diego Brow Lift Consultation
If you or someone you know is interested in having an eyebrow lift (forehead lift) to enhance the appearance of their brows, please contact our office today to arrange for a complimentary consultation. You can also learn more about cosmetic facial enhancement of the eyebrow region by visiting our comprehensive website at https://www.drhilinski.com. We look forward to meeting you.

#### Free Latisse! Get Longer, Fuller, Darker Lashes...
The Hilinski Clinic is now offering FREE LATISSE with purchase of either Botox or Juvederm! Latisse is the only prescription treatment available to help make your eyelashes longer, fuller and darker. Eligible patients can now receive a free box of Latisse (a $100 value) from the Hilinski Clinic with any concurrent purchase of Botox wrinkle treatment or Juvederm soft tissue filler treatment. Call us today to schedule your appointment. Visit us online at https://www.drhilinski.com

#### Freeze Fat or Sculpsure
We have been asked on several occasions by Coolsculpting patients to make a comparison with Sculpsure. Some patients even come in questioning whether or not Coolsculpting and Sculpsure are very similar. Both technologies are quite popular as non-surgical methods to help improve your body contour while reducing unwanted, excess fat. But there are major differences in the technologies that warrant some explanation - and are the reasons behind why Dr. Hilinski and his staff prefer to freeze fat away with Coolsculpting.

One advantage that Coolsculpting has over Sculpsure is the number of areas that are approved by the FDA for eliminating fat. Coolsculpting is currently FDA approved for treating more areas of the body, which includes the chin, abdomen, flanks and thighs.

Some of this relates to another advantage of Coolsculpting - the fact it has been on the market much longer than Sculpsure. Coolsculpting was approved for use back in 2010 while Sculpsure was approved in 2015. Consequently, Coolsculpting technology has been tested and validated more times over than Sculpsure. Just think of Coolsculpting as having a much more thorough track record within the plastic surgery community. Will Sculpsure eventually be proven to have such a solid track record? Maybe. But at this time, Coolsculpting is the clear winner when it comes to being time tested for non-surgical fat reduction and elimination.

One of the other main advantages of Coolsculpting is the fact that most patients will see a substantial change in the contour of their body after just one session or treatment. In comparison, Sculpsure patients will often times require more treatment sessions to attain similar results as are seen with Coolsculpting. The end result is that Sculpsure patients may end up paying significantly more in terms of cost of treatment.

Want to learn more? Contact our office today to schedule a personalized consultation with our team of certified Coolsculpting experts.

 

 

 

#### Freezing Fat in Older Patients
This is a nice case example of how Coolsculpting can be performed in patients who are a bit older than average. This lady from San Diego is 75 years old and simply desired to have some contouring of her mid section, or tummy. Unfortunately, invasive liposuction of the abdomen was just not in the cards given her age and lifestyle. So what options did she have to slim down her tummy region? Coolsculpting, of course!

Coolsculpting was a fantastic choice for her because it is completely non-invasive. Meaning, she could drive to the office and head home immediately with no downtime associated with the fat reduction treatment. In fact, our Coolsculpting treatment room is setup so that you can even watch TV while getting the fat frozen away. Or you can catch up on emails and missed text messages while getting Coolsculpted. For patients who are a bit older than the average Coolsculpting patient, this is a great alternative to undergoing surgical liposuction.

In this case, she opted to have 2 sessions of Coolsculpting to the abdomen region. She also opted for 1 session of a flank treatment with Coolsculpting. As the weeks and months unfolded after Coolsculpting, she began to notice a nice, steady decline in the girth of her mid section. Undoubtedly, her clothes started to fit a bit looser as the pounds started to disappear.

Here you can see her before and after images following the 2 Coolsculpting sessions performed by San Diego's #1 team of fat freezing specialists. From each of these oblique angles, you can readily appreciate how much fat has been frozen away around her tummy. Does she still have a good amount of fat across the mid section? Absolutely. But has she lost several inches around her waistline from the Coolsculpting treatments? You bet. And for many patients - particularly those who are more elderly and cannot work out as vigorously as they once did - this type of Coolsculpting transformation is just what they needed to feel better about their body short of undergoing the knife.
Coolsculpting Fat Reduction

#### Freezing Flank Fat in San Diego
Take a look at this absolutely amazing Coolsculpting transformation performed by Dr. John Hilinski's incredible medical spa staff!

This male patient from San Diego wanted to do something with his excess flank fat. Just like so many men out there - he tried to eat right and attempted to work out regularly. Unfortunately, the reality is that many men who do this still have problematic areas where excess fat simply won't go away! In this particular instance, the area was the flank - as can be seen here in the adjacent photo. Based on this examination, Dr. Hilinski and his medical spa staff recommended Coolsculpting to help freeze away much of the excess fatty layer in the flank. Could this patient have undergone liposuction surgery to reshape his hips and flank? Certainly! But his preference was to have a procedure done in the office setting that did not involve any surgical downtime, incisions/scarring and pain/discomfort. One of the only cosmetic treatment alternatives that satisfies this description is Coolsculpting. In fact, Coolsculpting is the only FDA-approved medical spa procedure that can freeze fat away using proprietary technology, which does not involve needles or any significant downtime.

Ultimately, this guy ended up undergoing a series of Coolsculpting treatments because he understood that 'stacking' fat freezing treatments like this would likely result in much better cosmetic results. Now not everyone needs to have a series of treatment with Coolsculpting. But out of those that choose to do a series of treatments, the cosmetic outcomes with Coolsculpting tend to be much more impressive.

With this particular cosmetic fat reduction treatment, patients are able to literally relax in our comfortable Coolsculpting treatment room. Because freezing fat has minimal discomfort associated with it, patients can play on their phones and/or watch TV as the treatment is completed. Each Coolsculpting session in this specific patient lasted about 60 minutes. Once done, the patient was able to drive home and resume his normal daily routine later that day. Yes, that is right - no downtime and no recovery!
Coolsculpting Flank Fat Results
Shown here are his actual Coolsculpting results, which demonstrate an amazing cosmetic improvement in the flanks. Whereas he had a number of unwanted flank fat folds prior to Coolsculpting, he now enjoys a markedly more shapely waist. If you look closely, you can also appreciate how much tighter his skin now looks. That is because Coolsculpting has also been known to help tighten the loose skin after the excess fat is frozen away. As you can imagine, he likely has also had  a significant reduction in his pant size since having Coolsculpting treatment. What an incredible change for someone who didn't have to undergo surgery to get this type of cosmetic improvement.

#### Galderma Preferred
Dr. John Hilinski and his staff are proud to be recognized by Galderma as a preferred center for cosmetic treatments. Galderma is the manufacturer of several products used by Dr. Hilinski on a regular basis. These include Dysport, Restylane, Resytlane Lyft, and Sculptra Aesthetic. All of these products are wonderful choices for patients of all ages to help keep them looking their best. Call our office today to discuss which Galderma product may be best for you!

#### Gauge Earring Repair - Torn Earlobe Repair in San Diego, CA
We are now seeing an increasing number of patients coming to our practice for repair of their gauge earring defects involving their earlobes. This is yet another example of a patient who previously had gauges in his ear and decided to stop wearing them. Unfortunately, like many patients out there, the remaining hole, or defect, in the earlobe was still quite visible. As you can see in the photos provided here, the hole can be seen even from across the room. He finally consulted with our office to discuss his options. I ended up recommended what is considered a standard office-based surgical procedure (otoplasty or ear reshaping) to repair the gauge earring defect. This was done under local anesthesia much like going to the dentist. The procedure took about an hour to do both ears, which had gauge earring defects. The adjacent skin of the earlobe was used to close the holes on both sides. Using meticulous suture technique, both defects were able to be closed very nicely. As you can see here, the end result is a very fine scar that is barely visible to the naked eye. The earlobe now looks essentially completely normal without any signs of having undergone a surgical procedure. If you have had gauged earlobe piercings in the past and are now looking to have the gauge earring defect closed, contact our office today to schedule a complimentary consultation with one of San Diego's foremost experts in otoplasty surgery.
Before and After Gauge Earring Defect Repair

#### Gauge Earring Repair Updates
With an increasing number of patients requesting repair of gauged earring holes, we have just added a new page to our growing plastic surgery website that focuses on the nuances of how the earlobe is repaired following gauge piercings. We hope this proves helpful to those prospective patients out there who are considering surgical closure of a gauged earlobe hole.

#### Gauge Repair in San Diego
This photo example shows why Dr. Hilinski is considered San Diego's premiere gauge earring defect repair expert. He has extensive knowledge and experience performing this operation and does so on a very regular basis. In fact, Dr. Hilinski is one of only a few plastic surgeons who has actually published a medical paper on the topic of gauge earring defect correction. Although many plastic surgeons perform this type of cosmetic ear surgery, many do so without being able to create a natural looking earlobe for the patient. This case example here is very representative of Dr. Hilinski's amazing work in the area of gauge earring repair highlighting his ability to create natural looking earlobes.
Gauge Earring Repair
Shown here are this patient's photos before surgery - where you can see a fairly extensive defect in the earlobe as a result of the gauge earrings worn for years. The middle photo shows his ear 1 week out from Dr. Hilinski's correction - where you can still see the slight ridge where the sutures (stitches) were carefully placed. The shine you see in the photo is due to the ointment the patient was applying to the incision to keep it clean. On the right is the ear many months down the road as they have healed over time. What an incredible transformation for this young man as he closes the chapter on his gauge earrings. Once again he has essentially normal looking earlobes with almost no sign of ever having had gauge earrings!

Before Surgery

1 Week Out

Months Later

#### Get $50 Off Dsyport And Get Ready For The Holidays!
The Hilinski Clinic is happy to announce our 2010 Dysport Holiday Offer! With a savings of $50 off a treatment session with Dysport, now there’s even more reasons to try Dysport - the only alternative to Botox for treatment of unwanted lines and wrinkles. Get ready for the fast approaching holiday season by getting your Dysport today. This promotion is available for a limited time, for treatments received from November 1 through December 31, 2010. So forward this message to your friends and family as soon as possible. We look forward to seeing you at the Hilinski Clinic of Facial Plastic Surgery.

#### Get Rid of Bra Fat
So many women between 35 years old and 55 years old struggle to deal with unwanted bra fat along their back. This is also referenced as bra bulge and bra overhang. Unsightly bra fat is especially common amongst post-menopausal women within this age range. Even with the benefit of fat burning workouts to reduce bra fat, most women will notice a little extra bulge that can detour them from wearing certain outfits.

Fortunately for this population of women, Coolsculpting was invented to help literally freeze that bra fat away! Bra fat removal is easily done with no needles, no invasive equipment, and no surgical downtime. What could be better? If it is that easy, why not schedule your consult today with Dr. Hilinski and San Diego's #1 Coolsculpting team.

Dr. Hilinski and his Coolsculpting specialists offer Dual Sculpting for bra fat - which means you can have both sides treated at the same time to reduce overall treatment time in half. That is because Dr. Hilinski's San Diego office has two - that's right two - Coolsculpting machines. Many offices treating excess bra fat by freezing it away only have one Coolsculpting machine. This means you have to treat one side first - then go to the other side to reduce the bra fat. This takes twice as long as Dual Sculpting does. So why not schedule your bra fat reduction procedure today with Dr. Hilinski?

#### Get Rid of Smoker's Lines
Are you seeking to get rid of unwanted smoker's lines around the mouth? Do vertical lip wrinkles detract from your appearance? Well you are not alone. Take, for instance, this patient from San Diego who had developed lip wrinkles over the years and wanted to have them smoothed out.

In years past, patients like her who have somewhat darker skin pigmentation would not be considered great candidates for laser skin resurfacing. That is because the new skin has a higher risk of pigmenting in an abnormal manner.

So what other options are there for vertical lip wrinkles like this? Well, there is the other option of trying lip filler injections, such as Restylane and Juvederm. But these fillers are not great when it comes to filling the vertical lip lines also referred to as smoker's lines. Even with meticulous injection technique outcomes can be unpredictable with undesirable lumpiness along the upper lip.

Because of the paucity of options for treating upper lip wrinkles, we welcomed the introduction of the plasma pen! Dr. Hilinski and his medical spa staff are one of the first cosmetic practices in San Diego offering plasma pen skin treatment. Plasma pen works by tightening the upper lip skin - specifically by targeting the skin in between the individual lip wrinkles. As the skin is tightened by delivery of plasma energy, the wrinkles begin to disappear and the skin becomes tighter and smoother. Like all areas of plasma pen treatment, the brown and black dots will be visible for several days before simply fading away. So downtime with upper lip plasma pen treatment is relatively short.
Lip Plasma Pen Results
Here are this patient's before and after photos following just one session of plasma pen for her upper lip wrinkles. As you can easily appreciate, her upper lip vertical wrinkles have been markedly improved with use of the plasma pen. The upper lip now appears smoother and the skin looks tighter - features that are the hallmark of plasma pen treatment in general. And you can see there are no issues with skin pigmentation - lighter or darker - after the plasma pen treatment. Nor are there any issues with bumpy contour irregularities. Plus, the changes seen here should last for several years to come as collagen remodeling is at the root of plasma pen skin enhancement.

Lip Plasma Pen Consult
If you have unwanted vertical lip wrinkles, or smoker's lines around the mouth, and you are looking to get the best possible cosmetic results, contact the office of Dr. John Hilinski today. Schedule your plasma pen upper lip smoothing procedure with San Diego's best medical spa, R.N., Kellie Hartman.

#### Get Your COVID Creases Treated
We are so happy to announce that our office is now back open and offering cosmetic Botox injections! Kellie, our amazing aesthetic RN, is available for all of you patients who have been anxiously waiting to get rid of those pesky 'COVID creases' that popped up during the quarantine!

Of course, we have implemented many precautionary measures within the office to help combat the spread of COVID-19. We realize these added measures may be inconvenient for you, but we all need to be responsible. We thank you in advance for your patience.

Kellie is offering Botox and Dysport injections mainly for the upper face region. After all, you will be required to wear a mask when visiting! But this type of Botox treatment includes the entire forehead region as well as the crow's feet - which is what a great majority of our patients have done anyway.

So if you are ready to resume getting your Botox cosmetic injection treatment, call our office today to get on our schedule as soon as you can. Kellie's schedule is filling up fast!

#### Getting Rid of Extra Baggage
This is a typical case example of an elderly patient with unwanted 'bags' under the eye. This is a fairly common complaint that is a result of fat pushing out from under the eye. A lower eyelid procedure was performed by making an incision inside of the eyelid so that all external scars can be avoided. The excess fat is removed - leaving the lower eyelid with a more favorable shape and contour.

#### Getting Rid of Sagging Face and Neck Skin?
Come see what an expert, board-certified facial plastic surgeon can do for your sagging neck skin! This is a 50 year old female who disliked the sagging skin along her upper neck and jowl region. I ended up performing a lower face and upper neck lift to get rid of this excess, loose skin. The end result shown here speaks for itself!

#### Getting to Know Sculptra Aesthetic!
To help determine if Sculptra Aesthetic is right for you, we have answered a few frequently asked questions.

What is Sculptra Aesthetic?

Sculptra Aesthetic is a facial injectable designed to replace lost collagen, correcting shallow to deep wrinkles and restoring lost volume. Sculptra's primary ingredient is poly-L-lactic acid (PLLA) - a biodegradable, biocompatible material that has been used by plastic surgeons for many years. PLLA is also commonly found in sutures used during surgery. Sculptra works deep in the skin to stimulate your own collagen production. Many patients enjoy the natural look of Sculptra due to the gradual results of just that - your own collagen production! Collagen keeps the skin looking youthful and smooth. As you age, your body's collagen production decreases and you may begin to see wrinkles and/or volume loss. Sculptra works to correct this issue by replacing that lost collagen, which can help provide a more rested looking appearance.

Am I a Candidate?

If you are bothered by any fine lines, wrinkles and/or volume loss throughout your face, you may be a candidate for Sculptra treatment! Sculptra can benefit patients in a wide range of age groups - whether you’re in your 50s and are looking to restore lost collagen and volume, or you’re in your 30s and wish to add more fullness to your cheek area.  Here are a few common treatment areas:

	Deep lines between the nose and the mouth (nasolabial folds), known as "smile lines"
	Lines framing the mouth, known as "marionette lines"
	Jowl and pre-jowl areas
	Wrinkles around the chin
	Hollow or sunken areas under the eyes
	Hollow or sunken areas of the cheek and/or mid face
	Hollowing in the temple area

As an added bonus, Sculptra can also improve the skin’s texture. Many patients have noticed an improvement in their skin’s overall appearance in the areas treated with Sculptra, adding even more youthfulness!

How long do results last?

Sculptra is rapidly becoming a physician and patient favorite, mostly due to the long-term, natural looking results. Sculptra is best known for being one of the longer lasting injectable treatment options. The natural looking results of Sculptra emerge over time, typically over a few weeks to a few months, and can last upwards of 2 years. Patient results may vary, as everyone develops and retains collagen at a different rate. Sculptra can be a great alternative or addition to the shorter lasting hyaluronic acid fillers, like Restylane and Juvederm. Click here to read about the differences between Sculptra and other injectable fillers.

What is the downtime?

Another one of the many great things about Sculptra is that it does not require much downtime. Patients are a bit puffy or swollen immediately following treatment, but this fullness subsides in about 24-48 hours. As with most injectable treatments, it’s usually a good idea to clear your schedule for a few days following treatment, just in case you experience any bruising or undue swelling. If any bruising does occur, it usually clears up within a few days. Most patients do not experience any major bruising and/or obvious swelling.

What can I expect during my appointment?

Check out this post here, in which we discuss a Sculptra treatment from start to finish!

What is the cost of Sculptra?

Treatment costs can vary from patient to patient, depending on the total number of vials recommended by Dr. Hilinski. Most patients require either 2 or 3 treatment sessions, involving 1-2 vials each visit. Treatments are typically spaced apart by about 6-8 weeks.

Is Sculptra FDA approved?  Are there any side effects?

Yes, Sculptra is FDA approved in the United States and has been used by plastic surgeons for many years. Most patients do not experience any negative side effects, but as with other injectable fillers, some reported side effects include injection site pain, redness, bruising, nodule formation, bleeding and/or swelling.

Before Sculptra

After Sculptra
Contact Us
To learn more about Sculptra® Aesthetic, please contact us today or call (619) 296-3223. We look forward to seeing you soon!

#### Glacial Rx for Inflamed Skin
Did you know that revolutionary Glacial Rx skin treatments can help improve inflamed skin?

In addition to helping reduce unwanted sunspots, aged spots and other skin blemishes, this cutting-edge freezing technology has been shown to greatly improve inflamed, erythematous (red) skin conditions. The beauty of Glacial Rx is that it can do so with minimal downtime and healing. In fact, as we say to our patients, think of Glacial Rx as the "Promise of a laser. The luxury of a facial" because there is such little downtime.

JH Medical Spa is one of the first clinics in all of San Diego to have Glacial Rx skincare technology and we are super excited to show you how and why nearly everyone should consider getting they face frozen!

#### Goodbye Crow's Feet!
Want to get rid of your crow's feet wrinkles? Do you have unwanted deep lines around the eyes? Why not consider the incredible plasma pen treatment offered by Dr. John Hilinski and his medical spa staff?

The plasma pen utilizes specialized technology to treat skin wrinkles and creases to help smooth and tighten your skin without surgery. Plasma pen crow's feet smoothing is done in the office setting using only topical anesthesia. Yes. That is correct. There are no injections needed to have plasma pen treatment performed. We normally recommend patients apply a topical numbing cream about 45 minutes prior to their scheduled appointment time. By the time you get to the office and have your plasma pen treatment, there is very little discomfort.

Dr. Hilinski and/or his aesthetic nurse, Kellie, will then perform the non-invasive skin tightening procedure using their plasma pen. The treatment is done by area - so in this case Kellie targeted the crow's feet to help reduce the coarse wrinkles and lines around the sides of the eyes. Although Botox and Dysport are still great options for treating dynamic wrinkles that form around the eyes, the plasma pen has been a game-changer to smooth out the wrinkles seen while at rest. In this particular instance, this patient was bothered by just that - the deeper wrinkles that outlined her lower eyelid and extended up to the outer part of her upper eyelid-brow.

The crow's feet plasma pen treatment took about 20 minutes to complete. At the conclusion of the treatment her skin appeared slightly red with mild swelling of the tissue - which is completely normal. She had the usual brown and black dots consistent with the pattern of the plasma pen treatment. These began to fade away within 3-5 days - leaving her skin looking fairly presentable by that period of time.

The plasma energy helps to tighten key components within the skin layer, which includes stimulation of fibroblast cells that help to tighten and rejuvenate the skin. This is why plasma crow's feet treatment is also commonly referred to as fibroblast skin tightening by many offices.
Crow's Feet Erased
And here she is nearly 2 months after 1 plasma pen treatment around the crow's feet. Just a quick glance will tell you that her crow's feet wrinkles have now been essentially erased! You can see for yourself that there has been a dramatic improvement in the creases and lines and no evidence that she had a procedure done. This is the magic of plasma pen technology. If you have crow's feet lines and wrinkles that are bothering you, why not undergo this amazing office-based, cosmetic treatment today? Contact San Diego's best office for plasma pen and fibroblast skin tightening.

#### Great Botox Results in San Diego
Best Botox Results
How does San Diego's leading plastic surgeon, Dr. Hilinski, get such amazing Botox and Dysport results on a such a consistent basis? First of all, Dr. Hilinski has unparalleled training here in San Diego when it comes to Botox and Dsyport treatments for unwanted wrinkles. He is a Harvard Medical School graduate with double board certification in the field. Dr. Hilinski knows the anatomy of how the face muscles move and work - and applies that advanced knowledge to each and every patient he treats with Botox and Dysport.

But one thing that Dr. Hilinski does - and many other Botox and Dysport clinics do not do - is he creates a digital 'road map' of your personalized Botox and/or Dysport treatment during each office visit. In doing so, Dr. Hilinski can maximize your results with Botox and Dysport by being as consistent as possible when he needs to be.
Botox Diagrams

As is shown here in the adjacent digital diagram taken from his electronic medical record system - the exact location of injection and dosage of Botox or Dysport is indicated by each of the colored dots. For example, the green dots may represent 2.5 units of Botox injected in each spot and the blue dots may represent 1.25 units of Botozx injected in each spot.

So when it comes time for your next office visit and treatment, Dr. Hilinski can simply replicate this Botox or Dysport map - or he can change things up to further customize your cosmetic treatment. By maintaining such consistency and detailed documentation, Dr. Hilinski and his staff are able to provide the best results when it comes to Botox and Dysport treatments here in San Diego.

#### Guess the Difference!
It is often said that the best plastic surgery is the type you cannot detect. I think this particular patient exemplifies just that - she looks improved and more rested - but has no obvious signs or stigmata of having had facial plastic surgery. But what has changed in the before and after photo? Guess what she had done and post your answers here!

#### Hand Rejuvenation
Many patients don't realize how much their hands will age them. But the reality is that your hands can be an obvious tell-tale sign of aging. In most instances, patients notice how the back of their hands begins to look almost skeletal-like. This is largely due to a loss of volume in between the tendons on the backside of the hand. As this volume loss gets worse, the back of the hand starts to appear prematurely aged - as if they belong on someone who is much, much older.

Fortunately, we can help with a quick office-based procedure that can rejuvenate your aged hands within minutes. Here is a fantastic example of this medical spa treatment that was performed by Dr. Hilinski. This patient was in her late 60s and was bothered by the fact that her hands aged her. She was a ballroom dancer and was feeling self-conscious about having her hands exposed on her younger partners' shoulders. When she found out we had a simple treatment option for her, she jumped at the opportunity to have Radiesse filler injected into the back of her hands.

Radiesse is one of only two FDA-approved injectable fillers that can be used to rejuvenate the back of the hands as an anti-aging treatment. In this case, Dr. Hilinski used a couple of syringes of Radiesse to fill in the shallows in between the various tendinous structures on the back of her hand. During the treatment, the Radiesse is then molded by Dr. Hilinski to help it blend smoothly and evenly across the hand. Within just a few minutes, the hands of time are turned back on the hands of the patient! In many cases, Radiesse can make the hands look a good 10 years younger.

See for yourself here in this patient's before and after photo - which shows how incredibly effective Radiesse hand injection can be in reversing the signs of aging. If you don't like how your hands are aging and are looking for an office-based treatment, contact our office today to schedule an appointment with one of our medical spa experts.
Radiesse Hand Treatment

#### Happy Holidays to All Of Our Patients and Colleagues!
I just wanted to take a moment and wish all of our patients and colleagues a happy 2011 holiday season! We are truly grateful and honored to have such an amazing group of loyal patients and trusted colleagues who motivate me everyday. From the San Diego Face and Neck Specialties family to yours - Merry Christmas!

#### Having Smaller Ears is Possible!
We just had to post this personal account of a patient who came to see Dr. Hilinski to get her ears made smaller in size. We are so honored to be part of these life-changing operations for patients like her!!
I started doing research for ear surgery about 20 years ago. I had a consultation with a surgeon and she recommended otoplasty, but I knew that’s not what I wanted. When I asked about making my ears SMALLER, she said it wasn’t possible. I lost hope and shelved the idea until last year when I started researching again, and after 20 years, and I happened upon Dr. Hilinski's practice. I was amazed at what I saw. Not just otoplasty, but macrotia surgery to reduce the size of ears. I looked at his gallery and my mouth dropped. Where has Dr. Hilinski been my whole life?

Fast forward to the day of surgery, you wouldn’t have even known I was having surgery. Dr. Hilinski, Andrew and I listened to country music, chatted and laughed the whole time and I just had such a wonderful, fun experience. I felt comfortable and knew I was in great hands. Everything was explained in depth, from the initial consultation, to the pre-op, during surgery and even after. No question or concern went unanswered. His entire staff, Nicole, Ariana, and Andrew are just wonderful.

Today I had my post surgery appointment and after Dr. Hilinski removed the bandages, I cried tears of happiness. I couldn’t believe my eyes. My hair was up, and even though my ears were moderately swollen and bruised, I could see beyond that and that my ears were beautiful! I am so happy with the results, it’s an understatement. For the remainder of the day I couldn’t stop staring at my ears. I kept thinking, “So THIS is what it’s like to have normal sized ears…”

My new, “designer ears” will go perfectly with my designer shoes, ha! I can’t wait to fully heal so I can experiment with all sorts of updos, something I’ve never been able to do, but have always dreamed of.

Dr. Hilinski has changed my whole life and it’s only 3 days post-op. It was like waking up on Christmas morning, and what I imagine Cinderella felt like after the proverbial Bippity Boppity Boo… Only at the stroke of midnight my ears will still be fabulous.

I’m eternally grateful to Dr. Hilinski for working his magic as well as to his entire staff who are just SO pleasant and put up with my million plus questions. I’ve waited my whole life for this.. THANK YOU Dr. Hilinski for not only making it possible, but for making my dreams come true.

#### Healing From Cervical Liposuction and Lipocontouring Double Chin Surgery
The following photo series provides you with a glimpse of what actual results are like following liposuction of the face and neck region for a double chin deformity. This particular patient had a combination of liposuction and chin implant to improve the appearance of her lower face and upper neck while providing improved definition. The photo series shown below depicts her preoperative chin and neck along with her healing at approximately one month out and three months out from surgery. As you will note, her appearance at one month out from surgery shows an improvement, but she still has a mild to moderate amount of swelling under the chin. As the healing process continues, the swelling begins to settle down more and more. As this progresses, the skin under the chin will begin to 'shrink wrap' further, which creates even more definition along the jawline and upper neck. Overall, it takes about 3-4 months before most of the swelling has settled down and the skin has healed sufficiently to see the final results. As you can see in her three month photo result, her double chin has now been corrected and she looks markedly better in terms of her lower face and upper neck region. If you are interested in having neck lift surgery using liposuction technique to correct a double chin deformity, contact our San Diego office today to schedule a consultation with Dr. John Hilinski.

#### Hispanic Ethnic Cosmetic Rhinoplasty
Learn more about cosmetic Hispanic ethnic rhinoplasty surgery in the latest addition to our online rhinoplasty tutorial. This young lady desired more refinement of her nose, yet wished to remain looking like herself. I performed cosmetic nose surgery that included addressing a number of the Hispanic features of her nose that were too exaggerated for her desires. Her Hispanic rhinoplasty surgery is discussed in more detail here using this link. Let us know what you think of her results!

#### Hispanic Male Septorhinoplasty
This is a great example of reconstructive septorhinoplasty (nose job surgery) in an ethnic male patient with a Hispanic background. This case shows just how important it is to be mindful of ethnicity when performing nose reshaping surgery. See more of this case example of ethnic male rhinoplasty (Hispanic rhinoplasty surgery) by clicking here.

#### How a Mini Facelift Can Maintain Your Youthful Appearance
Many people believe that facelifts are only for those experiencing significant signs of aging, such as deep wrinkles and sagging skin. However, more individuals in their 30s and 40s are now taking a proactive approach by choosing a mini facelift to subtly correct the early signs of facial aging. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we offer the mini facelift as a less invasive way to maintain your youthful appearance without the downtime or extensive changes associated with a full facelift.

Why Are More People Choosing a Mini Facelift?

In today's world, maintaining a fresh, youthful appearance is important for both personal and professional reasons. Rather than waiting for advanced signs of aging to appear, many people are opting for early intervention with a mini facelift. This procedure targets mild to moderate skin laxity, early jowls, and fine lines, helping patients preserve their youthful features.

Choosing a mini facelift early can delay the need for more extensive procedures later in life, keeping you looking refreshed without dramatic or obvious changes.

What Is a Mini Facelift?

A mini facelift, also known as a "short scar" facelift or mini lift, is a surgical procedure designed to address early signs of aging in the lower face and jawline. It involves smaller incisions and less tissue manipulation than a full facelift. The procedure focuses on:

Tightening loose skin around the cheeks and jawline

Reducing early jowls

Smoothing fine lines and mild wrinkles in the lower face

The goal is to provide a subtle yet noticeable rejuvenation that maintains your natural appearance. The procedure can also be combined with other treatments, such as dermal fillers or Botox®, for enhanced results.

Am I a Good Candidate for a Mini Facelift?

A mini facelift is ideal for patients in their 30s to 50s who are beginning to notice the following signs of aging:

Mild sagging around the jawline

Early jowls

Fine lines and wrinkles in the lower face

Slight loss of definition in the cheeks

Patients should also be in good overall health and have realistic expectations about the outcome. During your consultation at our San Diego office, Dr. Hilinski will assess your facial structure and discuss your goals to determine if a mini facelift is right for you.

What Are the Benefits of a Mini Facelift?

Patients choose mini facelifts because they offer numerous advantages, including:

Early Prevention of Aging: By addressing aging signs early, a mini facelift helps prevent more pronounced sagging and wrinkles from developing. This proactive approach keeps you looking younger for longer.

Minimal Scarring: The smaller incisions used in a mini facelift are typically well-hidden along the natural creases of the ears, resulting in minimal, barely visible scars.

Quick Recovery: With less tissue manipulation, patients experience less swelling, bruising, and discomfort, leading to a faster recovery. Most people can resume work and normal activities within a week to ten days.

Our goal is to provide subtle, natural-looking enhancements that leave you looking refreshed—not "overdone." Friends and family may notice that you look well-rested and rejuvenated without realizing you’ve had a procedure.

Maintaining Results with Additional Treatments

To maximize and maintain the benefits of your mini facelift, Dr. Hilinski may recommend complementary treatments such as:

Dermal Fillers: Restore volume to the cheeks or lips

Botox®: Smooth dynamic wrinkles, such as crow’s feet or forehead lines

Skin Rejuvenation: Treatments like chemical peels or laser therapy can enhance skin tone and texture

By combining a mini facelift with these treatments, you can achieve comprehensive facial rejuvenation.

Rejuvenate Your Look with Dr. John Hilinski

If you’re noticing the first signs of aging and want to maintain your youthful appearance, a mini facelift may be the perfect solution. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we offer advanced, personalized care to help you look and feel your best. Dr. Hilinski is a highly experienced facial plastic surgeon dedicated to delivering natural, elegant results that enhance your beauty.

Contact us today to schedule your consultation and learn how a mini facelift can help you maintain a youthful, confident appearance!

#### How Can I Tighten Skin on My Neck?
Loose or sagging skin along the jawline or neck can make a person look older than they actually are. This can occur even when the face itself does not show prominent signs of age. Although there are some laser and non-surgical techniques that can tighten the skin to some degree, the success of these methods can often be minimal. A neck lift is a surgical procedure designed to eliminate excess skin and tighten the remaining skin. Using incisions that are predominantly concealed behind the ear, a neck lift can redefine the contours of the neck and jaw for a smoother, firmer, more youthful appearance.

Ideal candidates for a neck lift are in good overall health but have skin laxity around the jaw and/or neck. Candidates may also have excess fat that hangs below the chin or sagging chin and neck muscles. Depending upon the amount of excess fat, some neck lift patients choose to combine the procedure with liposuction. Other patients often combine a neck lift with a facelift for more comprehensive facial rejuvenation. Ultimately, the best way to determine whether or not you are a good candidate for a neck lift is to consult a board-certified plastic surgeon. To schedule a consultation with Dr. John Hilinski, please contact our office today.

#### How Can You Best Prepare For Rhinoplasty? Dr. John Hilinski Answers Your Questions
Part one of our two-part rhinoplasty series entitled “San Diego Plastic Surgeon Answers Questions About Rhinoplasty Consultations” detailed what Dr. John Hilinski’s nose surgery patients can expect during the initial consultation process. In this post, our experienced plastic surgeon will outline how to prepare for rhinoplasty surgery, what to expect the day of surgery, and what he expects from patients during the recovery period.

Question: What can a patient do to make sure they are prepared for surgery?
Dr. Hilinski: Given how frequently I perform rhinoplasty, my office has developed a fairly comprehensive guide we give patients to prepare for the surgery. Much of this preparation involves avoiding certain types of medication that might encourage bleeding and bruising. Proper preparation also includes educating the patient regarding recommended methods to clean the areas around the nose following the procedure.

Question: What does the day of surgery entail?
DH: On the day of surgery, the patient checks in to our accredited ambulatory surgery center and meets the staff, including our board certified anesthesiologist, registered nursing staff, and surgical technician. The patient then completes any necessary clerical items still outstanding before entering the operating room. Once the patient is gently put to sleep by the anesthesiologist, the rhinoplasty surgery begins. A typical primary rhinoplasty surgery (for patients with no prior rhinoplasty) takes about two to three hours to complete. Within an hour, the patient is able to return home in the company of a friend or family member.

Question: Are there important recovery instructions for the day of the surgery?
DH: We have a fully developed guide that includes detailed instructions regarding the early healing process following rhinoplasty surgery. Our registered nursing staff will review these instructions prior to departure from the surgery center to ensure that each patient has clear expectations for the initial recovery period.

Question: Are there important recovery instructions for the week after surgery?
DH: Even one week out from surgery there are important instructions to follow. For example, I usually will remove bandages from the nose around five to six days out from rhinoplasty surgery. Although most patients begin to feel more comfortable out in the public eye around this time, there are still many restrictions that need to be minded. This includes avoiding even minor pressure to the nose, such as rolling over onto the nose inadvertently during sleep.

Question: How long until patients typically say they feel like themselves again?
DH: Most patients start to feel comfortable resuming their normal daily routine after seven to ten days. At this point in the recovery process, the bandages and sutures have been removed, so there are no overt signs of surgical recovery other than some swelling. Even bruising will be essentially resolved. Borrowing a term from one of my mentors, I like to tell patients that at this point they will look ‘supermarket presentable’—standing in line at the local supermarket, it will not be apparent that they have just had surgery. I don’t recommend that patients resume their exercise routines for about two to three weeks following rhinoplasty. In general, most patients will see 70% of the swelling resolved in about three months. There is still a moderate amount of healing that will occur over the course of that first year.

Question: Is there anything else a patient should know about the recovery process?
DH: I think the most important factor to consider when recovering from rhinoplasty is the length of time involved. Many patients do not grasp just how long it takes to see the final results of the rhinoplasty surgery. This is why I try to emphasize this point to all of my patients who are considering the surgery. Rhinoplasty is not the type of cosmetic surgery that will show the final results within five to six months. Even 10-12 months after rhinoplasty, there are changes that continue to manifest.

In addition, rhinoplasty recovery is very much a collaborative process. I certainly have my responsibilities as a rhinoplasty surgeon on the day of the surgery, but the rhinoplasty patient is also responsible for part of the healing process. Patient responsibilities include keeping their incisions clean, avoiding trauma to the nose that would compromise the results, attending all of the recommended postoperative office visits, and performing nasal exercises such as taping the nose when indicated during the postoperative recovery. These are very important aspects of the rhinoplasty recovery process that cannot be done by the rhinoplasty surgeon – they are the full responsibility of the rhinoplasty patient. I make sure that all of my rhinoplasty patients feel comfortable with this type of collaborative process well before we begin surgery.

To learn more about rhinoplasty from Dr. John Hilinski, please contact our office. In addition to rhinoplasty, Dr. Hilinski also offers a range of other facial rejuvenation procedures, including facelift, neck lift, and BOTOX® Cosmetic treatments. Find out more by contacting us today!

#### How Common Is Rhinoplasty Done With A Chin Implant?
The answer to this question is – quite commonly. I would say that nearly 20% of our patients seeking primary rhinoplasty (1st time rhinoplasty) also consider chin augmentation with an implant. One of the main goals of rhinoplasty is to achieve improved harmony with the rest of the face. In cases where the nose is disproportionately large compared to the rest of the face, the aim would be to make it smaller. Most of these cases involve noses that are projected too far out from the face and/or have an excessively high bridge. This usually is more pronounced when looking at the profile view (side view). Unfortunately, there is a limit to how much smaller the nose can be made, particularly if one has thicker than average skin. In cases like this where even more balance is necessary, one must consider the shape and size of the chin to help compensate. These patients have a chin that is quite weak or underdeveloped, which makes a large nose appear even larger (since the lower one-third of the face looks comparatively too small). By augmenting the chin and jawline with an implant, the lower face is brought into better balance with the remainder of the face. When doing this in combination with rhinoplasty to make the nose smaller, the results can be rather dramatic. In fact, in many cases this is often a multiplicative effect and not just additive (like 1+1=3!).

#### How Do You Choose Your Rhinoplasty Surgeon?
I see this exact question or some variation of it posed on forums all the time. The answer to this is actually fairly straightforward. The challenge is finding a rhinoplasty surgeon who fulfills all of the desired qualifications. Given the fact that rhinoplasty, or nose reshaping, is hands down the most difficult plastic surgery procedure to perform correctly, it is well worth the effort to research this topic carefully and thoroughly.

	The first thing you want to make sure is that your chosen plastic surgeon is board certified in Facial Plastic & Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery). This elite group of is a subset of plastic surgeons who have been deemed specialists in the face and neck region. Within this group, I would suggest finding a select few facial plastic surgeons who have practices that are largely dedicated to rhinoplasty and revision rhinoplasty. For instance, my practice here in San Diego is known as a regional referral center for complex, challenging rhinoplasty and revision rhinoplasty because a large part of my time is spent studying this one procedure.
	Make sure you review plenty of patient photos representing your chosen rhinoplasty surgeon's own work. This gives you some level of confidence that he or she has performed rhinoplasty with a high degree of success in terms of aesthetic outcomes. Reviewing previous patients' rhinoplasty results also gives you an idea of your rhinoplasty surgeon's aesthetic style. You never want to choose a rhinoplasty surgeon who has a 'signature nose' that appears on every face. That is not what I meant by aesthetic style. What I was referring to is how natural and balanced looking are the results being shown in terms of how the nose fits the remainder of the face. Is that particular rhinoplasty surgeon reshaping the nose to achieve consistency with the surrounding facial features or do the outcomes have the stigma of a surgical procedure? Stay away from the latter.
	Hopefully your rhinoplasty surgeon offers digital imaging of the nose. This involves use of a computer software program that can morph your nose to visually demonstrate the proposed changes that would be made to reshape the nose in context of your actual face. It is a wonderful tool for the patient to see what their nose may look like before surgery and the surgeon to determine if you, the patient, are being reasonable in terms of your expectations.

Hopefully these bullet points will serve you well in your decision making process to have rhinoplasty, or nose reshaping, surgery. Good luck. Dr. Hilinski

#### How FUE Hair Transplant Procedures Can Hide Scars from Previous Cosmetic Surgeries
Cosmetic surgeries such as facelifts and brow lifts often require incisions behind the hairline to achieve natural-looking results. While these scars are typically well-hidden, they can become visible over time as hair thins or recedes, especially with age. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we offer FUE hair transplant procedures to help camouflage scars from previous cosmetic surgeries, restoring a seamless appearance and enhancing your confidence.

Why Do Scars from Cosmetic Surgeries Become Noticeable?

Procedures like facelifts and brow lifts aim to rejuvenate the face by tightening the skin and repositioning tissues. These techniques often involve incisions behind the hairline to keep scars discreet. However, as the hairline shifts due to natural thinning or hair loss, scars can become exposed.

This is especially common in individuals who experience:

Age-related hair thinning.

Male or female pattern baldness.

Hairline recession is caused by other factors like genetics or hormonal changes.

Visible scars behind the hairline can detract from the overall results of a facelift or brow lift, making a previously hidden incision more noticeable.

What Is a FUE Hair Transplant?

Follicular Unit Extraction (FUE) is a minimally invasive hair restoration technique that involves extracting individual hair follicles from a donor area (typically the back or sides of the scalp) and implanting them into areas where hair is thinning or absent.

Unlike traditional hair transplant methods, FUE leaves no linear scars and provides highly natural-looking results. When used to treat scars, the procedure works by:

Placing Hair Follicles into the Scar Tissue: Transplanted hairs grow in the scarred area, blending it seamlessly with the surrounding hair.

Restoring Density: FUE restores volume around the scar, making it nearly undetectable.

Hairstyle Variations: By hiding the incision scars, individuals have more hairstyle options, such as wearing ponytails or shorter styles.

How FUE Helps Hide Scars from Facelifts and Brow Lifts

Each FUE procedure is tailored to the unique characteristics of the scar and surrounding hairline. Dr. Hilinski carefully assesses factors such as:

The location and size of the scar.

The angle and direction of the existing hair growth.

The thickness and density of the hair in the donor area.

By meticulously placing the grafts, the new hair growth seamlessly integrates with the natural hairline, effectively concealing scars left by facelifts, brow lifts, or other cosmetic procedures.

Benefits of FUE for Scar Camouflage

FUE hair transplants are minimally invasive, with no need for large incisions or stitches. Patients experience minimal downtime and can enjoy results that develop gradually as the transplanted hair grows naturally in the treated area. Other benefits include:

Natural-Looking Results: The precise placement of individual hair follicles ensures a natural appearance.

Minimized Downtime: Most patients can return to their normal activities within a few days.

Versatile Applications: FUE can address scars from a range of cosmetic procedures, including facelifts, brow lifts, and even previous hair transplants.

Permanent Solution: Once the transplanted hair grows, it remains in place, providing long-term coverage for scars.

Dr. John Hilinski in San Diego, CA, is a leading expert in cosmetic and reconstructive procedures, offering advanced solutions like FUE hair transplants to enhance your appearance. With a focus on precision and personalized care, Dr. Hilinski ensures optimal results that blend seamlessly with your natural hairline.

Restore Confidence with FUE Hair Transplants

If scars from previous cosmetic surgeries are becoming noticeable due to thinning hair, an FUE hair transplant can provide an effective solution. At John Hilinski, M.D. Plastic Surgery in San Diego, we specialize in scar camouflage techniques that help you achieve a flawless appearance. Contact us today to schedule a consultation and take the first step toward restoring your confidence.

#### How Long Do I Need To Wear Bandages After Ear Reshaping?
I get asked this question all the time by my patients undergoing ear reshaping, or otoplasty, here in San Diego. I recently developed a new online ear reshaping tutorial that you can reference to help answer this question and many others. But, in short, I recommend my San Diego ear reshaping patients wear their initial bandage for 1-2 days. This is usually a bulky, gauze wrap that helps compress the newly reshaped ears to prevent blood clots under the skin. We usually replace this with a foam type of wrap that is much more comfortable and can be changed by you, the patient. I like my otoplasty patients to continue wearing the foam wrap for most of the day up to one week out from their ear reshaping procedure. Thereafter, you can wear the wrap at night while sleeping for upwards of 6 weeks out. Hope this helps.

#### How Long Do Results Last After Facelift Surgery?
When you undergo a cosmetic procedure like facelift surgery, you want to know it’s a worthwhile investment that you can enjoy for years to come. Many patients who visit our practice with hopes of taking years off their face often inquire about how long they can expect their results from a facelift to last. To understand the answer to this question, there are a number of factors with which you must first be familiar.

First and foremost, it is important to remember that even after facelift surgery, you will still continue to age. However, you can expect to age at a more graceful rate and postpone the appearance of lines and wrinkles. In general, there are four major factors that will affect the longevity of your results:

	Quality of facial skin prior to your procedure
	How you take care of your skin after
	Expertise of the plastic surgeon
	Specific facelift procedure you undergo

With this in mind, Dr. Hilinski has seen patients who have undergone the full facelift enjoy their rejuvenated results for up to 10 years or more. However, this will ultimately vary based on each case. For more information about how Dr. Hilinski can help you achieve long-lasting facial rejuvenation, please contact us to schedule your consultation.

#### How Long Do Surgeons Generally Follow Up After a Face Lift?
I like to see my facelift, or face lift, patients fairly regularly following their surgery. I will continue seeing them upwards of 6-9 months out typically. It is around this time that facelift patients seem to reach a plateau in terms of their recovery process. Although facelift scars will continue to evolve up to a year or beyond, a majority of the healing will have taken place by this point in the recovery process.

#### How Long Should Swelling and Numbness Last After a Facelift?
Since the facelift procedure is customized to address each patient’s unique needs, the recovery will vary depending upon the techniques used by the surgeon. Mild swelling and bruising should be expected after surgery, and isolated areas of facial numbness are not uncommon. However, most patients report discomfort instead of pain after the facelift procedure, which can be easily managed with oral pain medication.

Within a week of surgery, postoperative swelling and bruising should begin to dissipate. Once the stitches are removed 5-6 days after the procedure, bruising and swelling should continue to subside. Most patients feel comfortable returning to work 7-10 days after their facelift, and makeup may be used to camouflage any residual bruising.

In regard to numbness, most patients will not experience any loss of sensation. Patients who do have postoperative facial numbness can expect normal feeling to gradually return in 1-3 months as the nerves regenerate. A tingling of the skin typically signals nerve growth and may precede the full return of feeling.

For more information about facelift surgery and the recovery process, or to schedule a consultation with our double board-certified facial plastic surgeon, please contact us today.

#### How Long Will Sculptra® Aesthetic Results Last?
Injectables provide rejuvenating effects in different ways - dermal fillers add volume to targeted facial areas, while BOTOX® Cosmetic weakens overactive facial muscles that lead to lines and wrinkles. An alternative to these options, Sculptra® Aesthetic, actually targets the cause of many facial wrinkles by enhancing and reinforcing the deeper layers of skin by replacing lost collagen. Achieving this exceptionally natural-looking effect can take a little longer to manifest than other injectable alternatives. The good news is that as time goes by, the results from your Sculptra® Aesthetic actually continue to improve as the underlying layers of skin receive an increasing amount of support and your natural collagen is replenished.

While the results from BOTOX® Cosmetic and many dermal fillers typically last between three and six months, the results from Sculptra® Aesthetic can last about two years. Using a series of about three treatments, you can watch the appearance of fine lines, wrinkles, and creases gradually disappear. If you are looking for a nonsurgical method of facial rejuvenation, Sculptra® Aesthetic is a great alternative to BOTOX® Cosmetic and traditional dermal fillers that can give you younger-looking skin and long-lasting results.

-       Dr. John Hilinski

Contact Us

For more information about Sculptra® Aesthetic, or to schedule a consultation with Dr. Hilinski, please contact us today.

#### How Millennials Can Benefit from Baby Botox
As millennials navigate their 20s and 30s, many are increasingly focused on maintaining their youthful appearance while embracing a proactive approach to skincare. One of the most popular cosmetic treatments gaining traction among this age group is Baby Botox, also known as Micro Botox. This subtle, preventative treatment is designed to minimize the early signs of aging, particularly dynamic lines like frown lines, worry lines, and crow's feet, which are caused by repetitive facial expressions. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, millennials can benefit from Baby Botox to maintain a refreshed, natural look without the fear of looking overdone.

What Is Baby Botox?

Baby Botox refers to the administration of smaller, more precise doses of Botox, a neuromodulator that temporarily relaxes the muscles responsible for creating dynamic lines. Unlike traditional Botox treatments, which are often associated with more dramatic results, Baby Botox aims for a more subtle effect. The goal is not to freeze facial expressions but to soften the appearance of fine lines and wrinkles, preventing them from becoming more pronounced over time.

This treatment particularly appeals to millennials who are beginning to notice the first signs of aging but still want to maintain their natural facial movements. By using lower doses of Botox, the treatment can smooth out lines while preserving the expressiveness of the face—a key concern for younger patients who desire a youthful yet authentic appearance.

The Benefits of Baby Botox for Millennials

One of the primary benefits of Baby Botox is its preventative nature. By addressing fine lines and wrinkles early, millennials can delay the deepening of these lines, which tend to become more pronounced with age. Regular Baby Botox treatments can help maintain a smooth, youthful complexion, reducing the need for more aggressive interventions later in life.

In addition to its preventative effects, Baby Botox offers other significant benefits:

Natural-Looking Results: Because the doses are smaller and more targeted, the results of Baby Botox are subtle and natural. The treatment smooths out lines without creating a stiff or frozen appearance, making it ideal for younger patients who want to avoid the telltale signs of cosmetic work.

Minimal Downtime: One of the reasons Baby Botox is so popular among millennials is the minimal downtime associated with the treatment. The procedure is quick, often taking less than 30 minutes, and patients can return to their daily activities immediately afterward.

Long-Lasting Effects: While Baby Botox uses smaller doses, the effects can still last for several months, typically between three to four months, depending on the individual. This means patients can enjoy a rejuvenated appearance with relatively infrequent treatments.

Statistics Highlighting the Popularity of Botox Among Millennials

The growing popularity of Baby Botox among millennials is reflected in recent statistics. According to the American Society of Plastic Surgeons, Botox procedures among individuals aged 20 to 29 increased by 28% between 2010 and 2020. The same age group accounted for over 760,000 Botox procedures in 2020 alone. This trend underscores the shift towards preventative skincare among younger generations, who are increasingly seeking subtle, non-invasive treatments to maintain their youthful appearance.

Why Choose Dr. John Hilinski for Your Baby Botox Treatment

At John Hilinski, M.D. Plastic Surgery in San Diego, CA, Dr. Hilinski offers expert Baby Botox treatments tailored to each patient's unique needs. With extensive experience in facial aesthetics, Dr. Hilinski understands the importance of achieving natural-looking results that enhance, rather than alter, your appearance for the ideal combination of form and function. His personalized approach ensures that each patient receives the precise amount of Botox needed to achieve their desired outcome.

If you’re a millennial or even an older Gen Z interested in maintaining your youthful appearance while preventing the early signs of aging, consider scheduling a consultation with Dr. Hilinski. Discover how Baby Botox can help you achieve a smooth, radiant complexion that reflects your inner vitality.

#### How Much Does Eyelid Surgery Cost?
Since each blepharoplasty (eyelid surgery) is custom-tailored to meet the individual’s unique goals, the price of the procedure will vary from patient to patient. Factors that can influence the cost of your procedure may include:

	Whether you choose upper blepharoplasty, lower blepharoplasty, or to combine both procedures
	The complexity of your procedure based upon your anatomical needs
	The type of anesthesia used and the skill of your anesthesiologist
	The experience of your plastic surgeon

Some patients also choose to combine blepharoplasty with a brow lift for a more complete facial rejuvenation, which can add to your total cost.

In most cases, upper eyelid surgery will cost less than a lower eyelid surgery since lower eyelid procedures tend to require fat removal as well as skin removal. In addition, depending upon your insurance company and the severity of upper eyelid drooping, your provider may cover the cost of an upper blepharoplasty if the surgery is considered medically necessary. Your insurance company may require photo documentation, a clinical exam performed by your physician, and a visual field test performed by your ophthalmologist to determine your eligibility for full coverage. For more information about blepharoplasty, please contact our office today.

#### How Old Do You Have to Be for Otoplasty?
Otoplasty is one of the few cosmetic surgeries performed on children. The procedure is often considered when parents recognize that their child is embarrassed of having prominent ears as they try to hide them. For example, girls may not want to wear their hair up, and boys may want to keep their hair long.

Ear pinning is most commonly performed on children who are between the ages of five and ten, since their ears will have developed close to their full adult size. By addressing the concern early, boys and girls can avoid being teased by classmates at school that can damage their self-image.

Should a child want to improve the appearance of their ears, it is important to schedule a consultation with a board-certified plastic surgeon who is experienced with otoplasty. Although most plastic surgeons are familiar with the procedure, very few actually have extensive experience performing otoplasty. This is why it is critical to do your research before choosing an otoplasty surgeon. During this visit, the surgeon can determine if the child is a good candidate for the procedure.

#### How Pix:E Can Change Your Skin with Minimal Downtime
Looking for a skin rejuvenation treatment that delivers real results without putting your life on hold? At John Hilinski, M.D. Plastic Surgery in San Diego, we’re proud to offer Pix:E, a revolutionary combination therapy that transforms your skin with minimal downtime. Whether you're dealing with wrinkles, acne scars, sun damage, or just want a smoother, firmer complexion, Pix:E is a powerful solution that’s designed to work with your lifestyle.
What Is Pix:E?
Pix:E is an FDA-cleared skin rejuvenation device that combines two gold-standard technologies in a single session: RF microneedling and Erbium YAG laser resurfacing. Together, these advanced modalities stimulate your skin’s natural healing response and boost collagen production for long-lasting improvement in tone, texture, and firmness.

If you’re in San Diego and looking for an innovative way to rejuvenate your appearance, Pix:E might be your new go-to solution. It combines two technologies in one game-changing treatment.
RF Microneedling
Radiofrequency (RF) microneedling uses tiny needles to penetrate deep into the skin and deliver RF energy where it's needed most—your dermis. This stimulates the production of collagen and elastin, the key building blocks of youthful, firm skin. It’s effective for:

 	Reducing fine lines and wrinkles
 	Tightening lax skin
 	Improving overall skin texture

Erbium YAG Laser Resurfacing
This gentle laser precisely removes damaged skin on the surface, encouraging new cell growth and a more even skin tone. It’s particularly effective for:

 	Minimizing sun damage and pigmentation
 	Smoothing acne scars
 	Reducing visible pores

Used together in the Pix:E system, these treatments work synergistically to provide immediate and progressive improvements, with far less downtime than you’d expect from traditional laser treatments.
Why San Diego Patients Love Pix:E
Living in a sunny city like San Diego means our skin is constantly exposed to UV rays and environmental stressors that accelerate aging. Pix:E is ideal for patients who want visible results without the extended recovery time of older laser systems. Benefits of Pix:E at Hilinski MedSpa:

 	Customizable settings for every skin type and concern
 	Quick treatment times—typically under an hour
 	Minimal downtime, allowing most patients to resume normal activities within a day
 	Natural-looking results that continue to improve over time
 	Safe for multiple areas, including face, neck, chest, and even for stretch marks on the abdomen

Whether you're prepping for a special event or simply want to take proactive steps toward healthier skin, Pix:E fits seamlessly into your schedule.
What to Expect from Your Pix:E Treatment
During your consultation at our San Diego medspa, we’ll assess your skin and develop a customized Pix:E plan tailored to your goals. Most patients begin to see visible improvements after just one session, with continued enhancements in the following weeks as collagen production increases.

A series of treatments may be recommended for optimal results, especially for deeper wrinkles or scarring.
Discover the Power of Pix:E at John Hilinski, M.D.
At John Hilinski, M.D. Plastic Surgery, we combine leading-edge technology with expert care to deliver natural, beautiful results. Our team has helped countless San Diego patients look and feel their best with advanced treatments like Pix:E.

Schedule your consultation today to learn how this revolutionary dual treatment can change your skin with minimal disruption to your routine—and help you face the world with confidence.

#### How Profound RF Can Rejuvenate Your Face and Neck Without Surgery
Aging can leave the skin on your face and neck looking tired, loose, and wrinkled. Traditional plastic surgery offers powerful solutions for these concerns, but for those seeking non-surgical options, Profound RF provides an advanced alternative. Dr. John Hilinski, a renowned plastic surgeon in San Diego, CA, is proud to offer Profound RF — a cutting-edge treatment designed to rejuvenate the skin by addressing three key factors of aging: collagen, elastin, and hyaluronic acid.

The Science Behind Profound RF’s Effectiveness

The effectiveness of Profound RF lies in its ability to target the very building blocks of youthful skin:

Collagen – Responsible for the skin’s firmness and structure.

Elastin – Provides the skin with elasticity, giving it a spring-like quality.

Hyaluronic Acid – Helps retain water, maintaining hydration and plumpness in the skin.

Over time, the body naturally decreases the production of these essential components, leading to sagging, wrinkles, and loss of volume. Profound RF is uniquely designed to stimulate the production of all three elements, restoring a smoother, more youthful appearance without the need for invasive surgery.

How Profound RF Works

Profound RF combines microneedling with radiofrequency (RF) energy to deliver optimal results. The device contains five pairs of specially designed microneedles that penetrate the skin, creating controlled micro-injuries. This process triggers the body's natural healing response, stimulating collagen production. Profound RF takes skin rejuvenation a step further by delivering RF energy at precisely the right temperature to enhance elastin and hyaluronic acid production as well.

Increased Collagen Production: RF energy amplifies the production of collagen, resulting in firmer, smoother skin.

Boosted Elastin Formation: Clinical studies show that Profound RF can increase elastin production by as much as 500%, restoring the skin’s elasticity.

Improved Hydration with Hyaluronic Acid: This essential molecule helps the skin retain moisture and regain a youthful volume, minimizing fine lines and wrinkles.

This combined approach ensures more dramatic and long-lasting results than typical microneedling alone.

Proven Results for Tighter, More Youthful Skin

Studies have reported that Profound RF can produce up to a 200% increase in collagen and a 500% increase in elastin, surpassing the capabilities of other non-invasive devices. With all three components working synergistically, patients often experience:

Tighter, firmer skin on the face and neck

Reduction in wrinkles and fine lines

Improved skin texture and hydration

These benefits make Profound RF an ideal choice for those looking to rejuvenate their appearance without surgery or downtime.

Why Choose Dr. John Hilinski for Profound RF in San Diego?

Dr. Hilinski is a leading expert in facial plastic surgery and non-surgical rejuvenation treatments. With extensive experience and a patient-focused approach, he ensures each treatment is customized to achieve natural-looking results. Patients in San Diego seeking a refreshed, youthful appearance can trust Dr. Hilinski’s expertise with Profound RF to deliver beautiful, lasting outcomes.

Profound RF offers an innovative way to turn back the clock by restoring the essential components of youthful skin. Contact Dr. Hilinski’s office today to schedule a consultation and discover how this revolutionary treatment can help you achieve tighter, more radiant skin without surgery.

#### How Soon Can I Run After Rhinoplasty?
Every case should be assessed individually, but, in general, most patients can begin aerobic type activity like running or fast-paced walking within 2-3 weeks of having rhinoplasty performed. At this point, patients will usually see more swelling of the nose the day after exercise, but this should not be a significant deterrent to resuming exercise. Most patients feel a sense of pressure or more localized pain in the nose with resumption of exercise. This is normal and due to preferential blood flow to the nose region as the tissues are healing. These are just general guidelines for rhinoplasty healing. Make sure you check with your particular rhinoplasty surgeon to get official clearance from them. Good luck.

#### How Swollen Am I 3 Months After A Closed Rhinoplasty?
The answer to this question is best answered with a photo example of one of my rhinoplasty patients from San Diego. She is actually a good example of Hispanic rhinoplasty. She really desired to have narrowing of her nose as seen on front view. We chose to perform a closed rhinoplasty procedure to reshape her nose. We performed slight reduction of her bridge height but more importantly narrowing of her nasal bones. As you can see in the attached photos she has an obvious improvement in her frontal appearance. Her bridge is now more narrow with better shadowing on both sides. Overall, her nose could be described as being more feminine in appearance. Although it will take nearly a year for her nose to fully heal, these results shown at 3 months out demonstrate what your nose might look like following a closed rhinoplasty procedure.

#### How to Eliminate a Double Chin
A double chin is a common cosmetic concern that can alter the shape of the face and reduce the prominence of the chin and natural jawline. Traditionally, surgical procedures such as liposuction or a neck lift have been used to address excess fat below the chin. For patients who want to take a more conservative approach to eliminating the appearance of a double chin, Dr. John Hilinski offers KYBELLA® – an injectable treatment designed to significantly reduce excess submental fat (fat under the chin).

KYBELLA® is designed to dissolve fat at the target area using a solution of deoxycholic acid that closely mirrors a naturally occurring substance in our bodies that metabolizes fat. This FDA-approved treatment is ideal for patients who want a more contoured neck and chin but do not wish to undergo surgery. To find out if KYBELLA® can meet your needs and expectations, or to schedule an appointment with Dr. Hilinski, please contact our office today.

#### How To Minimize Bruising Following Rhinoplasty and Revision Rhinoplasty
All patients undergoing rhinoplasty or revision rhinoplasty by my office are counseled on how to minimize chances of bruising following surgery. The onset and severity of bruising after cosmetic rhinoplasty is dependent on multiple factors, which can usually be accounted for by careful planning. All patients are instructed to review our list of restricted of medications that is handed out to you and is always on our website for reference. I prefer my patients avoid these potential blood thinners at least 10-14 days prior to their rhinoplasty procedure. I also highly recommend that my patients begin taking Arnica Montana starting two days before and continuing for one week after surgery (see photo below of the exact kit we carry in our office). Arnica is an herbal supplement that can significantly reduce chances of bruising from many plastic surgery procedures. Although scientific evidence of this effect is scant, I can tell you anecdotally that Arnica unequivocally aids in healing from nearly all plastic surgery procedures, including rhinoplasty and revision rhinoplasty. Patients who undergo osteotomies (breaking the bone) as part of their rhinoplasty procedure tend to have more bruising than those undergoing only cartilage and soft tissue reshaping of the nose. When performing osteotomies, rest assured I take extreme caution in my technique to help minimize unwanted bruising. This includes use of a specially formulated solution that I inject in your nose to chemically constrict the blood vessels. Elevating your head following surgery is another helpful step that works by counteracting gravity to decrease blood flow and, therefore, pooling of blood around the nasal bones. I am not a big fan of ice compresses applied directly over the nose as this can sometimes cause unwanted shifting of the cast and underlying bones. Instead, I prefer if patients apply a small packet of frozen peas or similar lightweight cold compress over each eye in a symmetric fashion. In doing so you can minimize chances of shifting the newly positioned bones and maximize control of bruising. Finally, limiting physical activity during the first 1-2 weeks following rhinoplasty further minimizes chances of bruising.

#### How To Narrow A Wide Middle Vault With Rhinoplasty
Management of a wide middle vault in rhinoplasty is one of the more difficult techniques when it comes to nasal reshaping. The reason is because you have to consider the positioning of the nasal bones in conjunction with their transition into the upper lateral cartilage as it helps form the brow-tip esthetic line. In order to familiarize yourself with these terms and their relevance in rhinoplasty, make sure to read our rhinoplasty tutorial entry on nasal analysis. This rhinoplasty patient from San Diego presented to our office with a chief complaint of a wide nose, particularly in the mid-dorsum of the bridge. You can see in her preoperative frontal photo that the middle portion of her nose, or middle vault, appears somewhat washed out. This was because her middle vault region was slightly lower than the upper bridge and lower tip. The end result was that she was slightly depressed thru this area. In addition, her nasal bones are slightly wide. Combined, these issues gave the appearance that her nose was too wide for her face. She elected to undergo a cosmetic septorhinoplasty procedure over one year ago. During the septorhinoplasty surgery we decided to break her nasal bones and narrow them appropriately. At the same time, we performed cartilage grafting through her middle vault region that helped raise up this portion of her bridge. We also narrowed her nasal tip slightly to maintain some degree of balance. You can see in her postoperative rhinoplasty photos below that she now has a more pleasing frontal appearance in terms of her nose. In addition, her nose now looks more feminine and harmonious with her remaining facial features.

#### Icing On The Cake
San Diego's #1 Coolsculpting team suggests patients think about Coolsculpting more as 'icing on the cake' when it comes to their overall weight loss plan. The best patients for Coolsculpting are those that have already dedicated themselves to a thoughtful weight loss program, which includes regular exercise and a healthy diet. As you begin to lose that unwanted weight, you will begin to see certain areas that are just more resistant to fat loss - a very common observation amongst people looking to reshape their body. As an alternative to undergoing something invasive like liposuction to get rid of the residual, excess fat - many patients nowadays look to Coolsculpting. The beauty of freezing the fat away is that there are no needles involved, no surgical incisions and essentially no downtime associated with Coolsculpting. Yet, you can see 25-30% reduction of unwanted fat in a variety of areas - the icing on the cake! Call our office today to schedule your Coolsculpting consultation.

#### Imaging Example In Ethnic Rhinoplasty
With as many questions as I get regarding rhinoplasty and computer imaging, I felt compelled to leave a quick post using an ethnic rhinoplasty patient of mine as an example. This particular patient consulted with us desiring reshaping of her nose for a dorsal bump, a depression in her supratip and ptosis (drooping) of her nasal tip. As can be seen from the attached photos, she is an ethnic rhinoplasty patient. Therefore, surgical planning in her particular case had to take this into consideration so that her final result would be in balance with her remaining ethnic facial features. As part of her rhinoplasty consultation, we performed computer imaging of her nose to gain a better understanding of the direction and degree of change that was desired. Her preoperative frontal and side views are shown below along with the computer imaged photos. The computer imaging helps provide the patient and surgeon with a realistic visual of what the final outcome might look like following rhinoplasty. In this patient example, I suggested we smooth out her nasal bridge, rotate her tip slightly and narrow the base of the nose in a conservative fashion. Combined, this was envisioned to provide her with a nice esthetic improvement without obvious signs of having had surgery all the while preserving her ethnic look. Based partially on these images, she decided to proceed with surgery.

She subsequently underwent an open rhinoplasty procedure, which included several maneuvers to also help improve her nasal breathing and function. I ended up rasping down her bridge in a conservative fashion. This was done to maintain a nice bridge height that would provide her favorable shadowing on the front view. At the same time I placed a small cartilage graft just above the tip region to help address the slight depression that she had. I also rotated and elevated her nasal tip to give a more feminine angle between her upper lip and nose. Finally, we narrowed her nasal base so that her nose did not appear as wide. Below you can see her actual before and after photos. The after photos (far right) were taken at one year postoperatively to give an accurate portrayal of a stable, long-term rhinoplasty result. As you can see from her after photos, she has a global improvement in the appearance of her nose while maintaining a natural, ethnically consistent look. In fact, she looks as if she could have easily been born with this nose. In addition, you can see that her actual final rhinoplasty result is very similar to what we had imaged during her preoperative consultation. To see her other before and after photos, including oblique and base views, simply click here.

#### Immediate Effects of Lower Eyelid Restylane Injection
Patients ask me all the time what they might look like immediately following a Restylane treatment to the lower eyelid - cheek region. As they say - a picture is worth a thousand words. So here is a quick photo example of what you can expect to look like within minutes of having Restylane injected along the lower eyelid region. This gentleman was actually referred to me by another plastic surgeon for treatment of his lower eyelid region. As you can see from his before photo, he has heavy 'bags' that are contributing to a more tired, aged look along the lower eyelids. Looking closer though, you can appreciate that he is actually more hollowed below the bags, which is really the more relevant finding on his examination. Instead of undergoing an invasive surgery to remove the fat and lift the lower eyelid (essentially a 'lower blepharoplasty' surgery), I recommended instead he consider doing an injectable treatment in the office that would help 'fill out' the lower eyelid hollows. So that is precisely what I did using Restylane - one of my favorite fillers for treating the mid-face area, or lower eyelid and cheek complex. Using nearly 2.5 cc of Restylane, I was able to provide him with a marked improvement along the lower eyelid region - rivaling what might be possible with something like lower eyelid blepharoplasty surgery. The procedure took about 10 minutes to perform and was tolerated quite well by the patient. The photo comparison provided here shows his results within minutes of having Restylane injection done in the office. As you can see he has some mild redness around the cheek area, which is a result of the injection just performed. This tends to resolve within a few hours. Overall, though, you can see how much of an improvement can be seen with this type of Restylane treatment to the lower eyelid region. Let us know what you think of his results!

#### Improved Vision From Eyelid Plastic Surgery
This is another example of how upper eyelid surgery (blepharoplasty) can be used to help improve one's vision. This very pleasant lady from San Diego presented to my office noting trouble with her peripheral vision. As you can see, she had a significant amount of excess, heavy skin that was weighing her upper eyelids down - contributing to the obstructed vision. I performed an upper eyelid blepharoplasty, or eyelid lift, on her to take away the excess weighted skin. As you can see, she now looks much more rested while still looking quite natural. More importantly, her vision has been markedly increased now that the heavy excess upper eyelid skin has been removed. Let us know what you think of her results!

#### Improving Neck Definition
This is a recent patient of mine who desired to have improved neck definition. I ended up performing neck liposuction, or sculpting of the neck fat, along with tightening of the platysma muscle that sits under the chin. The entire operation was done by making a small incision under his chin. The end result, seen here, is a marked improvement in definition along the neck and jawline. Let me know what you think of his results!

#### Improving Response to Botox
Patients often ask if there is something they can do to make their Botox or Dysport injection work better. The answer is - yes!

We do have some published guidelines on our website that help patients get the most out of their Botox and Dysport wrinkle treatments. Here is a link to those guidelines.

Here are a few other suggestions we recommend to our own San Diego patients considering Botox and Dysport treatment for wrinkles and dynamic lines.

 	Don't work out for 24-48 hours after Botox and/or Dysport treatment. If your heart rate and blood pressure rise before the Botox and Dysport have time to take full effect, you won't get the optimal treatment outcome desired.
 	Try and keep your head above your heart level for the rest of the day to also reduce chances of increased blood flow to the Botox and Dysport treatment areas.
 	Icing can help reduce any bruising, or chance of bruising. We recommend icing for the remainder of that day if possible.
 	Some patients take a zinc supplement starting a few days before Botox/Dysport treatment and continuing for 2-3 days after the injection. Years ago, a product called Zytase was being touted as something that helped potentiate patients' response to Botox injection. Unfortunately, the science and clinical studies to support this were just not there. However, there is anecdotal evidence that some patients will see a better response to Botox and Dysport by using a supplemental zinc preparation before and after treatment. Most patients will using zinc gluconate taken over the counter. Although there is not any substantial scientific evidence this works, a good number of patients swear by its use.

#### Increased Comfort For Botox and Dysport Treatment
Just a quick reminder to all of our Botox & Dysport patients and prospective patients out there who desire a little more comfort with their treatment. We have many patients who have requested and received a topical numbing cream to apply before coming to our office for their Botox & Dysport injections. The numbing agent contains a mixture of topical agents that help reduce pain and discomfort with the actual treatment. The numbing agents need to be applied 30-45 minutes prior to arrival at the office, therefore, it is best to have us call in a prescription for you. Make sure you are not allergic to any topical or injectable numbing agents before requesting this. Not everyone needs this for Botox & Dysport injections, but it sure can help those that do! See you around the office.

#### Incredible Ear Pinning Results!
Here is a case of cosmetic ear pinning, or otoplasty, where the results simply speak for themselves - and the result is just incredible!

This young lady came to Dr. Hilinski after doing online research and coming to the conclusion that he was considered the best cosmetic ear surgeon in San Diego. Her main concern was that her ears stuck out too far from the side of her head. In addition, like so many otoplasty patients seeking ear pinning surgery, her ears were very asymmetrical. This means that one ear - in her case, the left side - stuck out further than the other. This is readily appreciated in her preoperative photo shown here to the left. If her ears were simply made more symmetrical, that would take much of the unwanted attention away from the ears. But the fact of the matter was that the ears did stick out too far on both sides.

After close inspection and examination of her ears, Dr. Hilinski recommended cosmetic otoplasty surgery - most commonly referred to as ear pinning surgery. Over the past years, Dr. Hilinski has established himself as one of, if not, the best otoplasty surgeons in the entire region. In fact, patients come from all over the world - literally - to have Dr. Hilinski reshape their ears. This is because Dr. Hilinski does such a high volume of cosmetic ear surgery compared to most board certified plastic surgeons in practice today. Just take a look at his extensive online photo gallery showing amazing ear pinning results. Whereas most plastic surgeons can show you one or two real life examples of their otoplasty skill, Dr. Hilinski can show you case after case after case of fantastic ear pinning results. That is because he does so much more otoplasty than most plastic surgeons you will come across in your research. Don't believe this? Go ahead and look online for yourself and you will quickly realize that Dr. Hilinski stands out amongst all plastic surgeons as a true expert and specialist in ear pinning surgery.

In this particular patient, Dr. Hilinski performed what he refers to as a preservation otoplasty procedure, or a subperichondrial otoplasty technique. This is a fancy medical term that simply designates the tissue plane that Dr. Hilinski utilized in reshaping her prominent ears. By using the subperichondrial plane to dissect and expose the ear cartilage, Dr. Hilinski was better able to pin her ears back with much more accuracy and assurance versus the tissue plane most often used by other plastic surgeons. All of this was done from behind the ear where careful cartilage excision and suture placement allowed Dr. Hilinski to set her ears back closer to the side of the head. The entire surgery took about 2 hours to perform and was done under just local anesthesia where she was awake. Once the numbing medication was injected around the ear, the patient felt no pain at all. Like all of our otoplasty ear pinning patients, she wore a compression wrap around the head for about 4-5 days during the initial healing period. Thereafter, she just wore a bandage at night time while sleeping for upwards of 4-6 weeks after the ear pinning.

Results of her otoplasty surgery are shown below - several months out from the operation. As you can readily see, she has incredible results with a marked transformation of her overly prominent ears. Her ears are now (1) definitely closer to the side of her head with much less prominence as seen from the frontal angle and (2) significantly more symmetrical now with both ears looking pretty darn close to one another.

If you have prominent ears that stick out too far - and you desire to have your ears pinned back - come see San Diego's leading expert in otoplasty surgery, Dr. John Hilinski.

#### Incredible Tummy Flattening Results
This is just an incredible example of how Coolsculpting can be used to flatten your tummy with absolutely no incisions, no surgery and no downtime!

This young lady from San Diego was in good shape - but wanted to be in even better shape. Specifically, her main issue was with the mid abdominal section, which happens to be a very common concern for many patients seeking a better figure. In so many patients, getting rid of pesky abdominal fat can be a significant challenge - even when someone is working out vigorously on a regular basis and maintaining a healthy, balanced diet. After weighing her treatment options - which ranged from invasive surgical liposuction to non-surgical fat freezing - this patient elected to go with the world's #1 non-invasive fat treatment option, Coolsculpting.

She researched her choices for Coolsculpting offices in San Diego and decided to go with the medical spa staff led by board certified plastic surgeon, Dr. John Hilinski. As it turns out, she became the featured Coolsculpting model for one of Dr. Hilinski's CoolEvent seminars. These CoolEvents are scheduled nearly every quarter and are intended to help Dr. Hilinski's patients better understand why Coolsculpting is such a great choice for those seeking non-surgical fat reduction and body reshaping. The concept and theory behind fat freezing is reviewed as are case examples of actual patients who were made very happy from Coolsculpting treatment performed by Dr. Hilinski's incredible medical spa staff. So if you are on the fence about whether or not to have Coolsculpting performed, join our mailing list to get an invite for the next CoolEvent!

This particular patient ended up undergoing fat freezing of the abdominal area to help target the excess superficial fat layer that sits underneath the skin. The phenomenal thing about Coolsculpting is that the skin doesn't get damaged or injured during the treatment. The extremely cold temperature that is transmitted from the Coolsculpting adapter bypasses the skin and goes directly at the underlying fatty tissue layer. As this is done, the fat gets permanently destroyed. Once this destroyed fat gets absorbed away by the body in the ensuing weeks, the overlying skin layer starts to shrink wrap down to that new, slimmer shape. Although many patients begin to see this improved body shape within 1-2 months of Coolsculpting, most will see their new body reveal itself in 2-3 months.
Amazing Abdominal Coolsculpting
The photos shown here represent very stable changes in this patient beyond several months of the Coolsculpting treatment. If you take a close look at mid section, you can readily see just how much slimmer her tummy now is after treatment! She now has a flat stomach thanks to the science of freezing fat - and to Dr. Hilinski's medical spa staff! Overall, we would say these results are quite amazing for a cosmetic office-based treatment that requires no surgery and no downtime at all.

#### Influence of Scar Tissue Development on Rhinoplasty Healing
Some patients have inquired about scar tissue formation after rhinoplasty and revision rhinoplasty. Specifically, they ask if the nose permanently becomes bigger because of scar tissue development under the skin following nasal reshaping? In most cases, the nose will not enlarge significantly following rhinoplasty or revision rhinoplasty. In fact, in most cases the nose will trend toward shrinkage as the months and years go on. There are, however, instances where rhinoplasty and revision rhinoplasty patients will experience some degree of enlargement of the nose. In my experience this is more common in those patients with very thick skin, such as ethnic rhinoplasty candidates. The area just above the tip, called the supratip, is particularly susceptible to excess, unwanted scar tissue formation. If noted, fortunately steroid injections can be quite successful in managing this in the office. Overall, though, most experienced rhinoplasty and revision rhinoplasty experts will take into account the skin type and anticipated postoperative scarring during the actual procedure so that these variables have little to no impact in the final outcome.

#### Injectable Filler for Deep Forehead Wrinkles in San Diego, CA
This case example is a great learning case to visually see what dermal fillers can do for excessively deep, unwanted facial lines and wrinkles. This male patient from San Diego, CA was unhappy with a deep horizontal line across the forehead region. Although Botox injections could help minimize worsening of the line by stopping the underlying muscle movement, Botox injections were not sufficient to fully erase the line in its resting state. Instead, he required dermal fillers to smooth out the undesirable deep wrinkle. Dermal fillers include the more popular hyaluronic acid fillers, such as Juvederm, Restylane and Perlane. This particular patient opted to have Juvederm injections of the forehead region to correct the unwanted wrinkle line. During a 20 minute office-based procedure, Juvederm was injected just underneath the skin to push the deep aspect of the crease closer to the surface. This resulted in a marked improvement in contour across the central aspect of his forehead. And when comparing the before and after Juvederm injection photos, you can easily appreciate how much less noticeable the horizontal forehead wrinkle is following injectable filler treatment. This is the type of cosmetic improvement that would likely never be achieved with use of Botox injection alone, especially in the male patient population in the forehead region. If you are bothered by deep forehead lines and wrinkles and wish to have them treated during a quick, minimal downtime office-based cosmetic treatment, contact our San Diego facial plastic surgery office today to consult with Dr. John Hilinski - one of the most expert dermal filler injectors in the region.
Before and After Forehead Dermal Filler Injection

#### Injectable Silicone for Facial Enhancement of the Cheek
Many patients inquire about non-absorbable options for treating unwanted hollowing and volume deficiency of the face. These are patients that have tried temporary injectable fillers, such as Juvederm, Restylane, Perlane and Radiesse, but are unhappy with having to get repeated treatments every year. One alternative is to use liquid silicone injections to achieve a more long-lasting cosmetic enhancement. Silicone injections are considered off-label when used for this type of purpose. They are FDA approved for injection elsewhere in the face, but like Botox and hyaluronic acid fillers, silicone is used off-label (meaning off the FDA label) in other areas for cosmetic treatment of unwanted soft tissue depressions and hollowing. This includes undesirable shadowing around the lower eyelid-cheek junction and loss of facial volume in the mid-cheek region. The patient example below highlights the typical candidate for silicone injection.
Micro Injection of Silicone
This male patient from San Diego felt as if his cheeks were becoming too hollowed and thinned. On examination, he definitely demonstrated evidence of soft tissue atrophy (shrinkage) particularly through the cheek to lower eyelid region. We discussed the various options available to him. Ultimately, he chose to have micro silicone injections to help him achieve a more sustained, long-term cosmetic enhancement. By 'micro' what is implied is that the silicone is placed with much smaller volumes of injection distributed over a wide area. This in contrast to injecting the same amount of total volume into one or two confined areas. By distributing the silicone injections over a broader region, the body has greater opportunity to surround the micro droplets of silicone with collagen tissue. Thus, there is a more dramatic, smoother collagen response that translates into an improved cosmetic result with less chance of complications. Following a series of silicone injections spaced apart 6-8 weeks each, the body's own collagen elicits a controlled response to fill out the treated areas. As you can see in his before and after photos, there has been a notable volume enhancement through the cheek and lower eyelid region that gives him a 'fuller' look to his face. And what he sees in terms of a clinical response is there for the long run as silicone injections result in a more permanent outcome.

#### Injection Revision Rhinoplasty - But Not What You Think!
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!

#### Injection Rhinoplasty To Reshape The Asian Nose
I wanted to post a quick blog about one of our recent injection rhinoplasty patients. This Asian patient desired cosmetic reshaping of her nose but did not wish to undergo a surgical procedure. We discussed the possibility of undergoing an injection rhinoplasty procedure using one of many different injectable fillers to reshape the nose. She ultimately decided to have Artefill done. This particular product, Artefill, is the only FDA approved non-absorbable filler on the market in the USA. Artefill used in this manner (for Artefill injection rhinoplasty) is what we call an 'off label' use of the filler. Using a syringe of Artefill her nasal bridge was augmented, or elevated in height. We also lengthened her tip just slightly. We did this all the while maintaing her ethnic nose appearance. As you can see from her photos, this is a nice example of how permanent injectable fillers can be used to reshape the nose without having had surgery.

#### Inner Thigh Slimming
Check out this incredible change to the inner thigh region as a result of 2 sessions of Coolsculpting.

As San Diego's best team of fat freezing experts, we offer dual sculpting for thigh reshaping. This means you can have your thigh slimming procedure done in half the time it takes other Coolsculpting offices. Dr. Hilinski and his Coolsculpting experts have two machines (which is why it is called dual sculpting) that can work simultaneously to freeze fat away at twice the speed it would take other practices.

Dr. Hilinski has an amazing group of Coolsculpting specialists who have graduated from Cool University - meaning they have advanced training and expertise in fat freezing techniques beyond your average San Diego medspa staff. This translates into you getting the best treatment possible with Coolsculpting.

In addition, Dr. Hilinski's medspa practice is officially certified by Zeltiq - meaning they are among the elite Coolsculpting practices in all of San Diego.
Inner Thigh Coolsculpting
This female patient wanted to target the excess fat along the inner thigh region. And as you can see, not all Coolsculpting patients have ultra toned, muscular physiques. Many patients are just looking to reshape one or two areas of their body, like the thighs. This particular woman opted to undergo Coolsculpting due, in part, to the fact that freezing fat can be done without surgery and without any downtime. Inner and outer thigh Coolsculpting is a fairly popular choice and one of the more common types of fat freezing that our team of specialists offers. In this case, the inner thigh was targeted with the Coolsculpting CoolAdvantage applicator - which is designed specifically to treat anatomical areas, such as the inner thigh. Ultimately, this patient wanted to undergo two fat freezing sessions - spread apart by a few months. The results shown here represent her changes about 8 weeks after the second Coolsculpting thigh treatment. As you can readily see, there has been a marked improvement in her inner thigh region as a result of the excess fat having been frozen away. The great thing about Coolsculpting is that - once the fat has been frozen, it isn't coming back again. The patient was quite happy with her overall  transformation in the inner thigh area - noting a substantial improvement in the contour of her thighs. And to think that all of this was done without any needles and no surgical recovery of any type.

If you desire to have inner thigh contouring to give you slimmer thighs - contact the #1 Coolsculpting team in San Diego to discuss your candidacy and options to have the fat frozen away. We look forward to helping you attain your cosmetic goals.

#### Insurance-Based Nose Job
I get inquiries quite frequently from patients asking about insurance-based nose job surgery. This link here will explain in more detail the type of nose surgery that is commonly covered by PPO health insurance carriers like Cigna, Health Net, United Healthcare, Aetna and other PPO plans. This is just one example of many types of reconstructive nose surgery that is considered functional in nature. Although the main emphasis is to make the nose work better, there are often times passive changes in terms of the appearance of the nose that can make it look and function better at the same time - while still being covered by insurance. Let us know what you think of this latest addition to our online rhinoplasty tutorial.

#### IPL & Microdermabrasion Specials at the Hilinski Clinic
The Hilinski Clinic and Laser Skin Care Specialist Deanna Wegge, RN, would like to announce their Fall specials on Microdermabrasion and IPL treatments. Microdermabrasion is a great way to enhance your skin's appearance with no down time. Fine micro-crystals of sand are gently used to remove the outer dead layer of skin while giving your skin a more vibrant, rejuvenated look. IPL stands for Intense Pulsed-Light and is wonderful option for those seeking treatment for:

	Reduction / removal of hyperpigmented or dark skin
	Reduction in appearance of red spots and Rosacea
	Reduction of unwanted sun and age spots

Special Microdermabrasion pricing: $30 per treatment for new patients

Special IPL pricing: $75 per treatment for new patients and $125 per treatment for returning patients

Call our office today to schedule your private consultation and treatment with Deanna (619) 296-3223.

#### Is It Normal to Have My Ear Look Overcorrected After Otoplasty Procedure?
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

#### Is It Normal To Have Swelling After Removal Of My Cast Following Rhinoplasty?
I have heard this question asked on several occasions by my own rhinoplasty patients as well as those out there in cyberspace. The answer is - yes. It is quite normal to see a slight increase in swelling of the nose following removal of the cast after rhinoplasty or revision rhinoplasty. The cast and tape help compress the skin and soft tissue during the early healing process. Once removed there is typically some degree of rebound swelling that can occur for 24-48 hours longer. Usually within a few days of this, though, the swelling settles quite nicely so that most rhinoplasty patients feel fairly comfortable in the public eye within 10 days of the surgery.

#### Is Laser Skin Resurfacing Right for Me?
Typically, good candidates for laser skin resurfacing have a number of cosmetic concerns that can be treated simultaneously with our dynamic Lumenis® UltraPulse® Encore™ laser. With two configurations, this laser can be used to minimize the appearance of fine facial wrinkles, enhance skin tone, and improve texture. Since the laser encourages skin cell turnover, new collagen growth can tighten the skin, making skin resurfacing a beneficial procedure for patients seeking a non-surgical lift. Patients who wish to address moderate to severe facial creases or folds may be better suited for a traditional facelift.

Deeper wrinkles are not the only indication that laser skin resurfacing might not be the best procedure to suit a candidate’s needs. Patients who have excess or sagging skin or active acne may also not achieve their desired results with skin resurfacing. In addition, Dr. John Hilinski cautions that patients with darker skin tones may have a higher risk of developing hyperpigmentation after treatment. 

The best way to determine your candidacy for laser skin resurfacing is to schedule a consultation with a qualified plastic surgeon who can perform a physical exam and thoroughly discuss your personal goals. If you would like to make an appointment with Dr. Hilinski to discuss your candidacy, please contact our office today.

#### J Plasma Erases Smoker's Lines
Here is a short video demonstrating how Dr. Hilinski - San Diego's first plastic surgeon offering J Plasma - used cool helium plasma energy to erase away deep 'smoker's lines' in this female patient. If you have deep wrinkles around the mouth that bother you, contact our office today to schedule an appointment with Dr. Hilinski to see if you are a candidate for this amazing, revolutionary procedure.

Renuvion Skin Rejuvenation Video

#### Juvederm Lip Filler Treatment
Example of lip augmentation using Juvederm to give this young lady fuller, plumper, more shapely lips. A key to performing lip enhancement with injectable fillers like this is to always try and maintain a natural look. Contact our office today for a personalized consultation with Dr. Hilinski to see what filler (Juvederm, Restylane, the new Vollure) may be your best option to have more beautiful lips.

#### Juvederm Lip Plumping
This patient had Juvederm lip filler to create a plumper, smoother lip contour. Like many younger patients her age, she started off with reasonable lip shape and volume. But she wanted to have even fuller lips. Juvederm is an excellent option that I use on a very regular basis to achieve results like those shown here - where the lips appear enhanced, yet they do not look excessively puffy. This is the essence of doing high end facial plastic surgery - to enhance while maintaining a look as if the patient could have simply been born that way. Let us know what you think of her results!

#### Karo Syrup and Eyelid Swelling After Blepharoplasty
Eyelid swelling following blepharoplasty, or an eyelid lift, is quite common within the first 72 hours of the recovery period. The eyelid skin is rather thin and, therefore, even a small amount of inflammation will contribute to moderate swelling of the region. Because of this I recommend that all patients apply a cold/ice compress to the eyelids during the first three days of recovery. One handy trick that was recommended to me by one of my patients (thank you Dee Ann!) this past year involved using regular old Karo syrup! Karo is corn syrup that is commonly found in many kitchen cupboards. If placed into a ziplock sandwich bag and then the freezer, it becomes a nearly ideal cold compress for the eyes! The syrup will typically not freeze but does get sufficiently cold for our purpose. Unlike ice and even frozen peas, the cold liquid then conforms very nicely to the contour of the eye and surrounding cheek bone. The Karo syrup maintains a nice cold temperature for quite a while before having to place it back in the freezer. Most patients will keep two bags in the freezer while using one on each eye and rotating them accordingly. What a novel and effective way to keep your eyelid swelling to a minimum following blepharoplasty.

#### Kybella Double Chin Fat Treatment
Ever wanted to get rid of that pesky double chin? Do you have excess submental (below the chin) fat? Kybella may be the exact treatment you need to create a more defined neckline. Kybella is an FDA-approved office-based injection that can help melt unwanted fat under the chin. Dr. Hilinski, an expert in facial plastic surgery, is one of the area's leading experts on treating this type of cosmetic issue. Call our office today to see if you are a candidate for Kybella fat correction.

#### Large Ear Made Smaller
Yet another amazing case of ear reduction performed by San Diego cosmetic ear specialist, Dr. John Hilinski. If you research ear reduction surgery online, you are likely going to find that Dr. Hilinski is the country's leading expert when it comes to making large ears smaller in size. He has grown this niche segment of his plastic surgery practice over many years - accumulating the most experience and knowledge when it comes to making patient's ears smaller in size. This was a natural extension of his otoplasty, or ear pinning, practice. For so long, Dr. Hilinski has been performing otoplasty surgery. But many years ago, he realized so many of these otoplasty patients actually needed a different type of cosmetic ear surgery. This was the stimulus behind him starting to do so many ear reduction surgeries for macrotia. Since that time, he has developed a growing reputation as one of the best and only plastic surgeons in the country who performs this surgery on a regular basis. Take a look at his online gallery of ear reduction photos to see the type of incredible results he is able to achieve for patients with large, unshapely ears.

Immediate Surgical Ear Reduction

#### Large Gauge Earlobe Defect
Over the past several years, my practice has seen a huge increase in the number of patients seeking corrective plastic surgery for gauge earring defects. These patients have all had prior piercings with use of gauges that have stretched the earlobes to a variable degree. Once they stop using the gauges, the earlobes are left with a rather sizable defect. Correction of this type of earlobe abnormality requires very delicate plastic surgery performed by someone who is well-versed in cosmetic ear reshaping. To learn more about this niche procedure using a case example of one of my patients from San Diego, simply click here. Intrigued by the defect seen here? See the result of the surgery here and let me know what you think!

#### Laser Mole Removal
Here is another example of how Dr. Hilinski uses a CO2 laser to help reduce the visibility of a raised mole along the upper lip region. This patient, a male, was bothered by the fact he continuously cut the mole while shaving. This is not unusual for male patients with raised moles around the facial hair-bearing region. Dr. Hilinski discussed the various options available to him - ranging from shaving with a surgical blade to cutting it out. The patient opted to go with the laser procedure, which was done with a little injection of local anesthesia. Here is the video showing his procedure.

Laser Mole Removal

#### Latera Nasal Valve Procedure
Do you have chronic nasal obstruction that is not relieved with use of topical nasal steroid sprays? Does your nose collapse inward when you breathe in deeply? If so, you may be a candidate to undergo treatment with the Latera device.

Latera is a minimally invasive procedure that is done under local anesthesia to help patients breathe better. It was specifically designed to target what is called lateral wall collapse - which refers to a weak side wall of the nose. In some patients, the side of the nose is simply too flimsy from poor cartilage support. When these patients breathe inward, the side wall pinches inward, or collapses. This results in the subjective sense of nasal obstruction - meaning these patients can't breathe very well through their nose. The Latera device was created by experts to reinforce the weakened side wall of the nose - making it stiffer and less susceptible to collapse when breathing inward.

Dr. Hilinski is internationally known as an expert in nose reconstruction. As such, he utilizes some of the latest techniques to help his patients - which includes placement of the Latera device. In most cases, this is done while the patient is fully awake - using an injection of local anesthesia to numb up the side of the nose. The device is then placed through a small piercing made on the inner lining of the side wall. There is minimal recovery involved - but potentially a significant improvement in nasal breathing for patients having the Latera procedure.

If you feel like you may be a candidate for Latera placement by Dr. Hilinski, contact our office today to schedule your appointment. Latera is covered by most PPO health insurance plans.

#### Latest in Body Contouring
What is the latest technique when it comes to body contouring? It's Coolsculpting by Zeltiq!

Coolsculpting is a non-surgical, non-invasive method to reduce unwanted body fat by freezing it away. What happens to the fat once it is frozen? It is gone forever. What many patients don't know about body contouring and fat reduction is the fact that you are born with as many fat cells as you will ever have in your life. If a fat cell dies off, it will never be reborn and cannot return. Now the fat cells that remain can get bigger. But those fat cells that were destroyed, for example, by Coolsculpting treatment will never come back. So what are you waiting for? Get your body contoured and get that figure you have always wanted by freezing that fat away!

#### Latest Photo Example of Cosmetic Rhinoplasty
This is the latest addition to our ever-growing San Diego rhinoplasty gallery. This young lady from San Diego, CA desired to have her nose reshaped. More specifically, she disliked the bump on the bridge and the fact her tip hung down too low. This is actually a very common complaint among rhinoplasty candidates. I ended up performing her cosmetic rhinoplasty using an open approach technique. I reshaped the bridge by making it appear straighter. I then brought her tip up to a more appealing position, but avoided making the tip too high. As you can see from her before and after photos, there is an overall marked improvement in the appearance of her nose. However, she still looks quite natural - as if she could have been born with her new nose. Take a look at her before and after photos and let me know what you think!

 

#### Latest Rhinoplasty Case Example
Visit SanDiegoRhinoplasty.com to see the latest case example published online by San Diego's foremost expert in rhinoplasty surgery - Dr. John Hilinski. Our sister site was created with the intention of providing any patient considering cosmetic nose surgery an online resource to learn more in-depth about this amazingly complex surgical procedure. This latest case example focuses on how Dr. Hilinski is able to preserve the front view of the nose while taking down a large nasal hump deformity and lifting the nasal tip in this young lady from San Diego. Look under Rhinoplasty Topics to see the entire library of entries discussing rhinoplasty surgery. This particular rhinoplasty case discussion is titled Preserving Front Appearance of the Nose.

#### Lengthening The Short Nose in Rhinoplasty
Perhaps one of the most difficult procedures to perform in the world of rhinoplasty and revision rhinoplasty is lengthening the short nose. By 'short nose' I am referring to a nose that is overly rotated or turned up. In rare cases a short nose can be congenital, meaning it is simply the result of one's genetics. In a majority of cases, however, the short nose is something that is the result of prior rhinoplasty surgery that was unsuccessful. In these cases, something was done to the nasal tip region to cause the tip to turn, or rotate, upward excessively. Usually this is a consequence of trimming off too much cartilage in the nasal tip region. In other cases, this can be the result of the tip simply being positioned too high. Visually, the short nose is commonly described by lay people as looking like a pig nose. This is because the nostrils become quite visible when seen from the frontal direction. It is completely normal to see some nostril from the front of the average nose, but an excessive amount is seen in the short nose deformity. The surgery to correct this problem is quite difficult because you have to replace the deficiency in cartilage while reshaping the tip in its entirety to reproduce an anatomically normal nose. In essence, you are lengthening the nose by adding back on to the tip region. In addition, you have to re-stretch the skin so that it can accommodate the new length. If the skin has not already scarred down, this may not pose such a problem. But in many cases of revision rhinoplasty, the tip skin has scarred down so much that it is quite difficult to re-stretch it during the lengthening process. Several specialized maneuvers are then required to help lengthen the skin once again. Another concern in lengthening the short nose in rhinoplasty is having sufficient cartilage to rebuild the tip. If there is septal cartilage remaining, this is always a nice option for cartilage grafting. In some cases, taking ear cartilage to graft the tip of the nose may be a secondary option. But ear cartilage isn't always strong enough when it comes to lengthening the nose in revision cases. So rib cartilage grafting might be indicated in cases where a plentiful supply of resilient cartilage is needed. Provided below is a case example of a San Diego rhinoplasty patient of mine who had a short nose following surgery by another plastic surgeon. In this particular case, we were able to use her own ear cartilage to help lengthen the nose. I was able to free up her nasal tip skin and borrow from areas immediately above the tip region. I then completely reshaped the tip by adding cartilage on to her existing tip. In doing so, I lengthened her nose extending it downward. Once done, we were able to effectively reshape the tip while significantly reducing her nostril show as seen on the front view in particular. Her end result is actually one that looks quite natural without the stigmata of having had prior rhinoplasty surgery.

#### Limited Otoplasty for Keloid Scarring of Ear in San Diego, CA
This case example highlights a very common problem that is seen in our office - keloid scarring of the ear following piercing. This particular female from San Diego sought out our services because she developed a very unsightly scar on her ear after piercing it several years ago. This type of scarring is referred to as a keloid scar since the excess, hard tissue that developed began to overgrow the area. As you can imagine, this type of scar development can lead to great anxiety due to its very unusual appearance. After living with it long enough, this patient consulted with our office given my reputation as being one of the most experienced otoplasty (cosmetic ear reshaping) surgeons in the southern California area. After meeting with her, it was decided that a limited otoplasty procedure was indicated to reshape her outer ear to help recreate a more normal looking contour. She decided to have the otoplasty procedure performed, which was done in our office surgical suite under local anesthesia. This is much like going to the dentist where Novacaine is injected into the gums to numb any pain. The procedure began with removal of a good majority of the keloid scar that was contributing to the abnormal contour. I intentionally preserved (kept) some of the skin overlying the keloid scar so that I could use it to reshape the outer ear. Using very meticulous technique while carefully handling the tissue, I was able to essentially recreate a natural looking curvature along the outer border of the ear. She had an initial recovery from the otoplasty surgery of about 5-6 days before she could look presentable in the public eye. After several more months, the swelling resolved sufficiently and the skin color rebounded to the point she was quite comfortable in all social settings. As you can see by her before and after otoplasty photos below, her ear now looks like a normal ear.
Ear Plastic Surgery Photos - View 1

Ear Plastic Surgery Photos - View 2

Ear Plastic Surgery Photos - View 3

Ear Plastic Surgery Consult in San Diego
If you or someone you know is struggling with a similar problem that might benefit from plastic surgery of the ear, or otoplasty, feel free to contact our San Diego office today to schedule a consultation.

#### Lip Enhancement Augmentation With Juvederm
In order to help let our potential patients know what it looks like immediately after lip enhancement with Juvederm (or Restylane), I have provided the following case example. This young female patient presented for augmentation of her lips using an injectable filler. On examination you can see that her lips were clearly asymmetric with the right upper lip being much smaller than her left upper lip. As is indicated by the white arrow, one can appreciate that her right upper lip looks much flatter and, in fact, slants downward toward the corner of her mouth more so than her left side. This happens to be more the rule than the exception when it comes to lip enhancement or lip augmentation patients. All of us are asymmetric to some degree, which can include our lips. Fortunately, injectable fillers such as Juvederm and Restylane can be used effectively to address these asymmetries while also augmenting, or volumizing, the lips. In this particular female patient from San Diego, we used Juvederm to plump out her lips. First we started out correcting the asymmetry by adding volume to her right upper lip. Once we achieved adequate symmetry of the lips, we then began augmenting the lips with the filler. I injected her lips to give her a more pouty, puffy look while trying to maintain a natural shape and look. This was done in the office examination chair and took maybe 10 minutes at most to complete. The photos below show her 2 minutes after the injectable filler treatment to enhance her lips. As you can see, she now has improved symmetry with a moderate volume enhancement of her lips. She also now has a nicely defined vermillion border of the lip with a more feminine overall appearance. Importantly, you can appreciate that she is not significantly swollen. There is certainly some degree of swelling from the injection procedure, but not as much as many patients fear when they think of Juvederm or Restylane lip enhancement. And not bad at all for 2 minutes following the injection. Over the next 24-48 hours this will settle down to the point that hardly anyone would be able to tell she even had lip injections performed. So for those of you worried about excessive swelling and puffiness immediately following lip injections, hopefully this blog entry helps you in your decision making process!

#### Lip Filler in Coronado
Are you a resident of Coronado and looking for the best medspa services, such as Botox, Juvederm, and Restylane injections? Unlike the central San Diego area, there aren't many choices in Coronado when it comes to choosing an expert in facial cosmetic procedures to do your lip injections and/or wrinkle reduction treatments.

Dr. Hilinski and his incredible medspa team are a great choice for Coronado residents looking for any of these cosmetic treatments - including all dermal fillers, microneedling, PRP and Coolsculpting. For years, Dr. Hilinski has built his reputation as the #1 plastic surgeon in San Diego - and is now looking to bring his skills and experience to the community of Coronado.

If you live in Coronado, don't just settle for any office that provides these cosmetic services part-time. Dr. Hilinski and his team do this type of thing all day long - everyday. Dr. Hilinski's main office is located in beautiful Banker's Hill - just minutes over the Coronado Bay Bridge. As he began seeing more and more patients coming over from Coronado for Botox, Dysport, Juvederm, Restylane, Coolsculpting and many other cosmetic treatments, he started to think about having more of a presence on the island to cater to local residents who wanted minimally invasive, aesthetic face and body enhancements.
Coronado Juvederm Injection
Just one example of a common office-based procedure offered by Dr. Hilinski and his medspa staff is Juvederm lip filler. Juvederm is one of the most popular injectable fillers to plump and reshape lips. Juvederm Ultra XC is a specific type of Juvederm that is commonly requested by patients coming over from Coronado. This particular lip plumper - like many of our injectable fillers - contains lidocaine, which makes it much more comfortable for patients seeking fuller lips.

Here is an actual patient example of what Juvederm Ultra XC can do for lips that are in need of more volume and shape. This young lady consulted with our med spa staff because she wanted an injectable filler to give her fuller, plumper lips. This is often times referred to as non-surgical lip enhancement since there is no cutting or surgery involved. During the procedure, a tiny hypodermic needle is used to inject the upper and lower lip in various, strategic areas to increase the lip volume. By plumping up the lips, it gives more of a feminine shape, which is a common request among injectable filler patients. In this particular case, the upper lip started off being much smaller than the lower. Ideally, the upper lip should be smaller than the lower - but not this much. So for this patient, it was recommended she get Juvederm Ultra XC to fill out the upper lip more than the lower lip. In doing so, she would achieve more balance.

As you can see here for yourself, she had a beautiful, immediate improvement in the shape and size of her lips as a result of the Juvederm Ultra XC. Her upper lip was filled out a bit more than the lower - helping her get that nearly ideal balance. The other thing to note is that she has essentially no bruising and/or signs of having had her lips filler out with filler. This is because our team of cosmetic experts are amongst the best filler injectors in all of San Diego - including Coronado.

Coronado Juvederm Consult
If you live on the island of Coronado and are considering injectable fillers, Botox, microneedling, PRP and/or Coolsculpting - contact the office of Dr. Hilinski to schedule your complimentary consultation with his med spa staff.

#### Lip Flip
The latest rage is the plasma pen lip flip procedure as demonstrated here. Using revolutionary plasma technology, Dr. Hilinski and his medical spa staff can help you achieve more beautiful, plumper lips without having any injectable filler placed.

This young lady here came to Dr. Hilinski's office in Banker's Hill desiring lip enhancement. More specifically she wanted her lips to appear fuller and more shapely - but didn't necessarily want a filler, such as Juvederm, injected. She discovered there was a procedure called a lip flip that could help her out and opted to have it performed.

So how is the lip flip done? Using the plasma pen - or magic wand as it is commonly called in plastic surgery offices. The procedure can be completed using only topical numbing cream applied across the upper and lower lip region. The plasma pen is then used to tighten the skin above the upper lip and below the lower lip. In doing so, the skin above and below the lip is tightened. This results in the pink part of the lip (called the mucosal lip) flipping, or curling, outward. Visibly, this creates the appearance that the lip is fuller and plumper.

And the more plasma pen lip flip treatments you have done, the more of a result you will see in terms of improved pink show. Therefore, the lips will look even fuller with additional treatment sessions.
Lip Flip Photos
Don't believe in the plasma pen lip flip? Just take a look at her results shown here. As you can appreciate, her upper and lower lip now have improved shape and contour. This includes a more defined cupid's bow and vermillion border - some of the key characteristics of a beautiful lip. In addition, the amount of pink show that she now demonstrates is so much better. And the lips look less wrinkled with a smoother appearance. And all of this was achieved without a single injection of the lip!

San Diego Lip Flip Treatment
Do you want sexier, fuller lips without injection? Get the plasma pen lip flip done with San Diego's #1 plasma technology office - headed by board certified plastic surgeon, Dr. John Hilinski.

#### Lip Injections San Diego
Want to see why so many patients from San Diego, La Jolla and Coronado come to Dr. Hilinski and his medical spa team for lip injections? Here is just one example showing a patient looking to get lip filler injection.

This young lady came to our office complaining that she didn't have much of a lip. More specifically, she was looking to get some plumping of the upper lip, which she felt was simply too flat. This is actually one of the more common complaints that we see in patients seeking out lip filler - they just feel like their lips are deflated and need help with added volume and plumping. In many cases, these patients are looking to get lip enhancement so that they can more readily apply lipstick without having to constantly outline their 'pink' lip. The pink lip refers to the pink mucosal surface of the lip that sits below the vermillion border of the upper and above the vermillion of the lower. The vermillion border provides a nice outline to the lip, but it is this pink lip that really gives it volume and shape (or makes it appear deficient in both).

On examination, it was rather obvious that her upper lip was flatter than her lower lip. This is also a frequent observation amongst our many lip filler patients. If you look closely at this patient's upper lip, you will notice that her 'pink' lip was especially thin off to the sides. The middle portion of her upper lip had a decent amount of volume below cupid's bow. It was more the sides of the upper lip that were lacking in volume and shape. However, in a great majority of lip filler patients, you can't just add more volume to the upper lip without making it look imbalanced. Keep in mind that the lower lip should always big more plump than the upper. In fact, so often I still see people walking around town that have the obvious stigmata of undergoing lip filler injection - and that is an overly plumped upper lip that is much larger than the lower lip. We have all seen this, right? This duck looking lip is a result of someone putting too much filler in the upper lip and not enough in the lower lip. This is precisely why you need to get your lip filler treatments performed by an expert in facial cosmetic surgery - like Dr. Hilinski and his medical staff team.
Lip Filler Treatment
So it was determined that this patient was an excellent candidate to undergo lip filler treatment with the goal of plumping her upper lip more than her lower. Jointly we decided to opt for Juvederm as the filler of choice for her. Could we have used Restylane to inject her lips? Absolutely. But both fillers are great options when it comes to lip enhancement, which is why our office offers both Juvederm and Restylane to all patients.

Below you can see the results she obtained from the lip filler treatment done by Dr. Hilinski. And these photos were taken literally within 1-2 minutes of her lip filler treatment. As you can see, she now has lips! In particular, her upper lip has been plumped out very nicely to give it the necessary volume and shape that she desired. The lower lip was also injected with the Juvederm, but just not as much as the upper lip. This was done, again, just to maintain the proper balance needed between the upper and lower lip.

If you look at her vermillion border (the junction between the pink and white lip), it also looks better. But this is not from direct filler injection. In fact, Dr. Hilinski did not inject any filler directly into the vermillion border of her lip. He did, however, carefully put some Juvederm filler immediately adjacent to this area in an attempt to truly reshape her lip. Being able to create a beautiful lip, as is shown here, is sort of like being able to sculpt - not everyone can do it successfully. If someone simply injects a lip with filler without regard to sculpting, the patient will end up with a lip that looks more like a sausage - just plumped out all the way across without any real shape. Obviously, this is not the goal when it comes to lip filler treatment. Rather, the aim is to create a more shapely, plumper lip that has the specific features and highlights of a beautiful, aesthetically ideal lip.

Why does it look like she has lipstick in the after photo? Because her lip is slightly inflamed from the lip filler treatment that was just done. The deeper pink color is just a reflection of a needle having been used to inject the lip. But what you don't see is any bruising or lumping from the lip filler injection. That is because Dr. Hilinski and his expert medical spa team are incredibly careful and meticulous when it comes to performing filler injections in the lip. Although there is always this risk of bruising, it is only seen in a small minority of our patients getting the lips plumped out. And when it does occur, this usually resolves fairly quickly with ice compresses and arnica.

Lip Filler Injection Consult
If you live in San Diego, La Jolla, or Coronado and feel like your flat lips could use some plumping and volumizing, reach out to the best lip injection treatment practice in town for a complimentary consultation with one of our medical spa experts. You too can have beautiful, shapely lips with essentially no downtime.

#### Lip Lift Cupid's Bow
We wanted to update you San Diego upper lip lift fans by showing this patient who recently came in for her follow-up visit with Dr. Hilinski. She sought out an expert to help her shorten an elongated upper lip while also giving her better pink lip contour and shape.

Like so many other patients, she was unhappy with how her upper lip appeared too long. In addition, she desired to have a more defined cupid's bow along with more 'pink show' - where the pink portion of the lip is more visible as seen from the frontal view. The latter is the same type of change that so many patients get from filler injections, such as with Juvederm and Restylane. Unfortunately, these type injectable fillers do not provide a permanent change to the lip.

That is where upper lip lift surgery can be so beneficial as an alternative form of lip enhancement and augmentation. In the process of shortening the upper lip distance, the pink lip is rolled out and up - giving the appearance that the lip has been volumized and plumped out - but in a more permanent fashion. That is precisely what was done in this case. Her upper lip was shortened by removing skin. Concurrently, the pink upper lip was turned up and out - defining and refining her cupid's bow.

The overall result is a more enhanced and rejuvenated upper lip that has a more feminine appearance. This is very similar to what is done so often with injectable lip fillers - but this result is permanent and long-lasting!

#### Liposuction for Chipmunk Cheeks?
Some patients have asked whether or not liposuction can be used to reduce chipmunk cheeks. Unfortunately, the answer is no - liposuction is not a viable option for treating the buccal fat pad. This has to do with the fact that the buccal fat pad is surrounded by a number of important facial structures, which would be put at risk of being damaged by the liposuction device. In addition, the buccal fat pad is comprised of fatty tissue that is different than the fat layer that sits just underneath the skin surface. The latter is amenable to using a suction device to remove the fat, whereas the former requires a more specific surgical procedure to tease the buccal fat out of the cheek.

The good news is that buccal fat removal is arguably more straightforward than liposuction of the face. Buccal fat removal, like liposuction, can be done under local anesthesia (without having to go to sleep). But the surgical area being operated on is much more focused. Plus, the incisions used to perform buccal fat removal are completely hidden inside of the mouth. The swelling seen from removal of the buccal fat pad is also more limited than that typically seen with liposuction. So all in all, if you have chipmunk cheeks and want your face made slimmer, buccal fat removal is the best answer. To get this scheduled with buccal fat removal expert, Dr. John Hilinski, simply call our San Diego office today.

#### Long Term Rhinoplasty Results
This San Diego rhinoplasty patient recently returned for a quick inquiry about her nose. She is nearly 4 years out from cosmetic rhinoplasty that I performed on her. Normally, plastic surgeons and rhinoplasty experts, like myself, will see patients for upwards of a year or two after surgery. Rarely do we get to see our rhinoplasty patients 4 years out! As you can see from her photo comparisons provided here, she has a beautiful, sustained cosmetic rhinoplasty result that will hopefully last her the rest of her life!

 

 

#### Look 10 Years Younger!
Take a quick look at this lady in her mid 50s who wanted to turn back the clock. She elected to have Dr. Hilinski perform a lower face and upper neck lift on her, which was complemented by some laser skin resurfacing. We would say - wow - she looks at least 10 years younger overall following her procedure. She is only a few months into the recovery process, so you can still see signs of healing. But she is very much 'publicly presentable' and is ecstatic with the improvements noted. Not only does she look that much younger now, she also just looks more rested. If you look even closer you will see the laser peel has made her skin that much smoother and tighter with less visible sun damage as well. And look how much improvement was made to those pesky upper lip smoker lines (although she isn't a smoker, we still call them this). Arguably more important, she still looks like herself, which is so important when performing face and neck lift surgery - avoidance of that dreaded wind-swept look as if you just had your face lifted.
Facelift San Diego Results

#### Look What Sculptra Cosmetic Can Do For You!
Sculptra injections are quickly becoming one of my favorite office-based cosmetic treatments. Sculptra injections literally allow me to sculpt your face to create improved contour and fullness in certain locations that tend to be negatively affected by the aging process. As an example, you can easily see how Sculptra injections to the temple, mid face and jowl region have helped this particular patient. You will notice that her face now looks much fuller and more youthful because much of the volume loss has been replenished. And all of this is done while sitting in the office exam chair with minimal recovery. Let me know if you happen to 'like' her results!

#### Look Younger With Rhinoplasty?
That's right. A recent online study was published in Cosmetic Surgery Times eNews that discusses how many patients actually look 1-2 years younger from having cosmetic rhinoplasty surgery performed. Although this type of facial plastic surgery is quite different than having a facelift or neck lift procedure done, rhinoplasty surgery can indeed create a more youthful looking face overall. Learn more about this study from plastic surgeons in the Irvine area by clicking here for a link. Food for thought regarding cosmetic nose reshaping!

#### Looking Age Appropriate Following Facelift Surgery in San Diego, CA
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.

#### Lop Ear
Lop ear deformity is a condition that results from abnormal development of the top portion of the ear. It is also commonly referred to as a constricted ear or cup ear deformity. 

The hallmark of a lop ear deformity is a helical rim (the top border of the ear) that is folded over. This can be mild in some cases or rather severe in others. When the segment of the ear just inside of the helical rim, called the scapha, is involved, the top one-third of the ear can appear even more abnormal. In this instance, the ear can appear to be more compressed from the top, leading to the term constricted ear deformity. In short, any of these lop ear deformities make the ear look too short in a vertical direction. 

Lop Ear Correction

Any attempt at correcting the lop ear will involve some method of making the ear more vertical in height, or taller. 

If lop ear is addressed during infancy, it can frequently be done successfully with non-surgical ear molding options. Once the ear has grown, though, it requires true surgical reshaping to make it look more normal. 

Surgical repair of lop ear varies depending on the underlying deformity. In nearly all cases, the top portion of the ear has to be completely reshaped by strategic reorientation of the abnormal cartilage framework of the ear. In some cases, additional cartilage has to be taken from somewhere else in order to have sufficient ‘building material’ to properly reconstruct the ear. 

Expertise in Lop Ear Repair

So often you will see plastic surgeons online touting their expertise in managing and treating lop ear deformity. But when you look at their websites, you realize they are simply doing otoplasty, or ear pinning, surgery – and not true correction of a lop ear. The reality is that there are very few plastic surgeons out there – like Dr. Hilinski - who have dedicated experience in correcting the lop ear deformity and can show you actual photos of their own patients. 

Lop Ear Correction Photos

Here are some select examples of how Dr. Hilinski was able to correct the lop ear deformity.

#### Lose Weight Without Surgery
We understand that losing weight can often times be difficult, but with the CoolSculpting by Zeltiq it doesn’t have to be so challenging anymore. For those patients who have made the effort to exercise while eating healthy and still have some stubborn areas of fat they would like to get rid of, Coolsculpting may help you lose those extra pounds without the risk of invasive surgical liposuction.
What is Coolsculpt?
Coolsculpt is the process of freezing fat to eliminate unwanted contours and rolls in certain areas of the body - including the neck, arms, abdomen, back and thighs. In fact, this is the only FDA-approved method to get rid of fat using this revolutionary cooling technology invented by researchers from Dr. Hilinski's alma mater - Harvard Medical School.
Neck Coolsculpting
When it comes to the neck region, Coolsculpting was recently granted FDA approval for tightening the neck skin at the same time as freezing the fat away. This means you can count on this non-surgical, non-invasive office-based treatment to help give your neck a more defined contour and shape. And all of this can be done with essentially no downtime.

 

#### Lose Your Flank Fat
Want to get rid of your flank fat? Unwanted flank fat is one of the most common reasons why people seek out Coolsculpting treatment. This middle-aged female from San Diego consulted with us to try and reduce the excess flank fat that she had despite a good exercise regimen and healthy diet. Results here are just 4 weeks out from a single fat freezing session of her flanks with our aesthetic RN, Kellie Hartmann. Her treatment was completed in about an hour with no injections, no needles, and no downtime. Tell me what other non-surgical treatment will do this for your love handles in just one session? Nothing that we are aware of in the current world of plastic surgery! If you are ready to get rid of those pesky love handles and want to avoid surgical liposuction, contact San Diego's best team of Coolsculpting specialists today.

#### Lower Age Limit For Eyelid Lift Blepharoplasty?
Of lately we have had a series of younger patients coming into our San Diego office for consultation regarding an eyelid lift, also known as blepharoplasty. Many of them inquire whether or not they are seeking treatment too early given the fact they are in their early 30s-40s. The reality is there are many patients who have eyelid lift surgery at this age! You don't have to wait until you are in your 50s-60s before considering a blepharoplasty procedure. There are a number of patients out there who congenitally have excess upper and lower eyelid skin that creates a prematurely aged or tired look. Their eyelid skin tends to be more crepe than the average person. Many female patients begin to notice difficulty applying make-up to the upper eyelid because there is so much skin redundancy. These type of unwanted changes can certainly be seen as early as 30-40 years of age. So don't feel like you are alone out there when considering an upper eyelid lift at this age. The good news is that a blepharoplasty procedure can be one of the most satisfying procedures to have done with some of the biggest bang for your buck.

#### Lower Eyelid Filler Injection
What is Dr. Hilinski's favorite injectable filler for under the eyes? For many years it was Restylane - as many of you San Diego patients know from having your lower eyelids rejuvenated. Traditional Juvederm was simply too unpredictable when injected under the eyes as a non-surgical lower eyelid lift. That is because Juvederm absorbs a bit more water - resulting in an overly puffy, water-filled look to the lower eyelid region. Therefore, Restylane was Dr. Hilinski's preference for rejuvenating the lower eyelid-cheek zone.

But as of this past year, Juvederm Vollure has made a huge splash in the world of non-surgical lower eyelid lifts. So many patients come to Dr. Hilinski requesting to have their lower eyelids injected to help address unwanted shadowing and dark circles. This includes more and more San Diego patients in their 20s who have congenital hollowing of the lower eyelid region that makes them look prematurely aged and tired.

Juvederm Vollure is the real deal when it comes to creating beautiful, natural looking lower eyelids with improved volume and contour. That is because Vollure has been engineered specifically to avoid the issue that traditional Juvederm had when it came to lower eyelid filler injection. Now we have a solid, bonafide competitor to Restylane for correction of lower eyelid hollowing, bags and dark circles.

#### Lower Eyelid Hollows
Injectable fillers for lower eyelid hollowing continue to be a very popular med spa treatment for our San Diego patients. And within this group, younger patients are a growing segment seeking out a non-surgical option to rejuvenate their prematurely, tired looking lower eyelids. Here is a classic example of this type of injectable filler treatment in a younger female who presented with unwanted hollowing of her lower eyelids.

As you can see, she is much too young to attribute this hollowing to the aging process. Like so many younger patients around her age, this is a congenital predisposition to losing fullness, which is just more pronounced in her lower eyelid-cheek junction. Patients like her often times note they see abnormal shadowing or darkness across the lower eyelid. This is because the soft tissue in this area has thinned out and left her with hollowing. It is this loss of lower eyelid volume that then shadows when light hits the face from various angles. The clinical manifestation of this is looking tired and prematurely aged around the eyes.
Eyelid Injectable Fillers
So what is the best option for lower eyelid shadows and darkness from hollowing? Well, there are a number of options, fortunately. But in terms of non-surgical treatments that can be done in our med spa setting, injectable fillers are far and away the most popular choice. That is because the lower eyelids can be rejuvenated in the office with essentially no downtime or recovery. In 2019, the most frequently requested injectable fillers are Restylane and Juvederm Vollure when it comes to treating the lower eyelid hollows. Restylane classic and Restylane Refyne are probably the most common ones we use to treat the dark shadows. But Juvederm Vollure has come on in the last few years as an increasingly popular selection by many patients  and med spas. Both injectable fillers are very predictable and safe to use when rejuvenating the lower eyelids. In some cases, it really boils down to whether or not a patient has loyalty towards Galderma (the distributor of Restylane products) versus Allergan (distributor of Juvederm products). As we like to say, it really comes down to choosing between Coke or Pepsi - they are quite similar to one another and both injectable fillers will do the job.
Eyelid Filler Rejuvenation
And here is a typical result from injectable filler placement along the lower eyelid to help target unwanted darkness and shadows. In this case, Restylane was chosen to fill the hollows along each side. Just a small amount - about 1 syringe of Restylane - was used to augment the lower eyelid areas that were lacking in volume. As you can easily appreciate, the shadowing and hollows were filled in very nicely to give her a beautiful, natural-looking cosmetic improvement. She now appears more rested and rejuvenated, yet still looks like herself. And there was no bruising! These photos were taken minutes after her Restylane injection and shows how so many patients can have their lower eyelids treated with essentially no downtime.

#### Lower Eyelid Lift To Rejuvenate The Eyes - Case Example
We have just added a new segment to our online blepharoplasty procedure page focusing on a case example of lower eyelid rejuvenation for unwanted bags and puffiness. A lower eyelid lift can significantly enhance one's cosmetic appearance especially when there is moderate to severe puffiness involving the lower eyelid region. To learn more about how a lower eyelid lift is done and why, please take a look at our San Diego blepharoplasty procedure page.

#### Lower Eyelid Muscle Tuck
This is a great example of what can be accomplished with a lower eyelid muscle tuck procedure. This young lady was unhappy with the excess fullness running along the lower eyelid region. Unlike most lower eyelid patients, who typically have excess fatty deposits that produce unwanted 'bags' under the eyes, this patient had a different problem. Her main issue was the underlying muscle (called the orbicularis oculi muscle) was considered hypertrophic, or too thick.

I ended up performing a lower eyelid blepharoplasty, or lower eyelid cosmetic tuck procedure, to help improve her looks. This involved doing a surgical procedure that includes making an incision along a natural crease that runs underneath the lashes of the lower eyelid. This is represented by the red line shown in the adjacent photo diagram. The surgery also involved lifting up the lower eyelid skin to expose the underlying muscle. The muscle was then hemmed, or tightened upward. The excess lower eyelid skin was then conservatively trimmed to further tighten up the lower eyelid.

Here is a before and after photo comparison following the lower eyelid blepharoplasty procedure. As you can easily see - she has a nice cosmetic improvement in terms of the lower eyelid region. More specifically, the excess ridge or fullness that was once present is now gone. She has a much smoother looking lower eyelid contour that provides here with a much more rested, youthful appearance. And all of this was done with minimal visible scarring noted.

#### Macrotia (Scapha Reduction) Case Example
When it comes to making a large ear smaller, I happen to be one of the few surgeons in the country who does this on a regular basis. This is termed macrotia surgery - also known as scapha reduction since the actual scapha is made to be smaller. Keep in mind this is totally unlike ear pinning, or otoplasty, surgery where the ear is essentially brought closer to the side of the head. Macrotia (scapha reduction) is intended to make the vertical dimension of the ear significantly smaller. Take a look at the video below, which gives you more of a visual idea of what macrotia (scapha reduction) surgery can do for you.

#### Macrotia Ear Plastic Surgery to Actually Make an Ear Smaller
Learn how I can actually make your ear smaller using scapha reduction technique for macrotia - also known as excessively large ears. This type of ear plastic surgery is much different from ear pinning surgery, which is intended to simply pull the ears back closer to the surface of the head. Macrotia ear plastic surgery is aspecialized type of otoplasty surgery with the goal of cutting out part of the ear to make it smaller. Let me know what you think of this very unique cosmetic ear procedure!

#### Macrotia Surgery Instant Change
Macrotia surgery is a specific type of cosmetic ear reshaping procedure that helps to reduce the size of one's ear. Ear pinning is a completely different type of cosmetic ear surgery (otoplasty) that simple pulls the ear closer to the head and is much more commonly performed. Macrotia surgery involves actually making the size of the ear smaller - primarily focusing on reducing the upper half of the ear. This is a great example of a recent macrotia scapha reduction patient of mine showing what her ears looked like prior to the surgery and then what they looked like 10 days following surgery.

 

 

 

 

To learn more about macrotia ear reduction surgery in San Diego and to see her ongoing recovery, please use this link here to visit our sister site dedicated to ear reduction surgery.

To learn more about other types of otoplasty in San Diego - including ear pinning and scapha ear reduction surgery, visit our other sister site.

#### Magazine Features Dr. Hilinski for His Practice Software
Most people know Dr. John Hilinski for his expertise in facial plastic surgery. However, a little known fact about him is that he enjoys writing business software in his spare time. For the past two years, our team has been utilizing software that Dr. Hilinski developed - called “E-Log” - for a more efficient, paperless logging system.

“Each of our staff members carries an iPad to use the software, allowing them to track various practice details for easy access in the future. This cuts down on time searching for information, since important notes are all entered digitally. The program also acts as an internal communication outlet for our practice.”

The convenient, time-saving process of E-Log has not gone unnoticed. Outpatient Surgery Magazine - which covers news and general information about surgical facilities - recently featured Dr. Hilinski and his innovative software in their September issue, detailing how the program has helped the practice streamline its day-to-day efforts. The article also mentions that due to the software’s popularity, Dr. Hilinski has begun working with a software company to make E-Log available to other surgical facilities as well.

To learn more about the advanced tools we use at our practice, or to schedule a consultation with Dr. Hilinski, please feel free to contact us.

#### Make Money Getting Botox!
Make money getting Botox and Dysport! OK, maybe it's not cash money. But it is credit and loyalty points that can be used like money towards future Botox and Dysport treatments.

We have just updated our San Diego website to make it that much easier to earn credit with Allergan's Brilliant Distinctions and Galderma's Aspire Rewards programs. Just click on the Patient Info menu option on our homepage. You will see two quick links to the respective programs just mentioned.

If you are new to Brilliant Distinctions and/or Aspire Rewards, you can easily sign up for a new membership account. If you are a return patient, you can readily get log in to your active account to earn credits or redeem points.

The rewards programs include but are not limited to any of the following treatments you may receive by Dr. Hilinski and his staff:

 	Restylane (including Restylane Lift)
 	Dysport
 	Juvederm (including Juvederm Vollure and Juvederm Volbella)
 	Botox
 	Latisse

 

#### Making A Large Ear Smaller
No - this is not another case of otoplasty, or ear pinning. Look more closely. This amazing result came about after Dr. Hilinski performed macrotia, or scapha ear reduction, surgery on this young female patient. She was bothered by the fact that her ears were too large - as seen from top to bottom. So Dr. Hilinski reduced the upper portion of her ear by taking away skin and cartilage - then reducing the earlobe just a bit. The end result is an amazing transformation - providing her with ears that are now normal in size and shape.

Ear Reduction San Diego



#### Male Rhinoplasty vs Female Rhinoplasty
Though the basics of rhinoplasty surgery are the same for men and women, the success of the procedure is dependent upon the artistic eye of your board-certified plastic surgeon. Men and women typically have different cosmetic goals when it comes to the shape and size of the nose. While women typically desire a smaller nose with more defined features and a slightly upturned tip, men often want a longer nose with a higher bridge and less tip elevation.

These aesthetic differences can be characterized into traits that are more “masculine” or more “feminine,” but the most important factor in achieving your desired outcome is clear and open communication with your doctor. During the consultation process, be sure to carefully explain the aspects of your nose you wish to change and be as specific as possible. Viewing before-and-after photos of your plastic surgeon’s previous rhinoplasty patients can give you a visual reference when describing your goals and expectations. Dr. John Hilinski customizes each rhinoplasty surgical plan to meet the needs of the individual. To learn more or to schedule a consultation, please contact our office today.

#### Male, Ethnic Revision Open Rhinoplasty Case Example
This patient was recently seen in the office for follow-up evaluation after a revision open rhinoplasty procedure that I performed. I thought he was a good case example to discuss some of the nuances of bridge and tip reshaping in a male, ethnic revision rhinoplasty patient. This patient was originally operated on in the military several years ago where he had his tip and bridge reshaped. Unfortunately, he developed postoperative loss of his tip projection. Meaning, the position of his nasal tip was compromised and began to drop back closer to his face (see adjacent photo with red arrow). As this occurred, the tip also began to droop down leaving him with what we call tip ptosis. In addition, his bridge was reshaped but left too high - giving him somewhat of a convex, or curved, shape as seen on his profile view. Combined, the tip ptosis and convex bridge made his nose look even more droopy, distracting from an, otherwise, very masculine look. He subsequently consulted with us here in San Diego for a possible revision rhinoplasty procedure. On examination, I noted the issues he had with the bridge and tip ptosis.In addition, however, I also noted that his nasal pyramid (nasal bone) was too wide (see blue & white arrow) and his tip had a somewhat pinched appearance as it transitioned away from the midline (see red angles with shadowing). We performed computer imaging of his nose to gain a better understanding of what he envisioned following surgery. Based on the computer imaging and my discussion with him, he elected to go forth with the revision rhinoplasty to further reshape his nose.

He was brought to surgery where an open rhinoplasty approach was used to gain adequate exposure of his bridge and tip. I ended up rasping down his bridge to create less of a convex contour as seen on his profile view. I also performed osteotomies on both sides - or in other words broke his nasal bones to narrow them - to address the excess width. At the same time we were able to reshape his tip by bringing it up slightly and projecting it out the appropriate amount. He had very little septal cartilage remaining inside of his nose because of the prior septorhinoplasty that he underwent. Therefore, I had to harvest cartilage from his right ear in order to obtain sufficient grafting material to rebuild the nasal tip. The ear graft was used to widen his nasal tip and provide him a less pinched appearance. All the while, I had to keep in mind that he was an ethnic rhinoplasty patient and ensure that his outcome was going to be consistent with his remaining facial features. As you can see below in his before and after photo series, I think we accomplished the goals of the surgery - to reduce his bridge while preserving a strong masculine profile, narrow the nasal bones slightly, elevate the nasal tip with improved projection, less pinched appearance and maintenance of his ethnicity.

#### Management of Turbinate Hypertrophy in Rhinoplasty & Revision Rhinoplasty
Dr. John Hilinski, expert nose surgeon in San Diego, CA, is proud to announce the latest addition to the ever growing online San Diego Rhinoplasty Tutorial - one of the most comprehensive online sources for rhinoplasty and revision rhinoplasty information. Dr. Hilinski is considered a regional specialist when it comes to complex nose surgery - including cosmetic nose jobs and functional reconstruction of the nose. This latest topic focuses on management of inferior turbinate hypertrophy with turbinate reduction surgery techniques. Use this link here to read more in detail about this common problem among rhinoplasty and revision rhinoplasty candidates.

#### Massage
Many San Diego patients looking to get their fat frozen away ask about the role massage plays in getting the best Coolsculpting results.

At the completion of your Coolsculpting session, Dr. Hilinski or his staff will perform massage of the area just treated. It is thought that massaging the Coolsculpted area will help in breaking down the unwanted fatty tissue layer - thus helping to improve the final results of your treatment. Some offices will even recommend you continue to massage the areas on your own - going so far as to recommend use of vibrating device to help with what is thought to be lymphatic drainage. There are several reports available that seem to indicate that massaging in this manner after Coolsculpting can help improve your cosmetic result by 60% in some cases. Although there remains some controversy on this topic, that type of data is hard to ignore!

#### Medical Spa Services in San Diego
Did you know that - in addition to cosmetic facial surgery - our office offers a full complement of medical spa services to patients throughout San Diego? Under the direction and guidance of Dr. Hilinski, our medical spa performs a host of non-surgical cosmetic enhancement procedures. By far, the most popular of all the medspa treatments is Botox and Dysport. But dermal filler treatments, such as Restylane, Juvederm, Radiesse and Bellafill are also done on a regular basis. In addition, Kellie Hartman, our expert aesthetic RN, offers our patients plasma pen skin tightening, microneedling, PRP and PRF injections as well as the ever-popular Coolsculpting non-surgical body contouring treatment. Nearly all of these medical spa options come with minimal downtime - allowing you to get back to your 'normal' routine as quickly as possible.

#### Melt Your Flank and Back Fat Away
So many women in San Diego are bothered by unwanted flank and back fat, which is often times very difficult to get rid of even with good exercise regimens and healthy diets. Fortunately, there is Coolsculpting to help literally freeze that fat away!

Here is a great case example of a healthy female patient who works out regularly and maintains a healthy diet. Despite this, she had areas of unwanted, excess fat in her flank and back region. Rather than undergoing a more invasive plastic surgery procedure, such as liposuction, she opted to have her flank and back treated with Coolsculpting.

This particular patient had the procedure done in Dr. Hilinski's Coolsculpting treatment room as she literally surfed the internet and texted her friends. The fat freezing procedure took less than an hour to complete - and she was off to resume her normal daily activities! That is right - no downtime at all.

The Coolsculpting results shown here are just 4 weeks after the one treatment. Yep - just 4 weeks later you can see a dramatic change in the contour of her flank and back with a marked reduction in the fat. You can also see how her skin looks tighter following Coolsculpting. And she should continue to enjoy even better results than this as time goes on.

So if you have undesirable fat in the back and flank region, contact our office today to schedule a complimentary consultation with our Coolsculpting experts to finally freeze away your unwanted fat!

#### Merry Christmas From Dr. Hilinski and Staff!
Just wanted to wish all of our patients and colleagues a very merry Christmas from Dr. John Hilinski and the staff of San Diego Face and Neck Specialties and The Hilinski Ambulatory Surgery Center!

#### Merry Christmas To All
On behalf of the staff at The Hilinski Clinic of Facial Plastic & Reconstructive Surgery here in San Diego, we would like to wish all of our family, friends and patients a very merry Christmas!

#### Microneedling Hand Rejuvenation
Can microneedling be used to rejuvenate the hands? Absolutely! Take a look at the adjacent photo of a patient who underwent 2 microneedling SkinPen sessions on their left side (our right looking at the photo). As you can readily see, there is a marked improvement in the appearance of the hand following microneedling. What fantastic results for a minimally invasive, office-based procedure that is done with just topical anesthesia. So many people forget about their hands when they are discussing anti-aging treatments. But the reality is that many patients who are good about getting their facial cosmetic treatments done happen to show their real age in the hands. The good news is that microneedling can be done to help reduce those unwanted sun spots, age spots and wrinkles that form on the back of the hand. Contact San Diego's best microneedling experts to schedule your complimentary consultation.

#### Migraine Headaches and Botox
Did you know that Botox and Dysport can significantly improve migraine headaches? There are many, many patients here in San Diego who undergo Botox and Dysport treatment - and discover that their migraine headaches are much better after regular treatment. The migraines can be improved in both severity and frequency with Botox and Dysport injections.

There is a specific protocol that many neurologists will use in terms of Botox injection, which involves a well-established pattern of injection to help control migraine headache symptoms. But this is not always needed when it comes to reducing migraine severity and frequency. Some migraine sufferers have trigger points that are located more along the lower forehead and brow region. In this patients, Botox and Dysport injections every three months have been shown to help reduce their migraine attacks - sometimes to the point that migraine medication is no longer necessary.

#### Minimally-Invasive Neck Skin Tightening Options
Here is another great example of how J Plasma by Renuvion can help tighten and lift the neck skin.

This patient from San Diego was bothered by the fact that she had developed loose neck skin with unwanted wrinkle formation under the chin area. This is nothing unusual - in fact, this is pretty darn typical for the aging process in middle-aged patients. Many of these patients are simply looking to appear a bit more rested and youthful.

Now facelift and neck lift surgery are certainly options. However, these are considered more invasive surgeries that involve longer incisions (cuts) made around the ear (and under the chin). This type of aging face surgery also translates into a relatively long recovery period given the amount of surgical dissection that is involved in the effort.

For those patients looking to avoid these challenges with invasive facelifting, there are alternatives - such as J Plasma by Renuvion. J Plasma is a minimally invasive procedure that involves making short incisions behind the earlobes and under the chin. As part of the procedure, plasma energy is used underneath the neck skin to cause a tightening effect. As the soft tissue under the skin is heated to an optimal temperature, the neck line gets tighter with more definition. A few absorbable sutures are then placed and a wrap is placed around the neck and lower face. Within just a few days, patients can begin appearing in the public eye - and by the end of the first week of recovery, exercise is usually allowed by Dr. Hilinski. This type of downtime is markedly less compared with traditional facelift and neck lift surgery.

Here are the results of the patient shown above following J Plasma by Renuvion. These results represent her healing at nearly 8 months out from surgery. And as you can see, she has a nice improvement in her jawline and upper neck region. Now would she have more of a result with formal facelift surgery? Yes is the short answer. But this would also involve a much more expensive operation, more visible scarring, more risks and significantly more recovery than J Plasma. In this particular instance, the patient had much less healing time - yet still has a nice cosmetic improvement in her jaw and neck line.

#### Mixing Botox and Dysport
We have had many patients in the past ask whether or not you can mix Botox with Dysport for wrinkle reduction. The answer is - yes! There is no scientific and/or medical evidence that suggests there would be any problem with mixing these two neurotoxins together. Both Botox and Dysport work in a similar manner to modulate the nerve endings so that muscle contraction is reduced in the area of excess wrinkle formation. As long as your cosmetic doctor is careful in terms of dosing the medication, there should be no significant adverse effect. When does this situation arise? If, for example, someone goes to another office to get either Botox or Dysport and is not happy with the cosmetic outcome. They can readily go to a different office and get the neurotoxin they didn't get injected the first time around.

#### Mole Removal Without Obvious Scarring
This patient was recently seen for follow-up after having a mole removed from her face. I just thought she was a great example of facial mole removal. As you can see, she had a mole in the middle portion of her left cheek that she wanted removed for cosmetic purposes. As you can also tell, she has ethnic type skin that is darker and thicker. This type of skin can often be more difficult to work with when it comes to plastic surgery of the face. This is because darker, ethnic skin does not heal as well as whiter, thinner skin. In general, ethnic skin can result in more prominent scars. Because of this, patients with darker, ethnic skin should seek out experts in plastic surgery of the face when considering removal of moles like this one. This particular patient consulted with my office because of our expert experience and dedication in the field of cosmetic facial surgery. After all, she wanted to have the mole removed, but did not want to have a real obvious sign (or scar) as a result of the surgery. I ended up removing the mole under only local anesthesia (numbing medication injected under the skin) in our office procedure room. Using meticulous surgical technique, the mole was cut out and the surrounding skin used to close the defect, or hole. This included using proper eversion of the skin edges. This term, eversion, refers to lifting the skin edges up such that they look almost heaped up after the closure is complete. This is done to give the skin a natural laxity so when the scar stretches during the healing process there is minimal pulling on the skin. This translates into less scar visibility from the mole removal. As you can see in the larger photo provided here, there is barely any sign of the mole removal nearly 4-5 months after the minor surgery. Go ahead and look even closer. You can probably make out a very fine hint of where I made the cut to remove the mole, but it is certainly not real obvious. And keep in mind this patient has the thicker, darker ethnic skin that is typically more challenging when it comes to facial plastic surgery. But this is the goal whenever I perform mole removal on any particular patient - minimal signs of me having been there. If you have a facial mole or moles that you would like to have removed, do not hesitate in contacting my office today to discuss your options!

#### Most Popular Injectable Filler Lately
Many patients interested in having injectable filler treatment for volume enhancement of the face don't really know which of the many fillers they should choose. In fact, many of our patients here in San Diego ask us, "What is the most popular filler right now?"

Currently, I would say that Juvederm Vollure is one of the hottest fillers currently being used. For years, Restylane was the only filler that we used under the eye region to fill out unwanted hollows. This is because Restylane is so predictable as a filler to help volumize the lower eyelid area. Traditional Juvederm could have been used - but it often times created a water-filled appearance that left patients unhappy with the injection treatment. Fortunately, Allergan came up with Juvederm Vollure XC, which is the latest generation of Juvederm products that does not have this problem any longer. Because lower eyelid filler injection is so widespread (from patients in their 20s to patients in their 60s), it is not surprising that Vollure has gained such marked popularity in the last 6-9 months. Although I still use Restylane for enhancement of the lower eyelid region, Vollure has made huge splash and is now one of our go-to choices.

#### My Nose Is Numb One Month Following Rhinoplasty. Is This Normal?
The answer to this question is - yes. In fact, it is the rule of thumb that rhinoplasty and revision rhinoplasty patients will experience some degree of numbness and/or tingling of their nose for upwards of several months following surgery. Usually the heralding sign of normal return of sensation is pings of pain that some rhinoplasty and revision rhinoplasty patients note. The good news is that pain sensations are fairly blunted early on due to the numbness.

#### Myths About Pain Following Rhinoplasty & 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.

#### Narrowing a Wide Nasal Bridge
Learn more about narrowing a wide nasal bridge in this latest addition to our online rhinoplasty tutorial. This female patient desired to have (among other things) a more narrowed bridge. This was accomplished with osteotomies - whereby the nasal bones are intentionally broken and reshaped. Take a look at her before and after rhinoplasty results and let me know what you think!

#### Narrowing a Wide Nasal Tip
This is an example of cosmetic rhinoplasty to reshape a wide and droopy nasal tip. She is a very pleasant teenager who desired to have the tip of her nose reshaped. Using an open rhinoplasty technique, I was able to provide her with a nicely, narrowed tip that was rotated just enough to reduce the droopy appearance. She had moderately thick nasal skin, which proved to be somewhat of a challenge. But, as you can see, we were able to create much more tip definition and refinement - while maintaining a natural look overall. Both her and mom are quite happy with the results!

 

#### Nasal Base Reduction in Ethnic Rhinoplasty
My practice happens to see quite a variety of ethnic rhinoplasty patients on a regular basis. I would say that the two most common issues I see in ethnic rhinoplasty patients are insufficient bridge height and excessively wide nostrils. These particular case example of ethnic rhinoplasty highlights the latter issue - an excessively wide nasal base in an African American female patient seeking rhinoplasty. In this particular case, this patient required nasal base reduction as part of her nasal reshaping procedure. This was done by removing a portion of her nasal base using a technique called wedge excision. This was done of both sides to reduce the flare component that can easily be appreciated on the base views noted below. The incisions in this case were placed at the junction of the nose and upper lip. As you can see from her postoperative photo shown, this incision heals very nicely to the point of being barely perceptible to the naked eye. Overall, notice how her nostrils now appear less flared and the excessive width has been successfully addressed. More importantly, notice how her nose still looks quite natural with maintenance of her ethnic facial proportions.

#### Nasal Base Reduction in Rhinoplasty and Revision 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.

#### Nasal Exercises in Rhinoplasty and Revision 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.

#### Nasal Valve Stenosis Correction
This is a great example of how rhinoplasty technique is used to help correct a collapsed nasal tip - or narrowed external nasal valve area. This very pleasant gentleman from San Diego was having problems breathing through his nose - especially on his left side. As you can see in his before rhinoplasty surgery photos, the nostril wall would collapse inward upon inspiration. I ended up performing a complex open rhinoplasty procedure that included placement of cartilage grafts on both sides of his nasal tip. This was done to essentially reinforce the nostril wall to minimize collapse with breathing inward. As you can see in the post surgery photos, he now has a very stable nose that resists collapse. He not only looks better, but he can now breathe quite freely - and he is ecstatic about his rhinoplasty results! Tell me what you think of his results.
 

 

 

#### Natural Facelift Anti-Aging Surgery
One of the most popular procedures performed by Dr. Hilinski is facelift surgery. When you go to the right plastic surgeon, a facelift can provide you with a beautiful, natural looking cosmetic improvement that helps to rejuvenate your neckline and jawline at the same time.

This is a great example of what a facelift necklift combination can do for the average patient seeking cosmetic face surgery.

This female patient came to our San Diego office to consult with Dr. Hilinski regarding a possible facelift procedure. On examination, it was noted that she had findings consistent with so many other patients considering cosmetic face and neck surgery.

These included:

 	Jowl formation
 	Sagging jaw skin
 	Sagging neck skin
 	Banding of the neck (platysmal bands)
 	A prematurely tired look

Dr. Hilinski recommended she undergo a classic lower face and upper neck lift procedure. The intention was to help turn back the clock and help provide her with a more rested, rejuvenated appearance - while avoiding the dreaded surgical look of being pulled tight.

Results of her cosmetic face and neck procedure are shown here - where she is just a month or so out from surgery. As you can readily appreciate, she looks so much better now that her jawline and neckline have been tightened. She still looks like herself - just a better version. If you look more closely, you can see just how much improvement has been made in her neck where the coarse wrinkles and lines are now essentially gone. Her jawline is now much more defined and her overall appearance has been refined.
Beautiful Facelift Results

#### Natural Facelift Results
Many patients seeking possible facelift surgery often times worry about looking too stretched or pulled following the procedure. The reality is that plastic surgeons have to really go out of their way to create that type of undesirable look. This lady was recently seen back in my office following a lower face and upper neck lift I performed many months back. I thought she was a good example to show others what might be possible with this type of surgery. As you can see in her comparison photos, she looks quite natural following the facelift procedure. She certainly looks more rested and youthful - now with a more defined looking jawline. And she does not appear overly done or too tight. Let me know what you think of her results!

#### Natural Looking Botox
Botox Natural Results

The great thing about Botox and Dysport treatment is the simplicity of how both cosmetic treatments can create such natural looking results. Unfortunately, to many people (and doctors!) out there, if you have Botox or Dysport in your forehead your face will be frozen. That is  because so many people think that Botox and Dysport should freeze all of the muscles in your face. Knock on wood, that is NOT the expectation and purpose of Botox and Dysport.

Botox Goals

These two cosmetic, med spa treatments are actually intended to freeze specific muscles in the face so as to prevent unwanted dynamic wrinkles and creases. If done optimally, Botox and Dysport treatments should smooth out the forehead - while still leaving some movement with animation. The real goal of Botox and Dysport is NOT to freeze the face and leave patients looking inanimate. Patients should still look like themselves - just more rejuvenated as a result of the Botox or Dsyport. Here is a quick video showing fantastic results from Botox injection performed by San Diego's leading Botox injector, Dr. John Hilinski.

#### Neck Lift Without Facelift Surgery in San Diego
Want to know how to achieve a neck lift without having a facelift procedure? This is a great example of a patient who desired to have a more defined jaw and neckline, yet did not want to have a formal facelift with incisions made all around the ears. Given the fact she had relatively good skin elasticity, she was considered a candidate to undergo combined neck liposuction and tightening of her platysma muscle (called a platysmaplasty). The entire surgery was performed from under her chin with an incision placed in a natural skin crease. After the excess fat was removed, the platysma muscle was sutured in the middle to create a more defined neck line and profile. As you can see from her before and after photos here, she has an obvious improvement in her chin and neck line. You can also see that her jawline now looks more refined. Overall, she looks more rested and youthful I would say. And all of this done through a small incision under her chin! Not a bad alternative to formal facelift surgery.
Before and After Neck Liposuction & Platysmaplasty

#### Neck Lifting Using Liposuction, Platysmaplasty and Chin Implant
This is a great case example of how to perform a neck lift on a patient using a combined surgical approach. This particular male patient from San Diego, CA desired a more defined neck line. On examination he was found to have evidence of excess fat under the chin as well as a poorly shaped muscle, called the platysma muscle. Furthermore, he had less chin prominence than average. We discussed the various options available to him to provide a cosmetic enhancement of his neckline. Ultimately, he decided on a combined approach, which is what was performed on him. This included neck liposuction (also called cervical liposuction), tightening of the platysma muscle (called platysmaplasty) and placement of a chin implant to augment the jawline (also referred to as a mentoplasty). Following surgery, he was noted to have a significant enhancement in his neck and jaw region, which is precisely what he desired going into the procedure. To see his dramatic improvement from this combined necklift surgery, use this link here.

#### Neck Liposuction & Platysmaplasty For Improved Jawline Definition
Liposuction is one of the most common procedures we perform at The Hilinski Clinic of Facial Plastic & Reconstructive Surgery in San Diego, CA. In a great majority of cases, liposuctioning is performed along the upper neck region to help create a more rejuvenated facial appearance. In many of these facial plastic surgery patients, the platysma muscle is also tightened to provide even further enhancement. The following is one of our own San Diego facial plastic surgery patients who was very happy with the surgical results she attained following contouring of her lower face and upper neck. To see her entire story, including detailed information about her exact procedure (liposuction combined with platysmaplasty) and postoperative photos, please use this link here.

#### Neck Liposuction and Jaw Definition
Neck Liposuction Vs Kybella
In today's day and age of minimal downtime cosmetic treatments, everyone wants to look better without the downtime of traditional surgery. This is exactly why Kybella became so incredibly popular so quickly - it was touted as the non-surgical neck lift with results that mimicked what liposuctioning could do for you. Unfortunately, as Dr. Hilinski will openly say, that is simply not the case when it comes to comparing Kybella with surgical neck liposuctioning.
Kybella Falls Short
When looking at which treatment - Kybella versus neck liposuction - can provide the best cosmetic outcome, there is no question that surgical contouring is far better in terms of aesthetic enhancement of the neck region. Kybella is a great option for someone who wants more modest improvements and has just a small pocket of excess neck fat. But if you are looking to see a more dramatic improvement in your neck and jawline, Dr. Hilinski is going to recommend liposuction to remove the excess fat. In many cases, this can be done under just local anesthesia - without having to undergo a general anesthetic.

That is what was done here in this case. In addition, Dr. Hilinski may recommend tightening of the muscles immediately underneath the neck fat. This muscle is called the platysma - and tightening of this muscle is called a platysmaplasty procedure. The removal of the excess neck fat and platysmaplasty are performed through the same incision made under the chin in a natural skin crease. After Dr. Hilinski takes out the excess neck fat with liposuction technique, he then tightens the platysma muscle to create even more jawline and neck definition as is readily seen here in the before and after photos of this lovely young patient. There is no amount of Kybella that will be able to reproduce these type of changes in the neck and jaw. This type of cosmetic improvement really can only be achieved with liposuction with or without platysmaplasty.

#### Neck Liposuction in San Diego by Dr. John Hilinski
This is another great example of how neck liposuction can help provide improved definition along the upper neck region in patients from San Diego, CA. This female patient consulted with Dr. Hilinski because of his expertise in providing superior cosmetic results in the face and neck region. Her main desire was to look more rejuvenated by creating improved definition under the chin and along the upper neck region. Many neck liposuction patients often times describe this area as being excessively full under the chin. Others call it their double chin deformity. No matter how it is described, patients are referring to unwanted fatty deposits under the chin extending into the upper neck region.
Neck Liposuction Evaluation in San Diego, CA

On examination, that is precisely what was found in this particular female neck liposuction patient. When feeling her neck and jawline, there was an excess of unwanted fat under the chin (called the submental region) and along the upper neck. The end result was a lack of definition along the jawline. This can be seen in the adjacent photo diagram showing her appearance prior to having neck liposuction performed. As you can appreciate, there is extra volume under chin that is contributing to a more rounded appearance of the neck as seen from the side view (white arrow). Ideally, her jawline and neckline would meet where the curved red line is drawn to allow a more defined look. In this particular patient, the skin was still quite healthy with excellent elasticity. This term refers to the rubber-band like quality that allows skin to swiftly snap back into place when pinched and pulled - much like an elastic band. Elasticity is a very important quality to have when being considered for neck liposuction since you need to rely on the skin to 'shrink' down once the fat has been removed. If the skin is lacking in elasticity, it will simply just hang down after the fat has been removed - leaving the neck looking arguably even worse.
Neck Liposuction Treatment San Diego, CA
In patients like this one, neck liposuction can often times be performed successfully using  local anesthesia. Meaning, you don't have to be put to sleep completely in order to have neck liposuctioning performed. In this particular case, the neck liposuction was performed in our private surgical suite after giving her a low dose oral sedative (much like a sleeping pill). Once she was feeling relaxed, the neck area was then injected with a specialized solution containing a numbing agent to provide complete anesthesia from the chin down across the neck. This is called tumescent (pronounced "too-mess-ent") anesthesia when a dedicated pump is used to 'fill' the tissues under the chin with the chosen anesthetic solution. All the while, the patient is alert and breathing on her own - just not able to feel any pain in the region where the liposuction is planned.
San Diego Neck Liposuction for Improved Definition
The actual liposuction of the neck region is performed through a very tiny incision made under the chin and just behind the earlobes. A very narrow (2-3 millimeters) liposuction cannula (or rod) is gently placed under the skin directly into the fatty tissue layer. The excess, unwanted neck fat is then liposuctioned out using a medical vacuum device. During the procedure, it is very important to try and remove the overly prominent fatty neck tissue in a symmetric manner so that both sides of the neck appear equal in contour and shape. Once the excess fat has been liposuctioned out, the short incisions are closed with fine sutures (stitches). Since the patient did not require a general anesthetic for the neck liposuction, a bandage was placed around the neck and she was allowed to go directly home within minutes of finishing the procedure.
Neck Liposuction Beautiful Results in San Diego, CA
The neck bandage was removed in 4-5 days following the neck liposuction procedure. As the healing process unfolded, her neck skin would progressively shrink-wrap up to reveal the newly defined changes. This is the part that relies heavily on the skin elasticity that was referenced earlier in the blog discussion. As time continued, her neck contour became better and better as the outline of her jaw became increasingly visible and the angle of her neck became more refined. The results of her neck liposuction are shown below. As you can see, she looks fantastic following neck liposuctioning! Overall, her face and neck appear much thinner with improved definition. If you look at her jawline, in particular, you can see how much better the shadowing is following liposuction of the neck. Whereas her jawline was previously being 'masked' by the excess fat, it can now be readily seen as a result of the neck liposuction. And what happened to all that skin that was covering the fatty bulge under the chin? It has now shrunk wrap as a result of the skin elasticity forcing it to take the new shape of the freshly contoured neck. When looking from the side, or profile, view of the face and neck, you can really begin to appreciate just how much change in contour has been realized following liposuction. And perhaps the best thing is that she still looks like herself - just a more defined, refined, rested version of herself.

Neck Liposuction Plastic Surgeon in San Diego, CA
If you are interested in pursuing neck liposuction by a San Diego board certified facial plastic surgeon with dedicated experience in cosmetic neck contouring, contact our office today to meet with Dr. John Hilinski - one of San Diego's best neck liposuction surgeons.

#### Neck Liposuction Versus Having a Neck Lift
Just saw a new patient from San Diego who was interested in having more definition along her jawline and neck. She was 38 years old and was inquiring about whether she needed liposuction of the neck versus an actual neck lift procedure. What I explained to her is that there are, in general, three different types of patients when it comes to enhancing the neck contour.
Neck Liposuction
There are those who have fairly reasonable skin elasticity (where the skin quickly snaps back into place when pulled or pinched) with only excess fat. These patients are considered great candidates for neck liposuction. Others refer to this same procedure as cervical liposuction, lipocontouring, and liposculpture. Whatever name you use to refer to this procedure, it involves removal of excess fatty deposits under the chin and along the neckline. The skin then shrink wraps down to the new shape of the neck to give a more youthful appearance. An example of straight neck liposuction is below. This is a younger female San Diego liposuction patient of mine who disliked the fullness just under her chin. She was actually quite thin overall and had a pocket of fat under her chin that just wouldn't go away even with vigorous exercise. We performed neck liposuction on her and provided her with a marked improvement in terms of her neck definition.

Neck Liposuction & Platysmaplasty
Then there are those patients with excess fatty deposits under the chin who also have a poorly defined, neck muscle, called the platysma. The platysma is a muscle that extends from just under the jawline all the way down the neck to the collarbone. If this muscle is congenitally loose or becomes loose with age, it can causing a blunted appearance to the neck line thus detracting from any possible neck definition. In these patients, it is necessary to perform neck liposuction along with tightening of this neck muscle (called a platysmaplasty pronounced pla-tizma-plasty). We perform the usual neck liposuction from a small incision under the chin then use that incision to literally tighten the muscle in the middle. In doing so, the extra fat is removed to give definition and then platysma muscle tightening further adds to the definition of the neck. Below is an example of one of my San Diego liposuction & platysmaplasty patients. She had not only excess fat under her chin but also a congenitally poorly defined platysma muscle. I performed a combined liposculpture and tightening of her platysma muscle to give her more definition. As you can see from these oblique before and after photos she now has an improved jawline with a more defined neckline - and these photos are just 7 days out from surgery!

Neck Liposuction, Platysmaplasty & Lower Face Lift Upper Neck Lift
Finally, there are those who have excess fat, a poorly defined platysma muscle, as well as loose hanging skin. These patients typically have very poor skin elasticity and are usually older (in the range of late 40s to 70s). In these patients if I were to just liposuction the neck and tighten the muscle, their skin would likely not shrink wrap down. Instead, it would likely hang down from the chin and jawline. So in these cases, we need to lift the skin up using a lower face lift upper neck lift technique to redrape the excess skin. Hopefully, this quick summary helps those of you out there considering possible neck liposuction, neck lift or other neck contouring procedure.

#### Neck Skin Tightening
By now you may have heard of a revolutionary new technology that has gained popularity in the cosmetic surgery world. It is called J Plasma by Renuvion. Here is quick case example of how J Plasma can be used to help tighten neck skin using a minimally invasive approach.

This very pleasant lady from San Diego desired to have something done to help with her crepey neck skin. Like so many middle-aged women, she was bothered by the fact that her neck skin had become looser and more laxed. She wanted to undergo a cosmetic treatment, but did not necessarily desire to have a formal surgical face and neck lift procedure. After consulting with Dr. Hilinski, San Diego's first plastic surgeon to offer J Plasma, she opted to go with his recommendations for a more minimally invasive procedure.

Dr. Hilinski ended up performing what is called a J Plazty procedure on her - which is based on J Plasma energy that is used to tighten the neck and lower face skin from underneath. The procedure is performed under only local anesthesia where numbing medicine is injected under the skin to provide total comfort. Three small incisions are made - one under the chin and one on each side of the face just behind the earlobe. These incisions are used as access points to allow Dr. Hilinski to lift up the skin all the way down the neck. The J Plasma device is then inserted under the neck skin and activated. As the helium gas is released it is electrified to produce the desired plasma energy. This plasma energy is what causes the actual skin tightening. To a great degree, the skin is tightened rather immediately. In fact, the skin will literally feel tighter upon completion of the J Plazty procedure. A secondary tightening effect then occurs as the weeks and months unfold, which corresponds to your body's natural response to form collagen.
J Plazty Recovery
Most patients undergoing J Plazty will be required to wear a bandage around the neck and lower face for upwards of 3 days continuously. After this point, the bandage is worn more intermittently. It is around this time - 3 days out from J Plasma - that many patients will also begin to look more publicly presentable. Yes, there is still some swelling and even tissue discoloration. But, for the most part, patients can be seen out and about without many stares.

Pain levels are modest in most cases and very well controlled with low-dose narcotic medication, such as Vicodin. In some cases, patients will notice a mixed sensation of numbness and tingling in the areas treated with J Plasma. A great majority of these sensations will typically resolve 7-10 days out from the procedure.
J Plasma Photos
Below you will find the actual before and after photos for this case example. When you look at her neck skin, you can readily appreciate how it actually looks tighter. As a result of the plasma energy delivered, her neck lines are now much less pronounced - especially the deeper, horizontal neck lines. As you scan down the length of her neck, you can also appreciate how her neck skin just looks smoother and more youthful.

#### Neck Skin Tightening and Lifting
Here is a powerful example of how Renuvion's J Plasma can be used to tighten the neck while lifting the skin in a minimally invasive fashion.

This patient from San Diego desired some sort of cosmetic treatment to help improve her neck lines. She was bothered by the wrinkles that had slowly formed over years contributing to a more aged appearance - although she still felt young. This is a very common sentiment expressed by many patients seeking cosmetic surgery of the face and neck. When Dr. Hilinski examined her, he noted fairly loose skin - termed skin laxity - in the lower part of her face and the upper portions of her neck. A facelift with neck lift surgery was one option. But a less invasive option was J Plasma neck tightening. Given the less invasive nature of the latter, a decision was made to proceed with the Renuvion face and neck procedure.

The operation was done using just local anesthesia - meaning the patient did not have to go to sleep. A series of short incisions were made that would eventually hide very nicely in natural skin junctions. Using these 'ports' for access to the lower face and neck, the J Plasma wand was passed under the soft tissue and engaged. Once this is done, the deeper fibers under the skin (which attach the skin to the deeper muscles of the face and neck) contract, or tighten. The end result is tightening of the overlying skin layer - giving patients a more rejuvenated, youthful look.

The entire procedure takes about 2 hours to perform while you are awake. In some cases, patients will take a Valium to calm their nerves and relax them. But this is not necessary. Once the J Plasma procedure is completed, a bandage is placed around the lower face and neck to help compress the skin. This is typically worn for about 3 days - then it can be removed during the day. We do recommend patients wear something at night for upwards of 3-4 weeks to help keep the skin compressed during the early healing process.
J Plasma Before and After
Here are her results shown below where you can easily see how much improvement there has been in her neckline. Her neck skin is now much tighter and has the appearance as if it was lifted. Whereas she had quite a bit of skin redundancy prior to the J Plasma neck lift, these areas of concern are now markedly better. And all of this was able to be done through 3 small access incisions - thus avoiding the long incisions and scars of a traditional facelift surgery.

#### Nefertiti Neck Lift
What is this Nefertiti neck lift that you see mentioned as a non-surgical option to enhance your jaw and neck line? San Diego's best Botox injector, Dr. John Hilinski, tries to explain it here.

The Nefertiti neck lift is essentially a Botox injection treatment that is intended to target the muscles that pull the jaw and neck down. This primarily consists of the platysma muscle - which is a broad, thin muscle that spans the length of the neck from the jaw down to the clavicle, or collarbone. As you can see in the adjacent photo diagram, when this muscle contracts (for example, when someone says 'EEEEEE'), you can readily see the vertical bands of the platysma. The visual result of this is a pulling motion of the neck and jaw in a downward direction.

If Botox or Dysport is injected into this muscle in strategic locations, the muscle will no longer be able to contract. This results in a chemical neck and jaw lift since the neck muscles are no longer pulling in a downward motion.

The procedure, just like Botox used in other areas, is done in the office and takes just a few minutes to be completed. There is no downtime - other than not working out for 1-2 days. Within that time period, patients will then see the platysma muscle starting to relax and their neckline beginning to look more rested and youthful. The effects will typically last about 3 months before repeat treatment will be needed.

If you have unwanted neck lines and bands, contact our office today to see about getting a Nefertiti lift using Botox or Dysport.

#### Never Too Old For Eyelid Lift
This very pleasant lady demonstrates you are never too old to have cosmetic face surgery. She was bothered by her upper eyelids and how the excess skin contributed to a tired look for her eyes. In addition, she wanted the skin under her eyes to look smoother and more youthful.

She consulted with San Diego's leading expert in facial rejuvenation - Dr. John Hilinski - who advised her to undergo an upper eyelid lift combined with a lower eyelid laser peel. She proceeded to have this done under just local anesthesia - meaning, she did not have to go to sleep under general anesthesia. The operation took about 90 minutes to complete - and she was at home 15 minutes later!

Dr. Hilinski used her natural eyelid crease (which was hidden by the excess upper eyelid skin) to make the incision. The redundant skin was then removed. But efforts were made to try and keep her from looking 'surgical' or 'done' - as is so often the case in the world of plastic surgery. The lower eyelids were treated with a high-powered CO2 laser to try and reduce the appearance of wrinkles and coarse lines.
Before and After Eyelid Tuck & Laser Peel
Here are some early results from the surgery - showing a beautiful cosmetic eyelid result. Her upper eyelids are now more youthful looking because the excess skin has been removed. And her lower eyelids are smoother with less wrinkling. Yet, she still looks like herself - just a younger version!

#### New Case of The Over Projected Nasal Tip
Management of the over-projected nasal tip is one of the more challenging types of cosmetic nose reshaping. This is a good example of this type of nosejob procedure where the tip of the nose is brought back closer to the face. In this particular case, the nasal tip stuck out too far from the plane of the face, disrupting theharmony and balance of the nose. The goal of the nasal reshaping surgery was to bring the tip in closer, thus making the entire nose smaller but more proportional for her face. This is called deprojection in rhinoplastyterminology. As you can in her before and after photos, there has been a dramatic change to the shape of her nose as seen on side view. On frontal view of the nose, however, there has been much less change since the primary alteration was more front to back rather than side to side. She still has some degree of mild swelling in her tip and bridge in these photos, which should continue to improve as the months of healing go on. From the side and oblique (angled) views, you can see a rather obvious improvement in the balance and harmony of her nose. The nasal tip has now been deprojected and is in much more harmony with the surrounding facial features. In fact, this type of rhinoplasty surgery has really enhanced her inherently beautiful facial features.
Before and After Tip Deprojection

#### New Rhinoplasty Tutorial Chapter On Steroid Injections In Nose Surgery
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.

#### New San Diego Online Rhinoplasty Tutorial Chapter on Nasal Deprojection
San Diego's expert cosmetic nose reshaping surgeon, Dr. John Hilinski, is proud to announce his newest online rhinoplasty tutorial chapter focusing on deprojecting the nasal tip in facial plastic surgery. This latest chapter in the ever-growing San Diego Rhinoplasty Tutorial discusses the nuances involved with bringing the nasal tip closer to the face - also referred to as deprojection of the nasal tip. The San Diego Rhinoplasty Tutorial is one of the most comprehensive and detailed online resources when it comes to rhinoplasty and revision rhinoplasty surgery. We hope this particular chapter is helpful to anyone out there considering cosmetic tip reshaping that involves deprojection of the nose.

#### Nip and Tuck
This is a great example of what a little 'nip and tuck' can do for you. This very pleasant patient of mine wanted to simply look more refreshed. I ended up performing a lower face and upper neck tuck in combination with an upper eyelid lift to provide her with a nice, natural-looking cosmetic enhancement. In fact, she easily looks 10 years younger in my opinion!

#### No, It's Not Photoshop!
This is a great example of how meticulous technique (and a little luck!) can help essentially erase any signs of an unwanted facial mole. Although it looks like her image was just photoshopped, it actually took a real plastic surgery procedure to cut out the two dark moles under her right eye region. I was able to do this case with a very careful shave technique using a scalpel to excise (remove) the moles individually. Notice how there is barely any residual sign of the moles and no obvious scarring can be seen. Let me know what your think!

#### Non-Surgical Cheek Face Lifting
Check out these improvements that resulted from plasma pen skin tightening performed by the medical spa staff of Dr. John Hilinski. This patient decided to undergo plasma pen treatment to help give her a boost in her facial appearance. She elected to have the eyelid region and lower cheek/face region treated to try and tighten some of the skin.

Dr. Hilinski's medical spa registered nurse, Kellie Hartmann, performed the procedure using just topical numbing anesthesia to keep her comfortable. The idea was to use the plasma pen to tighten the skin with a grid-like pattern across the eyelids and along the lower face and cheek. The area around the mouth was also treated to help address the unwanted skin wrinkles. The pattern of the plasma pen treatment can be seen here in the adjacent photo as indicated by the blue dots. If you look closer at the jawline, you will see a faint blue arrow that shows the vector of how the lower face skin was tightened by the plasma pen. Effectively what was being accomplished with the plasma pen is that the jowl skin was tightened upward and back. A plasma pen does this by causing the superficial skin to tighten while stimulating a collagen response deep to this layer that causes change in the skin 6-8 weeks later.
Plasma Pen Skin Tightening
Fast forward 6-8 weeks later and you can see the type of change that the plasma pen can provide. If you look at her eyes, they just appear more open, which translates into a more rested look. As you scan down to her lower face and cheek, you can really tell how much improvement there is in her jawline and jowl region. That is because the plasma pen has tightened the skin around the mouth and lower cheek to result in the illusion that the lower face was pulled back and up. Not a bad result for a non-surgical procedure that was done entirely under topical anesthesia!

#### Non-Surgical Eyelid & Brow Lift!
Take a look at what the revolutionary plasma pen treatment can do to open your eyes while giving you a combined upper eyelid and brow lift. This young lady from San Diego simply wanted to look more refreshed, but didn't want to consider surgical options such as blepharoplasty and forehead lifting.

Instead, she opted to go with a revolutionary, new office-based procedure that is done with topical numbing cream - the plasma pen. This latest cosmetic treatment option utilizes plasma technology, which involves creation of a tiny spark when gas is electrified. This spark is what interacts with the skin surface to tighten the tissue. When the plasma pen is used across a certain area, such as the upper eyelid, brow or upper lip, the tissue is lifted while fine lines and creases are smoothed out at the same time.

Dr. Hilinski has chosen the Louise Walsh plasma pen over many other devices given its established history as a true medical grade instrument. Don't be fooled by other offices that may be offering plasma pen treatments, but are using devices that are more consumer grade. Not only do these devices not provide the type of change that you will desire, they are not considered as reliable and predictable as the Louise Walsh plasma pen.

In this particular case, the patient opted to have plasma pen treatment of the brow and upper eyelid in an attempt to 'open' her eyes a bit more. The goal was simply to tighten the upper eyelid - sort of like an upper eyelid blepharoplasty - and lift the brow.

Her plasma pen treatment was performed by our aesthetic RN, Kellie Hartmann, who has also been fully trained and certified by Louise Walsh and Plasma Pen Official as an accredited provider of this cosmetic treatment. The entire treatment was completed with the only topical numbing cream applied to the treatment areas. The little brown and black plasma dots were allowed to fall off over the first few days. Within that time period, the patient started to feel more comfortable with being in the public eye. Pain was minimal and wound care was very straight forward and simple.

Within a week or so, she could easily appreciate the cosmetic  improvements made by the plasma pen. More specifically, she was able to see how the treated skin just looked smoother with less fine lines. And her upper eyelid looked as if it had been rejuvenated - where the upper eyelid crease was more open and the skin appeared tighter. Furthermore, her eyebrow was raised as a result of the plasma pen. If you look at the video more closely, you will see how the the skin was treated with the plasma pen over the outer segment of the eyebrow - often called the tail of the brow. In treating only this area, the skin would be tightened - lifting the eyebrow tail upward. When you see her photos at just weeks out from her treatment you will see how her eyebrow is now beautifully arched and lifted - yet not unusually so that it screams cosmetic treatment. When you combine the tighter skin, the lifted upper eyelid margin and the brow elevation, you realize how effective the plasma pen can be as a cosmetic treatment option at our medical spa.

Plasma Pen Brow and Eyelid Lift

Plasma Pen San Diego

If you are interested in having plasma pen treatment, or fibroblast skin tightening as it has also been called, contact San Diego's #1 plasma pen office today! Dr. Hilinski and his support staff are just waiting to help you achieve the best possible cosmetic results with this revolutionary new procedure.

#### Non-Surgical Eyelid Lift
One of the hottest and most popular non-surgical treatments being done in our San Diego office nowadays is an eyelid lift, or eyelid rejuvenation. These widely popular treatments involve use of various injectable fillers to enhance the lower eyelid region in an effort to create a more rested, rejuvenated eyelid appearance.

So what fillers can be used to produce the look of a lower eyelid lift? We use the following injectable fillers on a regular basis:

 	Restylane
 	Juvederm Vollure
 	Juvederm Volbella
 	Bellafill

As of lately though, Juvederm Vollure has risen to the top as the most popular filler for eyelid rejuvenation in our office. We still use the others, but word has gotten out around San Diego about how good Juvederm Vollure is for this specific treatment.

A non-surgical eyelid lift is done in the office setting while you are wide awake. Since the fillers, like Juvederm Vollure, contain lidocaine within the gel substance, the pain is minimal - and is less and less as more of the filler is injected. The lower eyelid hollowing and shadowing is carefully filled out using Juvederm Vollure to try and create a slight convexity to the skin surface. This helps restore lost volume, which can be a tell-tale sign of aging especially in the lower eyelid region. The non-surgical eyelid lift is completed within 10-15 minutes with minimal bruising and swelling in most patients. Within seconds you will visibly see a difference - mimicking what a surgical eyelid lift can do - without the surgical recovery involved.

If you have tired looking lower eyelids and would like to have a bit of a refresher with no real downtime, call our office today to schedule an appointment with Dr. Hilinski - one of San Diego's best injectable filler specialists.

#### Non-Surgical Facial Volumizing
This is a great post showing exactly why Sculptra is one of our favorite non-surgical treatments for facial volumizing and contouring.

We had a younger female patient from San Diego who came to the office looking for facial rejuvenation. Dr. Hilinski and his med spa staff noted the major issue she had was premature loss of facial volume.

This is actually quite common and more related to genetic predisposition than anything else. As we say in the cosmetic world, volume is a sign of youth. So when a patient presents with a relative lack of volume in the face, we interpret this appearance as looking more aged than desired.
Lack of Facial Volume
So what is lacking in volume? This mostly has to do with subcutaneous fat and soft tissue that normally resides under the skin throughout the face. If you are congenitally predisposed, this fat will shrink down in size leading to the appearance of being volume deficient. Some doctors will refer to this process as atrophy - a term that implies the tissue has gotten smaller. In this instance, we are specifically referring to the fatty layer of the face. From a cosmetic standpoint, this is seen as flattening across certain areas of the face. Ideally, one would prefer to have a slight convex surface contour instead of flattening. That is because a convex surface on the face reflects light much more readily, which is often perceived as more cosmetically pleasing.

This volume issue is particularly relevant when it comes to the mid face region. In many patients, like the one shown here, this volume loss is especially pronounced in region between the lower eyelid and the upper lip. Although some people refer to this whole region as the cheek, it encompasses more than that and is more appropriately referenced as the mid face.

Using the patient example shown above, the adjacent photo diagram points out the specific regions where she was seen as having more marked facial volume deficiency (red outlined zones). This is what we are talking about when we say the mid face. If you look back at her photo above, this is, indeed, the most concentrated area where she has lost fat volume in the face. And the clinical manifestation of this fat atrophy is flattening with poor light reflexes. We interpret this as simply being more aged.
Sculptra for Flattened Cheeks
So what can you do for flattened cheeks and facial volume loss like this patient? The general answer is use of injectable fillers to plump out the face and help restore proper volume. Injectable fillers are incredibly popular because they can be done in the office setting and have essentially no downtime associated with them. This general category of injectable fillers for plumping of the face includes Restylane, Juvederm, Bellafill, Radiesse and Sculptra. These are, by far, the most popular non-surgical options to restore volume.

Out of these, Sculptra is becoming increasingly popular around San Diego for flattened cheeks for a number of reasons. This includes the fact that Sculptra lasts much longer than Restylane, Juvederm and Radiesse. Whereas those injectable fillers will give patients results for about 1 year, Sculptra can last upwards of twice that long in most patients. This translates into you having less treatments over time in order to sustain the aesthetic improvements you see. Although Sculptra does cost more than Restylane and Juvederm, for instance, the economics of it still pencil out in the long run.
Sculptra Cheek Example
So what does Sculptra cheek enhancement look like? Here you go! When you look at her before and after Sculptra treatment, you get that gestalt impression that she just looks better. You can't really pinpoint right off the bat what is different about her, but you know you prefer her look in the after photo. And that is precisely the goal of doing Sculptra cheek enhancement - you want it to look as natural as it can be without obvious signs of having had any cosmetic treatment done. Knowing what we know about her, though, you are already aware that we were targeting her flattened cheeks. So as you look through her mid face region, you can readily appreciate how she now has improved facial volume from the plumping effects of Sculptra. The cheek contour looks better because there is more convexity to the surface of her face, which allows light to reflex off in a more dramatic fashion. We interpret this as a more beautiful and aesthetically pleasing look. When you begin to turn her head to the 45 degree angle view, you can see this cheek transformation is more easily. Her mid face now has more volume and fullness - giving her an overall much more youthful appearance. Not so bad for an office-based treatment that takes 15-20 minutes with essentially no real downtime - and provides you with a 2 year result!

#### Non-Surgical Fat Reduction
Here is a recent example of non-surgical fat reduction to help contour the lower abdomen in this male patient from San Diego. This Coolsculpting patient desired to have a flatter stomach with removal of unwanted fat in the lower abdomen region. You can see in this oblique photo how he had shadowing below the tummy pooch as well as on the sides. This is because his abdomen had excess fat contributing to these contours.

Following just one session of Coolsculpting - with San Diego's best team of fat freezing experts - you can see how his lower abdomen has been sculpted to give a flatter overall contour. You can see - in comparison - how the shadows that were previously noted are now gone! You can imagine if he has any more Coolsculpting treatments done - he will be on his way to a six pack!

If you happen to have excess pockets of fat in the abdominal region and are looking to get a flatter stomach without incisions and surgery, call our Coolsculpting specialists today to schedule a consultation our certified Coolsculpting practice.
Before & After Fat Freezing

#### Non-Surgical Lower Eyelid Lift With Restylane
We have quite a number of San Diego plastic surgery patients who desire non-surgical enhancement of the lower eyelid region. Many people refer to this as a non-surgical eyelid lift procedure. This is because we can help rejuvenate the lower eyelid region without having to make an incisions in the skin. I wanted to post this quick blog entry to show potential non-surgical eyelid lift patients what they might look like immediately following this type of facial enhancement procedure. This patient was bothered by the hollowing under her eyes that contributed to unwanted shadows and dark circles. She felt as if she looked tired all the time. She was interested in something that could help give her a more rested look without having to undergo the knife. We discussed how using Restylane to rejuvenate the eyelid region has become an increasingly popular choice among plastic surgery patients. During that same visit, she elected to undergo the non-surgical eyelid lift procedure. We used a syringe of Restylane to inject the lower eyelid region along a gentle arc as indicated by the red arrows below. This is done to plump or push out the soft tissue of the lower eyelid and cheek region. In doing so, the lower eyelid becomes less hollow and shadows more favorably. As you can see in her immediate post procedure photo, there is an obvious improvement in the contour of the lower eyelid. Although there is a slight red hue from the actual injection, there is a smoother overall contour that mimics what many patients see with an actual lower eyelid lift. Also note no real bruising and this is literally minutes after the non-surgical eyelid lift.
Non-Surgical Eyelid Lift Candidate

Before & Immediately After Non-Surgical Eyelid Lift

#### Non-Surgical Tummy Flattening
Look what kind of results this patient got from two Coolsculpting treatment sessions on her abdomen region. This is one of the only methods to achieve a non-surgical tummy tuck-like result in terms of flattening the stomach area. Although  the overall result is pretty clear - there are a number of things that can be appreciated when you look even closer at her tummy, flank and back. For example, just look at the contour of her lower abdomen region where Coolsculpting has essentially gotten rid of the excess fat. As you come around her waist, you can also see how the fat has disappeared - eliminating the ridge and shadowing in this area - and that can be seen on a 2-D image! When you look at her flank region, you can also easily appreciate how her fat rolls have been markedly improved to give her a more fit figure. You can also see in the photo comparison how her skin just appears tighter and smoother. And all of this was done with just two sessions of our dual-sculpting, Coolsculpting treatment. Literally, there was no needles, no surgery and no downtime to get phenomenol fat freezing results like this! Call our office today to schedule your non-surgical tummy tuck with Kellie Hartmann, Dr. Hilinski's Coolsculpting aesthetic expert.

#### Not The 'Occasional' Rhinoplasty Surgeon
One of the main reasons why we do so many rhinoplasty and revision rhinoplasty surgeries is the fact that my practice has extensive experience when it comes to cosmetic reshaping of the nose. In fact, a large part of my San Diego Facial Plastic Surgery practice is dedicated to rhinoplasty and revision rhinoplasty. Facial plastic surgeons who are rhinoplasty specialists are vastly different from what my colleague, Dr. Steven Dayan in Chicago, refers to as the 'occasional' rhinoplasty surgeon. I think this is a great term for those plastic surgeons out there who perform all different types of cosmetic surgery. For instance, a majority of plastic surgeons here in San Diego perform breast augmentation and body sculpting on a very regular basis. They might even perform facelift surgery as part of their practice. But a large majority of these San Diego plastic surgeons are truly 'occasional' rhinoplasty surgeons. They might do nasal reshaping or cosmetic enhancement of a nose once a month or even less frequently. As a rhinoplasty expert and revision rhinoplasty specialist I can tell you without any hesitation at all that this is a setup for disappointment for both surgeon and patient. I cannot stress enough how important it is to perform rhinoplasty and revision rhinoplasty surgery on a very consistent basis. Cosmetic nose reshaping is arguably the most difficult plastic surgery procedure to perform. If you do this occasionally, you will get the occasional successful outcome. If you are a rhinoplasty and revision rhinoplasty specialist, you are much more likely to achieve the best rhinoplasty outcomes with the highest chance of the desired rhinoplasty result.

#### One Year Anniversary Rhinoplasty Results
Take a look at Christine's one year anniversary rhinoplasty results! We had previously posted on her progress several months out from cosmetic nose reshaping surgery that we did as her Christmas present in late 2011. She has been doing quite well since that time. We are now getting around to posting her one year nose job results here. Christine had her nasal tip lifted and narrowed while also having her nasal bridge height reduced. The end result is a nose that looks much more fitting for her face. It also appears quite natural in my humble opinion. Christine has been quite excited about her rhinoplasty results for some time - now I am excited to publish her results for all of you to see!
Before & After Rhinoplasty

#### One-Sided Ear Pinning
We get many patient inquiries about having just one ear pinned back. There are quite a few patients out there who are bothered by one ear sticking out - while the other is totally normal looking. That is just the case here where this male patient had one ear - his left side - that just stuck out along the top half. He was happy with the position and shape of his right ear. So Dr. Hilinski performed ear pinning on just one side to create much needed symmetry. Take a look at this short video showing the intraoperative transformation as a new fold was created on his left side.

Ear Pinning On Just One Side

#### Otoplasty (Ear Reshaping) Primer
The Hilinski Clinic in San Diego, CA, has now developed an otoplasty primer for any patient considering ear reshaping. The otoplasty primer was written in simple language that is easily understandable for those of you with minimal to no medical knowledge. The otoplasty primer starts off with an overview of the relevant anatomy involved with ear reshaping and transitions into more specific information regarding the actual procedure and recovery process. If you or anyone you know is interested in otoplasty, or ear reshaping, use this link here to learn more about what the procedure involves.

#### Otoplasty Helical Rim Reshaping
This is a visual case example showing how otoplasty surgery can help correct a prominent helical rim contour. This patient had otoplasty surgery to pin the ears back, but he was bothered by the fact his helical rim continued to stick out just a bit. This is actually not unusual when it comes to cosmetic ear surgery and otoplasty.

In order to address this problem, a procedure was performed under just local anesthesia. A short, summary video of the actual procedure is shown here. The touch up procedure involved making an incision along the inner margin of the helical rim to expose the offending cartilage segment. Once this was exposed, the cartilage was then trimmed off. The skin edges were then realigned and sutured together. The immediate intraoperative changes can be readily seen in the video where the contour of the helical rim is now much more vertical and less prominent as seen from the frontal view.

Before and after photos of the same patient are shown below where you can see, once again, how the helical rim is much improved in terms of the overall shape.

#### Otostick for Big Ears
As someone who sees patients quite regularly for surgical correction of big ears, I have heard from several patients saying they were using Otostick to help make their ears look less prominent. So what is Otostick? And is this a long-term option for patients with ears that stick out too far?

Otostick is basically an over-the-counter device that was designed to give patients a non-surgical option to pin their ears back closer to the side of the head. It uses a combination of silicone and adhesive to allow users to fold the ear back and keep it in place when out in the public eye. If you search for the product online, you will discover several Youtube testimonial videos discussing use of Otostick. The bottom line is that Otostick is a nice option for people who are insecure about their big ears and want to do something short of otoplasty surgery, or ear pinning. In essence, you will be using an adhesive to stick them back for whatever period you are wearing them out and about. Unfortunately, as with most adhesive products, they are not designed or intended to withstand all conditions, such as going in the water. Some folks have been able to wear them during vigorous activity and exercise, but there is the risk of having them fall off in the midst of doing these things. Other circumstances, like being in the military, will also prevent people from using Otostick on a daily basis.

Is Otostick permanent? Well, for really young kids, there is some evidence that constantly taping an ear back can lead to long-term reshaping and repositioning. But for adults, Otostick won't really do anything to help permanently reshape the ear. The reality is that surgery is the only true option for permanent pinning of the ear and reduction of prominence.

So now you are in the know regarding Otostick and how it fits into the spectrum of treatment options for people suffering from overly prominent ears!

#### Over 200 Rhinoplasty Examples
Our ever-growing rhinoplasty photo gallery now has over 200 individual patient examples in just the primary rhinoplasty category alone! And that doesn't even touch on the growing revision rhinoplasty gallery. Within each patient example there are typically multiple views shown of each nose.

What this tells you is that Dr. Hilinski is a true leader in the field and one San Diego's best and most qualified rhinoplasty experts. When you look at any plastic surgeon's website, you can usually tell how often a specific plastic surgery procedure is done by the number of photo examples that are shown. If that plastic surgeon only does rhinoplasty on occasion - they are not likely to have a robust photo gallery. The reason Dr. Hilinski has one of the largest galleries of nose job results is because he does rhinoplasty surgery so frequently - arguably more than anyone in San Diego.

Take a look for yourself and see the amazing results that patients are able to realize following nose job surgery by San Diego's rhinoplasty specialist - Dr. Hilinski. For more information on rhinoplasty surgery in San Diego, you can also visit our sister site dedicated to just nose job surgery offered by Dr. John Hilinski.

#### Pain with nasal exercises after revision 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.

#### Pediatric Ear Pinning in San Diego, CA by Dr. Hilinski
Dr. John Hilinski has extensive experience in ear pinning and otoplasty surgery to help cosmetically improve the appearance of prominent ears. This includes vast knowledge of pediatric ear pinning, or otoplasty for children. This particular patient is a great example of ear pinning in children. He is a young boy who had concerns with prominent ears and desired to have them reshaped to make the ears look smaller and more proportional for his face. Dr. Hilinski performed the ear pinning operation under intravenous sedation, which is sometimes referred to as a twilight anesthetic. This is one aspect of otoplasty in children that is different from ear pinning in the adult population. Young children like this patient require a little more sedation to be kept comfortable during the operation. This is usually simply a matter of controlling their anxiety more than their pain. Intravenous sedation for children undergoing otoplasty surgery is quite common and, in fact, the norm in our practice. This patient had the cosmetic ear reshaping without any issues and tolerated the procedure and anesthesia beautifully. Following surgery he did great with little downtime. To view his full series of photos before and after pediatric ear pinning, please use this link here. To learn more about pediatric otoplasty in San Diego, feel free to browse our otoplasty procedure discussion and/or our online ear pinning tutorial.

#### Permanent Lip Enhancement
Many patients currently getting Restylane or Juvederm lip injections to provide enhanced lip volume often times ask about a more permanent option. One of the best options for permanent fuller, plumper lips is the Surgisil Permalip lip implant procedure. I happen to perform this surgery on a regular basis for those patients seeking a more permanent alternative for enhanced lip shape and size. Learn more about this procedure by clicking here. Let us know what you think of these results!

#### Permanent Lower Lip Enhancement
Want an alternative to injectable fillers for lower lip plumping? Dr. Hilinski offers the lower lip mucosal advancement procedure to create fuller, plumper lower lips using your own body's tissue. Learn more about this highly specialized permanent lower lip enhancement technique by visiting our website today!

#### Persian or Iranian Nose Job Surgery
See the latest example of Persian or Iranian nose job surgery performed by San Diego rhinoplasty expert, Dr. John Hilinski. See how cosmetic nose surgery was performed to create a more refined, yet natural looking nose in this very pleasant rhinoplasty patient from San Diego.

#### Persian Rhinoplasty Nose Reshaping
This is the latest addition to our popular online rhinoplasty tutorial - a chapter focusing on Persian rhinoplasty surgery. Learn more about reshaping the Persian nose through this case example of a young female Persian patient from San Diego who desired functional and aesthetic reconstruction of her nose. Let us know what you think of her results!

#### Pinched Nasal Tip & Hanging Columella In Revision Rhinoplasty
I just finished a revision open rhinoplasty today on this female patient from San Diego. We took some intraoperative photographs to show others what the anatomy looks like when dealing with a pinched nasal tip and hanging columella. This patient had  a prior rhinoplasty done by another San Diego plastic surgeon. She was still unhappy with the appearance of her nose and consulted with my office for a revision rhinoplasty.
Preoperative Rhinoplasty Assessment
On preoperative rhinoplasty assessment, most of her issues were manifested on the frontal appearance. As you can see below, she had bilateral pinching of the nostrils with her right side being more severely collapsed compared with her left side (see blue arrows). This resulted in an asymmetric tip appearance. In addition, she had what is called a hanging columella. This implies the area in between the nostrils hangs down excessively (see shaded area). These abnormalities resulted from her prior surgery and were readily revealed once we opened up her nose.
Intraoperative Photos
As you will see from her intraoperative rhinoplasty photos, the lower lateral cartilage had been surgically altered clearly explaining the abnormal appearance of her nasal tip. To the left is a quick anatomy reference showing the lower lateral cartilage shaded red. The paired lower lateral cartilages contribute directly to the appearance of the nasal tip. Whenever a plastic surgeon performs a tip rhinoplasty to reshape the tip, the lower lateral cartilage is somehow or another altered. Unfortunately, there are many cases of rhinoplasty where the lower lateral cartilage is surgically altered in a way that compromises the support and position of the tip. For example, in rhinoplasty patients who had too much resected from the lower lateral cartilage, the tip can then pinch inward because the structural support has been excessively compromised. When this occurs, you can see the type of pinching present in this case example as well as development of the hanging columella deformity.

If you look at the first two photos below, you can see that the lower lateral cartilage in this revision rhinoplasty patient of mine has been previously resected, or cut out. In fact, the pink arrow points to her left lower lateral cartilage, which had been resected more aggressively and was trimmed irregularly versus her right side. The blue line spanning the lower lateral cartilage shows what is remaining from her original lower lateral cartilage. By actual measurement, this was about 6 mm wide. Unfortunately, when a rhinoplasty surgeon leaves only this remaining width of cartilage, it is insufficient to maintain proper shape and position. In this case, the narrow remaining segment of cartilage scarred upward at the same time it pinched inward. The medial, or center, segment of the lower lateral cartilage (called the medial crus) had been altered such that it was no longer connected to the nasal septum. In the setting of excess cartilage resection, this latter issue resulted in the hanging columella deformity. You can see from the blue arrow that the cartilage almost appears too heavy as if it were hanging down off the rest of the nasal tip.

In the third photo below, I have morphed her intraoperative rhinoplasty photo to show more what her nasal tip cartilage should look like ideally. The width of the lower lateral cartilage should be nearly twice as wide as shown. With this amount of cartilage, there is sufficient support for the nasal tip so that pinching is not a real concern. In addition, the medial crus should be shorter so that the columella does not look like its hanging. In this particular case, I fully reconstructed her nasal tip using an open revision rhinoplasty technique with ear cartilage grafting. Fortunately, we were able to achieve a very nice surgical result. I look forward to showing you the postoperative photos 10-12 months from now. I hope this blog entry was helpful in showing you potential revision rhinoplasty patients what a pinched nasal tip and hanging columella deformity looks like in surgery!

#### Pinched Nasal Tip in Rhinoplasty & Revision Rhinoplasty
The Hilinski Clinic of Facial Plastic Surgery in San Diego, CA, is happy to announce the most recent addition to our San Diego Rhinoplasty Tutorial - the Pinched Nasal Tip. Management of the pinched nasal tip is one of the more challenging dilemmas in the world of rhinoplasty and revision rhinoplasty surgery. Obtaining successful outcomes requires a thorough understanding of the anatomical problem and a well strategized surgical plan. To learn more about this updated rhinoplasty tutorial chapter, use this link here for additional information of the pinched nasal tip.

#### Pinched Nose Repair
Learn more about repairing a pinched nasal tip! See the latest addition to our ever-expanding online rhinoplasty tutorial. This most recent case focuses on a patient who had his tip collapsed following prior rhinoplasty by a different plastic surgeon. This very pleasant gentleman researched revision rhinoplasty online and discovered that our office was one of the most experienced in the nation. He lives outside of the San Diego area, but felt it was worthwhile to come visit us for a consultation and, ultimately, his actual rhinoplasty revision. See his results following complex open revision rhinoplasty using cadaveric rib grafting.

#### Pinning Effect of Ear Reduction
Here is a great 2 minute video that shows how Dr. Hilinski can make the ear look pinned back using macrotia ear reduction surgery technique. So many patients who have excessively big ears end up undergoing traditional otoplasty surgery, or ear pinning. Unfortunately, many of these patients end up in our office still unhappy with their excessively large ears. That is because ear pinning can help make the ear look a little less prominent from the front view because they don't stick out as much. But the fact of the matter is the ear is still quite large in overall size from top to bottom and front to back. When the patient turns their head to the side, the large size is readily seen - and contributes to the patient being persistently self-conscious about their ears.

One of the beautiful things about Dr. Hilinski's macrotia ear reduction surgery is that he can effectively pin the ear back closer to the side of the head while also shrinking a large ear down in size from top to bottom. This idea is shown visually in the attached video that highlights one of the main concepts of ear reduction surgery. This includes an actual ear reduction patient of Dr. Hilinski before and after macrotia surgery - where you can see a fairly dramatic reduction in the size of his ears. When looking at the transformation, pay particular attention to how the top portion of the ear now looks like it was also pinned back - without using traditional otoplasty technique.

#### Plasma Eyelid Lift
Traditionally, eyelid lifts were accomplished by surgical removal of the excess skin - commonly referred to as a blepharoplasty (pronounced bleff-r-o-plasty). I the past several years, plasma energy has been discovered to help rejuvenate the upper eyelid using a non-surgical technique that tightens the excess skin.
Renuvion Eyelid Lift
Here is a fantastic case example of a non-surgical blepharoplasty that utilized Renuvion's plasma energy device, called J Plasma, to rejuvenate the eyelid skin. This middle-aged female patient had obvious signs of aging and sun damage that affected her face. More specifically regarding her upper eyelids, her skin had  lost quite a bit of elasticity, which resulted in excess bunching of the skin across the lid. This can be seen quite readily in the adjacent photo taken prior to her Renuvion treatment.

Just like so many blepharoplasty patients, the upper eyelid skin had become so loose and redundant that it literally began to drape over her eyelashes. In fact, the upper eyelid had aged so much that you could no longer even see the natural eyelid crease along the lateral (outer) segment. If you look closer toward the nose along the medial eyelid, you can see her natural eyelid crease peeking out. But laterally, the excess, weighted upper eyelid skin began to hang over the natural crease. In doing so, it makes the eyelid region look prematurely aged and tired. This is precisely the anatomical issue that prompts so many patients to seek out cosmetic eyelid surgery to help them look more rested and youthful.
Non-Surgical Blepharoplasty
So instead of cutting out the excess upper eyelid skin, some cutting-edge cosmetic physicians are now using plasma energy to tighten the tissue. Plasma energy has been used in medicine for quite a while, but only recently has it been harnessed to be used more predictably for cosmetic enhancement of the face and neck region. When used for non-surgical blepharoplasty, plasma energy is employed without making an incisions or cuts along the upper eyelid. This saves you from having any scars as a result of cutting the skin open. The plasma energy wand is simply passed over the upper eyelid skin without even touching the surface. The plasma arc of the Renuvion device interacts with the skin of the eyelid to tighten the underlying tissue. Plasma energy does this so effectively that you can literally watch the upper eyelid contract, or shrink down, in front of your own eyes.
Plasma Pen Blepharoplasty
Can you get a result like this from using the newer plasma pens, such as the Louise Walsh Plasma Pen? Sort of, but not really. These plasma pens are another great alternative for non-surgical blepharoplasty, but they just aren't as strong as the Renuvion plasma device when it comes to tightening skin around the eyelid.
Plasma Eyelid Lift Results
Here is a quick series of photos that show how this patient responded to the Renuvion eyelid plasma treatment. The photo on the left is her before any treatment was done. In the middle is her healing from the Renuvion skin resurfacing procedure, which included other areas of the face obviously. But if you look, in particular, at her upper eyelid you can see that within days of having the procedure the skin is already showing signs of marked tightening and lifting. And then on the right is her appearance about 6-8 weeks out from the plasma eyelid lift. At this point in the healing, it is even more obvious in terms of how much improvement there is in the upper eyelid contour. Her skin has been beautifully tightened and lifted to help reveal the natural eyelid crease that was hiding under the upper lid for all these years. When you compare her before and after photos, they rival any traditional upper eyelid blepharoplasty result - just without having to make a cut or incision.

Plasma Eyelid Lift Consult
If you have excess upper eyelid skin and are looking for a non-surgical option to blepharoplasty, call our office today to discuss options with San Diego's leading plasma Renuvion treatment specialist, Dr. John Hilinski.

#### Plasma Pen Eyelid Lift
So can the plasma pen actually provide an upper eyelid lift result without making any surgical incisions? The answer is - it absolutely can! The proof - as they say - is in the pudding.

This very pleasant lady came to our office inquiring about possible treatment for her excess upper eyelid skin. As you can see in this close-up photo, she had redundant skin folds across the upper eyelid region that gave the appearance of her looking prematurely tired and aged. This is actually an incredibly common condition, especially in patients over the age of 45 years old. As we all start to age, this already very thin eyelid skin begins to lose elasticity (the rubber band quality that snaps back easily), which can result in the eyelid skin having a heaped up appearance.

So how do patients typically deal with these excess upper eyelid skin folds? Up until recently, upper eyelid blepharoplasty (a surgical eyelid lift) was really the only reliable method to address this cosmetic concern. As predictable and successful as it is, there are those patients who simply don't wish to have an upper eyelid surgical procedure due to concerns of abnormal scarring and an unnatural looking shape as a result of the blepharoplasty.

Fortunately, we now live in the era of plasma skin tightening, which offers patients with excess upper eyelid skin a new alternative to consider when it comes to rejuvenation. Plasma skin tightening is also commonly referred to as fibroblast skin tightening. The basic concept of plasma pen cosmetic skin treatment involves using a novel form of energy (plasma) to induce tightening of the skin. The plasma is delivered via a medical device that is called a plasma pen. The tip of the pen is hovered just a few millimeters over the skin surface and is then activated. As this is done, plasma energy is created between the pen and the skin - and can be readily seen as a brief spark. It is this brief creation of plasma energy that causes a rapid tightening of the skin - which can sometimes be seen even by the naked eye. In addition, the underlying skin layers are stimulated by the heat energy to respond in the form of collagensis - or creation of collagen fibers that further help to rejuvenate the skin. Within a certain region, tens if not hundreds of spots are treated using a grid-like pattern made with the plasma pen. So across an entire treatment area skin tightening is occurring uniformly based on the density and extent of plasma pen spots created.

When it comes to the upper eyelid and excess, unwanted skin folds, the plasma pen has become an increasingly popular choice because it can tighten the skin without having to make any incisions. Because the upper eyelid skin is so thin compared to other areas of the body, it responds quite favorably to the plasma pen. In addition, the plasma pen can be used in a very precise manner to help target the excess eyelid skin in specific patterns and locations based on individual aging. One of the great things about the plasma pen upper eyelid lift, or non-surgical blepharoplasty, is that no incisions (cuts) need to be made. The entire procedure can be done using just topical numbing cream that is applied about an hour before the procedure is done. Patients will usually feel a little warmth as the plasma pen eyelid treatment is done. But sharp pain and discomfort are not the norm. At the conclusion of the plasma pen eyelid lift, patients will see a grid of brown and black dots that represent each treatment spot. We will typically apply a colloidal ointment on the treatment area to help promote initial healing. It is then recommended that you leave the area alone for the first several days after the procedure. In most cases, the brown and black dots (carbonization spots) will fall off and fade away within 4-7 days of plasma pen treatment. Some patients will see a faint redness to the underlying skin, which can be easily camouflaged by make up.

True results of the plasma pen upper eyelid lift won't be fully seen for at least several months. There is a definite initial skin tightening that can be seen on the day of the procedure. However, full effects of the collagen response and skin tightening will not be seen for several months.
Plasma Pen Eyelid Lift
So here is the proof in the pudding when it comes to whether or not plasma pen can lift the upper eyelid skin. Results shown here are after just a single treatment of the upper eyelid region and were taken approximately 2 months after the procedure. As you can readily see, there has been a marked improvement in the amount of excess upper eyelid skin. Whereas she had redundant folds across the eyelid prior to plasma pen, she now has minimal wrinkling. This demonstrates loud and clear the power of plasma pen to lift the upper eyelid in a non-surgical manner - without making an incisions and without surgical scarring. If you have extra upper eyelid skin and are considering an office-based cosmetic treatment option, we recommend you consider possible plasma pen skin tightening with the medical spa staff at the office of Dr. John Hilinski.

 

#### Plastic Surgery for Earlobe Gauging - A Unique Case of Ear Reshaping or Otoplasty
I just finished one of the more unique cases of ear reshaping, or otoplasty, in quite a while. This particular patient presented to our San Diego plastic surgery office desiring reshaping of her ears. She had her earlobe gauging, or stretching, many years ago that created a progressively larger hole in her ear. After many years of this, she finally decided to remove the earlobe gauges and have her ears reshaped. Below left is a lateral view of her left ear showing the extent of the earlobe gauging or earlobe stretching. As you can see, there is a fairly dramatic change in the shape of the earlobe. In fact, it looks as if the bottom of her ear is simply just hanging off. Given the type of changes that were noted, I outlined a plan to reconstruct the earlobe to help restore a relatively normal looking ear for her. The reconstruction used to repair her damaged earlobe actually involves well-established plastic surgery techniques that are based on tissue expansion. In essence, I looked at her stretched earlobes as having already undergone one form of tissue expansion and utilized the excess soft tissue to recreate a more natural appearing earlobe. This included removal of a significant amount of excess tissue that was stretched and damaged from the earlobe gauges. The remaining soft tissue was then strategically trimmed and rotated around (repositioned) before being sutured in place. As you can see, even in the immediate postoperative ear reshaping photo below right (taken immediately after her otoplasty procedure), her ear looks markedly better. The blue threads correspond to the small suture, or stitches, that were used to realign the skin edges. Once these sutures are removed in 5-6 days, her ear will look even more normal with restoration of a very natural looking ear. If you or a friend have undergone gauging of the earlobe and are considering a return to a more natural looking ear through plastic surgery, give our office a call today. Or to learn more about ear plastic surgery, read our online otoplasty tutorial on ear reshaping surgery.

#### Plastic Surgery Skype Consult
Virtual plastic surgery consultations are becoming increasingly popular as the world becomings smaller and smaller thanks to the world wide web. For those plastic surgery patients outside of San Diego, we have been offering Skype consultations online. This includes several plastic surgery patients that live in outside countries. Many of these cosmetic surgery candidates discovered our San Diego plastic surgery practice while doing online research for their desired facial enhancement procedure. This includes patients seeking out rhinoplasty (nose reshaping), revision rhinoplasty (nose surgery following prior nasal reshaping), facelift (face lift), necklift, chin implant (chin reshaping), ear reshaping (otoplasty) and more. For instance, I just had a Skype consultation with a very nice lady who lives in Dubai. She heard of our plastic surgery practice through a previous facelift patient of mine who had come out from Dubai to have her surgery performed by me. Since there are considerable logistics that need go into planning a plastic surgery procedure from afar, we offer the Skype plastic surgery consultation as a nice preliminary option to meet each other. Although I am not able to physically examine the patient, I am able to gain a nice perspective of what their face and neck region look like. I can also have the patient rotate on camera, giving me an appreciation of their 3-dimensional appearance - a significant advantage over just photos. There is certainly no substitute for an in-person consultation when it comes to deciding on plastic surgery. However, a Skype cosmetic surgery consultation is a great way to determine one's overall candidacy for various plastic surgery procedures.

#### Plastic Surgery Virtual Consultation With Skype
Just finished another virtual plastic surgery consultation on Skype this morning with a previous patient on mine from Arizona. This is a patient on mine who had some facial plastic surgery years ago and is looking to have more cosmetic enhancement performed here in San Diego, CA. We have scheduled a tentative date for his surgery but he had some residual questions that he wanted answered prior to flying out. Skype is a great method for us to communicate with one another so that we can be as prepared as possible upon his arrival here in town. I am able to see him fairly clearly and visualize the areas of concern regarding his face. Having operated on him before, I was already familiar with his facial structure and the changes that had been made previously. He has a fantastic outcome from my previous facial plastic surgery with him. He simply wanted more contouring of the face for further cosmetic improvement. This particular patient is scheduled to have buccal fat pad removal and micro-liposuction of the face, but the Skype consultation works beautifully for other cosmetic facial procedures such as rhinoplasty, facelift, chin implant, eyelid lift, ear pinning and more. Despite a little technical glitch, the consultation went well. Just a reminder for any of you cosmetic surgery patients from out of San Diego who wish to have a more personalized virtual plastic surgery consultation, call our office at 619-296-3223 to schedule your Skype consultation today.

#### Playing Sports After Nose Fracture in San Diego, CA
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.

#### Post Open Rhinoplasty Appearance Less Than One Week Out
One of the most common questions I get asked from my San Diego nosejob (nose job) patients is what am I going to look like after the rhinoplasty bandages come off? Most rhinoplasty experts do not usually take photos of nose job patients this soon out. However, I think it is helpful for other prospective nasal reshaping patients to get a real realistic portrayal of what they might look like during this first week. That is precisely why I posted this plastic surgery blog entry for my potential rhinoplasty and revision rhinoplasty patients.
Rhinoplasty San Diego Case Example

This very pleasant young lady consulted with us regarding a possible reshaping of her nose. She mostly wanted to have her bridge height reduced (dorsal hump reduction) but also wanted her nasal tip to be brought closer to her face (called deprojection of the tip). At the same time we performed osteotomies of her nasal bone to narrow the bridge on frontal view once the bridge was brought down.
Nose Appearance 6 Days Out From San Diego Rhinoplasty
The photographs below show the frontal and side view of this San Diego rhinoplasty patient just 6 days out from nasal reshaping surgery. As you can readily appreciate, she is swollen and discolored around the nose region. However, for 6 days out from complete nasal reshaping, she is really quite presentable. Take note that she does not have black and blue eyes despite having her nasal bones broken and repositioned. In addition, the swelling and discoloration that she does have is quite mild overall. I usually tell my nasal reshaping patients that they will likely be 'supermarket presentable' (a term used by Dr. J. Regan Thomas) in about 10 days following rhinoplasty. Much of the swelling that this patient has at 6 days will actually resolve by day 10 such that she truly will be quite presentable in the public eye at that point in her recovery. Of course it will take up to a year or beyond for the nose to heal completely. But her appearance is not bad for 6 days out from rhinoplasty.

Detailed Comparison of Rhinoplasty Nose Changes Made
Looking in more detail at her side view, you can more readily appreciate the overall change in shape to her nose. The photo diagram below is provided so that you can visually see how her profile is now quite different. First off, her bridge has been clearly reduced in height to get rid of the dorsal bump. In addition, we took the bridge down even further to give her a more pleasing profile appearance. Even with swelling at 6 days out from rhinoplasty, the yellow line shows how much her nose has been brought down in terms of bridge height. Then take a close look at her tip region. Again, despite surgical swelling at 6 days out, her tip is now closer to her face as indicated by the red line. Now some of you may be thinking that this is not a significant change based on absolute measurement by the yellow and red lines. But keep in mind that rhinoplasty and revision rhinoplasty are very much finesse operations. A few millimeters here and a few millimeters there can translate into moderate amount of change in the overall nasal appearance. With time, this particular patient is going to see further refinements in the nose with improved definition. I will try and keep you up-to-date as she continues to come in for her follow-up visits over the next year or so. Sincerely, Dr. Hilinski.

#### Post Rhinoplasty Appearance Two Weeks Out
I wanted to post an update on this particular San Diego rhinoplasty patient. We previously posted on her rhinoplasty healing at day 6 out from nose job surgery. You can see read more about her day 6 rhinoplasty recovery and details of her nose job surgery by clicking here. One week later, she was seen for routine follow-up in my office and additional photos were taken to document her rhinoplasty healing. You can see her rhinoplasty photos below, which demonstrate a very nice early evolution in her healing. As I commonly discuss with my San Diego rhinoplasty patients, within 14 days of this type of nose reshaping surgery she looks quite presentable in the public eye. Yes, you can tell that she still has swelling of the nose and residual discoloration of her skin from the rhinoplasty surgery. But, overall, she looks quite presentable. In fact, not many strangers would even pay her much attention in line at the supermarket! What these photos also show many prospective rhinoplasty patients, is just how much change there actually is between recovery day 6 and recovery day 14. This change can really be appreciated on her profile rhinoplasty photos where a significant amount of the bridge swelling (called edema) has resolved at two weeks out. Over the next several months, she is going to enjoy even more refinement of her nose as a result of the rhinoplasty - ultimately achieving her final result around one year out.
Rhinoplasty San Diego Frontal Photos
Before

Day 6

Two Weeks
Rhinoplasty San Diego Profile Photos
Before

Day 6

Two Weeks

#### Power of Fat Transfer and Laser
So many of our patients seek out Dr. Hilinski because of the natural results he achieves with various cosmetic facial treatments. For example, this middle-aged female desired to look more rested and youthful. Her main concerns centered on volume loss and aging skin changes that were making her look older than she felt. This is an incredibly common sentiment amongst patients seeking facial plastic surgery in 2019. Patients simply feel like they are looking prematurely tired - and loss of facial volume is one of the main culprits. When you combine this with formation of unwanted skin wrinkles and fine lines (we call these rhytids), the aging process can seem like it is just picking up momentum much too early. However, most patients aren't looking to have a major transformation - largely because they want to look younger but do not want to risk looking fake or surgically altered.

This is where it so important for facial plastic surgeons and cosmetic dermatologists to exercise restraint in terms of what is recommended and done to these patients. As a board certified facial plastic surgeon, Dr. Hilinski has a wide array of options he can offer when it comes to cosmetic treatment. But he recommended this particular patient undergo just two procedures - fat transfer and laser skin resurfacing.

The fat transfer was recommended to restore lost volume in her mid to lower face region. As we age, loss of fat is a very common issue - sometimes affecting patients as young as those in their 30s. Fat transfer involves taking fat from another area of the body - typically around the abdomen - and transferring it to the face to help plump out volume-deficient tissue. Some people think - erroneously - that fat transfer is only a temporary procedure. The reality is that fat transfer is considered a permanent option to plump out the face. Some fat is lost in the process of transferring it to the face. But much of the fat does survive and continues to live on in its new location - giving patients the needed volume restoration they desire.

Laser skin resurfacing was recommended to help provide her smoother, less aged looking skin. To be more specific, Dr. Hilinski suggested the CO2 laser peel to help target blotchy brown pigmentation (a mix of sun and age spots) and fine lines and wrinkles throughout the face. Laser procedures like this help to remove the older, aged surface skin - allowing fresh, rejuvenated skin to take its place while giving patients a new, brighter complexion.
Fat Transfer and Laser Peel
When you take a look at her before and after photos, you can readily see she looks much improved after the fat transfer and CO2 laser peel. If you didn't know what she had done, you likely wouldn't be able to pick out precisely what was made better - but you know she looks better! If you look more closely, you can really start to appreciate how her facial volume has been increased. For example, look at her cheeks. They are now plumped out - especially through the lower eyelid-cheek junction. Her face just looks fuller and plumper - in a healthy way. But she still looks like herself - which is so key.

As a result of the CO2 laser resurfacing, her skin now glows so much brighter! It is not only smoother in texture, it is also less blotchy with more uniform color. It just looks more youthful - as if she recently returned from a relaxing vacation.

      
Natural Cosmetic Facial Surgery
If you interested in just looking like the best version of yourself - but want to keep it looking natural, contact our office today to schedule a personalized consult with San Diego's best facial plastic surgeon - Dr. John Hilinski.

#### Preserving One's Look in Rhinoplasty
The latest addition to our growing online rhinoplasty patient tutorial focuses on preservation of one's look during rhinoplasty surgery. This case of a patient from San Diego, CA is great illustrative example of how to perform rhinoplasty surgery while preserving the natural look of the face. We hope you enjoy it.

#### Price in San Diego
At our San Diego medical spa, we get phone calls on a nearly daily basis asking about the price of Botox. In so many of these instances, prospective patients seeking Botox treatment are price-shopping to see who they can go to in order to get the cheapest price for Botox. Unfortunately, what so many of these patients don't realize is that Botox price is only one of the major considerations you should ponder before deciding on who injects your face.
Cost of Botox San Diego
So should cost matter when it comes to Botox? Absolutely. We would be crazy if we suggested otherwise to anyone considering Botox in San Diego. But there is a range of normal pricing, which is about $9 per unit up to $14 per unit. If you live in San Diego and are being charged anything outside of this price range for Botox, you should find a new office to treat your wrinkles!  To learn more about the specifics of Botox prices and truth in advertising Botox costs, use this link here. If the Botox price being quoted to you is within this range, which is the standard for the San Diego community, you should then put more weight on the other considerations noted below.
Botox Injector
One of the most important considerations when getting Botox treatment is the person doing the injection. For example, does the Botox clinic have an on-site physician supervising the treatments? Or is the clinic being run essentially by an RN who works under a doctor that practices somewhere else? Your best bet for Botox treatments is to find a medical spa, like Dr. Hilinski's, that has an on-site physician who helps oversee any and all RNs offering cosmetic treatments.

Another factor to consider is whether or not the physician who runs the Botox clinic is someone who was trained as a plastic surgeon or cosmetic dermatologist. That is because a doctor with this type of training has spent literally years and years of training - whereas a 'medical director' who is an anesthesiologist or family practice doctor did not. In fact, their residency training was spent on putting patients to sleep or treating family medical conditions like diabetes, respectively. These 'non-core' physician medical directors of Botox clinics in San Diego jumped into the cosmetic industry because they wanted to make more money and move away from the insurance-based sector of medicine. Did they complete a residency in plastic surgery or cosmetic surgery? No! They often times just complete a 'weekend warrior' course to learn Botox injection technique - then run off to open their Botox clinic as a so-called expert. Although Botox isn't the most complex or challenging of all medical procedures, what you want is someone who has formal training in evaluating cosmetic concerns and recommending and performing the right procedure for your needs. At the end of the day, who would you rather have inject your face with Botox - a board certified plastic surgeon or an ex-family practice doctor?
Botox May Not Be Enough
The point above regarding your choice of injector plays directly into the fact that Botox may not be enough for many San Diego patients. Although Botox is great for reducing unwanted facial wrinkles, many people need more than Botox to get the type and degree of change they desire. This means it is even more important that you choose an injector who has bonafide experience and training in evaluating your face to achieve the best cosmetic result possible. If you ultimately opt to go with injectable fillers in combination with Botox treatment, you better hope that your medical spa practitioner is well-trained in facial reshaping with such products. If not, those dollars you may or may not have saved by going to the most discounted medical spa in town may pale in comparison to the headache and trouble you might face in correcting the issues that may arise.

#### Proud To Be An American
Just wanted to say 'thank you' to one of my San Diego plastic surgery patients for dropping off an American flag to me earlier today. As you can see, it is already sitting proudly on my office wall. He, like many other young men and women out there, proudly serves as a United States military member. He was kind enough to bring me a flag all the way from overseas. I just wanted to publicly say thank you again for everything you folks do to keep the rest of safe and sound. Sincerely, Dr. Hilinski.

#### Read About This Amazing Case of Revision Rhinoplasty
Read more about this amazing revision rhinoplasty case that involves a female patient who had previous nose job surgery by a different plastic surgeon. Unfortunately, her results were not as successful as she desired. She suffered for many years with a nose that simply did not fit her face - until she discovered Dr. Hilinski was a regional expert in revision rhinoplasty surgery to correct previously unsuccessful nose job results. Her case is discussed in detail and is the basis of the latest online chapter in the ever-growing rhinoplasty tutorial presented by Dr. Hilinski. Learn more about her case and other issues related to cosmetic nose reshaping by visiting our rhinoplasty tutorial.

#### RealSelf Ranking
According to RealSelf.com, Coolsculpting non-surgical body contouring ranks as one of the best treatment options to get rid of excess body fat in the neck, arms, abdomen, back and thighs. In fact, nearly 80% of all patients who underwent Coolsculpting fat freezing treatment were quite happy with their results. Keep in mind there is really no cosmetic treatment that has 100% satisfaction. So with nearly 8 of every 10 patients saying they would do Coolsculpting all over again, that is considered within the cosmetic industry as a highly effective treatment option. If you are struggling to get rid of excess fatty deposits in any of these problematic areas, contact our San Diego office today to schedule a complimentary Coolsculpting consultation with one of our expert team members.

#### Rebuilding One Side of the Nose
Learn about closed revision rhinoplasty technique used to rebuild this San Diego revision rhinoplasty patient's nose following trauma and collapse. Dr. John Hilinski was sought out because of his widespread reputation as one of the leading rhinoplasty and nose reconstruction specialists in all of San Diego, CA. This particular female revision rhinoplasty patient suffered trauma to the nose with subsequent collapse of her right side. Dr. Hilinski was able to use ear cartilage grafting and  a closed revision rhinoplasty technique to rebuild the one side of her nose to create a very natural looking nasal contour. See this case example and learn from the discussion in the latest addition to the ever expanding San Diego online rhinoplasty tutorial resource.

#### Reconstructing A New Nasal Tip
About every 3-4 months or so, I see a revision rhinoplasty patient who needs to have the entire nasal tip reconstructed. The following patient is a great example of exactly this type of rhinoplasty procedure. If you look at this particular patient, the tip of his nose looks as if it were truncated, or removed. After consulting with our office, he elected to proceed with the surgery to reshape his nose. We performed his rhinoplasty along with septal cartilage harvesting. The septal cartilage was used to rebuild his nasal tip region and reproject his nose outward from the plane of his face. As you can see in his postop lateral view, his nose now looks more normal. His profile has been restored with a straight bridge that gently transitions into a more anatomically correct tip shape. Since he was recently seen in the office, it reminded me to post a quick entry on possibilities when it comes to reconstructing a new nasal tip.

#### Reconstructive Rhinoplasty for MOHS Defect
As an expert in nasal reconstruction, I commonly see patients who are seeking to have their noses repaired following skin cancer removal, or MOHS surgery. This is particularly common in this region of the country where sun exposure is so common year round. This very pleasant lady from San Diego consulted with me to see if I could help restore a more natural looking nostril rim after the skin cancer removal created a notched looking deformity. Read more about her full story and the surgical effort that was involved. Let me know what you think of her results!

#### Reduced Pain with Vibrata
What can help with pain when getting Botox injections? One measure that San Diego expert injector, Dr. John Hilinski, uses to reduce pain associated with Botox and Dysport treatment is the vibrata device shown here. This is essentially a small vibrating tool that can be placed on the face during placement of the Botox or Dysport. By creating a buzzing sensation, this helps to distract your brain from the actual pain and discomfort of the Botox and Dysport needles. This relies on what is called the gate theory of pain - where your brain can only process one sensation at a time. If your brain senses more of the vibration from the vibrata, you will feel less pain associated with your Botox and Dysport treatments!

#### Refresh Your Eyes with Non-Surgical Blepharoplasty
The delicate skin around your eyes is one of the first areas to show signs of aging, often resulting in puffiness, sagging skin, dark circles, and fine lines. If you're looking to refresh your appearance without undergoing surgery, non-surgical blepharoplasty treatments can help you achieve youthful, rejuvenated eyes. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we offer a variety of non-invasive treatments designed to target these concerns, providing natural-looking results and minimal downtime.

Dermal Fillers

For patients with hollow tear troughs, under-eye bags, or dark circles, dermal fillers such as Restylane® and JUVÉDERM® offer an effective solution. These injectable fillers work by adding volume to the under-eye area, reducing the appearance of hollows and shadows that contribute to a tired look. Dermal fillers help restore a refreshed and more vibrant appearance, giving the eyes a fuller, smoother contour.

By filling in the tear troughs, the transition between the lower eyelid and the cheek becomes more seamless, instantly reducing under-eye bags and dark circles. Results are visible immediately after treatment and can last up to a year or more, depending on the specific filler used.

Botox

Crow’s feet and fine lines around the eyes can make you appear older or fatigued. Botox injections are an excellent option for smoothing out these wrinkles. Botox works by temporarily relaxing the muscles that cause lines and creases when you smile or squint, resulting in a smoother and more youthful appearance.

A quick, in-office procedure, Botox injections require little to no downtime, and results typically appear within a few days. You can enjoy the benefits of smoother skin for 3 to 6 months, making Botox an ideal treatment to pair with other non-surgical blepharoplasty options.

Profound RF (Radiofrequency Microneedling)

For patients with loose or sagging skin around the eyes, Profound RF combines microneedling with radiofrequency energy to tighten and lift the skin. This treatment works by stimulating the production of collagen and elastin, which helps firm up the skin and reduce sagging.

Profound RF is a great option for those looking to address under-eye sagging or drooping eyelids without the need for surgical intervention. The results continue to improve over the months following treatment as your skin naturally produces more collagen.

Ultherapy

Ultherapy uses ultrasound technology to target the deeper layers of skin, stimulating collagen production for a natural lifting effect. This non-invasive treatment is particularly effective for patients seeking to lift the brow or reduce sagging under the eyes.

Ultherapy offers gradual, long-lasting improvements and is a popular choice for individuals looking to avoid downtime. The procedure is comfortable, and over the course of several months, you’ll notice firmer, tighter skin around the eyes.

Plasma Pen

The Plasma Pen offers a unique solution for tightening skin, especially around the eyelids. This treatment uses plasma energy to create controlled micro-injuries to the skin, encouraging the natural healing process and collagen production.

Plasma Pen treatments are ideal for reducing wrinkles, fine lines, and mild sagging on the upper and lower eyelids, providing a lifted and more youthful appearance.

Laser Skin Resurfacing

For individuals looking to improve skin texture, reduce fine lines, and rejuvenate the overall appearance of the eye area, laser skin resurfacing is an excellent choice. CO2 laser resurfacing promotes collagen renewal by creating micro-damage in the skin, prompting the body to repair and renew the treated area.

Laser treatments can smooth out wrinkles and improve skin tone, leaving the under-eye area looking brighter and more refreshed.

Rejuvenate Your Eyes without Surgery

At John Hilinski, M.D. Plastic Surgery, we specialize in non-surgical blepharoplasty treatments that provide natural-looking results with minimal downtime. Whether you're concerned about puffiness, sagging skin, or dark circles, we have a range of solutions that can be tailored to your unique needs.

Contact us today to schedule a consultation and discover how non-surgical treatments can refresh your eyes and restore your confidence!

#### Rejuvenating TCA Chemical Peel For Aging Spots & Facial Hyperpigmentation
Chemical peeling is a well-established technique for rejuvenating your skin that is quite affordable and very effective. This is a great case example of what a TCA (trichloroacetic acid) chemical peel might do for someone with aging spots and hyperpigmentation. In today's day and age of expensive, fancy laser skin rejuvenation devices, chemical peeling is a fantastic office-based skin enhancement procedure. This very pleasant San Diego patient presented to the office noting dark age spots around her cheeks that she desired to have treated. We reviewed the various skin rejuvenation options ranging from lasers (like a CO2 laser) to application of chemicals to peel the skin. She elected to undergo a chemical peel using TCA to help rejuvenate her facial skin while lightening the unwanted dark spots. We performed a 25% TCA full face peel in the office setting. Within 5-6 days, her skin was healing well enough such that she was publicly presentable. Her before and after photos are presented below.
Before and After TCA Chemical Peel
In the before photo (below left) you can easily appreciate the age spots and hyperpigmentation that she has involving her face, especially in the cheek region. As is noted in the diagrammed photo, there is a fairly intense, larger age spot that is particularly obvious.  This was also quite bothersome to the patient. Following the TCA chemical peel, you can see the overall improvements that can be realized in many cases. Her skin now more uniform in color with less blotchiness. The largest, most pronounced age spot is now markedly better in appearance. In addition, her skin is smoother. And these results are seen following one chemical peel treatment at a 25% TCA concentration. In many cases, we can go higher than this and attain even better results. In this particular patient, her native skin color (slightly more ethnic skin) inhibited us from going too strong with the chemical concentration. But 25% was a safe yet effective choice in terms of the TCA peel. We plan on performing another peel in about 6 months to further enhance her facial appearance and hope to keep you informed of her progress.

#### Removal of Facial Moles
I was recently asked to provide some more detailed information regarding removal of facial moles. This is a relatively straightforward facial enhancement procedure that I happen to do on a regular basis as a facial plastic surgeon. Here is a link to the latest addition to our ever-growing website that focuses on facial cosmetic enhancement here in San Diego. Let me know what you think!

#### Removing Tape After Rhinoplasty or Revision Rhinoplasty
Many rhinoplasty patients out there are instructed to tape their nose on a regular basis to help the nasal skin shrink wrap down to the new shape of the nose. If you haven't done so yet, please take a look at our online rhinoplasty tutorial on taping the nose following rhinoplasty and revision rhinoplasty. One helpful hint that I wanted to point out with regard to taping the nose has to do with removal of the tape. One recent San Diego rhinoplasty patient of mine inquired about anything she might be able to put on her nose that would aid in taking the tape off more gently. I recommended she try and get some Detachol topical solution. Detachol is an adhesive remover that can be dripped on to the tape, which helps break up the attachment to the skin surface. The tape can then be removed much easier from the nose. In this manner, you can be much more gentle with handling your nose following a delicate rhinoplasty or revision rhinoplasty surgery. You might need to search online to find where to buy Detachol or an equivalent adhesive removal product out there. Good luck and hope this helps some of you nose reshaping patients!

#### Renuvion J Plasma Neck Tightening
Here is a great video showing what typical patients look like 1 day after having Renuvion J Plasma skin tightening. This is the type of plasma treatment that is done subdermally - meaning from underneath the skin rather than on the surface of the skin. A few sutures were placed to help lift and tighten the platysma muscle - making this procedure more of a J Plazty face and neck lift. But make no mistake about it, the Renuvion J Plasma wand is what was used to tighten the skin from underneath. Her face and neck skin look somewhat discolored due to bruising and inflammation. But more obvious is how much tighter her skin looks with much less laxity.

#### Renuvion Skin Rejuvenation
See what Renuvion J Plasma skin rejuvenation can do for you. Here is an older, female patient from San Diego who desired to look more rested and youthful. Dr. Hilinski and her decided to proceed with this revolutionary helium gas skin rejuvenation treatment. Here are some close-up photos of her skin showing just how powerful J Plasma can be when it comes to turning back the clock. You can readily appreciate just how aged her skin appeared prior to the Renuvion treatment. Following the procedure, her new skin is now much, much smoother with less wrinkle formation and better pigmentation throughout. Can you get similar results with a laser skin treatment? Not really. Although lasers can improve the appearance of your skin, typically you won't see this type of change that happens even into the deeper tissues of the face. If you care interested in this revolutionary technique for facial enhancement, contact San Diego's first plastic surgeon to offer J Plasma by Renuvion - Dr. John Hilinski.

#### Repair of the Broken Crooked Twisted Nose
Learn more about repair of the broken nose in this latest addition to our online San Diego rhinoplasty tutorial. This most recent chapter focuses on a patient who broke his nose resulting in a crooked alignment that required surgical repair to help restore a more normal appearing alignment. I hope this provides helpful insight to anyone out there who has a crooked nose from injury and is contemplating reconstructive rhinoplasty surgery.

#### Repeat Treatment of an Area
As part of our ongoing effort to keep our patients fully informed, Dr. Hilinski wanted to post a quick entry regarding what some patients experience during their repeat Coolsculpting sessions. A repeat session refers to an area that has already undergone Coolsculpting and is about to undergo a second or third treatment. Although most patients note a significant improvement after just one fat freezing session, some patients elect to get even better body contouring results with a second or third Coolsculpting treatment. It is worth noting that some of these patients will note a slight increase in the level of discomfort during the intial phases of the treatment. Just like the first Coolsculpting session, the area goes numb within a few minutes. But patients may want to be prepared that the discomfort level may be more intense than the initial treatment. Despite this, there is still no surgery, no needles and no downtime!

#### Restylane Eyelid Lift
Have unwanted lower eyelid hollows? Do your eyes look prematurely tired? Do you have lower eyelid bags or shadows, but don't want facial plastic surgery? If you answered 'yes' to any of these questions, then you need to contact one of San Diego's finest medical spas offering Restylane and Juvederm injectable filler treatment. The offices of Dr. Hilinski have assembled an amazing team of experts - including an RN aesthetic specialist - who can help you improve those pesky lower eyelid hollows and shadows by injecting a filler during an office-based procedure.

This patient here opted for just that - using Restylane to fill in her lower eyelid - cheek junction to soften and rejuvenate unwanted hollowing that crept up on her prematurely. If you look at her before photo here, you can see that she has a moderate volume deficiency under her eyes, which contributes to her looking unnecessarily tired. The lack of volume across the lower eyelid contributes to the fact that she has darkening in this region due to shadowing.

Fortunately for her, she found one of San Diego's leading medical spas that offered her a wonderful solution using Restylane injection. During a routine 15 minute visit to the clinic she was treated with the Restylane filler in a very strategic and gentle manner to plump out the lower eyelid tissue as it transitioned into the cheek. By adding the filler, volume was increased so that it created more of a soft convex surface along her lower eyelid - think of the slightly curved surface over an eggshell. By doing so, light would then reflect off this area much more readily - giving her a much more rested and rejuvenated lower eyelid look.
Before and After Eyelid Restylane
Take a look for yourself to see her amazing results from Restylane lower eyelid treatment. The after photo was taken literally within minutes of undergoing the eyelid filler treatment. And as you can see for yourself, she has minimal bruising and barely any swelling of the lower eyelid. What she does have, however, is a much improved cosmetic appearance where the lower eyelid has been filled out to make her look simply rested and youthful.

If you live in San Diego and are looking for dermal filler injections for lower eyelid rejuvenation, don't hesitate in contacting our medical spa staff today to get your treatment done!

#### Restylane Wrinkle Filler
It is no surprise to see how fillers, such as Restylane and Juvederm, help to improve the appearance of facial wrinkles. But here is a great visual of just how much improvement can be realized with this type of simple office-based procedure. This older, female patient would certainly have benefitted from a laser skin procedure, but didn't want to deal with the downtime. So she opted for a quick filler injection treatment done in the office with essentially no downtime. As you can see, adding something like Restylane under the skin helps to expand and volumize the tissue - creating a smoother skin surface and more youthful look!

#### Results! Results! Results!
Check out these fantastic results from Coolsculpting of the abdomen in this male patient from San Diego.

His main concern was some excess fat around the abdomen region, which is a common complaint among many men. Despite exercise and a good diet, the area around the belly button can be very difficult to tone and tighten.

He consulted with Dr. Hilinski's medical spa staff regarding the possibility of freezing the fat away. After discussing this in more detail, he opted to undergo two sessions of Coolsculpting.

The treatments were conducted about 6-8 weeks apart from one another. Coolsculpting is done in our specially designed room while patients relax comfortably during the treatment.

Results of his Coolsculpting can be seen below. As you can readily see, there has been quite an improvement in the central abdomen contour and shape. His tummy is now much toner and tighter - giving him a much flatter overall appearance. And the beauty is that the fat, which was frozen away, is gone forever!

#### Reverse Brow Lift For Excessively Long Forehead
I was just speaking with one of my plastic surgery colleagues here in San Diego about recent inquiries regarding patients with excessively long foreheads. Believe it or not this is a relatively common complaint among patients, particularly females. Usually patients note that their hairline starts much higher up than normal. This gives the appearance the forehead is much longer in an up and down direction. The only real treatment for this particular problem is to shorten the forehead. The following is a quick summary description of this procedure. The technique for lowering the hairline essentially involves a reverse brow lift type of procedure. An incision is typically made along the front of the hairline, which tends to heal very nicely with little visible scarring if done carefully. The hair-bearing portion of your scalp is then mobilized and brought forward. The excess forehead skin is trimmed away and the hairline is placed down in its new lower position. Effectively the forehead is shortened and the hairline is brought down very naturally. Contact my office and let me know if you have any specific questions regarding a possible reverse brow lift, or hair line lowering procedure. Sincerely, Dr. Hilinski

#### Revision of Nose Done in Mexico
Want to see a dramatic transformation of a nose that was previously done in Mexico? Dr. Hilinski has added a new case example to his SanDiegoRhinoplasty.com website that is dedicated to cosmetic and functional nose surgery. This young lady had her first nose job done in Mexico. Unfortunately, she came out with a nose that was overly rotated upward and stuck out too far from her face. In addition, she had severe asymmetry of the tip cartilages from the prior rhinoplasty work that was done.

Dr. Hilinski was able to revise her nose and give her a much improved overall look. This included a reduced bridge height, counter rotated nasal tip, drop in projection and much more symmetry. To see her dramatic change and a full explanation of what was discovered during her revision rhinoplasty, use this link here.

#### Revision Reconstructive Nose Surgery for Pinched Nasal Tip and Collapsed Nostrils
Learn more about management of a pinched and collapsed nasal tip. This patient from San Diego had prior surgery by a different surgeon years ago. Unfortunately, her nasal tip began to collapse leaving her with a pinched appearance. In addition, she had issues with the contour and shape of her nasal bridge following prior unsuccessful nose surgery. I ended up performing a revision reconstructive nose surgery to help repair her breathing. In the process, we also were able to get her nose looking more like a normal nose. To see her before and after revision rhinoplasty photos, click here.

#### Revision Rhinoplasty For A Severely Pinched Nasal Tip
Repair of the pinched nasal tip is one of the most challenging cases in the world of rhinoplasty, or nasal reshaping. Below is a case example of a San Diego patient who had prior unsuccessful rhinoplasty performed by a different rhinoplasty surgeon. She was, unfortunately, left with a severely pinched nasal tip as seen below. In addition to her cosmetic nose concerns, she had a significant problem with breathing through her nose as one might expect. When I first met this patient, I was actually quite concerned about taking her on as a patient despite my extensive experience as a revision rhinoplasty expert. After very careful inspection of her nose and meticulous surgical planning, I decided to perform her revision rhinoplasty using an open approach. In addition, I used a variety of structural cartilage grafts to reshape the nose. Much of this was required to rebuild the structural support of the nasal tip. One of the most difficult aspects of her revision rhinoplasty procedure was elevation of her skin around the actual tip of the nose. As you can imagine from looking at her before photo below, the skin was quite scarred down to the underlying cartilage as a result of the prior rhinoplasty surgery. After very meticulous surgical dissection, I was able to expose her nasal tip sufficiently to place the cartilage grafts. Once this was accomplished, I ended up using temporal fascia grafting to bolster the nasal tip skin and provide a more natural rounded contour. The end result of her secondary rhinoplasty procedure can be seen below. The final result after one year shows a much more natural looking nose. This includes a softer shape from the nasal tip out to the sides of the nose. In addition, her nose functioned much better following the revision rhinoplasty where the support of the nasal tip was reinforced. If you have a pinched nasal tip and are considering revision rhinoplasty, give our office a call today and take advantage of our extensive expertise in revision rhinoplasty.

To see additional photos of this San Diego revision rhinoplasty patient, use this link to be taken to our revision rhinoplasty gallery.
Photos of Pinched Nasal Tip - Revision Rhinoplasty Repair

#### Revision Rhinoplasty For Pollybeak Deformity
As a revision rhinoplasty specialist in San Diego, we are continually trying to update our website with useful rhinoplasty information. Toward this end, we recently added a new section to our online rhinoplasty tutorial focusing on management of the pollybeak deformity in revision rhinoplasty. I hope this helps anyone out there considering revision rhinoplasty surgery to address this type of abnormality of the nose. Sincerely, Dr. Hilinski

#### Revision Rhinoplasty To Create A More Feminine Profile View
This revision rhinoplasty patient was recently in the office for a follow-up evaluation and was a great example of how to create a more pleasing, feminine profile view. She had surgery by a plastic surgeon in the Beverly Hills area and was unsatisfied with her original outcome. She then sought consultation with our office for a formal revision rhinoplasty. She was mostly displeased with her profile view, especially the tip to bridge transition. In addition, she was unhappy with the height of upper bridge near the eyes. On examination you can see that her tip looked somewhat ptotic, or droopy in comparison with her bridge height and position. Her upper bridge was also just slightly high for her face. We performed an open revision rhinoplasty with bilateral ear cartilage grafting to reconstruct her nose. As can been seen in her before and after photos below, she now has a much more pleasing profile view with improved transition from her tip to the bridge.

#### Revision Rhinoplasty: San Diego Facial Plastic Surgeon Reveals Common Patient Concerns
The thought of undergoing a secondary rhinoplasty procedure may be unsettling, but Dr. John Hilinski says patients needing revision nose surgery in San Diego are not alone.

San Diego, CA -- Dr. John Hilinski, a facial plastic surgeon in San Diego, says revision rhinoplasty is one of the most popular procedures requested at his practice. He performs revision rhinoplasty on a weekly basis. Because rhinoplasty is one of the most intricately complex treatments in aesthetic surgery, he says there are a number of reasons patients may need to have a secondary procedure, and choosing a surgeon with the proper experience and credentials is essential to ensuring the outcome is both safe and satisfactory.

At his San Diego facial plastic surgery practice, Dr. Hilinski says some of the most common motivations for seeking a secondary rhinoplasty procedure include:

An Overdone Appearance: “Often times patients have had excessive cartilage removed from their nose in an attempt to create a more refined-looking nose. Unfortunately, this overcorrection can structurally weaken the nose and lead to a nasal collapse several months or years later. These patients may also notice pinched nasal tips or abnormal shadowing throughout other areas of the nose, including the middle segment of the bridge.”
Insufficient Reshaping: “Other patients complain that their nose was not reshaped enough. They may have a bridge that was left too high or a tip that is still poorly defined. In similar cases, the alignment was not adequately addressed, leaving the patient with a nasal bridge that is still crooked when seen from the front.”

Much like primary rhinoplasty, Dr. Hilinski says secondary nasal surgery involves the cosmetic and functional reshaping of a patient’s nose; however, prior anatomical distortion, abnormal scarring, and surgical manipulation from prior procedures can make the procedure a very different type of operation. Because of these additional factors, he says, “revision rhinoplasty is a much more challenging operation than primary rhinoplasty because there are so many more variables involved in the surgery.” Another challenge he says plastic surgeons tasked with performing a revision rhinoplasty procedure may face is the patient’s psychology, having been disappointed by the results of their previous experience.

“Revision rhinoplasty patients have already gone through a primary rhinoplasty and a good number have also already had prior attempts and revision rhinoplasty,” says Dr. Hilinski. “It is imperative that a revision rhinoplasty expert be able to confidently allay these concerns when consulting with revision rhinoplasty patients. And the only real way to do this is to be a true specialist in this operation with advanced knowledge and expertise in being able to perform revision rhinoplasty.”

In any case, Dr. Hilinski says consulting with a properly-trained, board-certified rhinoplasty surgeon is a crucial step in making sure patients receive quality care and the right results for their needs. He encourages anyone considering a revision procedure to take the time to adequately research their chosen surgeon’s practice before undergoing any treatment.

“As a revision rhinoplasty specialist, there is enormous responsibility and expectation that I am going to be the last stop in this process of getting the nose to the desired shape and size,” he says. “It is this precise concept that motivates me on a daily basis to continue building my practice and reputation as one of the best revision rhinoplasty experts out there.”

About John M. Hilinski, MD
Dr. John Hilinski is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery, as well as a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology-Head and Neck Surgery, and several other professional organizations. He is available for interview upon request.

#### Revision Upper Lip Lift
This is a very pleasant middle-aged female from out of state who consulted with me to have a revision upper lip lift procedure. She had prior upper lip lifting by another plastic surgeon. Unfortunately, her lip elongated and she needed to have a revision procedure. I performed shortening of her upper lip length using a subnasale upper lip lift technique. The end result is shown here. As you can see, her upper lip is now in much better balance in terms of proportion. You can also see how her upper lip shape has been enhanced with improved definition. More specifically, you can appreciate how her vermillion border and philtral columns have a more feminine appearance. Furthermore, her scar is barely visible as you can see here. This is precisely why my office has become increasingly popular over the past several years in terms of performing more and more upper lip lift surgeries. Let us know what you think of her results!

#### Rhinophyma Laser Treatment
This is another example of CO2 laser treatment for a condition called rhinophyma. This is a disease that causes the skin of the nose to become overgrown - resulting in the appearance of a very bulbous nasal tip region. For many patients, this can become a significant cosmetic disturbance. In others, this heavy, thick skin can also result in some degree of breathing difficulty. The patient shown here had developed rhinophyma over a period of several years and became increasingly bothered by the appearance of his nose. More specifically, he was unhappy with the abnormal creases that were developing because of the overgrown rhinophyma skin changes. Ultimately, I performed CO2 laser surgery on his nose to reduce the bulky skin changes. The end result can be seen here in these photos that show a marked improvement in his nasal size and shape. Let us know what you think of his results!

 

 

#### Rhinophyma Surgical Treatment in San Diego
Learn more about rhinophyma surgical treatment in the latest addition to our growing online rhinoplasty tutorial at drhilinski.com. Rhinophyma is a somewhat uncommon condition that results in the nose skin becoming excessively thick and nodular in appearance. In many cases, this creates much anxiety in rhinophyma patients simply due to the unusual appearance. In cases like this, I will use a carbon dioxide laser to surgically treat the skin to help restore a more normal appearance. Click here to read more about this very interesting condition.

#### Rhinoplasty and Revision Rhinoplasty Photos
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

#### Rhinoplasty and Spreader Grafts
In many cases where patients are undergoing reshaping of the dorsum (bridge) I will recommend that we place spreader grafts at the time of the surgery. Spreader grafts are long, rectangular-shaped pieces of cartilage that are placed in parallel with the bridge in between the septum and the upper lateral cartilage. They are what we term ‘hidden’ grafts in that they are placed within a precise pocket without contacting the skin directly. This is in comparison to other grafts we use in rhinoplasty and revision rhinoplasty, such as tip and dorsal onlay grafts, that directly contact the skin and alter shape of the nose. Spreader grafts, in contrast, push or spread the upper lateral cartilage outward, thereby widening the middle one-third of the bridge indirectly. For this reason, the most common indication for spreader graft placement in cosmetic rhinoplasty is a pinched middle vault (another term for the middle one-third of the bridge). This can be a congenital finding in some patients who have never had rhinoplasty but also frequently occurs as a result of having had a prior nose job where this area of the nose was overlooked. In the latter instance, many of these revision rhinoplasty candidates present with what is called an inverted V deformity where the upper lateral cartilage has collapse inward creating unwanted shadowing in this particular shape. Other candidates for spreader graft placement are those with functional problems and difficulty breathing through the nose. These patients have narrowing of their breathing passage as a result of the upper lateral cartilage collapsing inward. When this occurs, a critical area inside termed the internal nasal valve becomes excessively narrowed causing a subjective feeling of difficulty breathing through the nose. In this case, spreader grafts are used to reopen the valve area and restore more optimal nasal breathing. It is for this reason that many patients who undergo spreader graft placement for cosmetic rhinoplasty also enjoy a moderate to significant improvement in their breathing as a passive side effect. To learn more about spreader grafts, you can read my online book chapter “Rhinoplasty, Spreader Grafts” on Emedicine.com (http://emedicine.medscape.com/article/1292527-overview).

#### Rhinoplasty and Steroid Injections
Question: What are steroid injections and why are they used for rhinoplasty and revision rhinoplasty patients?

Answer: Steroid injections refer to an injectable corticosteroid (called steroid for short) solution that is used to decrease swelling and dissolve unwanted scar tissue. I use steroids quite commonly to help during the healing process following rhinoplasty and revision rhinoplasty. If taping the nose does not address the issue sufficiently and/or quickly enough, I might recommend a steroid injection to reduce an unwanted contour or prominence. Contrary to popular belief, steroid injections can be used even very late in the rhinoplasty healing process (like 6-12 months out).

#### Rhinoplasty Before & After Gallery
San Diego rhinoplasty specialist and California revision rhinoplasty expert, Dr. John Hilinski, is proud to report that he now has one of if not the largest rhinoplasty photo galleries in all of San Diego. In fact, Dr. Hilinski likely has one of the largest galleries of rhinoplasty photos in all of Southern California. As a San Diego double board certified facial plastic surgeon, he has a specialty focus in rhinoplasty surgery - arguably the most challenging and complex plastic surgery procedure. Over the years, Dr. Hilinski has developed a reputation in San Diego and beyond as a regional plastic surgery expert in cosmetic nose reshaping. In addition, he is well-known as a specialist in reconstructive nose surgery that is commonly involved in rhinoplasty and revision rhinoplasty. To see actual rhinoplasty photos of patients who have undergone nasal reshaping surgery by Dr. John Hilinski, visit our San Diego rhinoplasty gallery and San Diego revision rhinoplasty gallery.

#### Rhinoplasty Bridge Augmentation Question
One of the most common questions I get asked during rhinoplasty consultation relates to how the nasal bridge (or dorsum) can be augmented or elevated. Different surgeons prefer different methods based on what works best in their hands. My preference is to use the patient’s own cartilage for dorsal augmentation if it is available in sufficient quantity. If only a slight amount of elevation is desired and/or there is only a short segment of the bridge to augment, cartilage taken from inside the nose (from the septum) or from the ear is generally sufficient. If there is septal cartilage present, this should be used before consideration of ear cartilage. If there is a more significant amount of augmentation desired, I may recommend you opt for costal, or rib, cartilage grafting. Rib grafting allows me to build up the bridge essentially using a single, long piece of cartilage. This method is preferred over use of several different pieces of cartilage, which increases the risk of unwanted absorption and, thus, contour irregularities. Rib cartilage can be harvested from one of your own ribs or as an alternative is provided by a tissue bank (termed cadaveric rib cartilage). When shaped with what we term is concentric carving technique, rib grafting can be done with less risk of warping and resorption.

It is worth noting in many cases of ethnic rhinoplasty (including Asian and African-American noses), the amount of septal cartilage available for harvesting is simply insufficient for bridge augmentation. In many of these ethnic noses, the amount of augmentation desired is considerable. Because of these factors, ethnic rhinoplasty often requires rib grafting to achieve the desired amount of bridge augmentation. In the rare case where a patient simply does not wish to undergo rib grafting or use cartilage from a tissue bank, we will discuss possible use of an implant, such as Goretex. In those ethnic patients with very thick skin overlying the nose, this type of material can be used with successful long-term results for bridge enhancement. However, patients must understand there is a higher risk of infection with use of Goretex and rejection of the material can occur in the future.

#### Rhinoplasty Correction - Crooked Nose Deformity
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.

#### Rhinoplasty Fascia Grafting
I happen to perform fascia grafting as part of rhinoplasty and revision rhinoplasty on a fairly regular basis. I do this type of grafting mostly in rhinoplasty patients with thin skin. In this patient population, anything done to reshape the nose can cause unwanted visible contour irregularities post-operatively because thin skin has a tendency to rapidly shrink wrap down to the new shape. In order to minimize risks of visible contour irregularities after rhinoplasty or revision rhinoplasty, I place a layer of fascia under the skin and over the cartilage or bone. This helps to bolster the thickness of the skin and reduces chances that even minor contour irregularities can be seen as the skin shrink wraps down. The fascia is essentially a thin layer or sheet of connective tissue that can be found in many areas of the body. I happen to use temporal fascia for my grafting since it is readily available and in plentiful supply. Many patients inquire about the incision used for the harvesting of the temporal fascia in rhinoplasty. I provided the photo below to visually demonstrate to potential patients where the actual incision is made. I performed a rhinoplasty with temporal fascia grafting on this patient just yesterday, which prompted me to post a quick blog entry. As you can see, I make a vertical incision above the right ear, which is completely contained within the hair (see blue arrows). Once this heals, it is incredibly difficult to even see it. I don't shave any hair to make the incision, which is a common concern among patients getting ready to have this done. The photo below shows the actual incision after I have closed it with absorbable sutures (meaning no sutures have to be removed). The incision tends to heal quite nicely and after a week or so most rhinoplasty patients don't even really remember having had the fascia grafting portion of the surgery.

#### Rhinoplasty For Hump & Poorly Projected Nasal Tip
One of the most common complaints among patients seeking rhinoplasty is a dorsal hump and lack of tip projection. Because how common this is noted among rhinoplasty candidates, I decided to post a quick blog entry using a case example. Most of these patients present with a chief complaint of a bump along the bridge. When this is combined with poor tip projection, both issues can be exaggerated more than there are individually. For instance, in the patient noted below, she presented with a dorsal hump or bump as well as a tip that did not project out sufficiently. In many cases, these issues are not as apparent on the frontal view as they are on the oblique (or 45 degree angle) and side views. In the preoperative rhinoplasty photos below, make note of how the bump and tip issues are better appreciated when looking from the oblique and side views. The red arrows indicate the hump or bump along the bridge while the blue arrow indicates her lack of tip projection. Following rhinoplasty surgery, which included reduction of the bump and a minor revision to reshape the tip, you can notice an overall marked improvement. Again, this is mostly apparent on the oblique and side views as seen below. She now has a much straighter profile view along the bridge and her tip is now positioned further outward to give her more definition. Most importantly, her nose looks quite natural without visible signs of having had nasal reshaping surgery.

#### Rhinoplasty For Just Hump Reduction
Question: Is it possible to just get rid of a bump without having my tip fall down?

Answer: The answer to this often asked question is - yes. There are plenty of potential rhinoplasty patients out there who simply dislike the bump on their nose. If your tip is in good position and has a nice shape, it is certainly a possibility to reshape the nose by reducing just the bump. The concern in some cases is that the tip will then fall at some point after the rhinoplasty. If you are at risk of this happening, a qualified rhinoplasty specialist would be able to pick this finding up during your consultation and recommend the appropriate intervention to minimize chances of this occurring.

#### Rhinoplasty For Moderately Complex Asymmetry Of The Nose
This particular patient was a great example of how we utilize spreader grafting technique as part of a nasal reshaping process. This pleasant male patient presented with difficulty breathing through his nose as well as cosmetic concerns regarding the appearance of his nose. On nasal examination he was found to have a fairly complex nose in terms of anatomical problems. As you can see in the photo diagrams below, his nasal bridge was fairly displaced but in a somewhat unique fashion. The upper portion of his bridge was collapsed inward (as shown by the blue arrow) on his right side and pushed out on his left side (as shown by the upper end of the white line). The lower portion of his nose was more displaced to his right side. The end result was a nose that looked as if it ran obliquely across the middle of his face. In addition, he had a slight bump on his bridge immediately above a depression involving the left side of his bridge. The curvilinear blue line in the diagram below follows the outline of his nose as seen on this oblique view highlighting just how misaligned his nasal bridge really was preoperatively. Although this is not the most dramatic crooked nose deformity that you might have seen, this particular nose encompassed a number of fairly complicated deformities that needed to be addressed concurrently.

The Rhinoplasty Repair
We were able to perform a combined functional and cosmetic rhinoplasty procedure using an open rhinoplasty approach. As part of the corrective process in reshaping his nose, we reduced the upper portion of his bridge where the bump was present. We also performed osteotomies to fracture the nasal bones and reposition them. However, this only resulted in correction of the upper 1/3 of his nasal bridge. At the same time, we had to place a spreader graft on his left side in order to rebuild the middle vault region where he was noted to have an obvious depression on the oblique view referenced above. Not only did this spreader graft help elevate and widen his nose in this area (see his oblique after photo showing a nice straight nasal outline), it also helped improve his nasal function. Coincident with these rhinoplasty maneuvers we reduced his right tip volume to give him a more symmetric frontal view. Combined, these various rhinoplasty techniques made for a fairly challenging and complex nasal reshaping process. Fortunately, we were able to provide him a nice overall improvement in nasal shape and function. We did end up performing a secondary refinement procedure to give him even more improvement with the end result shown below in the photo series. One can appreciate the new nasal shape as one that is a clear improvement over his preoperative nose. In addition, he still looks quite natural while maintaining a nice masculine overall appearance.

#### Rhinoplasty Healing 1 Month Out in San Diego, CA
I wanted to update everyone on Christine's progress following rhinoplasty surgery performed nearly one month ago now. For those of you who don't know, Christine works in the front office here at the clinic. We previously posted a blog entry showing her healing within weeks of having cosmetic nose surgery to lift her tip and reduce the bridge, performed by Dr. Hilinski in mid December 2011. These photos shown here are her rhinoplasty progress shots nearly one month out of surgery. As you can see, there has been a fairly significant decline in the tip and bridge swelling that was previously noted at 2 weeks after rhinoplasty. The right frontal and side photos shown below represent her at approximately one month out. Her nasal bridge is starting to thin and her tip is beginning to show more definition. On the side view, you can see the entire nose is shrinking down in size. The nose also is now less projected (sticks out less from her face) and smaller. You can see that her overall nasal tip position is still quite stable with a marked improvement when compared to before rhinoplasty. I hope this helps those patients wondering what rhinoplasty healing is like and the time course they can expect when it comes to resolution of the swelling.

#### Rhinoplasty Healing San Diego Nose Job Surgery by Dr. Hilinski
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.

#### Rhinoplasty Imaging & Realistic Nose Reshaping Results
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.

#### Rhinoplasty Imaging Versus Real Life Results
Many nosejob patients from San Diego and beyond inquire about digital imaging that can be done to simulate potential rhinoplasty outcomes. This particular San Diego nosejob patient is a great example of how computer imaging can be used to help guide the rhinoplasty surgery and nasal reshaping process. This ethnic male nosejob patient from San Diego desired to have his nose reshaped to address a nasal bridge that was wider than desired. He also wanted the bridge smoothed out and the nasal tip refined while the nasal base was narrowed. I performed computer imaging of his nose using a specialized software program that facial plastic surgeons commonly use to show patients potential results. In this patient, you can see his preoperative frontal view below left and the computer enhanced photo in the middle. This represented what would be envisioned following the nosejob procedure. This included narrowing of the nasal bridge, smoothing of the dorsum, refinement of the nasal tip and narrowing of the nasal base. As you can see from the real life nosejob result shown below right, you can see how similar his computer enhanced photo is when compared to the actual nosejob outcome.

#### Rhinoplasty Incision Care
As part of my normal preoperative consultation for planned rhinoplasty and revision rhinoplasty I will to to emphasize the importance of taking care of the incision line following surgery. I thought I would post a quick blog entry regarding this since, as they say, pictures are worth a thousand words. It is a three step process that includes (1) cleaning the incision/sutures with a q-tip and hydrogen peroxide first, (2) then dry the incision/sutures with a dry q-tip, (3) followed by application of topical bacitracin ointment to the incision/sutures using a new q-tip. Patients are instructed to do this 2-3 times throughout the day, starting on the evening of surgery. If done properly, the incision/sutures should not develop any scabbing or crusting - both of which can impede proper wound healing. Scabbing and crusting of the incision can also make for more discomfort when I go to take the sutures out. In the attached photo example you can see one of my own male rhinoplasty patients from San Diego at 5 days out from surgery. I provide this photo as a great example of what all of my patients should be doing when it comes to cleaning their rhinoplasty incision. You can see his skin and the blue sutures and that is it. No scabbing and no crusting is noted. Use this as a visualize guide and goal when it comes to caring for your rhinoplasty incision.

#### Rhinoplasty Incision Cleaning
We now have an instructional rhinoplasty video up on the website that goes into visual detail on how to properly clean your rhinoplasty incision. This should be helpful for anyone out there having an open rhinoplasty approach. You will find the video link on our ever-growing Rhinoplasty Tutorial page. I hope you find it useful. I also wanted to take this opportunity to thank our patient for offering her modeling services!

#### Rhinoplasty Lecture at UCSD School of Medicine
I had the pleasure of speaking at the University of California, San Diego School of Medicine, Division of Plastic Surgery Grand Rounds this past Saturday. It was a great meeting of the minds with many local and regional plastic surgeons getting together to exchange ideas. I spoke about rhinoplasty pearls - various topics related to my personal approach to rhinoplasty and revision rhinoplasty. I was joined by Dr. Malcolm Lesavoy, a plastic surgeon from the Los Angeles area. La Jolla oculoplastic surgeon, Dr. Don Kikkawa, also spoke. The meeting was a milestone in the San Diego plastic surgery field with representatives from many different surgical disciplines all at this one meeting. I look forward to future collaboration with the many different San Diego plastic surgeons who attended. Thanks again to Drs. Steve Cohen and Marek Dobke who organized the event. Sincerely, Dr. Hilinski

#### Rhinoplasty Nose Reconstruction Following MOHS Surgery San Diego, CA
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.

#### Rhinoplasty Patient Examples
As one of the regions top experts in cosmetic nose reshaping and functional nasal reconstruction, it stands to reason that Dr. Hilinski's before and after gallery of patient examples is quite expanse. In fact, Dr. Hilinski has literally hundreds of before and after rhinoplasty examples. This includes an incredibly wide range of primary rhinoplasty photos as well has revision rhinoplasty photos. Take a look at his gallery of some of the best rhinoplasty examples out there.

#### Rhinoplasty Recovery Timeline & Tips: Expert Advice from Dr. John Hilinski, California’s Leading Rhinoplasty Surgeon
So, you’ve decided to get a rhinoplasty - congratulations on taking this exciting step! Whether your goal is to improve your nose’s appearance, correct breathing problems, or both, what happens after surgery is just as important as the procedure itself.

Proper rhinoplasty recovery plays a huge role in achieving your ideal results. From minimizing swelling to avoiding complications, the healing process requires careful attention, patience, and expert guidance.

As one of California’s top facial plastic surgeons, Dr. John Hilinski has helped thousands of patients experience smooth recoveries with natural-looking results. In this comprehensive guide, he shares what to expect during each stage of healing and provides real-world tips to help you recover faster and more comfortably.

Meet Dr. John Hilinski: A Trusted Rhinoplasty Expert in California

Dr. John Hilinski is a Harvard-trained, board-certified facial plastic surgeon specializing in rhinoplasty and revision rhinoplasty. Known for his surgical precision and artistic eye, Dr. Hilinski has earned a reputation as one of the best rhinoplasty surgeons in California.

Why So Many Patients Choose Dr. Hilinski:

Over two decades of experience in facial plastic surgery

Expertise in ethnic rhinoplasty, closed and open techniques, and functional nasal surgery

Known for minimal swelling and fast recovery thanks to gentle, tissue-preserving techniques

Serves patients throughout California, including San Diego, Los Angeles, Orange County, and beyond

Dr. Hilinski says: 

“A great rhinoplasty isn’t just about what happens in the OR—it’s also about how well you heal. I give each patient a customized recovery plan to help them feel better and see results faster.”

Rhinoplasty Recovery Timeline: What to Expect at Each Stage

Healing after rhinoplasty doesn’t happen overnight. Here’s what most patients experience during the recovery journey:

Days 1–2: Immediately After Surgery

What to Expect:

Grogginess from anesthesia

A splint on the nose, sometimes with internal stents

Mild bleeding, congestion, swelling, and tenderness

Care Tips:

Have a loved one drive you home and stay with you

Sleep with your head elevated at a 30-45° angle (2–3 pillows or wedge pillow)

Begin cleaning the incisions per Dr. Hilinski’s established protocol

Apply cold compresses to the cheeks—not directly on the nose

Take medications as prescribed for comfort

Dr. Hilinski’s Tip: 

“Sleeping upright reduces swelling significantly. I tell all my patients that the first 48 hours set the tone for your entire recovery.”

Days 3–7: The Most Sensitive Phase

What to Expect:

Swelling and bruising peak around Day 3 or 4

You may feel pressure or congestion inside your nose

A follow-up appointment typically happens at the end of this period to remove splints/stitches

Care Tips:

Avoid touching or blowing your nose

Keep your head elevated while sleeping

Stay hydrated and eat anti-inflammatory foods (think leafy greens, salmon, berries)

If you wear glasses, switch to contacts or use a forehead strap to avoid nose pressure

Dr. Hilinski’s Tip: 

“Feeling congested is totally normal. Saline sprays can help, but don’t blow your nose for at least four weeks to avoid disrupting healing.”

Weeks 2–3: Looking & Feeling More Like Yourself

What to Expect:

Bruising is rarely visbile by Week 2

Swelling begins to subside, though the tip may still look puffy

You’ll start feeling more confident returning to social settings

Care Tips:

Resume light activities like walking and basic chores

Still avoid vigorous exercise or nose contact

Continue using saline spray and following your surgeon’s aftercare plan

Dr. Hilinski’s Tip: 

“By the third week, many patients feel ‘normal’ again, but don’t let that trick you—internal and external healing is still happening!”

Weeks 4–6: Gradual Return to Normal Activities

What to Expect:

Swelling continues to decrease

Nasal breathing improves

By Week 4, most patients are cleared for full exercise and normal routines

Dr. Hilinski’s Tip: 

“Nasal bones begin to stabilize around this point, but if you play contact sports, be extra careful. Even a small bump can delay healing.”

Months 3–12: Final Refinement Phase

What to Expect:

60–70% of swelling is gone by Month 3

Subtle contour changes and tip definition improve month-to-month

Full results usually visible around the one-year mark

Dr. Hilinski’s Tip: 

“Patients with thicker skin or more complex surgeries often see gradual refinement over many months. Stay patient—it’s worth it.”

Rhinoplasty Recovery Checklist

Here’s a quick reference guide to stay on track during your healing journey:

Sleep with your head elevated

Clean the incisions as directed

Don’t blow your nose for at least two weeks

Use saline spray as directed

Avoid glasses unless supported from the forehead

Eat nutrient-rich, anti-inflammatory meals

No strenuous activity or contact sports for 6 weeks

Attend all follow-up visits

Be patient—healing takes time!

Frequently Asked Questions About Rhinoplasty Recovery

Ready to Start Your Rhinoplasty Journey?

Your rhinoplasty journey doesn’t end with surgery—it continues through a smooth, successful recovery. If you’re considering rhinoplasty in San Diego, Los Angeles, or are willing to travel to California from anywhere in the world, trust Dr. John Hilinski—one of the most experienced and sought-after facial plastic surgeons—for exceptional, natural-looking results.

Call Dr. John Hilinski’s office or fill out our online consultation form to get started. We’ll guide you every step of the way and ensure you achieve a beautiful, balanced, and natural-looking result.

#### Rhinoplasty Refinement of the Ethnic Nose
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.

#### Rhinoplasty Results 3 Years Out
I just saw this male rhinoplasty patient in the office earlier this morning and thought it was a good opportunity to post a blog about long-term rhinoplasty results. Many patients and plastic surgeons are under the mistaken impression that the nose heals from rhinoplasty within 3-6 months of the surgery. The reality is that rhinoplasty results can take at least a year if not longer for the entire healing process to take place. That is precisely why I see my rhinoplasty patients for a long time before discharging them from my clinic. The attached photos show 3 year results of one of my rhinoplasty patients who had what I described to him as a 'finesse' nose reshaping procedure. As you can see from the photos, he has a very nice sustained cosmetic improvement in his nasal appearance. He was most unhappy with a poorly defined nasal tip and the asymmetries along his bridge. We performed a finesse rhinoplasty to reshape his nose. As you can appreciate, he now has a smoother looking bridge with more tip definition. In fact, look closely at his nasal tip on side and front view. Note how the tip is clearly more defined and sharper, but does not appear surgically altered. We were able to accomplish these esthetic changes while also maintaing a nice masculine looking nose. And these results are 3 years out showing how rhinoplasty, when done well, can produce a highly successful outcome.
Rhinoplasty Results

#### Rhinoplasty Still Reigns
According to NewBeauty, the most popular facial plastic surgery requested in 2017 was rhinoplasty.

This is not surprising, given how many patients seek out Dr. Hilinski here in San Diego for nose job surgery. What was a bit surprising was that nearly 97% of plastic surgeons reported that they perform rhinoplasty surgery on a consistent basis. Most FACIAL plastic surgeons perform cosmetic nose reshaping regularly. But most plastic surgeons who perform breast augmentation and body shaping procedures - like liposuction and tummy tucks - perform very little rhinoplasty surgery. That is why San Diego rhinoplasty specialists, such as Dr. Hilinski, get nose job referrals on a regular basis from other plastic surgeons. That is because rhinoplasty surgery is so, so challenging - especially when compared to other plastic surgery, like breast implant surgery.

Don't get fooled by plastic surgeons who perform rhinoplasty only on occasion. This is an operation that requires and demands dedicated experience and training in cosmetic rhinoplasty technique in order to achieve consistently, great results.

#### Rhinoplasty Tip Reshaping
Learn more about what can be done for a collapsed tip through this latest revision rhinoplasty case example of Dr. John Hilinski. This case highlights what might happen with excess removal of tip cartilage and the surgical methods that may be indicated to help restore proper nasal tip shape and contour. This is the most recent addition to our ever-growing online rhinoplasty resource for patients considering cosmetic and functional nose surgery. Let us know what you think of her cosmetic outcome.

#### Rise in Chin Augmentation with Chin Implant Surgery
There was a recent report that discussed the noted rise in number of facial plastic surgery patients seeking chin augmentation with chin implant surgery. This is a great example of one of my patients who was seen back in the office following chin implant surgery. She simply desired to have more definition along her lower face and upper neck region. Her chin was notably recessed and poorly defined mostly as seen from the 45 degree angle view and the profile view. I performed a chin implant surgery (termed chin augmentation with a chin implant) to bring the chin forward with improved definition. In combination with this, I performed liposuction of the neck region to give an even more pronounced change in her appearance. As you can see from her before and after photos, there has been a marked improvement in the definition seen along the jawline. She almost looks as if she has lost considerable weight. In fact, though, the chin has been projected forward using an appropriately sized chin implant. The neck was then given a more angulated look by liposuctioning the excess fat away. Overall, you can see that she has much more chin definition and shape now while still looking quite natural. If you or someone you know is interested in chin and neck enhancement surgery, do not hesitate in contacting our office today!
Before and After Chin Implant
 

#### San Diego Earlobe Repair Gauge Piercings Corrected
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.

#### San Diego Ethnic Rhinoplasty Case Study
Ethnic rhinoplasty is a particularly specialized form of nasal reshaping that takes into account the fact that different ethnicities demand different approaches when it comes to cosmetic nose surgery. Unfortunately, there are still many rhinoplasty surgeons practicing out there who simply perform the same type of rhinoplasty procedure whether they are treating an ethnic patient or not. In many of these cases, patients are left unhappy because their new nose is inconsistent and out of balance with their remaining ethnic facial features. In fact, a large part of my revision rhinoplasty practice focuses on repairing ethnic rhinoplasty patients whose noses require further reshaping to be appear more consistent with their ethnicity. This includes Asian noses, African-American noses, Middle Eastern noses and others. With my facial plastic surgery practice based here in San Diego, we have quite a variety of ethnic rhinoplasty patients and, thus, fairly extensive experience in this niche rhinoplasty population. The case example below reminded me to post a quick blog to highlight some of the nuances when it comes to ethnic rhinoplasty. This particular ethnic rhinoplasty patient from San Diego presented to our office complaining that her nose was too big for face. She specifically noted that her bridge was too high, her tip too wide and desired an overall more refined look. During her consultation, we discussed how her ethnic facial features would guide much of what we were going to do with her nose. This was a great example of ethnic rhinoplasty where an attempt to reshape her nose in a more aggressive fashion would result in something that simply did not fit her face. Instead, I suggested a number of things that would improve the appearance of her nose while maintaining ethnic consistency. She underwent an ethnic rhinoplasty procedure well over a year ago. During her procedure we reduced her bridge height as indicated by the red rectangle below. Once this was done, we narrowed her nasal bones to give a more narrow look from the front. At the same time, we elevated the portion of her bridge in between the eyes, called the radix. This was done with what we term is a radix graft (see blue ellipse along the upper bridge), which is cartilage taken from her own body that is grafted to this area. What this did was raise her bridge in this select area while making her eyes look slightly closer together and more open. We also narrowed her tip (see red ellipses indicating reduction of volume) to create a more feminine look while rotating the tip upward slightly. Altogether, you can clearly see that her nose looks different following ethnic rhinoplasty. However, her new nose is very consistent with her surrounding facial features and just seems to fit her face - almost as if she could have been born with this exact nose. Sure, more could possibly have been done to her nose, but with ethnic rhinoplasty I think you are much better off doing a little here and a little there without risking a surgically altered appearance.

#### San Diego Eyelid Lift To Improve Vision
Ever consider having an upper eyelid lift to help improve your impaired vision? Learn more about this particular type of blepharoplasty procedure to help reshape the eyelid. In many cases patients don't even realize how much the upper eyelid can obscure their peripheral vision and what impact this has on their daily routine. In many of these patients, an upper eyelid lift can be performed by a qualified board certified eyelid lift specialist to help alleviate these problems. And often times your health insurance company will cover the cost to have the procedure done. A common byproduct of this type of blepharoplasty surgery is that the eyelid also looks much more rejuvenated following the eyelid lift.

#### San Diego Facial Plastic Surgeon Compares Dermal Fillers
Dr. John Hilinski breaks down dermal fillers into three separate types

San Diego, CA – Dr. John Hilinski, a San Diego plastic surgeon, has devoted his career to facial plastic surgery. In addition to being a recognized expert in the field of rhinoplasty, Dr. Hilinski offers a number of injectable filler treatments at his private practice.
 
According to Dr. Hilinski, dermal fillers are used to:

	Correct fine lines, wrinkles and skin creases
	Augment areas of the face that would benefit from added volume and shape, such as the lips or cheeks

Hyaluronic acid fillers – such as Restylane® and Juvederm® – are the most common dermal fillers used at Dr. Hilinski’s practice. This category of filler is made of a biologically compatible gel containing a synthetic version of hyaluronic acid that mimics the hyaluronic acid already present in a patient’s body. According to Dr. Hilinski, the cosmetic results of most hyaluronic acid fillers last 10-12 months.
 
The second most common filler used at Dr. Hilinski’s practice is Artefill®, which is the only FDA-approved non-absorbable (aka permanent) filler on the market. Dr. Hilinski says Artefill® offers an alternative for patients who have enjoyed the success of dermal filler injections but do not want to continually visit the doctor’s office for the maintenance injections associated with hyaluronic acid fillers.
 
Dr. Hilinski notes that a dermal filler like Radiesse® has a duration of action in between hyaluronic acid fillers and Artefill®. The aesthetic results from a Radiesse® injection can last 2-3 years.
 
According to Dr. Hilinski, one disadvantage of longer lasting dermal fillers is that if a patient is unhappy with the results, they have to wait for the results to wear off. He says that undesirable results from dermal filler injections are extremely rare and can be minimized by visiting a board-certified facial plastic surgeon for treatments.
 
The most common area of the face Dr. Hilinski treats is the nasolabial folds (smile lines). In many of Dr. Hilinski’s San Diego facial plastic surgery patients, these smile lines can become quite deep and create a significant shadow, causing patients to look prematurely aged or tired. By injecting a dermal filler under the smile line, Dr. Hilinski can help soften this unwanted crease, providing a more rested, youthful appearance.
 
About John M. Hilinski, M.D.
Dr. John Hilinski is double board-certified in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery. He earned his medical degree at Harvard Medical School and has published numerous journal articles and book chapters on a variety of topics in facial plastic surgery. In addition to procedures including revision rhinoplasty and facelift surgery, Dr. Hilinski also offers BOTOX® Cosmetic. He is available for interview upon request.

#### San Diego Facial Plastic Surgeon Discusses Common Misconceptions About Rhinoplasty Recovery
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.

###

#### San Diego Facial Plastic Surgeon Featured
San Diego's own Dr. John Hilinski, an expert in facial plastic surgery, was featured in the first edition of Aesthetics News Today discussing his choice in electronic medical records. Dr. Hilinski proudly discusses why he ultimately chose to use PatientNow - one of the most advanced systems for surgeons in the plastic surgery industry. Here is a link to the publication that originally appeared in the Journal of Anti-Aging and Cosmetic Innovations.

#### San Diego Facial Plastic Surgeon Launches Mobile Website to Aid Patients on the Go
San Diego, CA -- Dr. John Hilinski, a facial plastic surgeon in San Diego, has recently announced the launch of a new mobile website for his practice to help assist patients in their search for online care and procedure information. As mobile phones and tablets continue to become an integral part of mainstream culture, Dr. Hilinski says more and more patients are utilizing the internet to research their facial plastic surgery procedures. He says adding the mobile website to his patient services provides a unique opportunity to meet patients where they are with accurate and reliable education.

At his practice, Dr. Hilinski focuses on a wide variety of facial plastic procedures with a particular emphasis on rhinoplasty in San Diego. He says maintaining open communication with his patients is essential for ensuring the proper results are achieved. With the launch of the new mobile website, Dr. Hilinski says he hopes to offer another outlet for patients to explore all of the potential plastic surgery possibilities in the burgeoning aesthetic industry: “I think anytime we, as facial plastic surgeons, can equip our patients with more accurate, up-to-date information regarding their procedure of interest, it will increase the likelihood of achieving successful surgical outcomes. With a growing percentage of patients utilizing mobile devices for plastic surgery research online, it is important that we help in providing them with the proper tools to conduct this research in a user-friendly manner.”

According to the most recent statistics from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), over 42 percent of patients now receive most of their information about plastic surgery from social media. Dr. Hilinski says mobile phones and portable internet connections are now making social media a more valuable and accessible resource for finding details and advice about facial plastic surgery procedures. He says by providing patients with a mobile community, he hopes they will be able to get the latest information and most trustworthy reviews so that they can make the best decision possible regarding their treatment: “I think it is important for patients to have widespread access to a variety of social networks so they can gather as much valid data as possible that will lead to a more informed decision regarding plastic surgery.”

Regardless of whether they are looking for a surgical procedure such as rhinoplasty or a minimally invasive treatment like BOTOX® Cosmetic, Dr. Hilinski says patients should be sure to conduct extensive research both online and during a personalized consultation. He encourages all patients to seek treatment and advice from a board-certified facial plastic surgeon before undergoing any procedure, so as to ensure they receive the safest, highest quality results possible. Dr. Hilinski adds that he is excited for the release of the new mobile website as it will provide patients with an accurate resource for reliable, handy information, whatever their plastic surgery needs may be: “There are so many non-plastic surgeons out there trying to garner the attention of prospective patients that it is more important than ever for patients to do their due diligence to find a board-certified plastic surgeon. Chat sites and forums have their role, but by and large patients should stick with recommendations and suggestions that come directly from a board certified specialist who has spent years in education and training to be a true authority on the subject.”

About John Hilinski, MD

Dr. John Hilinski earned his medical degree from Harvard Medical School, after which he completed a general surgery internship followed by a Head and Neck Surgery Residency at the University of California, San Diego. He has served as a Clinical Instructor in the Division of Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and was chosen for a Facial Plastic and Reconstructive Surgery Fellowship sponsored by the American Academy of Facial Plastic and Reconstructive Surgery. Dr. Hilinski is double board-certified in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery, in addition to being a member of the American Academy of Facial Plastic and Reconstructive Surgery, the California Society of Facial Plastic Surgery, the American Academy of Otolaryngology-Head and Neck Surgery, and several other professional organizations. He has been published in several medical journals and book chapters for his work in rhinoplasty and revision rhinoplasty.

Located at 3720 Fourth Avenue in San Diego, CA, Dr. Hilinski’s practice can be reached at (619) 296-3223. It can also be contacted online via the website drhilinski.com or his San Diego facial plastic surgery Facebook page. His mobile website may be viewed by visiting www.drhilinski.com on any mobile device.

#### San Diego Facial Plastic Surgeon Launches New Website
Dr. John Hilinski, board-certified San Diego facial plastic surgeon, recently launched a new website that provides a comprehensive network of information to enhance his current and potential patients’ virtual experience with his practice. The website incorporates the latest website technology to showcase the wide range of procedures and extensive experience of Dr. Hilinski as he remains dedicated to the refinement of his patients’ natural beauty.

Facial Plastic Surgery San Diego

The aesthetically pleasing design offers an easy-to-navigate framework and in-depth exploration of Dr. Hilinski’s San Diego facial plastic surgery practice. By providing detailed descriptions of all surgical and minimally-invasive procedures he specializes in, as well as patient testimonials, and tutorials on rhinoplasty in San Diego, Dr. Hilinski’s new website streamlines his patients' online experience.

After exploring the website, contact us to schedule a consultation on facial plastic surgery in San Diego.

#### San Diego Facial Plastic Surgeon Lectures on Ethnic Rhinoplasty at CSPS Meeting
San Diego, CA -- At the recent Annual Meeting of the California Society of Plastic Surgeons (CSPS), board-certified facial plastic surgeon Dr. John Hilinski delivered a presentation that discussed various techniques and approaches to ethnic rhinoplasty. The event, held at the Hotel del Coronado, featured a host of lectures and courses on the latest innovations in nose surgery, as well as other plastic and reconstructive procedure topics. Dr. Hilinski says he is very thankful to have had the opportunity to share his experience in performing rhinoplasty in San Diego and hopes his presentations imparted a new level of skill and knowledge about the complexities of the intricate procedure.

Dr. Hilinski and his San Diego rhinoplasty and facial plastic surgery practice also provide services in a number of other aesthetic enhancements such as facelifts, eyelid surgery, and injectable fillers. Having been published in several book chapters and publications in addition to his background as a lecturer, he says being able to help further the field of rhinoplasty by educating his peers is both rewarding and humbling. Dr. Hilinski says his presentation at the CSPS offered those in attendance the opportunity to broaden their skills and techniques in their approach to ethnic rhinoplasty.

During his lecture, Dr. Hilinski and a panel of other surgeons addressed in detail several essential steps in the operation. The discussions covered topics including evaluation of the ethnic patient, secondary rhinoplasty and revising the Asian nose, alar base reconstruction, the “Mestizo” nose, and Persian rhinoplasty. Dr. Hilinski says he hopes doctors who attended his lectures left the presentation with the ability to identify the diagnostic and treatment differences related to ethnic patients as well as examine the technical differences in performing operations for these patient demographics.

Having returned to his practice in San Diego, Dr. Hilinski says he is honored to have taken part in the CSPS meeting and is looking forward to continuing his pursuit of the most effective and successful techniques in nose surgery. Whether they are performing rhinoplasty or eyelid surgery, he says staying abreast of the latest developments in facial plastic surgery is essential for providing patients with safe, aesthetically-pleasing results. Dr. Hilinski adds that he is excited about future opportunities to share his findings with his peers and hopes they are equally rewarding and inspiring.

“Keeping up to date with the latest in surgical techniques forces me to constantly reflect on my current approach to facial plastic surgery and to question whether or not further refinements can be adopted to my current repertoire in the hopes providing an even higher quality of care,” he says.

About John Hilinski, MD

Dr. John Hilinski earned his medical degree from Harvard Medical School, after which he completed a General Surgery Internship and a Head and Neck Surgery Residency at the University of California, San Diego Medical Center. He has 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 University of California, San Diego Cancer Center. Dr. Hilinski serves as a staff surgeon at Scripps Green Hospital, as well as a Clinical Faculty Instructor on Facial Plastic and Reconstructive Surgery at Veterans Administration Medical Center and the UCSD Medical Center. He is double board-certified in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery, and 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.

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 drhilinski.com or his San Diego facial plastic surgery Facebook page.

#### San Diego Facial Plastic Surgeon on Benefits of Eyelid Surgery
Dr. John Hilinski performs blepharoplasty on both upper and lower eyelids for a more youthful appearance

San Diego, CA – Dr. John Hilinski is a double board-certified San Diego facial plastic surgeon and recognized expert in the field. Among the many cosmetic facial surgeries he performs, Dr. Hilinski also offers his patients eyelid lift treatments (blepharoplasty) to re-contour the upper and/or lower eyelids.

Dr. Hilinski says the benefits of eyelid surgery are largely related to the cosmetic enhancement of the eyes. While upper eyelid surgery can remove heavy, weighted excess skin and yield a rejuvenated look, lower eyelid surgery can tighten up and contour the lower eyelid while enhancing the general appearance of the adjacent cheek. Dr. Hilinski notes that in addition to the aesthetic benefits, there are potential functional benefits to the procedures.

According to Dr. Hilinski, candidates for eyelid surgery seek to:

	Remove excess skin
	Relieve the eye of a “heavy appearance”
	Relieve the eye of puffiness or “bags”
	Allow for an easier, cleaner application of eye shadow and liner
	Restore impaired vision

Dr. Hilinski notes that upper eyelid surgery can be done readily under local anesthesia, but patients can also be provided with an oral sedative to feel more relaxed. An upper eyelid blepharoplasty can typically be performed in about an hour in Dr. Hilinski’s ambulatory surgery center.

Lower eyelid surgery can be a bit more sensitive for patients and usually requires at least IV sedation, according to Dr. Hilinski. This surgery can be performed without any external incisions and no visible scarring.

During both surgeries, any incisions that are used to remove skin and tighten the eyelid are carefully placed in the patient’s natural skin creases to minimize any visible scarring. When patients opt for both upper and lower eyelid surgery, stitches are usually removed after 4-5 days and most swelling and bruising resolves in 7-10 days.

“In today’s day and age, I am performing upper eyelid blepharoplasty surgery more commonly than lower eyelid lifting,” says Dr. Hilinski. He believes his San Diego facial plastic surgery patients choose upper eyelid surgery in large part because only local anesthesia is necessary. Nevertheless, he still sees a large number of patients who opt to undergo combined upper and lower eyelid surgical enhancement.

About John M. Hilinski, M.D.
Dr. John Hilinski is a double board-certified plastic surgeon in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery. He earned his medical degree at Harvard Medical School and completed his residency at the University of California, San Diego (UCSD) Medical Center. Dr. Hilinski is extensively trained in a number of procedures including rhinoplasty and facelift surgery. He is available for interview upon request.

#### San Diego Female Rhinoplasty Bridge & Tip Reshaping
See the latest addition to the ever growing online rhinoplasty resource written by Dr. John Hilinski - one of San Diego's best rhinoplasty and revision rhinoplasty surgeons. This latest online rhinoplasty chapter focuses on a San Diego female patient with a dorsal hump and bulbous nasal tip who sought out Dr. Hilinski for his skills in managing this type of nose. Although many potential rhinoplasty patients in San Diego consider this to be a relatively easy form of cosmetic nose reshaping surgery, Dr. Hilinski will outline why this particular type of cosmetic nose surgery should only be undertaken by true experts in rhinoplasty surgery. Learn more about San Diego rhinoplasty surgery by clicking here to be taken to one of the most comprehensive online resources dedicated to cosmetic and reconstructive nose surgery.

#### San Diego Finesse Rhinoplasty Surgery Expert
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!

#### San Diego Nasal Tip Rhinoplasty For A Wide Tip
This is a great example of nasal tip rhinoplasty, or just tip rhinoplasty for short. This is a young female patient who was referred to our San Diego office for rhinoplasty by a friend of hers who was happy with a cosmetic rhinoplasty done by us years ago. This patient was most concerned about her nasal tip. In fact, she was unhappy with the rounded, or bulbous, appearance to her nasal tip. She wanted to undergo cosmetic reshaping of the nose to really address this one main issue with the tip. She is a very attractive young lady who some would say doesn't even need to have a nose job. However, her wide nasal tip did detract a little from her overall facial features. And, more importantly, she was seeking to have a rhinoplasty not to please others, but to make herself more confident and content. There are few better reasons to consider having cosmetic rhinoplasty surgery.
Before Nasal Tip Rhinoplasty
As you can see in her before rhinoplasty photo, the tip of her nose is moderately wide and is disproportionately large for her surrounding facial features. This was visually demonstrated in her photo by the blue horizontal line that depicts the true width of her nasal tip. Her bridge is actually quite nice in terms of width and shadowing. And as noted before, she is a very pretty young lady. So her nasal tip was the only real concern on my evaluation of her face.
Tip Rhinoplasty Recommendation
Based on her examination and desires, I recommended she undergo a cosmetic tip rhinoplasty procedure to simply try and narrow the nasal tip. Now in situations like this, my recommendation is to err on the side of being conservative with the nasal reshaping process. After all, she has an attractive face with the exception of the tip of her nose. Just a little bit of nose reshaping is all that is needed to create more harmony and balance with her face. I elected to perform her nose job through a closed rhinoplasty approach so that we limited incisions and scarring. The nose reshaping surgery involved a delivery technique, which is a rhinoplasty term used to describe how the tip cartilage is exposed to provide optimal visualization when performing a closed rhinoplasty. A conservative cephalic trim maneuver was performed - meaning I trimmed down the bulbous tip cartilage to create a thinner tip overall. I also repositioned the tip cartilage to give a more refined look.
Before & After Tip Rhinoplasty
Here are her before and after photographs following her tip rhinoplasty procedure performed at our San Diego, CA office based surgery center. As you can appreciate, she still very much looks like herself. But her nasal tip is now more defined and looks more appropriate for her face. The nose is now more balanced and in harmony with her eyes and cheeks - the essence and goal of the best rhinoplasty surgery results. As shown by the white arrows, her tip has now been brought inward on both sides. And you can compare just how much narrower the nasal tip now is when looking at how wide it used to be (as indicated by the blue horizontal line from her preoperative nose). I hope this is a good educational example of what is possible with carefully performed rhinoplasty surgery. If you have issues with a wide or bulbous nasal tip and are considering cosmetic nose reshaping, or nose job, contact our office today for a formal rhinoplasty consultation. As a rhinoplasty specialist, I think you will appreciate the difference between a facial plastic surgery nose expert and a general plastic surgeon. We look forward to hearing from you in the future.

#### San Diego Otoplasty Update
This was a great example of otoplasty, or ear reshaping, in an ethnic patient from San Diego who desired to have his ears reshaped for excess prominence. Overall, however, he did not wish to have a significant change. In fact, a majority of what we did during his ear reshaping procedure involved his lobule and lower auricle. As you can see in his photo series below, it was the lower half of his ear that protruded out mostly. You can see this rather easily on frontal and base view. On the side view of his ears, one also appreciate how the lower portion of his ear seems to stick out from the side of the head. In his after photos the improvement from the otoplasty is quite obvious, yet natural looking. The lower portion of his ear has now been reshaped to be in a better line with the side of his head. In addition, the middle portion of his auricle was brought closer to the head so that the overall orientation of his ears is much better balanced.

#### San Diego Plastic Surgeon Answers Your Questions About Rhinoplasty Consultations
Dr. John Hilinski recently took some time to answer questions about what patients can expect when they visit our San Diego plastic surgery practice for a rhinoplasty consultation. Below are Dr. Hilinski’s answers about his own consultation process and why he encourages his prospective patients to seek out a second opinion if they feel unsure about the procedure.

Question: What does a rhinoplasty consultation entail?
Dr. Hilinski: The consultation entails a thorough dialogue, focusing on the unique ways each patient wishes to shape the nose. I always like to hear the patient’s concerns framed in his or her own words. The consultation also includes a detailed examination of the face as a whole and the nose in particular. It is critical to analyze the nose in context of the face since achieving harmony with the surrounding facial features is the ultimate goal of rhinoplasty.

In addition to assessment of the skin and framework of the nose, it is vital that the internal workings of the nose be evaluated to ensure proper function. Computer morphing technology is a very powerful tool for rhinoplasty surgeons that allows us to use actual photographic images of the patient’s nose to visually demonstrate what the nose might look like after surgery. This process provides valuable insight into the results the patient is truly envisioning, which sometimes differs from what they describe using words alone. I can also determine whether or not the patient is being realistic in terms of what rhinoplasty can really do for them.

Question: How long is the consultation and how many office visits are required?
DH: My office typically reserves upwards of one hour for new rhinoplasty consultations. This provides us with ample time to discuss all of the relevant issues with the patient’s nose. A good percentage of our rhinoplasty patients feel sufficiently comfortable after this one visit to make an educated decision about having the surgery. If patients decide to proceed with the rhinoplasty procedure, they will return to the office again for a formal pre-operative visit. During this second visit, we prepare the patient for the actual date of surgery by reviewing pre-operative instructions and guidelines.

Question: Do you recommend family members or friends attend the consultation?
DH: In some cases it is helpful to have a family member or friend accompany the patient during the rhinoplasty consultation. Family members or friends who are close to the patient will be able to provide insightful comments, especially when it comes to viewing the morphed computer images. We also email the morphed images to the patient for further review, which is very helpful in those instances where family and friends are unable to attend the consultation. Ultimately though, I encourage my rhinoplasty patients to try and make the final decision on their own. After all, rhinoplasty is a very intimate decision that should be largely influenced by personal motivation.

Question: What is the next step? 
DH: The next step is contemplation. I think it is very healthy when patients go home and let the recommended changes to their nose truly sink in. In some cases, patients seek out different opinions from other rhinoplasty surgeons, which I encourage. I feel quite confident in my abilities as an expert rhinoplasty surgeon, and in a good majority of cases, patients who seek out other opinions will be even more assured about choosing me as their rhinoplasty surgeon.

To schedule a rhinoplasty consultation with Dr. Hilinski, please contact our office today. Check back with our blog soon for the second installment of our two-part rhinoplasty series. In the next post, we will detail what patients can expect during the pre-operative, day-of-surgery, and post-operative periods.

#### San Diego Plastic Surgery Expert in Revision Rhinoplasty Nostril Reshaping
One of the more common reasons for patients seeking revision rhinoplasty, or cosmetic nose reshaping, is for issues related to nostril asymmetry. For example, the San Diego rhinoplasty patient highlighted below had a prior nose job by a different plastic surgeon prior to consulting with our office. She consulted with us because of our reputation here in San Diego as a regional referral expert in rhinoplasty and revision rhinoplasty surgery.
Nostril Asymmetry
Her main issue was the fact her right nostril (see arrow) was still asymmetrically shaped versus her left side following the first rhinoplasty surgery she had done elsewhere. On close inspection of her nose during our rhinoplasty consultation, her right nostril almost appeared notched, or scarred upward. As I have posted before in previous blogs, nostril asymmetry can be tolerated if it can be only seen when looking at the nose from below. However, if it is really obvious when looking at the nose from the frontal view, as in this rhinoplasty patient, then revision rhinoplasty surgery may be warranted. In this rhinoplasty patient, she elected to opt for revision surgery in the form of an open procedure to further reshape the tip of the nose.
Before and After San Diego Revision Rhinoplasty
As you can see in the following before and after revision rhinoplasty photos, I was able to reshape her nose to provide her with much more symmetry when seen on this frontal view. She was quite happy she elected to undergo another nosejob surgery and is even happier that she does not need any further cosmetic reshaping of the nose. You can even see a little smile shining through!

#### San Diego Revision Rhinoplasty Specialist Discusses Secondary Rhinoplasty Surgery
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.

#### San Diego Rhinoplasty (Nosejob) Healing From Closed Approach
This was a great case example to use for discussing the healing process following a closed rhinoplasty procedure (nosejob). This particular San Diego nasal reshaping patient presented to our office noting difficulty breathing through the nose along with some cosmetic concerns about the appearance of her nose. After examination, it was determined that she had collapse of her nasal bridge (also called the dorsum) and a drooping nasal tip (called ptosis and pronounced toe-sis). Both of these issues were significant contributors to her nasal obstruction symptoms as they caused a narrowing of her breathing passage on both sides. In addition, she had what we often refer to as bony horns where the bony portion of her bridge was curved outward contributing to a prominence on both sides plus an abnormally high nasal bridge.
Pre Rhinoplasty Photos
The following pre rhinoplasty photos are shown below to help visually demonstrate these issues. As you can see in her frontal view, she has bilateral bony horns that contribute to a prominence on each side of her nasal bridge, disrupting the normal brow-tip esthetic line (see red parentheses on each side). In addition, her frontal view is washed out in the middle portion where she has a noted depression across the nose. It almost appears as if her nose is flattened across this region (see blue arrows). On her profile (side) view, you can see that her upper bridge is high and tip is ptotic, or drooping down. The red angle is representative of her nasolabial angle. In her case, this is less than 90 degrees, which is about 5-10 degrees off compared with the ideal angulation in a female rhinoplasty patient. To refresh your memory of nasal analysis in rhinoplasty, use this link here to our online rhinoplasty tutorial. In addition, you can see that her bridge is depressed as shown by the blue arrow pointing to the transition zone between the tip and upper bridge of the nose.

Rhinoplasty (Nosejob) Surgery Performed
We decided to perform a combined functional and cosmetic nosejob procedure to help improve her nasal breathing while also enhancing the appearance of her nose. Given the issues she had, we decided on using a closed rhinoplasty approach - meaning we did not make any external cuts on her nose. The incisions were essentially all 'hidden' inside of the nose. We began the nose reshaping process with reduction of the upper bridge height with a rasping (sanding) technique. We then augmented the depressed bridge with use of cartilage grafts taken from her septum. We then rotated her nasal tip upward and brought it slightly closer to the face (called 'deprojection of the nasal tip'). This last maneuver was accomplished with what is called a lateral crural overlay technique. This means that her cartilage was preserved in terms of its structural integrity, but was overlapped on itself to reposition and reshape the tip of the nose. Throughout the rhinoplasty procedure, we made sure to maximize improvements in terms of her nasal function. This included performing a septoplasty (click here to learn more about septal surgery for improved nasal breathing) and nasal valve repair.
Results of Closed Rhinoplasty Surgery
Her surgical results are shown below as she continues to heal from the rhinoplasty procedure. As you can see, she still has notable swelling of her nose as is best appreciated on frontal view. However, the swelling several months out is not as dramatic compared with the appearance of a nose that was done with an open rhinoplasty approach at this same point in the healing process. But despite the persistent swelling, she still looks much smoother in terms of her bridge contour. The previously noted bony horns have now been rasped down along with her upper bridge height. The area of the bridge that was previously noted to be flat on frontal view is now more shapely and transitions better into her nasal tip. The side view confirms a more pleasing bridge height and contour now that the cartilage grafts have been placed above the nasal tip. The tip of her nose is also now in a more optimal position with a nasolabial angle that is closer to 95 degrees. In addition to looking more esthetically pleasing, her nose now also functions much better following the surgery. Over the coming months, she will continue to demonstrate gradual refinement in terms of her nasal appearance with stabilization of her nose around one year out from surgery. I hope this was helpful in understanding possible changes to the look and function of the nose using a closed rhinoplasty approach.

#### San Diego's #1 Cosmetic Ear Specialist
Here is yet another example of why Dr. Hilinski is considered San Diego's leading otoplasty surgeon.

For many years now, Dr. Hilinski has been known as the best and most qualified plastic surgeon in San Diego performing cosmetic ear surgery. When he first came into practice in La Jolla, this mainly involved ear pinning, or otoplasty surgery. As his cosmetic surgery practice grew, Dr. Hilinski began doing more and more otoplasty surgery, which naturally attracted other patients looking to do even more reshaping of their ears. This ranged from earlobe reduction surgery to full blown ear reduction surgery (called macrotia). Fast forward many years and he has now established himself as the region's #1 cosmetic ear surgery expert with patients flying in from all over the world to have surgery with Dr. Hilinski.

This most recent example demonstrates a very common complaint amongst patients - earlobes that are larger than desired. As you can see in the adjacent photo, her earlobes dangled down too low for her desires. This occurs from a genetic predisposition to having elongated, fleshy earlobes and/or wearing heavier earrings that pull the earlobes down too much. Regardless of the etiology, these patients are quite bothered by the longer earlobes and desire to have them shortened for cosmetic reasons.

This is precisely what was done in this patient with longer earlobes. Dr. Hilinski recommended reshaping of the earlobes to make them less heavy and less fleshy appearing. To be more specific, a segment of the soft tissue was removed and the edges of the earlobe were then stitched back together. The end result can be seen here in the photos shown below. As you can readily appreciate, her earlobes are now much smaller in size. And the earlobes are no longer hanging down as much as they once did. Most importantly, her earlobes still look quite natural in overall shape and size - thus avoiding the stigma associated with some patients whose ears literally look like they were operated on by a surgeon.

San Diego Otoplasty Expert
If you are unhappy with the shape and/or size of your ears, don't hesitate to contact San Diego's best otoplasty and cosmetic ear surgeon, Dr. John Hilinski, for a complimentary appointment.

#### San Diego's Bellafill Expert
Dr. Hilinski is widely considered a regional expert when it comes to Bellafill injection for facial enhancement.

Dr. Hilinski is one of just a handful of cosmetic doctors who have been using Bellafill ever since it came out many years ago. That provides him with unparalleled experience and expertise in the use of Bellafill to help you address unwanted wrinkles and volume loss from facial aging. Dr. Hilinski has been using this injectable filler for so long - it actually was being made and distributed by a different company - Artes Medical. And the filler was referred to as Artefill back then. Since that time, Suneva has taken over the manufacturing and sales of what we now know as Bellafill - the only FDA-approved permanent filler on the U.S. market today.

In addition, Dr. Hilinski uses Bellafill on a regular basis to help patients who have undesirable acne scarring of the face.
San Diego Bellafill Expert
Many years ago, Dr. Hilinski was asked to help author several publications on the use of Bellafill - which was being called Artefill back in the day. He co-authored the papers with a fellow plastic surgery colleague here in San Diego - Dr. Cohen.

The papers were considered authoritative guides on the clinical use of Bellafill injection for soft tissue augmentation of the face - and helped other plastic surgeons and cosmetic dermatologists when it came to adopting Bellafill in their practices.

So if you are considering switching over to the longest lasting injectable filler on the market - Bellafill - contact our office today to schedule a personalized consultation with San Diego's Bellafill expert - Dr. John Hilinski.

#### Save $50 on Botox Cosmetic For Frown Lines
Save $50 on your next Botox cosmetic treatment for those unwanted frown lines and crow's feet! Get ready for the upcoming 2011 holiday season by looking your best with a Botox treatment session by San Diego board certified facial plastic surgeon, Dr. John Hilinski. Botox cosmetic is an incredibly popular office-based procedure that can make a dramatic improvement in your facial appearance with no downtime. Whether you are a Botox veteran or a first time Botox user, why not take advantage of this special offer from Allergan, the makers of Botox cosmetic. Learn more by referencing the attached brochure. We look forward to seeing you soon!

#### Scapha Reduction Macrotia Surgery
Here is another example of one of my patients who underwent scapha reduction, or macrotia, ear surgery. This is a very rare type of surgery currently only performed by less than a handful of plastic surgeons - but one that I perform on a fairly regular basis. Although this is often discussed as being part of otoplasty surgery - it is quite different than doing ear pinning surgery.  There are quite a few plastic surgeons who offer otoplasty surgery here in San Diego - but barely any that know about scapha ear reduction surgery.

This patient was bothered by how the upper portion of his ear was shaped. He felt as if the ear was too large because of what is termed the scapha region.

 
The scapha is the flatter portion of the ear that comprises the top 1/3 to 1/4 of the entire ear. This is indicated by the red crescent shadowing in the adjacent photo. When this is over developed - the ear can look too large for the patient. Some people refer to this as scapha enlargement. Others call it macrotia. And still others refer to this as a shell ear deformity.

Fortunately, there is a surgery that can help make the ears smaller in size - which is something that traditional otoplasty just doesn't do for patients.

To learn more about this highly specialized otoplasty-type procedure offered by our San Diego office - use the following links below to visit our sister website dedicated to this type of cosmetic ear surgery.

Macrotia Ear Reduction Surgeon in San Diego

#### Scar Revision Wound Healing
I hear it all the time from scar revision patients - "But it looked so good when the emergency doctor finished sewing it up." Unfortunately, as I tell all my facial scar revision patients, the wound should not look very good if the surgical closure is done properly. If you suffer a laceration, for instance, to the forehead or cheek, you will likely need sutures to repair the injury. In my opinion, any laceration that is in a highly visible area of the face, should be managed by a board certified facial plastic surgeon or board certified general plastic surgeon. Although there are some emergency room doctors that are better than others, they simply don't have anywhere near the experience that we board certified facial plastic surgeons have when it comes to sewing up the skin of the face. One of the most common errors made when repairing facial lacerations or other related facial injuries is not closing the deeper layers under the skin properly. In order to repair a soft tissue injury of the face like this, you must properly close the layer under the outer skin using a principle called 'eversion' of the dermis. The dermis refers to the thicker, fibrous tissue under the outer skin surface. This is the more resilient layer of tissue that can resist more tension and, thus, be used to the surgeon's advantage to provide strength to the wound as it is healing. All wounds will tend to want to pull apart with time. This doesn't always occur in the first few weeks following surgical repair. This can also occur months down the road. If you don't account for this normal part of wound healing, the skin will stretch apart in time and create an undesirable scar that is much more visible. To counteract this unwanted tension in the scar, you must evert the skin edges during repair of a laceration or closure of a surgical incision. This eversion process makes the incision or wound appear as if it is raised up like a slight mound, or ridge. This wound eversion is sort of like a built-in 'slack' in the skin. This then allows the skin to stretch as it will do through normal healing without creating a wide or unsightly scar. This is precisely why a facial laceration or wound should look less than ideal if closed properly by a facial plastic surgeon.
San Diego Scar Revision Example

A visual example of this is provided here. This young boy from San Diego sustained a facial laceration of his forehead. Unfortunately, it did not heal as desired and left him with a widened, stretched scar. I performed scar revision on him, which involved removal of the old scar and meticulous realignment of the skin edges. In performing the scar revision surgery, I very carefully everted the skin edges to create the ridge that I alluded to earlier.
Eversion of Scar
As you can see from his photo, which was taken 8 days after the scar revision, the skin is raised up where the repair was performed. This ridge of skin will eventually flatten out naturally with time as the normal forces of healing pull on the wound. Had I not performed eversion of the skin as part of the scar revision, these eventual forces would have made the scar widened and stretched once again. Hopefully this helps any of you out there wondering why the skin looks like it does following this type of plastic surgery repair. I will try and keep you posted as to this patient's progress over the next year or so.

#### Scheduling Botox Treatments
Botox Appointments
Don't worry about missing your next Botox or Dysport appointment! For several years now, Dr. Hilinski and his staff have been sending out friendly reminders to all of our Botox and Dysport patients in San Diego.

Currently, we use a system called PatientNow that helps us to keep you informed of when you need to come in for a Botox or Dysport treatment. Patients will typically get a text and/or email reminder sent to them so they can remain up-to-date regarding their next Botox or Dysport office appointment with Dr. Hilinski.
Botox Frequency
A great majority of Botox and Dysport patients need to have repeat treatment done every 3 months on average. With all of us being so busy with our personal lives, we can easily forget that our Botox and Dysport are wearing off after 3 months. By the time you begin to see those pesky wrinkles and unwanted lines coming back, it might be too late to see Dr. Hilinski on short notice as is schedule is usually very packed. In fact, sometimes you won't be able to get your Botox or Dysport for another month or so - which puts you way behind! Fortunately, our reminder system does all this for you a good month in advance of when you should be back to see Dr. Hilinski - keeping you informed so timing of your Botox or Dysport is always right on!

#### Sculptra Cheek Contouring
This is a nice example of what Sculptra cosmetic injections can do in terms of cheek enhancement. This pleasant lady consulted with me regarding possible augmentation of her cheek region. After discussion, we both decided that Sculptra would be a great choice for her. Sculptra cosmetic happens to be one of my favorite volumizing treatments for the face. The visible benefits of Sculptra happen somewhat gradually over the first few weeks after an office-based treatment and can last upwards of two years in many cases. Plus, Sculptra enhances facial contour by stimulating your body's own collagen response. In this particular case, I used 3 vials of Sculptra to achieve these results. Notice that she now has improved volume throughout the cheek region with excellent highlights seen in terms of shape and contour - the type of result that we often used to see with cheek implant placement. But now, this type of cosmetic cheek enhancement can be accomplished with Sculptra injection without undergoing surgery. If you are interested in cheek enhancement with Sculptra cosmetic, do not hesitate in contacting one of San Diego's leading Sculptra injectors.

#### Sculptra Facial Enhancement
This is a great example of why Sculptra has become one of my favorite facial volumizers. This middle-aged lady from San Diego desired to have more facial fullness and plumping, yet, like many, she did not want to look overfilled. I performed Sculptra injections a 1-2 month period during a simple office visit. What I absolutely love about this injectable filler alternative is how you cannot really point out where the product was injected into her face. You know she looks better - more volumized and plumper with better looking skin - but you just can't pinpoint where the Sculptra was injected. In my opinion, this is the essence of any highly successful facial cosmetic treatment. Let me know what you think of her overall results!

#### Sculptra Liquid Facelift Treatment
We have seen a recent rise in terms of patient inquiries regarding liquid facelift treatment using Sculptra - one of the best options for facial rejuvenation. Sculptra is an injectable solution that can be used to help restore lost volume in the face to help you regain a more youthful and rested facial appearance. In many cases, patients are able to achieve such a nice cosmetic enhancement, they appear to have had a facelift - thus the term 'liquid facelift' treatment. To learn more about Sculptra cosmetic offered by San Diego board certified facial plastic surgeon, Dr. John Hilinski, contact our office today to schedule a complimentary consultation.

#### Septoplasty (Septal Reconstruction) Tutorial
We are proud to announce that we have added a new page to our San Diego Rhinoplasty Tutorial focusing on septal reconstruction, or septoplasty. Here is the link to the new septoplasty tutorial page. We hope this provides some assistance to those patients out there who are considering septoplasty surgery for difficulty breathing through the nose.

#### Septoplasty Repair in San Diego, CA
One method to confirm whether or not a nose reconstruction surgeon has adequately repaired a deviated septum - or crooked nasal septum - is to pass an instrument once the nasal airway has been fixed. This is a great visual example of this being performed by San Diego's leading expert in septoplasty and rhinoplasty - Dr. John Hilinski. This patient underwent a number of changes to the shape of her nose. But she also needed her deviated septum fixed. So Dr. Hilinski performed a standard septoplasty surgery to allow her to breathe easier through her nose. At the conclusion of the septal repair, he used a surgical forceps to confirm that the airway was, indeed, very open - as can be seen here in the video below.

#### Shaving Your Hair For Transplant?
Many patients ask whether or not their hair will need to be shaved in preparation for hair transplantation surgery. The short answer is yes for follicular unit extraction, or FUE.

In the region where the hair is being taken from (called the donor site) we will need to shave the hair down to an appropriate level that allows us to harvest the grafts more readily. But it is not as if we shave the entire backside of your head! We only shave down the rectangular area of scalp where the hair is being harvested.

If you have bushy or long hair, this will typically hide the donor site area where the hair is harvested. If you hair is on the shorter side, you will see the area where we have taken the grafts from because that hair will have been shaved. Fortunately, this hasn't really been a major issue for patients undergoing FUE hair transplant.

#### Short and Long-term Ear Pinning Results in San Diego, CA
Dr. Hilinski would like to present the short and long-term follow-up results of an ear pinning patient from San Diego, CA. This attractive female patient underwent otoplasty, or ear pinning, surgery to address her overly prominent ears. As you can see, her ears were somewhat different from right to left, which is more the rule than the exception when it comes to otoplasty patients. Dr. Hilinski performed the cosmetic ear reshaping surgery from behind the ears so that any scarring would be minimized in terms of visible appearance. The following is a photo series showing the patient before otoplasty (A), one week following otoplasty (B), 4 weeks after otoplasty (C), and then 5 months after otoplasty (D). The last photo is very indicative of a long-term result following ear pinning surgery. As you can see, her one week post-otoplasty photos show the ears to be over-corrected as would be expected for this stage of the recovery process. As the following 4 weeks unfolded, the ears began to take more of the proper shape and position. And as the 5 month mark came around, you can appreciate that she has a very stable cosmetic otoplasty result. Comparing the before and 5 month after otoplasty photos in particular, you can see that she has a very obvious improvement in the cosmetic appearance of her ears. They are now set in closer to her head and are much more symmetric than before. If you have been considering ear pinning surgery here in San Diego, CA and have wondered what the healing process might be like, this case example gives you a nice visual on what you can possibly expect. Call us today to schedule your complimentary consultation for cosmetic ear pinning surgery.

A

B

C

D

#### Should I Have A Chin Implant or Chin Liposuction?
I have seen this question or a variation of this online. The answer is it really depends on what your anatomy is like. To help clarify this question about chin implant versus neck liposuction/neck reshaping, I posted a blog entry with case description a little while ago. Here is the link for your review: Case example of chin implant and neck liposuction with platysmaplasty.

#### Shrink the Size of Your Ear?
Can Dr. Hilinski actually make my ears shrink down in size? Yep! Take a look here at the most recent addition to his gallery of otoplasty surgery - which is more of a variant called macrotia, or scapha reduction surgery. This is a great example of how a highly trained otoplasty surgeon can take your ears from being too large (and prominent) to being just perfect in terms of size. After years and years of doing classic otoplasty (ear pinning), Dr. Hilinski began fully reshaping peoples' ears to actually make them shrink down in size. Read more about this highly specialized type of otoplasty surgery as offered by one of San Diego's best and most experienced cosmetic ear surgeons.

#### Skin Pinch Lower Eyelid Lift (Blepharoplasty) in San Diego
I happen to see quite a few facial plastic surgery patients in San Diego who are looking to have more of a 'finesse' type of lower eyelid lift. These are patients that are relatively younger compared with most lower eyelid lift patients. They usually present with some degree of excess lower eyelid skin and bunching under the eyes, but typically don't have significant 'pseudohernation' of the fat (often referred to as eyelid 'bags' by many patients).
Typical Lower Eyelid Lift Skin Pinch Surgery Candidate
The typical lower eyelid lift skin pinch patient demonstrates unwanted ridges of skin just underneath the eyelash region. As you can see in the patient example below, there does not appear to be an excessive amount of fat protruding from under the eye. For the most part the lower eyelid - cheek junction is fairly youthful still. What bothers most of these patients is the redundancy of lower eyelid skin - eyelid wrinkles that detract from an, otherwise, smooth lower eyelid contour. For instance, the white arrows and red curved line point to the area of concern in this particular blepharoplasty patient example. As you can see, she is quite youthful and takes great care of her face and skin. But she has unwanted skin folds along the lower eyelid that distract from her eyes.

Skin Pinch Surgery Eyelid Rejuvenation
A skin pinch lower eyelid lift surgery is intended to provide a more rejuvenated and rested look for the facial plastic surgery patient. As mentioned above, these patients do not have a significant amount of fat protruding out from under the eyes. Therefore, the eyelid lift surgery in this patient population can be more targeted to just the excess skin folds. Consequently, my skin pinch lower eyelid lift patients in San Diego can have their procedure under basically local anesthesia (like going to the dentist). After numbing up the lower eyelid with a novacaine-like injection, the eyelid lift is performed by making an incision under the eyelashes. As the incision extends out to the side of the eye, it is hidden in one of the normal crow's feet lines that nearly everyone has in this area. I elevate, or lift up, the eyelid skin and remove the redundant or excess eyelid wrinkles. I then very carefully suture (stitch) the eyelid incision closed. Within 5 days, the sutures are removed in the office. Usually by 7-10 days after surgery, most skin pinch eyelid lift patients feel comfortable enough to be in the public eye with a little concealer on. As you can see in the following before and after photos, patients can have a very nice improvement in their lower eyelid appearance following a skin pinch lower blepharoplasty. In this case, you can barely even see the incision that was made. And this patient has more of an ethnic skin type, which is usually more challenging when it comes to hiding scars. So if you are bothered by unwanted lower eyelid skin folds, you might be a good candidate to undergo a skin pinch lower eyelid blepharoplasty procedure. Done under local anesthesia in the office with little downtime, this type of minimally invasive lower eyelid lift can potentially give you fantastic, natural looking eyelids.

#### Skype for Rhinoplasty Consultations!
An online inquiry just today reminded me to post a blog about Skype for rhinoplasty consultations. We have an increasing number of patients from out of town requesting virtual consultations for rhinoplasty and revision rhinoplasty. As I tell my patients, there is really no substitute for an in-office rhinoplasty consultation where we can sit down in private and perform digital imaging of the nose. However, for those patients seeking rhinoplasty who hail from out of the San Diego and Southern California region, the logistics can make an in-office consultation difficult. For those rhinoplasty and revision rhinoplasty patients outside of San Diego, I can now offer you Skype as an alternative virtual consultation. Given my busy schedule, we have been doing these in the evening (pacific standard time) as much as possible. Please call my office staff and let them know this is what you desire. I look forward to seeing you. Sincerely, Dr. Hilinski

#### Slimmer Hips
Want a slimmer waistline without undergoing cosmetic surgery? Call our office today to schedule your Coolsculpting treatment! This patient shown here underwent two treatment sessions with San Diego's best Coolsculpting team - under the direction of San Diego plastic surgeon, Dr. John Hilinski. Our medspa offers a wide variety of non-surgical cosmetic enhancement procedures, including the widely popular Coolsculpting fat freezing treatments.

So many patients out there simply cannot afford to undergo an invasive surgical procedure. This is because of economic concerns as well as logistical issues of not having the downtime available to recover from cosmetic liposuction or a tummy tuck. For these patients, Coolsculpting may be the answer. As is shown here, you can have substantial changes to the shape of your body with a non-invasive procedure that does not involve any needles or cutting.

If you are interested in slimming down your waist and hips by freezing the fat away forever, contact our office today to schedule your complimentary Coolsculpting consultation.

#### Slimmer Thighs
Check out how this patient got slimmer thighs from just one Coolsculpting treatment session! Like so many medspa patients, this female from San Diego simply didn't want to have surgical liposuction. Instead, she opted to have Coolsculpting of the inner and outer thighs. The single fat freezing session was performed in our beautiful and relaxing San Diego office Coolsculpting treatment room. Since Dr. Hilinski and his medspa team have dual sculpting - two Coolsculpting machines - the patient was able to have her fat frozen in just half the time it would take in many other Coolsculpting offices.

Her results shown here are approximately 6 months after just one session of Coolsculpting. As you can see, her lateral thigh has undergone a fairly significant reduction to the point where she now no longer has such wide hips. This area is also commonly referred to as the saddlebag since it resembles the appearance of an actual saddlebag. Although liposuction is commonly employed to contour this area of the thigh, Coolsculpting can reduce these saddlebags without having to do anything invasive.

In  addition, her inner thighs have been contoured very nicely to complement her outer thigh reshaping. And all of this was accomplished with just one treatment! And there were no needles, no surgery, and no downtime at all.

And the beauty is that once fat has been frozen away or destroyed by Coolsculpting, it will not be coming back ever again!

One interesting way to look at her change is to view just the outline of her thighs as is shown here in the silhouette of her before and after photos. What you really see in this comparison is how the outline of her thighs - particularly the outer thigh - has been greatly changed due to the Coolsculpting treatment.

If you live in San Diego (Hillcrest, Coronado, Chula Vista, and Downtown included) and desire to have more shapely thighs, contact Dr. Hilinski's advanced Coolsculpting medspa experts for a complimentary consultation to get that unwanted fat frozen away.

#### Smaller Earlobes
Here is a great case example of how an earlobe can be made smaller in size. However, this is not your typical enlarged earlobe.

When this patient first came to see San Diego's #1 cosmetic ear specialist, Dr. John Hilinski, she simply wanted to have her earlobes made smaller in size. In a great majority of cases, this can be done rather simply (for a board certified plastic surgeon!) by removing the excess skin and soft tissue. But this is mainly done for patients who have a 'hanging' earlobe that is just too large.

In this particular case, her earlobes did not hang down off the side of the face. Rather, the earlobes were attached directly to the side of the face and they were elongated. Just take a look at the adjacent photo diagram that shows a very long earlobe - but the whole thing is attached to the face with no real dependent, or hanging, component.

So can an attached and elongated earlobe be made smaller in size with cosmetic ear surgery? Absolutely. Proof of that is shown here by Dr. Hilinski. Over the years, Dr. Hilinski has established himself as San Diego's leading expert when it comes to plastic surgery of the ear - having performed more cosmetic ear surgery than essentially all plastic surgeons in the city. In addition, he performs a wider variety of cosmetic ear reshaping than nearly all of this peers. And this includes reshaping earlobes such as this where there is excess length (or height) in the setting of being attached to the face.
Earlobe Reduction
So how did Dr. Hilinski go about reshaping this enlarged earlobe? First, he reduced the amount of soft tissue by removing the excess from the bottom of the earlobe. In this manner, he was better able to conceal or camouflage the resulting scar. After all, there is no way of doing this type of surgery without creating a scar. But in most cases, this scar can be 'hidden' nicely from the naked eye. Second, he then had to tackle the issue of how the new, smaller earlobe would attach to the side of the face. This was done by creating a new attachment point and carefully suturing the skin edges together so that it looked nice and natural. As you can see, her new earlobe looks essentially like she could have been born like this - just without the elongated shape and size. And how much smaller are her new earlobes? Just take a closer look at her old piercings, which were not moved in the process. Based on this simple landmark, you can see that the earlobes are now considerably shorter. If you have elongated earlobes and desire smaller ones, don't hesitate in contacting San Diego's #1 expert in cosmetic ear reshaping, Dr. John Hilinski.

 

 

#### Smaller Ears From Macrotia Surgery
Dr. Hilinski is seeing increasing numbers of patients seeking smaller ears. In nearly all of these cases, macrotia scapha enlargement is present and contributes to the ear looking too big from various angles.

Here is yet another example of just this problem. This particular patient - like so many of our macrotia ear reduction surgery patients - flew to the United States from another country to see Dr. Hilinski. He was especially bothered by the fact that his left ear was misshapen versus his right ear. More specifically, he disliked the fact his left ear had an enlarged scapha region as his shown in the adjacent clinical photo. You can readily appreciate how the upper portion of his auricle - the flatter appearing section - is over developed. This gives the appearance the ear juts out too much in an upward direction. In addition, the helical rim of his ear was abnormally shaped since it follows the unusual shape of the enlarged scapha. After researching abnormally large ears online, the patient discovered Dr. Hilinski and the fact that he is one of the only plastic surgeons in America who performs cosmetic ear reduction surgery on a regular basis. Furthermore, Dr. Hilinski had the largest online gallery of photo examples of patients who underwent macrotia ear reduction surgery by him. Knowing he would be in good hands, the patient made arrangements to fly to San Diego to have his surgery performed by Dr. Hilinski.

The surgery performed on this patient's left ear is the same surgery that Dr. Hilinski performs on a regular basis for patients with bilateral scapha enlargement. The goal of the surgery was simply to reduce the size of the left ear to better approximate the shape and size of the patient's right ear. The operation took about 75 minutes to complete and was performed under only local anesthesia - like going to the dentist. At the conclusion of the macrotia ear reduction surgery, Dr. Hilinski placed a compression wrap around the ear to prevent unwanted complications. After 2-3 days, this bandage can be removed in the office setting. Thereafter, patients are allowed to go without any bandages during the day. When patients go to sleep Dr. Hilinski recommends use of an athletic headband to protect the ears from getting kinked while sleeping. But, otherwise, bandages are not necessary.

Within a few days, this patient was allowed to fly home to his native country. Like so many of our out of town (and out of country) patients, this one elected to have his follow-up appointment via Skype. That is when this after photo was taken - about 6 weeks out from macrotia surgery - showing a beautiful surgical outcome. You can see in the comparisons shown here just how much improvement was made by Dr. Hilinski. No longer is this patient bothered by the excess cartilage and skin that contributed to the overly developed appearance of his ear. His ear now has a much more natural, gentle curvature to it - and better matches his right ear. Overall, the patient was quite happy with his results and utterly content with his choice of surgeon.

If you have overly developed, large ears - and desire to have them made smaller - contact Dr. John Hilinski today. He is one of the only board certified plastic surgeons in the United States who has dedicated expertise and experience in making ears smaller in size using macrotia ear reduction techniques.

 

#### Smiling After Rhinoplasty/Nose Reshaping
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

#### Spot the Difference in the Before and After Photos?
What's different in the before and after photos? Let's see who can guess what was done to this very pleasant female patient of mine from San Diego. This case example  demonstrates the essence of what facial plastic surgery should do for people. It is intended to make a visual enhancement to the face and/or neck while keeping people guessing as to what might have been done. Let's hear what you think!

#### Spreader Grafting in Rhinoplasty (Nose Reshaping)
We recently published our San Diego online rhinoplasty tutorial on spreader graft use in the world of rhinoplasty and nose reshaping. Building on this particular topic in rhinoplasty and revision rhinoplasty, I decided to post this blog entry focusing on a recent San Diego nosejob patient who was in for a follow-up visit.
Rhinoplasty Patient
This particular San Diego rhinoplasty patient originally consulted with us to have her nose reshaped for cosmetic reasons. If you look at her preoperative rhinoplasty photos below you can see that much of her problem had to do with the middle one third of her nose. She has very attractive facial features and thought that her nose was slightly distracting. You can see on her frontal view of the nose that her alignment is slightly off to her right side. On the oblique view, it almost appears as if her nose curves away from you. And on her side view of the nose, she has a slight hump only.

Diagramming The Nose
The following rhinoplasty diagrams are provided to help further understand her main issues with the nose. Although she had a slight bump on the bridge, the real concerns that I had involved the middle one third of the nose as mentioned. Specifically, this involved what is called the middle nasal vault, which impacts the cosmetic appearance of the nose overall but is also critically important to the function of the nose. For these two reasons, I had to carefully evaluate this small area with a very well mapped out game plan as far as her rhinoplasty procedure was concerned. This is not the type of nose that needed significant changes to the shape. This patient has an already attractive appearance. A few millimeters here and there is all that was necessary. Unfortunately, these minute changes involved the middle vault region, which is arguably the hardest area of the nose to reshape when performing rhinoplasty. Referencing the diagrams below, you can see that the middle vault was curved off to the side. On her left side (right side when looking at her photo), this created a depression with abnormal shadowing of the nose as was also appreciated on her oblique rhinoplasty view. On her right side, she had more of a prominence due to the cartilage in this region being shifted off to that side. Combined these two issues caused disruption of her brow-tip aesthetic line (please refer to our San Diego online rhinoplasty tutorial on nasal analysis to remind yourself of these often used terms).

Rhinoplasty Technique and Spreader Grafts
So how do you reshape this type of nose to correct the middle one-third of the bridge without disrupting the other features of her nose that seem to be just fine? In this particular case of rhinoplasty, I opted to accomplish the goals by using spreader grafts as part of the nosejob procedure. First, I reduced the slight hump and performed nasal osteotomies (breaking the nose) to help reposition the bones (upper one-third of the nose). Once this was done, I then focused in on her middle vault region, which was still quite asymmetric or crooked. In order to straighten the nose alignment in this specific area, I placed spreader grafts. These are grafts that are created from cartilage taken out of her own septum. So there is no foreign material used in this process. The spreader grafts are made of her own body's tissue. To learn more detailed information about spreader grafting, please refer to our San Diego online rhinoplasty tutorial on spreader grafts in rhinoplasty. The spreader grafts are carefully placed between the upper lateral cartilage and the ridge of nasal septum that runs in the middle of the bridge. As you can see in the adjacent diagram, these grafts are placed on both sides, although they do not necessarily have to be equal in size or length. The spreader grafts are sewn into the nose (blue threads) and anchored to the surrounding cartilage. The placement of the spreader grafts is quite deep inside of the nose, therefore, they are sometimes referred to as hidden graft since they are sandwiched between other parts of the nose. The spreader graft helps to 'splint' the middle vault of the nose and creates the desired symmetry. Without them, it would have been quite difficult to reshape the nose in this particular rhinoplasty patient and achieve the desired outcome of an improved brow-tip esthetic line. Below you can see her complete before and after rhinoplasty photo series. As you can see, she has a nice, finesse improvement in her nasal appearance following cosmetic reshaping of the nose. She still looks like the patient that walked in the office that first day - just a more refined, symmetric version of that young lady.
San Diego Before and After Rhinoplasty

#### Spreader Grafting in Rhinoplasty & Revision Rhinoplasty
San Diego nose specialist and California rhinoplasty expert, Dr. John Hilinski, has just added a new online chapter to the rhinoplasty tutorial guide. This latest rhinoplasty discussion focuses on use of spreader grafts in nose reshaping and correction of nasal obstruction. Spreader grafts are a specific surgical maneuver performed during nasal reshaping and typically only done by specialists in rhinoplasty and revision rhinoplasty. To learn more about spreader grafts in nose surgery, click here to be taken to the latest chapter in our online rhinoplasty tutorial.

#### Steroid Injections for Thick Skin in Revision Rhinoplasty
One of my revision rhinoplasty patients from San Diego was seen in follow-up evaluation today, which reminded me to post a quick note on thick skinned patients undergoing revision rhinoplasty. This particular patient had undergone three previous rhinoplasty surgeries performed by three different plastic surgeons. Her main issue was a lack of definition along the bridge and tip as well as a persistent bump seen on her lateral view. Her last plastic surgeon told her they had reached the maximum amount of bridge and tip definition possible due to her having extremely thick skin. The last plastic surgeon was also unsure her bridge skin would shrink wrap down following further reduction of the bridge height. During her revision rhinoplasty consult, we had a very long discussion regarding her skin, which truly was one of the thickest soft tissue coverings I had seen in a long time. In fact, this was probably the main reason she had not achieved the type of definition she desired following three prior rhinoplasty surgeries. Over one year ago I performed her revision open rhinoplasty procedure. I utilized an ear graft in order to recreate a new nasal tip that would project into her thick skin to create the desired definition. At the same time, I reduced the bridge height and thinned her skin over the bridge to promote better 'shrink wrapping' following surgery. As she went through the healing process, I followed her quite closely as we do all our rhinoplasty patients. Within several months we began instituting steroid (Kenalog) injections to help further thin out her skin and encourage more definition to be seen along the bridge and tip. Contrary to popular belief among rhinoplasty patients and surgeons, steroids can be used months to years out to help further shape a nose. But it does take knowledge of the proper type and amount of steroid to use. In this particular case, we injected her at intervals of 8-10 weeks. In the attached photos, you can see the progression of her healing. The first photo shows her preoperative profile image. Her bridge has a bump and her tip is poorly defined, partly due to a lack of tip projection. The second photo shows her six months out from her revision rhinoplasty. She is improved but not quite there just yet. She was a great candidate at this point for steroid injections. The third photo shows her one year result following serial steroid injections to further shrink wrap her nasal skin. This type of revision rhinoplasty result would likely not be achieved without the use of injectable steroids during the latter half of her healing. I hope this case example helps anyone out there with thick nasal skin considering revision rhinoplasty. Sincerely, Dr. Hilinski

#### Stopping Blood Thinners For Rhinoplasty Surgery
I was seeing a preoperative rhinoplasty patient today in the office and we got on the topic of stopping blood thinners prior to her scheduled surgery. She raised the question of whether or not this was considered a high risk operation in terms of bleeding. I counseled her that rhinoplasty and revision rhinoplasty are actually not considered high risk surgeries in terms of bleeding. However, if you are taking a restricted medication that you should have avoided you are indeed risking having a potential complication from bleeding during and/or after the rhinoplasty. This risk is still quite low in experienced hands. I mostly recommend avoiding these blood thinning medications before rhinoplasty so that patients can maximize their initial recovery period. This is particularly appropriate when we are performing osteotomies (breaking your nasal bone) as part of your rhinoplasty. By following my recommendations in terms of restricted medicines, you should have minimal bruising and swelling even at 5 days out from your rhinoplasty or revision rhinoplasty. If there is a certain medication that you are taking that is not on our list and is still a concern, feel free to contact my staff at any time. Sincerely, Dr. Hilinski

#### Straightening a Crooked Septum With Suture Technique
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.

#### Stretched Earlobe Laceration Repair
This is the latest addition to our growing photo gallery of earlobe repair patients. This one would be considered a less dramatic case of gauge earring piercing correction. This young female from San Diego decided to get rid of her gauge earlobe piercings at an earlier stage than many other gauge earring users. Her earlobe defects were obvious but not as extensive as other patients that are seeking repair of the stretched earlobe. Like other patients, hers was repaired under local anesthesia in the office setting with minimal downtime in her schedule. As you can see from the before and after gauge earring repair photos, she now has holes that are closed off with an earlobe that appears quite normal looking. You can also see that I was happy to perform her first piercing after the surgical repair. Of course, we used a small studded earring - but very special ones that were provided to the patient by her mom to celebrate the results of her surgery!
Before and After Gauge Earring Repair (Left)

Before and After Gauge Earring Repair (Right)

#### Subnasale Lip Lift Surgery in San Diego
This case presentation highlights a fairly uncommon upper lip enhancement procedure termed a subnasale lip lift. This is a procedure that is requested by patients who are looking to shorten their upper lip to create a more balanced appearance to this region of the face. Patients considering a subnasale lip lift have an elongated upper lip when measured in the vertical direction. By shortening this segment, the upper lip can be enhanced in terms of the amount of pink (or red) lip showing as seen from the frontal view. The incision is placed in the junction where the nose meets the upper lip, which allows the scar to be well hidden. This particular patient from San Diego, CA is a great example of what can be accomplished with this type of cosmetic lip enhancement procedure and demonstrates how well the incision can heal. An upper lip lift is typically done under local anesthesia in the office setting with less than a week of downtime. If you or someone you know is considering an upper lip lift, contact our office today to learn more about this procedure. To see the full series of before and after photos of this patient's subnasale upper lip lift use this link here. To learn more about the subnasale upper lip lift, use this link here.

#### Subnasale Upper Lip Lift to Shorten An Elongated Upper Lip
This is another great example of how a subnasale upper lip lift can be used to treat an excessively long upper lip (elongated upper lip). This female from San Diego, CA came to me requesting a shorter upper lip. She simply did not like the fact that her upper lip was too long when seen from the various angles. If you look at her upper lip, you can appreciate the fact that it is, indeed, too long for her face. Just look at the distance from where her nose ends and where the red portion of her upper lip starts. Based on this, we decided to perform an upper lip lift to shorten the vertical length of her upper lip. This was done with a subnasale upper lip lift technique where an incision is made under the nose. This is done to conceal the incision as much as possible. In this particular case, the upper lip shortening procedure was done with removal of nearly 7-8 millimeters of skin - leaving behind nearly 15 millimeters of her upper lip. You can see her before and after lip shortening photos below. As you can now tell, her upper lip is much shorter and in better balance with her surrounding facial features. You can really see this change on her side view, where the actual vertical height of the upper lip is obviously shorter now. The subnasale lip lift also provides her with a more enhanced red lip appearance (her upper lip now looks more volumized) as seen from the frontal view. You can see that her incision is slightly red still at this point in time, which is not bad considering she is only about 8 weeks out from surgery. With more time, the scar will continue to fade to become barely visible at nearly one year out from the lip lift surgery.
Before and After Subnasale Lip Lift Surgery

Before and After Lip Shortening Surgery

#### Subnasale Upper Lip Shortening
Just finished another subnasale upper lip lift surgery today on a very charming young lady who flew out from South Carolina to have me operate on her. Her surgery went beautifully - giving her a nice enhanced upper lip appearance by providing much better proportion and balance.

#### Subtle Deprojection of the Nasal Tip in 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.

#### Success with Botox & Dysport Injections
Patients ask me all the time - how do I get such consistently, great results with Botox and Dysport injections? Part of the reason why my patients continually coming back for repeat Botox and Dysport treatment rests on the fact that I keep a 'roadmap' of every patient's injection pattern. Meaning, I document in your chart the precise location and distribution of Botox and Dysport being given. A sample of this is shown here where you can see exactly where the Botox and/or Dysport was placed to control those unwanted wrinkles and lines. When it comes time for repeat treatment, I simply reference your last Botox and/or Dysport roadmap in order to ensure the best possible cosmetic result!

#### Summer Body Ready
What do you do when things starting heating up outside here in San Diego? Get Coolsculpting done to get summer body ready! Since you need about 2 months to start seeing the slimming effects from Coolsculpting and Cool Mini, we recommend you stop by the office now to undergo Coolsculpting. Amazing results in terms of non-surgical body contouring and fat reduction are just hours away with the only FDA approved method to freeze fat for permanent weight loss and reshaping.

 

#### Suture Reshaping of the Ear
Learn more about suture reshaping of the ear in this latest addition to our otoplasty discussion page. This case example focuses on use of Mustarde suture technique - a specific method that can be used to cosmetically reshape the overly prominent ear in otoplasty patients. See for yourself why our office has become a regional referral center for plastic surgery of the ear.

#### Taping The Nose After Rhinoplasty
Many times I will ask that my patients begin taping their nose following rhinoplasty. This is recommended to encourage your nose skin to adhere down to the underlying cartilage and bone that was just reshaped. In rhinoplasty patients with thin skin, this is usually not necessary. In rhinoplasty patients with thick skin, however, taping for several weeks to months following surgery can be of significant benefit. I will direct you if and when to start doing this as needed. I recommend that my patients use 1/2″ x 3″ steri-strips manufactured by 3M since these seem to provide the best quality tape for our purpose. In the past I have referred most patients to the 3M website since most pharmacies do not carry this specific brand. For my San Diego rhinoplasty patients, we have now discovered a local pharmacy close by in La Jolla that carries these same steri-strips. It is Burns Drugs at 7824 Girard Avenue and their website is burnsdrugs.com. Thanks to one of my revision rhinoplasty patients in La Jolla, Julie, for the updated information!

#### Taping the Nose Following Rhinoplasty
We have just added a new segment to our online rhinoplasty tutorial titled Taping the Nose. This segment was added for all of you rhinoplasty and revision rhinoplasty patients who have been instructed to tape your nose at night. The tutorial covers my general guidelines and techniques for taping the nose after nasal reshaping surgery. Hope it helps.

#### Teenage Nose Job Surgery
See the latest addition to our online rhinoplasty tutorial focusing on teenagers undergoing cosmetic nose job surgery. This young lady from San Diego desired to have her nose reshaped after several years of contemplating what nose job surgery might do for her facial appearance. This demographic group of teenagers seeking cosmetic nose surgery is a growing part of my rhinoplasty practice - largely due to the dynamics of social media such as Instagram and Facebook. See photos of her beautiful transformation including some photos taken during the actual rhinoplasty surgery. Let us what you think of her improvements!

#### Temporary Injectable Fillers for the Nose
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).

#### The Advantages of Choosing Preservation Rhinoplasty
When it comes to enhancing the appearance of the nose, rhinoplasty is one of the most sought-after cosmetic procedures. According to the American Society of Plastic Surgeons (ASPS), over 47,000 rhinoplasty procedures were completed in the U.S. in 2023. Traditional rhinoplasty techniques often involve significant reshaping of the nose, which can require the removal and reconstruction of cartilage and bone. However, preservation rhinoplasty offers a more refined approach, focusing on maintaining the original nasal structure as much as possible while still achieving your aesthetic goals. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we are proud to offer preservation rhinoplasty as a superior option for those seeking natural, long-lasting results.

What is Preservation Rhinoplasty?

Preservation rhinoplasty is an advanced surgical technique that aims to reshape the nose while preserving its natural anatomy. Unlike traditional rhinoplasty, which often involves excising cartilage and bone to achieve the desired shape, preservation rhinoplasty minimizes these alterations. The technique involves refining the nasal structure by reshaping and repositioning the existing cartilage and bone rather than removing and reconstructing it.

By preserving the natural framework of the nose, this method reduces the need for extensive reconstruction and can provide more harmonious, natural-looking results. Patients often choose preservation rhinoplasty for its ability to enhance their appearance while maintaining the integrity of their nasal structure.

Superior Aesthetic Results

One of the key advantages of preservation rhinoplasty is the superior aesthetic results it can achieve. By maintaining the original cartilage and bone, this technique allows for a more natural outcome. The nose retains its structural integrity, leading to a smoother and more refined appearance. Preservation rhinoplasty is particularly effective for addressing issues such as dorsal humps or nasal bumps without dramatically altering the natural shape of the nose.

Because the nose’s natural anatomy is preserved, the results are often more consistent with the patient’s original facial features, leading to a more balanced and aesthetically pleasing look. This approach is ideal for patients who want to make subtle improvements without compromising their natural appearance.

Less Invasive with Reduced Recovery Time

Preservation rhinoplasty is generally less invasive than traditional rhinoplasty techniques. Since there is less bone and cartilage removal, the surgery often involves smaller incisions and less trauma to the nasal tissues. This results in reduced swelling and bruising post-surgery, leading to a quicker and more comfortable recovery period.

Patients who undergo preservation rhinoplasty typically experience less downtime compared to traditional rhinoplasty. The minimized tissue disruption allows for a faster return to daily activities, and many patients find that they can resume their normal routines sooner than expected. The reduced recovery time is a significant benefit for those with busy lifestyles who cannot afford extended periods of downtime.

Long-Lasting and Stable Outcomes

Another advantage of preservation rhinoplasty is the stability and longevity of the results. Because the natural structure of the nose is largely maintained, the risk of complications, such as nasal collapse or unnatural reshaping over time, is minimized. The preservation of the nasal framework ensures that the nose remains stable and resilient, providing long-lasting results that age well with the patient.

The refined techniques used in preservation rhinoplasty also contribute to the stability of the outcomes. By carefully reshaping and repositioning the existing structures rather than removing them, the surgeon can create a result that is both aesthetically pleasing and durable.

Why Choose Dr. John Hilinski for Preservation Rhinoplasty?

Dr. John Hilinski is a highly experienced and skilled plastic surgeon in San Diego, CA, specializing in advanced rhinoplasty techniques, including preservation rhinoplasty. His expertise in this field allows him to deliver exceptional results that align with each patient’s unique aesthetic goals. Dr. Hilinski’s approach is patient-centered, ensuring that every procedure is tailored to achieve the most natural and harmonious outcome.

Preservation rhinoplasty offers a cutting-edge approach to nasal reshaping, focusing on preserving the natural structure of the nose while achieving your desired aesthetic enhancements. Preservation rhinoplasty is an excellent choice for those seeking a natural, balanced appearance. If you’re considering rhinoplasty, contact John Hilinski, M.D. Plastic Surgery in San Diego, CA, to schedule a consultation and explore the benefits of preservation rhinoplasty.

#### The Difference Between Facelift & Mini Lift Procedures
When patients visit Dr. John Hilinski with the desire to rejuvenate their facial appearance, a number of procedures are considered -- both surgical and non-surgical. One solution, in particular, has proven to address some of the most common concerns caused by aging: the facelift. While some patients can achieve beautiful results with this popular procedure, Dr. Hilinski explains that others may be able to reach their goals through a less extensive version: the “mini lift.” We’ve differentiated between the two procedures below to help patients better understand their options.

The traditional facelift is a great solution for patients who have more advanced signs of aging they would like to address. The procedure is designed to address the lower one-third of the face and the upper neck. Excess skin on the lower aspect of the cheeks and upper aspect of the neck is removed, and Dr. Hilinski then recontours the areas to provide a younger-looking aesthetic.

The mini lift, on the other hand, is not as comprehensive of a procedure compared to the full facelift. It can benefit those who have more subtle aging concerns they would like addressed or those who have previously undergone a facelift. Candidates are typically those with sagging skin on the lower face and upper neck that needs minor tightening.

In addition to the facelift and mini lift, Dr. Hilinski performs the mid facelift. Stay tuned for our next blog post to learn who makes the best candidates for this procedure specifically. To learn which option might be best for your individual needs and aesthetic goals, please contact us to schedule your consultation with Dr. Hilinski.

#### The Dramatic Impact of Upper Blepharoplasty (Eyelid Lift)
I wanted to post a quick blog entry regarding the potentially dramatic impact of having an upper eyelid blepharoplasty procedure, or upper eyelid lift. This female patient from San Diego presented to our clinic requesting evaluation for her upper eyelids. She actually noted that she was having difficulty with her peripheral vision. In addition, she noted that her upper eyelids were becoming increasingly heavy. On examination she was found to have evidence of moderately severe upper eyelid dermatochalasia. This is a term that implies there is excess skin that is contributing to an unwanted draping effect. If you look closely at this particular blepharoplasty patient, you can appreciate how her upper eyelid skin hangs over so much that it is nearly on her lash line. In fact, you can no longer see her upper eyelid crease due to the eyelid dermatochalasia. In her case, we sent her off for additional diagnostic testing to objectively measure her visual field acuity. The testing revealed an actual blockage in her vision as a result of the excess upper eyelid skin. Fortunately for her, health insurance provided coverage for an upper eyelid lift (blepharoplasty).
Preop Blepharoplasty (Eyelid Lift) Photos
Blepharoplasty (Upper Eyelid Lift)
I ended up taking her to surgery and performed an upper eyelid lift or blepharoplasty procedure. We made our standard incision starting in the crows foot area just to the side of the eye. This was then extended across the upper eyelid in her hidden natural skin crease. The excess skin was then removed with preservation of her underlying eyelid muscle and fat. In cases like this, it is my personal opinion that you should preserve the upper eyelid natural fat and muscle to maintain sufficient volume. In doing so, I also avoid creating an eye that looks sunken or hollowed out. We closed her upper eyelid incision with meticulously placed sutures that were removed in 5 days. She had approximately one week of surgical downtime following the blepharoplasty. She went on to heal quite well from her eyelid tuck.
Before and After Blepharoplasty (Eyelid Lift) Photos
Her before and after blepharoplasty (eyelid tuck) photos are provided herein. As you can see, she has a fairly dramatic improvement in terms of her upper eyelid shape. In fact, she looks like she could be a model with her new eyes! She now has a much more rested look after the eyelid lift. Her eyes clearly look more open. As you can imagine, she subjectively feels like her eyelids are no longer heavy and she has a marked improvement in terms of her peripheral vision. Most importantly, she looks very natural following her blepharoplasty - almost as if she never had any plastic surgery at all.

#### The Hilinski Foundation for Surgery
Stay tuned tomorrow night (Friday, Nov. 21st) to Channel 10 News at 5:00 pm and 6:00 pm when this little guy, Brian, from San Diego will be featured following recent facial plastic surgery to reshape his ears. I am very proud to say that our own Hilinski Foundation for Surgery was able to offer the services to him free of charge as part of our mission to provide charitable facial plastic surgery to deserving youth in and around San Diego. Our team that day included Dr. Leo Ventura (anesthesia), Kathy Bynon (registered nurse), Marichelle Ramos (surgical technician), and myself, Dr. Hilinski. Together, we were able to provide Brian just what he wanted - a new set of ears! Tune in tomorrow night to see his early results and let us know what you think.

#### The Hilinski Foundation In the San Diego News
The Hilinski Foundation Helps Children in Need of Plastic Surgery

Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, CA, is announcing the launch of a non-profit organization dedicated to providing free plastic surgery procedures for children 6-18 years old. The Hilinski Foundation for Surgery will provide surgical procedures such as nose reconstruction, ear pinning, scar revision, facial reconstruction and more for socially and economically disadvantaged children in San Diego County.

San Diego facial plastic surgeon Dr. John Hilinski is announcing the establishment of a non-profit organization dedicated to providing plastic surgery for children in need. The Hilinski Foundation for Surgery will give children aged 6-18 that meet certain social and economic criteria the ability to undergo a range of procedures to improve their lives, whether they are in need of nose surgery, scar revision, or any other facial plastic surgery procedure.

Supporting the San Diego community was especially important to Dr. Hilinski: “My wife and I are very excited about the future of The Hilinski Foundation and the families that will benefit from our efforts. For years we have dreamed about doing something like this to give back to the communities where we both grew up.”

Charitable missions have been a part of Dr. Hilinski’s practice from the start. However, he adds that the ability to provide safe and effective treatment with regularity satisfies his ultimate goal. “With our own ambulatory surgery center, we now have the ability to commit to this type of charitable work on an ongoing basis. We are also fortunate enough to have a wonderful, collaborative team of surgical and nursing specialists that have joined the foundation who are just as committed to the mission. We can’t wait to get started.”

About Dr. Hilinski

Dr. John Hilinski earned his medical degree from Harvard University. He then completed his general surgery residency and a Head and Neck Surgery residency at the University of California, San Diego Medical Center. After being chosen for a Facial Plastic and Reconstructive Surgery fellowship, he served as a Clinical Instructor in the same division at the University of Illinois, Chicago College of Medicine, where he learned to perform the latest advancements in facial plastic surgery and procedures such as rhinoplasty and revision rhinoplasty. Dr. Hilinski is double board-certified, and is a member of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology Head and Neck Surgery, and the San Diego County Medical Society.

Dr. Hilinski’s facial plastic surgery practice is located at 3720 Fourth Ave. in San Diego, CA 92103, and can be reached at (619) 296-3223. For more information about the practice, visit https://www.drhilinski.com, or the Hilinski Foundation for Surgery at http://hilinskifoundation.org, or the Dr. John Hilinski Facial Plastic Surgery Facebook page.

###

#### The New Liposuction
So what is the new liposuction in 2018? Coolsculpting! Freezing fat away with non-surgical methods that do not require any type of anesthesia and have essentially no downtime is all the rage. In the past few years, this technique of getting rid of excess fat has become increasingly popular as an alternative to liposuction surgery. Coolsculpting, including Cool Mini for the neck, is the #1 option if you are searching for non-invasive methods to help you slim down in size while getting your body contoured to the desired shape.

How do you get it done? Easy. Call the office of Dr. Hilinski today to schedule a personalized consult with our aesthetic RN, Kellie Hartmann, who is a trained specialist in Coolsculpting technique. Kellie will give you a complete assessment and provide you with a Coolsculpting game plan to help you get rid of that excess weight once and for all.

 

 

#### The Truth About Botox®
Dr. Hilinski recently added a new section to our Botox® Cosmetic page that focuses on the truth about Botox® injections here in San Diego. He goes into detailed information regarding Botox pricing, so-called Botox® specials, and how to know what you are getting for your money. Spend a few moments reading this important information before you consider getting Botox® treatment by just any office here in San Diego.

#### The Truth Behind Rhinoplasty Photos
A photo gallery can be a great resource when determining the best rhinoplasty surgeon for you. Under the best circumstances, these photographs can give you an idea of the skill, experience, and artistic eye of the plastic surgeon. However, Dr. John Hilinski offers a couple tips to keep in mind when viewing these galleries to make sure you are looking at a true representation of the surgeon’s work.

Dr. Hilinski highlights that many of these photo galleries for rhinoplasty procedures show the results of the surgery just two or three months afterward. In addition, many of these photos are taken from a single angle, such as the side view, which does not exhibit the full extent of the changes made to the size and shape of the nose. For example, many surgeons will show before and after side views of a hump being taken down. But in many instances, they do not show the front view of that same nose. The front view changes as well – even with hump reduction rhinoplasty. So you have to ask yourself – why do they not include the frontal view? The reason is likely because something does not look right with that nose when viewed from the front. If the nose looked better, why not show the frontal view? The real reason has to do with the fact that getting the front view of the nose correct is one of the most challenging aspects of rhinoplasty surgery. While most patients feel comfortable returning to their daily routines about a week after surgery, the final results of a rhinoplasty are often not fully visible until nine to twelve months later. At this time the body is usually fully healed and all residual swelling has receded, leaving you with a more contoured, beautifully shaped nose. Ask your plastic surgeon for photos from multiple angles and photos that are taken up to one year later for a more truthful view of the surgeon’s results.

If you have questions about rhinoplasty surgery, or would like to schedule a consultation, please contact us today.

#### The Ultimate Aesthetic Workshop
I had a great time this weekend presenting a number of talks during The Ultimate Aesthetic Training Workshop that took place at The Luxe Hotel in Beverly Hills. I gave some talks on Bellafill reshaping of the face, Sculptra Volumizing Techniques and Use of Microcannulas in Cosmetic Face Enhancement. It was a great opportunity to catch up with other plastic surgeons who practice in the Los Angeles area. A special thank you goes out to Dr. John Vartanian for the invite to speak. I look forward to future speaking engagements with these friends and colleagues!!

#### The Unique Benefits of Sculptra® and Radiesse®
Dermal fillers are designed to restore lost facial volume, combating the common signs of aging by giving your skin a smoother, firmer appearance. Each dermal filler has its own strengths and, when used properly, can effectively address different cosmetic concerns.

Unlike many dermal fillers, Radiesse® utilizes very tiny crystals containing calcium hydroxyapatite to treat facial aging rather than hyaluronic acid (HA). Calcium hydroxyapatite is a substance that resembles constituents of bone found naturally in the body, and can be used to sculpt or recontour your facial features in addition to diminishing the appearance of lines, wrinkles, deep creases, or even scarring. Our patients commonly use this dermal filler to smooth nasolabial folds or rejuvenate the cheek area.

Sculptra® Aesthetic is another popular injectable that is, technically speaking, not a dermal filler. The unique formula is designed to rebuild the skin’s underlying structure by restoring lost collagen. Using a unique poly-L-lactic acid formula, Sculptra® can enhance the deepest levels of your facial skin, stimulate your body’s natural collagen production, and gradually cause your skin to look healthy and smooth.

Remember: it is important to seek out doctors who have the highest level of education and training to perform these services. The cost of the treatment should not be your main concern when you are considering a procedure that can alter the appearance of your face. An experienced plastic surgeon with a history of success can deliver consistent results that look natural, youthful, and beautiful.

- Dr. John Hilinski
Contact Us
To learn more about the benefits of Sculptra® Aesthetic or Radiesse®, please contact us today.

#### Thigh Fat Reduction
Do you have unwanted lateral thigh fat? This unwanted bulge is also commonly called a saddle bag since it creates a silhouette mimicking this when seen from the front or back view. Despite a dedicated exercise regimen in combination with a healthy diet, these pesky saddle bags along the lateral thigh can be quite difficult to get rid of for many patients. Can you have liposuction to get rid of this excess thigh fat? You could. But you have to be ready for an actual surgical procedure - along with the attendant scars, risks and recovery. That is where Coolsculpting should be next on your mind as the best non-surgical alternative to contour the lateral thigh fat.

Coolsculpting allows for the excessive fat to be frozen away without surgery, without needles and without any downtime or recovery. Yes, that is right. You can drive to the office, have your treatment done and then drive home. In fact, because Dr. Hilinski has two Coolsculpting machines, his expert staff are able to perform 'dual sculpting' on your thigh fat. That means each thigh can be treated at the same time - which means your fat freezing session will take half as long as offices that don't offer dual sculpting. In real time, that translates into about 45 minutes of actual Coolsculpting.
Saddle Bag Coolsculpting Before and After
Shown here is a classic case example of what the Coolsculpting fat reduction system can do for your outer thigh fat. This lady from San Diego was bothered by the excess contour seen along the outer thigh region as a result of unwanted fat accumulation. This is precisely what we are referring to when we mention saddle bag thigh fat. After doing her own online research, she found out that Coolsculpting was a wonderful non-surgical, office-based procedure to help with her problem thighs. She decided to proceed and underwent dual sculpting, which was performed by Dr. Hilinski's certified Coolsculpting specialists. Results shown here are just a few months out from her treatment. As you can see, there has been a really nice improvement in the contour of her outer thigh. Following  the treatment, she no longer has the extra bulge of fat that created the saddle bag deformity. Now her lateral thigh is slimmer with an overall better shape. And this result here is after just one (1) session of Coolsculpting! You can imagine how much better her thighs could potentially be if she elected to do more fat freezing in the future.

Coolsculpting Consult for Thigh Fat
Remember, summer is going to be here before you realize it! And if you have some saddle bags that are making you afraid to get into your favorite bathing suit, call our San Diego office today to schedule your Coolsculpting thigh treatment!

#### Three Weeks Post Rhinoplasty - Nose Looks Wider Than Previously
"I had a rhinoplasty procedure nearly 3 weeks ago and now my nose looks wider than it did preoperatively. Is this normal or should I be worried?" This question or a variation of this question is often asked on online rhinoplasty forums. The reality is that many rhinoplasty and revision rhinoplasty patients can appear wider at 3 weeks out than they did before surgery. This can be especially noted if grafting was performed as part of your nasal reshaping process. Stay calm and allow the healing process to unfold. Avoid salty foods as this can aggravate postoperative swelling from rhinoplasty. Any increase in activity around this time can also make the swelling worse. The bottom line is that your nose will take upwards of a year or more to heal completely from a nose reshaping procedure. Three weeks out is relatively early in the big scheme of things. Happy healing.

#### Tighter Tummy
Here is another example of how you can get a tighter tummy without surgery!

This patient desired a flatter abdomen but didn't want to go under the knife to achieve results. So she opted for non-surgical Coolsculpting to contour her abdomen. More specifically, she underwent fat freezing to target the abdomen region.

Here are her results just 8 weeks after only 1 treatment session! You can visibly see she now has a flatter, tighter tummy - particularly notable along the lower abdomen region where her pooch is now much improved. And with Coolsculpting, remember, there are no needles, no incisions and no downtime.

If you have pockets of unwanted fat and desire to have it treated without surgery, contact San Diego's #1 Coolsculpting team led by Dr. John Hilinski.

#### Tighter, Smoother Neck!
Look how much better this lady's neck looks after J Plasma Renuvion treatment! She was particularly bothered by how her neck skin was beginning to show too many wrinkles and coarse lines as a result of aging. In addition to the normal horizontal skin creases that we all have (even at a younger age), she had actual wrinkling of the skin.

There were a variety of options she could have chosen, but she ultimately opted for Renuvion J Plasma. Dr. Hilinski recommended she undergo J Plasma treatment because of what the revolutionary plasma energy can do underneath the neck skin to help tighten the deeper, fibrous skin attachments. As these fibers undergo shortening (or contraction) from exposure to the plasma, the overlying skin begins to tighten and shrink wrap. The end result is neck skin that looks (and feels) smoother and tighter.

The procedure was performed under only local anesthesia - where the patient remained awake the whole time. Very short incisions were made under the chin and behind the earlobe on each side. These small 'ports' were used to allow passage of the J Plasma device underneath the neck skin. This was done from the back of the jaw to the chin, then down the length of her neck. As the plasma energy was released, the fibrous attachments between the surface skin and the deeper neck structures began to contract. As J Plasma is performed, there is an immediate skin tightening that can be appreciated. But a lot of the change will occur once the procedure is done as collagen tightening develops over the next several months.
J Plasma Neck Results
The results of her J Plasma neck tightening can be seen here. If you pay close attention to her neck skin, you will easily see just how much improvement was made with Renuvion. Her neck skin now looks so much smoother and tighter! Although she still has those horizontal neck lines (which will always be there), you don't see the coarse wrinkling she had prior to the J Plasma procedure. Simply stated, her neck skin just looks like it was cleaned up! And these marked improvements can be seen all the way across her neck skin.

J Plasma Consult
If you are bothered by excess neck skin wrinkling and aging, contact San Diego's best J Plasma office to schedule your consultation with Renuvion expert Dr. John Hilinski.

#### Tip Rebuilding and Deprojection
See how this patient had his nose rebuilt following prior unsuccessful nose surgery performed by a different plastic surgeon. In the process of making his nose function better, I was able to bring the tip in closer to his face. This latter maneuver is called deprojection of the nasal tip. This featured patient is the latest addition in our ever-expanding online rhinoplasty patient tutorial. Let us know what you think of his results!

#### Tip Rhinoplasty Case Example
See the latest from Dr. Hilinski's SanDiegoRhinoplasty.com website - a case example of tip rhinoplasty to repair a deviated nasal tip deformity in a young lady from San Diego.

Fixing a displaced, or crooked, nasal tip is perhaps one of the most challenging types of cosmetic rhinoplasty. But this is the type of surgery that Dr. Hilinski - San Diego's best rhinoplasty expert - performs on a consistent basis to achieve absolutely beautiful results for his patients.

Use the links provided here to read more about this particular case while learning more about the nuances of this highly specialized plastic surgery procedure.

#### Tip Rhinoplasty Following Nasal Cancer in San Diego, CA
This is great example of tip rhinoplasty, or nasal tip reshaping, in a patient who had an obvious deformity following skin cancer involving her nose. This patient underwent removal of a skin cancer in the nasal tip region, which was performed by a different plastic surgery years prior. Unfortunately, the area where the skin cancer was removed from the nose did not heal well - leaving the patient with a very visible depression. As you can see in this preoperative photo, there is an obvious area of her left nasal tip that is missing, which translates into an abnormal cosmetic contour. Looking at a 45 degree angle from her right side, you can easily appreciate what was bothering her in terms of the nasal tip shape. In addition, this type of collapse of the nasal tip created difficulty in breathing through the nose as well. She was ultimately referred to our rhinoplasty clinic in San Diego, CA because of Dr. Hilinski's known expertise as one of the regions best rhinoplasty specialists.
Rhinoplasty to Reshape the Nasal Tip
Dr. Hilinski recommended an open rhinoplasty procedure to reshape the nasal tip region. This included use of septal cartilage from inside of the nose to graft the tip. In addition, he used temporal fascia grafting to help bolster or soften the skin overlying the defect. The rhinoplasty surgery was performed by first lifting the skin off of the nose. The septal cartilage grafts were then used to literally rebuild the nasal tip concentrating on creating a more symmetric looking nose. The fascia graft was finally layered over the cartilage grafts before the nose was closed. The final results of this type of tip rhinoplasty surgery are shown herein. As you can see, there has been a significant improvement in terms of her tip shape - especially in terms of symmetry of the nose. As one will also appreciate, her right angled view demonstrates how her nasal tip is now better contoured with a more natural looking rhinoplasty result.

Rhinoplasty Consultation in San Diego, CA
If you have had prior cancer of the nose and are considering further reconstructive surgery to help restore a more normal appearance, feel free to contact one of San Diego's busiest and most experienced rhinoplasty clinics - the office of Dr. John Hilinski.

#### TMJ Treatment
Over the years, Botox has become increasingly popular as an adjunct treatment for San Diego patients who suffer from symptoms of TMJ.

One of the stronger muscles involved in TMJ disorder is the masseter muscle - a rectangular-shaped muscle that sits over the side of the jaw as is shown diagrammatically in the adjacent photo. It is the masseter muscle that commonly contributes to problems related to TMJ disorder - which includes chronic, recurrent pain and discomfort. So in patients who have exhausted many of the other TMJ treatment options, such as a soft diet, compresses, anti-inflammatory medication and even dental appliances - medical spa treatments that can help reduce a hyperactive masseter muscle have shown great success.

Botox treatment for TMJ symptoms works by injecting the body of the masseter muscle in a manner that is very similar to the use of Botox for facial wrinkles. In most cases, the doctor will ask you to clench your jaw to identify the true outline of the masseter muscle. Once this is established, the Botox can be injected through the skin directly into the muscle. On average, it can take 15-25 units of Botox on each side to reduce the masseter muscle activity enough that will have a favorable impact on the pain it was causing. But the good news is that - in our experience - TMJ Botox has a longer lasting effect than many cosmetic Botox treatments. This means that rather than having Botox injections every 3 months, it can be done less frequently for TMJ issues.

If you suffer from TMJ symptoms and are frustrated with the lack of improvement with other conservative therapies, you might want to call one of San Diego's leading medical spa staffs to get your TMJ Botox done today!

#### Toner Flatter Tummy at 67!
Is there an age limit to getting a toner, flatter tummy with Coolsculpting? Not really. This 67 year old female from San Diego desired to get Coolsculpting to help with her tummy region. She wanted to target unwanted fat around the mid abdomen or belly button region. This was a problematic area for her that simply didn't  want to budge with good diet and regular exercise. At 67 years old, a slowed metabolism was undoubtedly also playing a role.

Fortunately for her, Coolsculpting doesn't really care about your age! She underwent a  series of two fat freezing sessions that were aimed at the upper and lower abdomen fat. After two sessions of Coolsculpting, you can see a very obvious improvement in her mid section - with a tighter, toner, flatter tummy.

This is really obvious on her frontal view, but  can arguably be even better appreciated on her oblique, or 45 degree angle, view. These changes you see are also a visual testimony to the fact that Coolsculpting can, indeed, help with tightening skin in the process of freezing fat away for good. If this wasn't the case, her tummy skin would look more looser and wrinkled. Instead, it has shrunken down nicely to accommodate her new slimmer tummy shape and contour.

#### Toner Tighter Tummy
For those of you who think Coolsculpting is only for those people who have lots of excess fat, think again! Here is a nice example of what abdominal Coolsculpting can do for patients who are already fit.

This female in her late 20s wanted to get a toner, tighter tummy without undergoing a surgical procedure, such as liposuction. As you can see, she did not have an overabundance of tummy fat. She simply wanted to have a flatter tummy without needles, surgery or downtime.

She opted to undergo non-surgical treatment at San Diego's leading Coolsculpting office headed by board certified plastic surgeon Dr. John Hilinski. The easy fat freezing session  was done while she literally played on her phone for 45 minutes. The abdominal region was treated to help target the unwanted fat around the belly button.

As the weeks unfolded after Coolsculpting, she was able to visibly appreciate a tighter and more toned tummy. You can readily see this in her before and after Coolsculpting photos where the abdomen is flatter looking all around the belly button. Do you see the scars? Of course not! There aren't any with Coolsculpting! And there wasn't any downtime either. Just beautiful results from just one Coolsculpting treatment.

Summer will be here sooner than you think! If you are looking to get into summer body shape and need a little help, contact San Diego's best Coolsculpting office today to schedule your consultation with one of our expert fat freezing specialists.

#### Top 3 Areas Facial Implants Can Enhance
Facial implants can be an excellent option for patients wishing to achieve added contour and dimension for their facial appearance. Our facial plastic surgeon, Dr. John Hilinski, offers implants to enhance various areas of the face but emphasizes three areas in particular that can be significantly improved: the cheeks, chin, and jaw.

Cheek implants:  Also known as malar implants, cheek implants can provide a more desired contour to the midface. Oftentimes, people are unhappy with sunken or flat-looking cheeks, which is typically a result from the underlying bone structure or lost volume from the aging process. Facial implants in the cheeks can enhance the projection for a fuller-looking aesthetic.

Chin implants: Augmenting the chin with an implant can correct the common concern of a weak or underdeveloped chin. This procedure can improve the overall balance of facial features and is often performed in conjunction with another procedure, such as rhinoplasty.

Jaw implants: Just as implants can add more definition to the chin area, they can also improve a weak jawline. Common concerns that can often be remedied with jaw implants include facial imbalance from the jaw not appearing separate from the neck or a jaw angle that seems to slope from the ear to the chin.

When you come in for your consultation with Dr. Hilinski, he will help you understand whether facial implants can help you reach your aesthetic goals, or if another solution is more appropriate. Contact us today to schedule your visit!

#### Transformative Cosmetic Nose Reshaping
This is a fairly dramatic example of how cosmetic rhinoplasty surgery can completely transform one's facial appearance. This very pleasant lady desired to have cosmetic rhinoplasty to reshape her very droopy and bulbous nasal tip. When you see her photos on the side and oblique views, you can gain a better understanding of how much impact these features had on her overall facial appearance. On her side smiling view, these same features become even more prominent. I ended up performing an open cosmetic septorhinoplasty procedure to reshape her entire nose. Her post-rhinoplasty before and after photos speak for themselves in terms of demonstrating what I happen to think is complete transformation of her mid face region. Let me know what you folks think of the results!

 

 

#### Transformative Rhinoplasty
The latest addition to our ever-growing online rhinoplasty tutorial focuses on how rhinoplasty surgery provided a beautiful transformation of this young lady's appearance. This type of transformative cosmetic nose reshaping surgery can ofte times have a significant, positive impact on overall facial esthetics. Her particular case included hump reduction, nasal bone reshaping and tip enhancement. Learn more about this case by click here.

#### Treatment Areas
What are the areas where Bellafill can be used in the face? Originally, Bellafill was FDA approved for injection into the smile lines, also known as a parenthesis deformity. Use of Bellafill to soften these lines is shown in the case example displayed here. The photo on the left side is her face as it appeared when she first met Dr. Hilinski in San Diego. The middle photo shows what her smile lines looked like after one Bellafill injection treatment of the smile lines. On the right is what she looked like after another treatment session a few months later to get an even better result from Bellafill.

But the smile lines are not the only area where Bellafill is used routinely nowadays in the world of cosmetic surgery. Bellafill is also FDA approved for treating unwanted, unsightly acne scars. In these patients, the Bellafill is injected just underneath the scar to make the skin surface appear smoother and more uniform. The following areas are considered 'off label' uses for Bellafill. This means that the FDA has not officially recommended it be injected in these areas - but the cosmetic and plastic surgery industry as a whole has accepted as fact that Bellafill can be safely used in these areas for cosmetic enhancement.
Off Label Uses for Bellafill

 	Midface - includes high and low cheeks
 	Jawline - for improved definition and shadowing where the face meets the neck
 	Chin - as an alternative to chin implant placement to help improve chin projection

The one area where you should be incredibly cautious with Bellafill injection is the lip. At this point in time, the risk of developing complications from Bellafill injection are just too high when it comes to the lips. Although you may find some cosmetic doctors that will offer this as a treatment, Dr. Hilinski advises against this.

#### Tummy Goes Flat to Flatter
Are you one of these patients who has a relatively flat tummy but wants to contour it down to be even flatter without undergoing the knife? If so, then Coolsculpting may be just what you are looking for in terms of a proven non-surgical option.

This young lady from San Diego was already in fairly good shape as you can see in her before photo posted here. Her tummy was nicely shaped and toned. However, like many patients seeking cosmetic treatments these days, she wanted an even flatter tummy. But she wasn't really interested in going under the knife to achieve those type of cosmetic improvements. She was more intrigued by non-surgical options that would get her abdomen to look more toned and tightened. This is when she found out about Coolsculpting as the only FDA-approved treatment to non-surgically get rid of unwanted tummy fat without the downtime and risks associated with liposuction surgery.

Fortunately for her, she stumbled upon Dr. Hilinski's incredible medical spa staff through a personal referral. His staff examined her and determined that she had enough 'pinchable' fat around her lower tummy that warranted Coolsculpting treatment. This is one of the main criteria when it comes to freezing fat away in any part of the body - there has to be a 'pinchable' area of excess fat. The reasoning behind this has to do with the technicalities of attaching the Coolsculpting device over the skin. If the targeted area does not allow for pinching of the excess fat the treatment cannot be rendered successfully. In this particular case, she indeed had an area of fat that could be pinched along the lower abdomen - below her belly button.

Dr. Hilinski's aesthetic nurse, Kellie, performed her treatment using the CoolCore Coolsculpting adapter, which was placed over the lower tummy region. A little less than 1 hour later, her treatment was completed. And during that time, she was able to literally lay back and relax while watching TV and playing on her phone. Aside from a little redness and localized swelling of the skin from the freezing cold temperature, she had really no downtime. This is in stark contrast to a surgical liposuction procedure that would have left her with mild to moderate pain and 1-2 weeks of actual downtime. In addition, there were no needles and no incisions to deal with from Coolsculpting. Immediately after her tummy flattening treatment, she was able to drive home on her own.
Coolsculpting Results
The patient returned to our office about 30 days after her Coolsculpting session for a quick follow-up examination and photos. Here they are below showing what we think is a beautiful, natural looking improvement in her lower abdomen region. She went from having a pretty flat tummy to having an even flatter tummy in just one Coolsculpting session! What a pretty incredible change for this young lady without any needles and no surgical scarring. Sometimes, as in this case here, just a little change in contour can make a big difference visually. As you stare at her Coolsculpting photos, you can really see how much flatter her tummy now is because of the fat freezing treatment. She just looks that much more toned and tightened. And that is saying a lot given how flat her tummy was to start. When you begin to rotate her body around and you look more closely at her side view, you can really see the improvements made from Coolsculpting. Whereas she had a little pooch below her belly button before treatment, she now has a much flatter - and flattering - tummy contour.

Coolsculpting Summer Season
And with summer coming upon us in just a few months, now is the time to get your Coolsculpting done to be bikini ready! If you are like this patient here and have a bothersome pooch to your tummy from excess fat, why not get rid of it just like that with a no downtime non-surgical procedure?

#### Tummy Tuck Without  Surgery
Here is another fantastic example of how Coolsculpting can give you a non-surgical tummy tuck. This female patient from San Diego wanted to have a flatter tummy - but didn't want an invasive plastic surgery procedure. She came to Dr. Hilinski and his team of Coolsculpting experts. She is undergoing a series of fat freezing sessions - but we couldn't resist showing her photos 5 weeks after just one (1) single treatment! It doesn't take a plastic surgeon to see how her tummy is now flatter with less fatty contour. Look more specifically at her lower abdomen (below her belly button) where you can literally see that her tummy has been made flatter and more toned. The day she took this photo, she elected to undergo even more Coolsculpting of her tummy. We can't wait to see how much more improvement she will get after the additional fat freezing sessions! If you want a flatter tummy - but don't want any needles, surgery or downtime - contact San Diego's leading team of Coolsculpting experts lead by Dr. John Hilinski.

#### Under Eye Wrinkles and Botox
Every once in a while you will hear someone say their under eyes are more wrinkled after getting Botox or Dysport in the crow's feet. When patients get Botox and Dysport in the crow's feet area, the intention is to stop that portion of the muscle to reduce animation lines and wrinkles - particularly when people are smiling. This graphic here helps to explain why the area under the eye can appear more wrinkled after crow's feet Botox and Dysport.

The muscle that is responsible for creating the crow's feet lines is an oval-shaped muscle called the orbicularis oculi. It is shown here as the purple oval. When this muscle contracts - for example, when you smile - the crow's feet appear. Botox and Dysport (the X in the adjacent graphic) help by stopping this segment of the oval muscle. Botox and Dysport work by smoothing this  area out and reducing formation of the wrinkles. Unfortunately, because it is a continuous, oval muscle, the remainder of it can still contract and move even after the crow's feet have been injected with Botox and Dysport. Sometimes there can be 'compensatory' orbicularis oculi muscle movement under the eye - within the eyelid - that creates unwanted wrinkles in this area (indicated by the green arrows).

The corrective measure for this would be to simply go back to your cosmetic doctor to have them inject a few more Botox or Dysport units into the lower eyelid area. Care should be taken to avoid injecting too much Botox and Dysport in the actual lower eyelid - as this can make the eyelid appear too flaccid or weak. In most cases, the additional Botox and Dysport will help to slow down this undesirable compensatory muscle movement - giving you a smoother, less wrinkled appearance all around the eye.

#### Undergoing Primary Tip Open Rhinoplasty in San Diego, CA
This is another example of primary tip open rhinoplasty in a female patient who was from San Diego, CA. This young lady was unhappy with how her nasal tip appeared droopy (ptotic) and was excessively wide. The nose was also asymmetrical (crooked) in terms of the front view. During her consultation with me, we performed digital imaging of her nose using a plastic surgery software program that allows us to visualize what certain changes might look like on her face. She decided to proceed with the surgery, which was done in our own private ambulatory surgery center. I performed an open rhinoplasty to allow optimal exposure and visualization of her nasal tip region. I then lifted her nasal tip and brought it to a more midline position. In the process, I was also able to give her nasal tip a more narrow appearance without looking pinched. I think the final result shows a natural looking nose that is very fitting for her face. In fact, the patient and her family were so happy with the rhinoplasty results that another member of their family just had the same thing done by me!

#### Unilateral Otoplasty
This otoplasty patient of mine was seen in follow-up evaluation just recently and is a great example of how otoplasty, or ear reshaping, can be done for patients who have only one ear that is prominent. This male patient presented to our office with a chief complaint that his left ear has always stuck out further than his right. Indeed, his left ear was clearly less developed than his right and was definitely more prominent. I subsequently performed a unilateral (one sided) otoplasty, or ear reshaping procedure, on his left side. The incisions were completely hidden behind the ear to minimize any signs of having had surgery. His before and after photos below demonstrate a significant improvement in positioning of the left ear. In fact, he now looks quite symmetric and appears as if he could have easily been born like this. If you have overly prominent ears and are considering otoplasty, or ear reshaping, we would be happy to offer a complimentary consultation to discuss the various options available.

#### Update On Dermal Fillers
Many patients ask whether or not fillers can be used in the more aged patient as an alternative to undergoing the knife. The reality is that many patients, including more elderly patients, are considered great candidates to undergo dermal filler treatment of their face. The following patient is a great example of exactly what I am referring to with dermal fillers. This female patient from San Diego is 77 years old and simply didn't want to undergo a surgical procedure for rejuvenation of her chin and jowl region. So we discussed in detail using a dermal filler to help volumize this region and provide a more youthful look in a non-surgical manner. She chose to use Artefill, which is the only FDA-approved permanent filler on the market. Her treatment was completed in one office visit with minimal downtime. Photos below demonstrate the result. Notice an overall more youthful looking chin and jowl region with less skin creasing and wrinkling. Now she could certainly benefit from more procedures to further resurface her skin and provide her even more improvement, however, this particular patient wanted to keep things simple. She is quite happy with the natural appearing results that she has and had essentially no downtime at all! Plus, the cost savings versus having a surgical procedure were fairly significant. If you were ever considering a non-surgical option to help rejuvenate your lower face and upper neck region, give The Hilinski Clinic a call today.

#### Update On Necklift With Platysmaplasty & Neck Liposuction
I wanted to post an update on a neck lift patient who had contouring of her neck and lower face using neck liposuction combined with platysmaplasty. She is a wonderfully pleasant young lady from San Diego who desired more definition along her lower face and upper neck region. We consulted with her and discussed in detail the various options including possible liposuction and tightening of the neck muscle, termed a platysmaplasty. Given her anatomy and desired goal, I recommended she undergo combined neck liposuction and platysmaplasty to lift her neck region. We took her to surgery several months ago and performed liposculpture of the neck to remove the excess unwanted fat. Going under the chin we also tightened the neck muscle. The end result is a fairly dramatic improvement in her lower face and neck appearance as seen in the attached photos. On front and side views of her face, one can see how much change there was by looking at the shaded areas. This happens to be a very common procedure in my facial plastic surgery practice in terms of neck lift choice of procedures.

#### Upper Eyelid Lift
Do you have sagging upper eyelid skin? Don't want a surgical eyelid lift? Maybe it's time to consider a non-surgical route using the plasma pen technique as offered by San Diego's best medical spa team headed by Dr. John Hilinski. The plasma pen uses a special type of energy to tighten loose skin in certain areas such as the upper eyelid.

Take a look at how we perform non-surgical upper eyelid lifts without making any cuts using revolutionary plasma pen technology. Dr. Hilinski and his medical spa staff are certified in use of the Plasma Pen as offered by Louise Walsh.

#### Upper Eyelid Lift - Droopy Eyes San Diego, CA
Droopy eyes? Looking tired? Perhaps you would benefit from an upper eyelid lift. Learn more about functional and cosmetic enhancement of the eyelid using blepharoplasty technique. As a board certified facial plastic surgeon, Dr. John Hilinski performs eyelid lift surgery on a very regular basis. This latest addition to our comprehensive San Diego plastic surgery website focuses on eyelid lift surgery to correct droopy, tired looking eyes. To learn more about this most recent update on blepharoplasty surgery in San Diego, go to https://www.drhilinski.com/procedures/eyelid-surgery/ for additional information and photos.

#### Upper Lip Lift - Cosmetic Lip Shortening Surgery
I just finished doing another subnasale upper lip lift procedure here in the office this morning. This latest patient to have this type of cosmetic upper lip surgery was a very pleasant young lady who flew out from New York to have me perform the procedure. Like most upper lip lift surgery candidates, her main concern was an excessively elongated upper lip. After much online research, she decided to fly out to San Diego for me to perform the surgery. You might ask 'why would someone fly out that far to have this type of surgery performed? Are there not any qualified plastic surgeons in New York she could have seen?' The answer is because I happen to perform this niche procedure on a very regular basis compared with most other board certified plastic surgeons. In fact, there are two main offices, ours included, that commonly pop up in online searches for upper lip lift. Although there are certainly qualified plastic surgeons in New York, this type of cosmetic upper lip surgery to shorten the upper lip is very unique and requires a surgeon who does upper lip shortening surgery on a consistent basis.

Of note, today's patient did very well. Her surgery took about 1.5 hours to complete and was done using only local anesthesia - like going to the dentist. I ended up excising about 5 mm of skin along the central portion of her lip and 6 mm of skin on each side of the upper lip - leaving her upper lip with about 13-14 mm of remaining skin. For those of you contemplating this type of upper lip lift surgery, you will realize these numbers are just about ideal. Overall, I think she is going to have a fantastic cosmetic improvement in the upper lip contour and shape.

If you are considering upper lip lift surgery to address an elongated or excessively long upper lip, feel free to contact our office today.

#### Upper Lip Lift - Lip Shortening Procedure by John Hilinski, M.D.
We have seen a recent surge in requests by patients who desire to have their upper lip lifted. This is also referred to by many patients as an upper lip shortening procedure, since the actual vertical lip length is reduced in size. The reason our office has seen such a marked increase in requests for upper lip lift surgery is because my practice is so focused on facial plastic surgery, including the many niche procedures that are involved with this highly dedicated specialty. This particular blog entry highlights upper lip shortening, or upper lip lift, surgery using a case example of a female patient from San Diego, CA. In the adjacent patient photo, you can see that the vertical height of her upper lip (indicated by the double red arrow) is somewhat excessive, or long. This creates a disproportionate balance in the face with many patients being quite bothered by this appearance. Other upper lip lift candidates come in noting how the elongated upper lip covers too much of their teeth for their liking. Patients with an elongated upper lip are looking to have the upper lip shortened by removing some of the excess upper lip skin. That is precisely why it is called a lip shortening procedure. By virtue of how the lip is lifted upward, it is also commonly referred to as an upper lip lift. The end result of this type of cosmetic lip surgery is a shorter upper lip with better overall balance in terms of the facial appearance. In addition, the pink portion of the upper lip becomes more visible with an added sense of fullness - a very desirable change in shape and size when it comes to female lip enhancement. To learn more about upper lip lift surgery, or upper lip shortening procedures, designed to create a more beautiful upper lip appearance, link here to our webpage fully dedicated to this particular cosmetic upper lip treatment. This growing section of our website also features several patient examples of upper lip lift surgery.

#### Upper Lip Lift Techniques For Best Results
In our last blog post, Dr. John Hilinski, our board-certified facial plastic surgeon, discussed balancing facial proportions with an upper lip lift. In this follow-up post, Dr. Hilinski will reveal his preferred upper lip lift technique and how injectable fillers can assist some patients in maximizing the benefits of the procedure.

There are two main techniques plastic surgeons use for upper lip lift surgery: one technique utilizes an incision made just below the nose and the other technique utilizes an incision that is made along the actual vermillion border of the upper lip. While both techniques remove excess skin, my preferred method is to make the incision below the nose. In my opinion, this technique allows the scar to be more easily hidden. However, my approach in determining which technique is best for each individual is based on patient feedback. Once the patient and I discuss the available techniques, I always allow the patient to make the final decision for the treatment.

Some patients considering cosmetic nose reshaping and an upper lip lift ask me whether or not these two procedures can be done in conjunction with one another. In general, the upper lip lift procedure is performed in isolation from other procedures. In cases where the patient is having a closed rhinoplasty performed, an upper lip lift can sometimes be performed simultaneously. For patients having open rhinoplasty surgery, I recommend to separate the two procedures by at least several months.

Injectable fillers are more commonly performed in conjunction with an upper lip lift, but these treatments are usually limited to lower lip injection. To preserve the overall balance of the face, the lower lip should always appear slightly fuller than the upper lip. Therefore, if the upper lip lift creates more upper lip volume for the patient, it is often beneficial to augment the lower lip at the same time to maintain aesthetic harmony.

To learn more about upper lip lift surgery, or to schedule a consultation to discuss how an upper lip lift can help achieve your cosmetic goals, please contact our office today.

#### Video Testimonial
Want to know what it is like to have your ears made smaller in size? Ever consider having cosmetic ear reduction surgery, but weren't so sure what to expect? Take a look at this eye-opening interview and expose on macrotia ear reduction surgery that was focused on one of Dr. Hilinski's own patients. She was so happy with the outcome of her surgery to make her new, designer ears that she helped in the production of this video - with the intent and goal of helping patients with excessively large ears to better understand the process of making the ears smaller in size. Learn more by using the links provided here.

#### Volume Is A Sign of Youth
See why Sculptra has become one of the most popular non-surgical treatments in San Diego for facial rejuvenation. We have a common saying in the plastic surgery world - volume is a sign of youth. That is because as we age, one of the first things to happen is volume loss in certain areas of the face. In fact, Dr. Hilinski talks about the aging process as a deflating balloon. As time marches on, our face starts to fall. But in addition to tissues falling down, our face starts to lose volume as well - just as a deflating balloon does. The latter process is something that tends to happen earlier on in life - which prompts so many young to middle-age patients to look in the mirror and see the aging process approaching. As this volume loss progresses, we tend to see more signs of aging. That is precisely why we say that volume is a sign of youth!
Fight Aging with Volume Restoration
So what can you do about this loss of volume as it relates to aging? One of the most common treatments is a filler - such as Juvederm or Restylane - to refill the face. But most of these injectable treatments will only give you about 1 year of cosmetic facial enhancement. Sculptra, in comparison, will last you about twice as long. Yes, that is right. Sculptra injections in the face will typically give you results that persist upwards of 2 years in duration. That is a really nice alternative option when it comes to restoring lost facial volume.

Sculptra does what Dr. Hilinski often talks about is 'regional' volume restoration. What this means is that Sculptra is not intended to target a few select lines or wrinkles. Instead, it's purpose is to rejuvenate volume deficient areas of the face by region. So, for example, if your cheeks have deflated over time and you are looking to get back some degree of cheek definition, Sculptra would be a great choice to regionally volumize this  area of the face. Or if your temples have hollowed out due to aging, Sculptra would be a wonderful option to fill out the depressed area and get rid of the unwanted shadowing.
Top Sculptra Injection Sites
Here is a list of the top places Dr. Hilinski and his medical spa staff utilize Sculptra cosmetic:

 	Cheek enhancement to give a more heart-shaped face (instead of cheek implants)
 	Temporal injection for hollowing of the temples
 	Jawline enhancement to create more definition between the jaw and the neck

Sculptra Case Discussion
Here is a great case example of what Sculptra cosmetic injection can do for your face. This middle-aged lady from San Diego has taken good care of her skin and face over the years. However, one thing that was difficult to fight off was the loss of volume from the aging process.

As you look at her photo provided her, you don't see it immediately. But as you study her face, you can begin to appreciate certain areas where she has lost volume that could benefit from replenishment. This includes both of her temples as well as the cheeks. She was bothered by this enough to consider undergoing Sculptra cosmetic injections by Dr. Hilinski's medical spa staff.

Dr. Hilinski recommended several vials of Sculptra to replenish the lost volume. He started off with injection into the temple areas then transitioned into augmentation of the cheeks. Additionally, the mid to lower face was injected to blend the volumization process.

Unlike traditional 'fillers' used in most medical spas, the results of Sculptra weren't apparent after a few days. During the actual Sculptra treatment session, her face plumped out where the Sculptra was placed. This sort of 'preview' stage will last about 3 days in most patients before the visible effects disappear. Over the following 6-8 weeks, the face gradually plumps out and volumizes as the body forms collagen around the Sculptra that was injected. This is when you really begin to the cosmetic benefits of the Sculptra treatment.
Sculptra Results
Here are the results of her Sculptra cosmetic injection treatment. As you will note, she just looks more rested and youthful. That is because volume has been properly restored thanks to the Sculptra. You can't really pick out specific areas of her face where the volumizer was injected. It is just a gestalt impression that she looks more refreshed from having volume added back into her face. She just looks better in the after photo - and that is precisely the impression that you want when someone looks at you after having a cosmetic medical spa treatment - that you just look better than before.

Knowing where the Sculptra was injected, you can look more closely at her temples and cheeks to really see the bigger changes that have occurred as a result of treatment. These areas are now fuller with better light reflexes - which is often times what volume helps to do in the face region. More importantly, she still looks quite natural - just a better version of herself. And this is all due to adding volume back into the face with Sculptra. As we have said before, volume is a sign of youth!

#### Waist Fat Begone!
Ever look in the mirror and see excess fat that you wished was just gone? Patients do this all the time. But the real question is what will it take to get rid of that fat once and for all? Do you opt to have invasive body liposuction that involves scarring of the skin, tight postoperative compression bandages, and prolonged healing? Or is there a medical spa, office-based cosmetic procedure to get rid of unwanted waist fat that does not involve the risks associated with liposuction? Fortunately for thousands and thousands of patients, the answer is a resounding 'yes' to the latter question!

Coolsculpting is the actual procedure referenced above - a cosmetic treatment that can be done in the office to permanently get rid of excess fat without any incisions, needles or downtime. This male patient from San Diego was unhappy with his waistline as is seen here in the adjacent photo. Like so many men and women, a bulging waistline can the source of much frustration when it comes to trying to achieve an ideal body shape and size.

Fortunately for this patient and so many other San Diego, La Jolla and Coronado residents, Coolsculpting is readily available to you as offered by one of San Diego's leading medical spa teams headed by Dr. John Hilinski. In this case example, Coolsculpting was recommended to get rid of the excess waist fat - without having to make any cuts through the skin and with essentially no downtime.
Coolsculpting Waist Fat
After a few Coolsculpting treatment sessions, much of the excess waist fat was gone! Just take a look here. This is considered a pretty incredible cosmetic improvement for a procedure that was done in a comfortable office setting while answering emails and surfing the internet! And the great thing about Coolsculpting fat freezing treatments is that once fat has been killed off, it won't return again! That is because you are born with as many fat cells as you will ever have in your life. So once fat cells have been frozen away, they can't return to haunt you. Now residual fat cells can still enlarge if you fail to maintain a healthy diet and regular exercise routine. But the fat cells that were frozen away by Coolsculpting won't suddenly reappear down the road.

#### Wearing Glasses After Cosmetic Ear Reshaping
A question that has come up frequently over the past few months involves whether or not patients can wear eyeglasses or sunglasses after cosmetic ear reshaping, or otoplasty. Our San Diego facial plastic surgery office happens to do a very high volume of otoplasty surgery with probably more experience in cosmetic ear reshaping than most plastic surgeons in Southern California. Over the past few months many of our otoplasty patients have asked about resuming use of their glasses following surgery. The answer is that essentially all otoplasty patients can eventually wear their eyeglasses and sunglasses quite comfortably. The glasses may feel slightly different sitting on your ear following cosmetic ear reshaping, but you should have no significant discomfort or problem. In the first few weeks there certainly may be some pain since the incision line behind the ear does extend up to the top. However, most otoplasty patients can resume normal use of their glasses within 2-3 weeks of the surgery. Hope this helps anyone out there considering ear reshaping surgery in San Diego. To learn more about otoplasty and cosmetic ear surgery in San Diego, CA, use these links here to be taken to some of the most comprehensive online resources dedicated to otoplasty surgery and cosmetic ear reshaping - the San Diego otoplasty procedure page and the San Diego otoplasty primer for potential ear reshaping patients.

#### What A Nice Surprise!
I was treated to a very nice surprise yesterday when Tara and her husband, Neal, popped in to visit with me during clinic! Tara is a wonderful nurse who previously worked with us before moving back to Florida with Neal. It was nice reminiscing and catching up with the two of them.

#### What Are Nasal Exercises For After Rhinoplasty?
In many rhinoplasty cases where I have performed osteotomies (breaking the bone) I may ask my patients to do what we term are nasal exercises. Basically these involve pressure strategically placed along the side of the nasal bone using the patients’ fingers. During the rhinoplasty procedure we break the bone and reshape the nose to the desired position. A cast is then placed to fixate the bones during the first week or so. Once the cast is removed, the bones typically stay in their new position until they fuse completely around 6-8 weeks out from surgery. In some cases, however, the bones may drift slightly right after the cast has been removed. Sometimes this will not be visible for 1-2 weeks more because the overlying soft tissue is swollen and conceals the displacement. If the bone is noted to have drifted once swelling has subsided (appearing asymmetric or crooked), nasal exercises are recommended to get it back into proper alignment. This is a critical window of opportunity since the bones are still mobile and malleable up to 8 weeks out from surgery. Specific instructions to begin doing exercises should be provided by your surgeon as sometimes more pressure should be applied on one side versus the other (do not initiate this process on your own!). Usually the exercises are done 15-30 times throughout the day. Patients continue doing the exercises for up to 6-8 weeks. After that time the nasal bones are no longer mobile due to fusion of the fracture line, but hopefully by then the bridge is shadowing in a more symmetric, refined fashion.

#### What Are the Benefits of Laser Skin Resurfacing?
Designed to rejuvenate the surface of the skin, laser skin resurfacing treatments use a distinctly different tactic than facelift procedures. While a facelift is best used to minimize the appearance of deep facial creases and folds, laser skin resurfacing can better address fine facial wrinkles. Since laser skin resurfacing is a non-surgical procedure, the recovery from these treatments can be both faster and easier.

At our practice, Dr. John Hilinski uses the Lumenis® UltraPulse® Encore™ laser, which can revitalize the skin with two different configurations: ActiveFX™ and DeepFX™. This versatility allows Dr. Hilinski to customize each laser skin resurfacing treatment to target a wide range of common facial skin concerns, including:

 	Wrinkles
 	Acne scars
 	Cosmetic lesions
 	Precancerous lesions
 	Brown spots
 	Sun damage
 	Pigment inconsistencies
 	Uneven texture

The UltraPulse® laser can also simulate the growth of younger, healthy skin that can cause a tightening effect. As the collagen fibers begin to regenerate, patients often notice a “mini-lift” to the face. To learn more about the benefits of laser skin resurfacing, please contact our office today to schedule an appointment.

#### What Are the Benefits of Otoplasty Surgery?
Otoplasty, also known as ear pinning or ear shaping, can improve the position and/or shape of the ears. The procedure is most common in children between the ages of five and ten, as it helps prevent them from being teased and embarrassed at school. Otoplasty is also a viable option for adults who are self-conscious about their ears.

Ear surgery can improve a variety of cosmetic concerns, including:

 	The balance from one ear to the other
 	The proportion to the rest of the facial features
 	A disfigured or abnormal contour
 	The ear position on the head

Children typically require one to two weeks off from school to recover, while adults can often return to work within a week. With its minimal downtime, otoplasty proves to be a highly beneficial solution for individuals with prominent or abnormally shaped ears.

#### What Do I Look Like After Rhinoplasty?
This is a frequent question that I get asked from potential rhinoplasty and revision rhinoplasty patients. Normally most rhinoplasty patients will look ’supermarket’ presentable in about 10-14 days. I will remove the sutures, tape and cast (if placed) 5-6 days following your surgery. The nose looks swollen that day but, in general, rhinoplasty patients can appreciate the changes that were made even at that point in time. A significant improvement will be seen between that day and the 10-14 day mark to the point that most patients feel comfortable in the public eye.

#### What Is A Lip Lift Procedure?
A lip lift procedure is intended to shorten an excessively long upper lip. It is a procedure that is not done as commonly as other lip enhancement procedures. In fact, it is quite difficult to find a plastic surgeon who has any real experience in performing a lip lift procedure. There are basically two ways to shorten the vertical length of the upper lift. One involves making an incision under the nose where it junctions with the upper lip. This is called the subnasale approach. The second involves making an incision along the upper lip vermillion border where the pink and white lip meet. In either approach, a portion of the upper lip skin is resected, or removed, and the remaining skin is carefully sewn together. You might ask at this point, are patients really bothered by an excessively long upper lip? The answer is - absolutely. For instance, look at the case example provided below. This patient was bothered by the fact her upper lip appeared much too long for her face. The reality is her upper lip was indeed too long. I performed a subnasale upper lip lift procedure on her to remove a moderate amount of upper lip skin. This was done under local anesthesia in the office setting with only a few days of down time. The end result was a shorter upper lip that was more proportional for her face. A nice byproduct of a lip lift procedure is that many patients will see improved volume in the upper lip as it rolls up and out as a result of the vertical lift.

#### What is a Mid Facelift?
As discussed in our recent blog post comparing the difference between facelift and mini lift procedures, no one lifting procedure is right for everyone. In fact, our facial plastic surgeon explains that the mid facelift may be an effective

The mid facelift is a specialized procedure designed to correct loose, sagging tissue of the cheek area, a region of the face that is not always effectively treated by the traditional facelift. Patients who make the best candidates for the mid facelift are those who are unhappy with lost contour in the cheeks and drooping skin of the midface.

During the mid facelift procedure, Dr. John Hilinski lifts the muscles and tissue around the cheek area. This not only rejuvenates the cheeks, but it can also minimize under eye bags that tend to be accentuated with sagging tissue of the midface. By repositioning the tissue, volume that has seemingly depleted from the cheeks can often be restored.

The mid facelift is a minimally invasive facial procedure that can often provide beautiful results for patients with significant signs of aging of the midface. To learn if the procedure is right for you, please contact us to schedule your consultation with our skilled plastic surgeon.

#### What is Artefill?
Artefill, made by Suneva Medical in San Diego, is the only FDA approved permanent injectable filler on the market. Artefill is a fantastic injectable filler product that is a great alternative to Restylane, Perlane, Juvederm, Radiesse and Sculptra. It is used very much like the other fillers for smoothing out unwanted facial lines, creases and wrinkles. The one exception is the lip where Artefill should not be used. You do have to get skin tested before getting Artefill but it is highly unusual that patients respond to the skin test. If you are thinking of having a permanent dermal filler for soft tissue augmentation of your face, just give us a call. Let my staff know you are interested in Artefill. Look forward to seeing you.

Dr. Hilinski

#### What Is the Best Age for a Facelift?
The ideal age for you to undergo a facelift will ultimately depend upon your degree of facial aging. However, knowing the average age can help you understand if you may be a good candidate for the procedure. Among the patients who seek Dr. John Hilinski for facelift surgery, the most common age range is the mid to late 50s.

Signs of aging often become more noticeable as people near their late 30s. As you continue to age, the appearance of deep lines, skin folds, and volume loss gradually worsen. It is not uncommon for Dr. Hilinski to perform facelifts on patients in their 40s, though many people don’t need surgical intervention until they reach their 50s.

There is a benefit to undergoing facelift surgery earlier rather than later though. If you prove to be a good candidate for the procedure in your 40s, you can enjoy your results for longer and also benefit from the refreshed appearance during a time that is often important for one’s career. In addition, by addressing facial aging before it has become severe, you can achieve enhanced results and the ability to age more gracefully over time.

Although facelift surgery can provide beautiful, youthful results for many individuals, the procedure is not always the best solution. Some people need less invasive solutions to correct their milder forms of facial aging. Dermal fillers and BOTOX® Cosmetic, for example, may be more appropriate for some individuals.

In the end, your health and candidacy is more important than how old you are. There isn’t a specific age that is too young or too advanced for the procedure. If you have been considering a facelift, but aren’t sure if it is right for you, please feel free to schedule a consultation with Dr. Hilinski. By doing so, he can help guide you to the most beneficial solution based on your needs.

#### What is the Difference Between BOTOX® Cosmetic and Dysport®?
BOTOX® Cosmetic and Dysport® can both effectively minimize the appearance of facial lines and wrinkles for smoother, more youthful-looking skin. These popular injectables are neuromodulators that can temporarily inhibit the overactive facial muscles that often lead to unwanted wrinkles and fine lines. Both BOTOX® Cosmetic and Dysport® are nonsurgical treatments that can be used to treat the forehead, the lower face, and the area around the eyes.

There are, however, a couple key differences. In many cases, Dysport® can be more effective at treating the forehead region, while BOTOX® Cosmetic can more effectively treat the lower face. Additionally, while the results of Dysport® can often be seen within 24 hours, the results of BOTOX® Cosmetic can take one to two weeks to fully appear. The best way to determine which injectable can best achieve your cosmetic goals is to schedule a consultation with a board-certified facial plastic surgeon.

To learn more about BOTOX® Cosmetic and Dysport®, or to schedule a consultation with Dr. John Hilinski, please contact us today.

#### What To Expect During Your Sculptra Treatment
How long does the appointment take?

You can expect to spend a total of about an hour at the office for a Sculptra treatment. The majority of the this time is dedicated to the preparation, including application of a topical numbing agent over the desired treatment areas. The actual injection portion is only a couple of minutes!

What happens during treatment?

Patients are told to arrive approximately 30 minutes prior to their treatment, in order to allow ample time for numbing. A topical numbing medication is applied to the skin prior to treatment. Once the numbing cream has done it's job, the skin is then prepped with an antiseptic, antimicrobial skin cleanser. Sculptra is then carefully prepared and injected by Dr. Hilinski. Sculptra is mixed with lidocaine prior to injection, aiming to make the treatment as painless as possible. Most patients are very comfortable during the injection process.

What happens after treatment?

Upon leaving the office, Dr. Hilinsk’s staff will provide you with aftercare instructions following Sculptra treatment. You will be instructed to massage the injected areas for 5 minutes, 5 times a day, and for about 5 days. Dr. Hilinski and the staff will demonstrate how to properly perform this type of massaging. Massaging the areas treated with Sculptra helps to promote a smooth distribution of the product, thus aiding in the best possible results. This is also a critical step in terms of helping to reduce the incidence of nodule formation.

Will I see results right away?

Since Sculptra works by stimulating your own collagen production, it will take some time to see your results. After all, you didn’t lose that collagen overnight! You can expect to gradually watch the results emerge over the course of a few weeks to a few months. However, patients will see an immediate response of fullness, which we like to call a “preview,” that lasts for about 24-72 hours. Dr. Hilinski will typically see patients 6-8 weeks after their initial Sculptra treatment to check on the progress. Most patients can expect results to last upwards of 2 years.

Contact Us

To learn more about Sculptra® Aesthetic, please contact us today or call (619) 296-3223. We look forward to seeing you soon!

#### What Today’s Rhinoplasty Trends Reveal — and Why Some Patients Are Asking to Restore Their Original Nose
A recent GQ feature took a deep dive into the complicated world of modern rhinoplasty — exploring everything from long-standing insecurities to the pressures of social media, the rise of non-surgical contouring, and the risks of traveling abroad for cut-rate procedures. Through stories from men who reshaped their appearance, regretted their results, or rediscovered confidence in their natural features, the article highlighted just how emotionally charged nose surgery can be.
While some patients pursue refinement to feel more like themselves, others realize after surgery that they’ve lost a key part of their identity. That insight is where San Diego facial plastic surgeon Dr. John Hilinski offered one of the article’s most striking perspectives. Dr. Hilinski described a growing trend he sees in his practice: patients who want their nasal bumps put back after a previous surgery left them looking unfamiliar — even disconnected from their cultural or family background.
To address this need, Dr. Hilinski performs dorsal hump restoration, an advanced revision rhinoplasty technique that rebuilds a natural-looking profile rather than removing more cartilage. He explained that patients often seek him out from across the country and internationally for this highly specialized approach. For many, restoring the bump restores something deeper — a sense of authenticity, belonging, and self-recognition.
The GQ piece underscores how nuanced rhinoplasty truly is. Procedures can be life-changing in positive ways, as seen in patients who gained confidence after thoughtful, well-planned surgery. But the article also cautions against rushed decisions, overly aggressive cosmetic trends, and high-risk, low-cost surgeries performed abroad. It reminds readers that the nose is not simply an aesthetic feature — it’s tied to heritage, personal identity, and emotional well-being.
Dr. Hilinski’s contribution adds a crucial dimension to the conversation: rhinoplasty isn’t always about making the nose smaller or more uniform. Sometimes, the most meaningful transformation is helping patients feel like themselves again.

Read the Full Article Here

#### When Do Rhinoplasty Patients Typically Become Happy With Their Noses?
This is a question often asked by rhinoplasty & revision rhinoplasty patients. The answer to this in my patient population is usually around 1-2 months out. Most people feel presentable in the public eye around 10-14 days out from surgery but still don't quite appreciate the changes made to the nose. As the swelling subsides in the first 1-2 months, a majority of patients will begin to see the new shape of their nose becoming increasingly apparent. Obviously, skin thickness and type of nasal reshaping will impact the amount of swelling that one has. And keep in mind it does take upwards of a year or longer to see complete healing following rhinoplasty. But, in general, 1-2 months is fairly reasonable in terms of time it takes for rhinoplasty and revision rhinoplasty patients to become happy with their noses. Dr. Hilinski

#### Why Dilution Matters When It Comes to Botox Treatment
When it comes to Botox injections, achieving the best results isn’t just about the number of units used—it’s also about how the Botox is diluted and administered. Dilution plays a critical role in ensuring the effectiveness, longevity, and precision of your treatment. At John Hilinski, M.D. Plastic Surgery in San Diego, CA, we take a customized approach to Botox injections, carefully adjusting the dilution to suit each patient’s unique needs and treatment area.
The Science Behind Botox Dilution
Allergan, the manufacturer of Botox, recommends the standard dilution of mixing 2.5 cc to 4 cc of sterile saline solution with a 100-unit vial of Botox. This creates a concentration of 25 units per 1 cc of solution when using 4 cc of saline—a commonly used ratio for treating dynamic wrinkles on the forehead or crow’s feet.

However, not all areas of the face and neck require the same dilution. The appropriate concentration varies based on the size of the treatment area, muscle strength, and desired results. A more concentrated Botox solution may be used in targeted areas requiring precision, while a more diluted solution is often preferred for broader, more delicate areas.
Customized Botox Dilution for Different Treatment Areas
At John Hilinski, M.D. Plastic Surgery, we personalize each Botox treatment based on the patient’s aesthetic goals and facial anatomy. Here’s how dilution varies across different treatment areas:

 	Forehead Lines: The standard 25 units per 1 cc dilution is commonly used for treating horizontal forehead lines. This concentration effectively smooths wrinkles while preserving some natural movement for an expressive, youthful appearance.
 	Crow’s Feet: For the delicate area around the eyes, a slightly higher concentration may be used to ensure precise control while maintaining natural facial expressions.
 	Bunny Lines: The small muscles on the nose require a more concentrated solution, allowing for targeted treatment without affecting surrounding areas.
 	Botox Lip Flip: A more diluted Botox solution is ideal for the Botox Lip Flip, which subtly relaxes the muscles around the upper lip to enhance the shape without adding volume.
 	Neck and Jawline: Broader areas like the neck and jawline require a more diluted Botox solution to gently soften wrinkles and sagging skin without compromising natural muscle movement.

How to Tell If Botox Has Been Over-Diluted
Some providers may over-dilute Botox to stretch the product, which can lead to weaker results, shorter-lasting effects, and uneven outcomes. At Hilinski Plastic Surgery, we ensure patients receive the correct dosage for optimal, natural-looking results by charging per unit, not per syringe or treatment area.
Trust an Expert for the Best Botox Results
Choosing an experienced provider who understands the importance of proper Botox dilution is key to achieving long-lasting, natural results. At John Hilinski, M.D. Plastic Surgery in San Diego, we use precision techniques to ensure every Botox treatment is tailored to your unique facial structure and aesthetic goals.

Schedule your consultation today to experience the difference of expertly diluted and administered Botox!

 

#### Why Rhinoplasty May be Better Than the Non-Surgical Nose Job
Recently, there has been some buzz about changing the shape of the nose without the need for rhinoplasty surgery. While non-surgical alternatives are often attractive due to lower costs and shorter recovery times, they may not always be the better option in the long run.

In some cases, in order to change the shape of the nose without surgery, it requires a great deal of dermal filler to build up the bridge of the nose and reshape the nostrils. Some plastic surgeons believe that dermal filler injections performed on the nose have a higher risk of complications—some of which are irreversible. Additionally, while the price of a non-surgical rhinoplasty will cost less to begin with, patients will need to periodically return to their plastic surgeon when the effects of the injections begin to wear off. Over the course of a couple decades, the price of a non-surgical rhinoplasty may far outweigh the cost of a traditional rhinoplasty—not to mention the inconvenience of continuous follow-up appointments to maintain your results.

Finally, depending upon the shape of your nose and your cosmetic goals, non-surgical rhinoplasty may not be able to meet your expectations. For example, if you want to change the shape of a dorsal bump or minimize the appearance of a large nose, injectables will not be able to achieve results that are comparable to a surgical reshaping procedure. For more information about rhinoplasty, or to discover if you are a good candidate for this surgery, please contact us today.

#### Widening the Narrow Nasal Tip
I just saw one of my revision rhinoplasty patients in follow-up today and it reminded me to post a quick note on management of the narrow nasal tip following prior rhinoplasty. This particular patient had prior rhinoplasty performed by a different plastic surgeon years ago. He was unhappy with the fact his nasal tip was too narrow for his face. If you look at his preoperative frontal photo below left you can appreciate that his tip does appear excessively narrowed. In a male patient this can particularly distracting and an obvious indication of prior nasal reshaping. This patient elected to undergo revision rhinoplasty to help widen the tip and remove some of the stigmata of having had prior surgery. So how is this done technically? I performed an open rhinoplasty approach to afford me the best exposure possible. I then harvested ear cartilage, which was grafted to his existing nasal tip in order to widen the tip region as it transitioned to the sides of his nose. The red arrows below indicate precisely where the grafts were placed to widen the nasal tip. His postoperative rhinoplasty photo below right shows him following the surgery. Notice how his nasal tip is now wider with more appropriate balance when compared with the remainder of his nose and face. He still looks like the same patient, but with a more proportional nasal tip now.

#### Wow! See What Upper Eyelid Blepharoplasty Can Do!
Take a look at this more dramatic example of what upper eyelid blepharoplasty (eyelid lift) can do for you. This very pleasant lady was suffering from very heavy upper eyelids due to excess, weighted skin. I ended up performing a cosmetic upper eyelid lift to help give her a more rested and rejuvenated look. Let me know what you think of her results!

#### Wrinkle-Free Wednesdays
Just a quick historical note on Botox. Years ago, Dr. Hilinski came up with a Botox promotional called wrinkle-free Wednesdays, which was intended to give special pricing to San Diego Botox patients who scheduled on Wednesdays. By having so many Botox patients come in on one day - our office schedule and flow was made much easier. Unfortunately, as the months went on, Dr. Hilinski realized that nearly every Wednesday, the schedule was simply too booked to accommodate everyone wanting Botox and Dysport. So he had to open up other days of the week to treat all the patients wanting Botox and Dysport from the wrinkle-free Wednesday special. Since that time, Botox and Dysport have become so popular in our office that we got rid of our weekly special altogether - since every day is now wrinkle-free! On occasion, we do run specials on Botox and Dysport - but mainly through the distributors, Allergan and Galderma. Dr. Hilinski and Kellie Hartmann - our aesthetic RN - both offer injectable treatment services. When Botox and Dysport are scheduled with Kellie, there is a 10% discount offered. Contact our office today to schedule your appointment!

#### Youngest Age for Rhinoplasty in San Diego, CA
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.

#### Zwivel's Guide To Facelift Surgery Featuring Dr. Hilinski
Dr. John Hilinski is dedicated to helping patients reach their aesthetic goals. In addition to his surgical skill, Dr. Hilinski’s patients also benefit from his extensive knowledge and experience. He takes time to advise potential patients of their options, explain the benefits of each procedure, and develop a personalized treatment plan. Dr. Hilinski was recently featured as an expert in Zwivel’s Complete Guide To Facelift Surgery. Zwivel is a comprehensive plastic surgery platform that helps patients make informed decisions about cosmetic surgery.

On the topic of considering your age in the decision to have a facelift, Dr. Hilinski says, “There is a benefit to undergoing facelift surgery earlier rather than later. If you prove to be a good candidate for the procedure in your 40s, you can enjoy your results for longer and also benefit from the refreshed appearance during a time that is often important for one’s career. In addition, by addressing facial aging before it has become severe, you can achieve enhanced results and the ability to age more gracefully over time.” Learn more about facelift and mini facelift surgery at our San Diego office.

In their complete guide to plastic surgery, the team at Zwivel also put together tips for preparing for your facelift and optimizing recovery, including nutrition guidance. They also advise conducting thorough research when choosing a plastic surgeon in order to find a surgeon with upstanding credentials and adequate experience. Dr. Hilinski is double board certified and trained at Harvard Medical School - learn more about his credentials and experience.

Contact us with any questions, or to schedule a facelift consultation.

### Pages

#### About Us
About John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are dedicated to providing the highest standard of care in cosmetic and reconstructive facial surgery. Led by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, our practice offers advanced surgical and non-surgical solutions to help you achieve natural, beautiful results. With extensive expertise in rhinoplasty, facial rejuvenation, and other facial procedures, Dr. Hilinski and his experienced team are committed to delivering personalized, patient-centered care in a comfortable and welcoming environment.

Why Choose John Hilinski MD Facial Plastic Surgery?

When it comes to facial plastic surgery, choosing a highly qualified surgeon is crucial for achieving your aesthetic goals. Dr. John Hilinski is not only a board-certified facial plastic surgeon but also a respected leader in the field. With training from Harvard Medical School and specialized fellowship training in facial plastic and reconstructive surgery, Dr. Hilinski has the experience and expertise to perform a wide range of surgical procedures with precision and artistry.

At our San Diego practice, we are dedicated to providing cutting-edge treatments, including rhinoplasty, facelifts, eyelid surgery, and non-surgical treatments such as Botox and dermal fillers. We prioritize patient safety, comfort, and satisfaction, ensuring that every treatment is tailored to meet your specific needs and aesthetic goals.

Meet Dr. John Hilinski

Dr. John Hilinski is a board-certified facial plastic surgeon specializing in rhinoplasty, facial rejuvenation, and other cosmetic and reconstructive facial procedures. With extensive training and years of experience, Dr. Hilinski is renowned for his expertise in creating natural-looking results that enhance facial harmony. Learn more about Dr. Hilinski's background and approach to facial plastic surgery.

Please visit the pages below for more information about our practice:

At John Hilinski MD Facial Plastic Surgery, we believe that every patient deserves personalized attention and exceptional results. Our commitment to excellence ensures that you are in the best hands for all your facial cosmetic and reconstructive needs. Contact us today to schedule your consultation and take the first step toward enhancing your natural beauty!

#### Accessibility Policy
John Hilinski, M.D. is committed to ensuring that our website is accessible to people with disabilities. We seek to ensure that our website meets Level AA success criteria from the World Wide Web Consortium (W3C) Web Accessibility Initiatives (WAI) Web Content Accessibility Guidelines 2.1 (WCAG 2.1). These guidelines are the internationally recognized benchmark for building accessible websites. The  website has been developed using code compliant with W3C standards to display adequately on commonly used browsers and to be compatible with commonly used screen readers.

Pages on our website are being reviewed periodically by our trained staff and automatically with the help of axe: the Accessibility Engine software, to evaluate for compliance to accessibility guidelines. This is an ongoing process to improve the content accessibility of our website and issues that might come up are being taken care of.
Contact Us
Should you have any difficulty accessing the content of this site or have accessibility concerns, please contact using this form or if you would prefer not to use the form, you may email us at consultant@drhilinski.com.
Accessibility features of this website
Style switcher
If you find the text is too hard to read because of its color, please use the style switcher button available in the upper left side of every page. It will change the texts on our website and its background so that it can be read by people with moderately low vision
Text size
If you find the text on this site is too small, you can change it easily with a built-in zoom feature available in every modern browser. To do this select the appropriate option from the web browser menu or use the following keyboard combination

 	Zoom in: Ctrl +
 	Zoom out: Ctrl -

Motion Controls
All moving, blinking, scrolling and auto-updating elements on our website have an option to stop them right next to them.
Volume Control
Each video and audio file on our website has its own volume control available at the bottom right side of the media player.

#### African American Nose Case
This is a great example of what cosmetic nose reshaping can do in the African American rhinoplasty patient. This particular African American male presented to my office desiring to have his nose reshaped. He was unhappy with the fact he had a bump on the nose (also referred to by many patients as a ‘hump’ deformity) as seen from the side view and the bridge was too wide as seen from the front view. In addition, he had somewhat poor tip definition due to a more rounded shape and a broad, wide nostril base.

Typical African American Nose Features

All in all, these features are seen quite commonly in the African American nose and are a frequent source for those seeking cosmetic ethnic rhinoplasty surgery. African American noses often times have a nasal bridge that is too low, but, as in this case example, some African American rhinoplasty patients actually have a bump on the bridge. This is noted in the adjacent photo diagram as indicated by the white arrow, which shows the dorsal hump deformity on his profile view. What the dorsal hump deformity usually does is disrupt what would otherwise be a straight nasal profile while drawing unwanted attention to this area.

This finding is seen commonly seen in conjunction with a bridge that looks too wide from the front view. This is because the African American patient usually has a short nasal bone that does not allow the bridge to project very far out from the plane of the face. In addition the nasal bone comes off of the face in a more lateral (toward the side of the head) location. Consequently, the bony portion of the nasal bridge gives the nose the appearance of being too wide, or broad, when seen from the front.

The lack of tip definition in this African American rhinoplasty patient is directly related to the underlying anatomy. In the average African American nose, the tip skin is quite thick and the underlying cartilage is fairly weak. This is a setup for poor tip definition since the thick ethnic skin tends to easily ‘hide’ the underlying cartilage, which is the one thing that gives the nasal tip its shape. As seen in the adjacent photograph, this African American patient’s nasal tip is moderately rounded with a relative lack of definition.

With regard to his broad, wide nostril base – this is also frequently seen in the African American rhinoplasty candidate. In many cases, not only is the actual width of the base (as measured from the outer margin of one nostril to the outer margin of the opposite side) excessive, the width of the nostril opening (referring to the sill region) is also too wide. In the adjacent photo diagram, the overall nasal width is indicated by the red line that spans the distance from the outer margin of one nostril to the outer margin of the other. We often times refer to this portion of the nostril base as being excessively ‘flared’ when we describe it being too wide. This is because the thick skin in this region curves outward, or flares, to the side of the nose. The more flaring that is present, the wider the nasal base appears. But one must also pay attention to the sill region as indicated by the yellow line. This segment corresponds to the actual width of the nostril opening, which is commonly excessive in the African American nose and has to be acknowledged in conjunction with the wide, flared nostril base, if present.

African American Rhinoplasty

In this particular case, I recommended an open rhinoplasty approach for the cosmetic reshaping process. The open approach in the African American rhinoplasty patient provides significant advantages in terms of surgical exposure and ability to more accurately reshape the nose.

Using this open rhinoplasty approach, his nasal bridge was rasped, or sanded, down to try and reduce the prominence of the hump deformity. Once the bump was addressed, attention was then turned to the nasal bones. As shown in the adjacent photo diagram, I actually had to cut his nasal bone on each side. This corresponds to the dashed yellow line in the photo where an instrument called an osteotome was used on the inside of the nose under the skin to cut the bone. Once the bone is cut on both sides, it can then be moved inward to narrow the bridge. Many African American rhinoplasty patients and surgeons refer to this maneuver as ‘breaking the nasal bones’ when it is performed. In essence, that is what is being done, but with a very precise technique to create as much symmetry in the nose as possible. If you look closely, though, you will see that these osteotomies to ‘break the nasal bones’ only really narrow the upper one third to one half of the nose. As a result, something else has to be done to the lower one half of the nose – the tip, in particular – to narrow the remainder as desired.

In this particular African American rhinoplasty case example, the tip was narrowed using a number of maneuvers. This is actually more the rule than the exception when it comes to ethnic rhinoplasty cases like African American noses – a sequence of surgical steps is necessary to achieve the desired change in tip shape. In this instance, the nasal tip was defined using a combination of cartilage reshaping and conservative thinning of the overlying soft tissue. This latter maneuver was necessary in order to make the skin thinner so that it would more readily show the type of changes being made to the cartilage.

The wide nasal base was addressed by using a combination of wedge and sill excisions. This involved removing some of the thicker, flared soft tissue around the base (bottom) of the nose while also removing some skin from inside of the actual nostril opening.

African American Rhinoplasty Results

Shown below are the results of this particular patient’s African American rhinoplasty procedure.

Frontal Before and After

As you can see from the before and after frontal photos, he now has a more refined looking nose that, in general, appears more narrow. It certainly does not look too thin for his surrounding facial features. It just shadows better when seen from the frontal view and is not as broad as it used to be in terms of the nasal tip and base. Most importantly, his nose still appears ethnic as it should for any African American rhinoplasty patient. Keep in mind the goal in ethnic rhinoplasty is to reshape the nose such that certain undesirable features are minimized – but maintenance of an ethnic appearing face (and nose) is vital to achieving natural looking results.

Oblique Before and After

The oblique before and after photos also visually demonstrate how the nose now looks smaller from an angled view. As you can see in his before surgery photo, the nasal base is quite rounded and flared – contributing to the appearance that his nose is just wide at the bottom. This is one of the more common issues encountered in African American rhinoplasty. Following surgery, though, you can tell this portion of the nose has been reshaped to look more narrow.

Lateral Before and After

On the lateral before and after photos, you can see that the bridge has been reshaped to appear straighter on his profile view. This gives the illusion the nose is smaller and now more refined.

Base Before and After

On the base view of the nose, you can appreciate even more so how the bottom of the nose has been narrowed. More specifically, you can see how the wedge and sill excisions made around the base of the nose create a less flared appearance. In combination with the tip reshaping, the overall appearance of his nasal base is now more triangular and defined.

#### African American Nose Job
This is a great case example that illustrates many of the considerations involved in African-American rhinoplasty (nose job) surgery. Like many African-American rhinoplasty patients seeking nose job surgery, this young lady from San Diego found my office after researching rhinoplasty surgery online. She then schedule a consultation with my office to determine whether or not cosmetic nose surgery was an appropriate choice for her.

African-American Rhinoplasty Presentation

On presentation, her main desire was to have a nose that was more refined through the tip region. But she also desired a higher bridge and more narrow nasal base. Much like many other rhinoplasty patients, she desired these changes, yet clearly wanted to maintain a nose that was ethnically consistent with her African-American facial features.

You can see from the preoperative photos shown here that she had several of the more common characteristics seen in African-American patients seeking cosmetic nose surgery. This included thick nasal skin, a low nasal starting point, a flat, wide nasal bridge, poor nasal tip definition with a bulbous appearance, and a wide nasal base.

With regard to her low nasal starting point, this deserves a bit more of a detailed explanation. The ‘starting’ point of the nose is typically evaluated from the lateral view as is shown here. In simple terms, this corresponds to the point where the forehead ends and the bridge of the nose begins. Ultimately, the perceived length of the nose is based on where it starts – which is why the nasal starting point can significantly impact the cosmetic appearance of the nose. In cases where the nasal starting is too high, the nose will often times look excessively long. If the nasal starting point is too low, as is the case here, the length of the nose will appear somewhat short. In the latter instance, something needs to be done to lift, or elevate, the upper portion of the nasal bridge in order to change the nasal starting point. In doing so, the perceived length of the nose will be increased as desired.

African American Nose Job Surgery

During consultation with this patient, a more specific surgical planned had to be devised to raise the bridge height. This is commonly referred to as dorsal augmentation in the rhinoplasty world. In most ethnic rhinoplasty patients, there are several options for dorsal augmentation. These options essentially distill down to two main categories that include the following:

Cartilage

Autogenous septal cartilage

Autogenous ear cartilage

Autogenous costal, or rib, cartilage

Cadaveric (tissue banked) costal cartilage

Nasal implants

Goretex

Porex

Silicone

In terms of cartilage, there are several different potential sources with the septum, ear and rib being the most common choices. Autogenous is a term that simply means the cartilage is taken from your own body. So, for example, an autogenous septal cartilage graft refers to a segment of cartilage taken from inside of the nose (the septum) and placed elsewhere to effectively change the overall shape. In this setting, the septal cartilage would be used to augment, or raise, the bridge height. Cadaveric cartilage is an alternative source that can be obtained from a tissue bank and used for similar purposes in terms of grafting. Some rhinoplasty surgeons prefer to use autogenous rib cartilage, while others lean toward use of cadaveric rib cartilage instead. Because there are advantages and disadvantages with each source, the final decision is one that should be made with your rhinoplasty surgeon only after thorough discussion.

In terms of nasal implants, all of these are comprised of biocompatible synthetic materials that can be substituted for cartilage grafting. Like the various cartilage choices, each of these also has advantages and disadvantages. One of the primary risks with nasal implants is rejection of the synthetic material because it can act as a foreign body once placed into the nose. Fortunately, this is not very common when the patient has moderately thick nasal skin and meticulous surgical technique is used.

In this particular case, we had gone into surgery with the idea that Goretex would likely be used to build up her bridge height. This was largely because most ethnic rhinoplasty patients have an insufficient amount of septal cartilage for complete bridge augmentation. Surprisingly, once I began performing her rhinoplasty procedure, I discovered a more-than-average amount of septal cartilage that could be used to build up her nasal bridge height – obviating the need to use any nasal implant. Not only did she have enough septal cartilage for raising the bridge, she also had a sufficient amount to reshape the nasal tip.

The adjacent rhinoplasty diagram summarizes more graphically the key maneuvers used to reshape this patient’s nose. An open rhinoplasty approach was utilized to gain optimal exposure of the nasal tip and bridge. One of the first steps during her rhinoplasty was to assess whether or not there was sufficient septal cartilage for the planned grafting. As noted previously, there was a surprising amount that was able to be harvested (indicated by the partially transparent red shaded area). This cartilage was taken out of the inside of the nose while preserving an adequate amount to maintain structural support of the bridge and tip. The cartilage was then recycled to produce the various grafts needed to reshape the nose.

In order to augment the dorsal height, a layered graft was created and placed over the upper one-half of the bridge. This is represented by the solid orange shaded areas. An additional softer type of graft, called a crushed cartilage graft, was placed just below this area near the middle of the bridge. Crushed cartilage grafts like this are commonly used to help transition the contour in very specific areas.

The same septal cartilage was also used to generate what is called a ‘cap’ graft that was carefully placed in the tip to improve definition. The cap graft was placed only after permanent sutures were used to narrow the native tip cartilage in an attempt to reduce the unwanted bulbous appearance. To further narrow the look of her tip, conservative cephalic trimming was performed (indicated by the solid red shaded areas along the lower lateral cartilages). The cephalic trimming helped to reduce some of the excess volume in the supra-tip region, thus helping to create an even more shapely, refined nasal tip.

Finally, the base of her nose was considered somewhat wide, especially with smiling and animation. This is actually a finding frequently encountered in the African-American rhinoplasty population. In order to help narrow the base, bilateral ‘sill excisions’ were performed. These are shown in the diagram as the red shaded areas at the bottom of the nostril openings. This represents where some of the excess soft tissue was removed from around the nostril opening in order to allow the base of the nose to be narrowed. This type of base narrowing technique is different from what is called a ‘wedge’ or ‘Weir’ excision. The latter involves taking a wedge of soft tissue out of the base of the nose, but closer to where the nose junctions with the cheek. Although both types of base reduction technique are commonly used, they differ in how they will help to narrow the nose.

African-American Rhinoplasty Recovery

Before the results of this particular African-American rhinoplasty procedure are shown, it is worth noting that additional care may be needed during the recovery process following rhinoplasty. For instance, in this particular case example, the patient had slight resorption along the inferior border of the bridge graft. Resorption and warpage of cartilage grafts is a well-known, potential complication of rhinoplasty surgery. Fortunately, it only occurs in a minority of rhinoplasty patients. But when it is encountered, certain additional measures need to be taken to address the issue so that the best possible rhinoplasty outcome is achieved.

As the cartilage reabsorbed, the middle portion of her nasal bridge developed a slight depression that was more easily seen from the side view of the nose. After discussing with her the various options to restore proper bridge contour, we both decided on a non-surgical technique. This involved using a non-absorbable injectable filler, called Bellafill (previously known as Artefill). Over several office visits, tiny amounts of Bellafill were added to the specific location along the bridge where the cartilage had reabsorbed. Gradually, this area was built back up to restore the desired bridge contour and shape. In the end, this option proved to be quite effective while avoiding additional, revision rhinoplasty surgery.

African-American Nose Job Result

This African-American patient’s nose job results are shown here from various angles. Overall, you can tell that she now has a much more refined looking nose. More specifically, her nasal bridge has now been nicely augmented resulting in a nose that now looks longer. In addition, her nasal bridge is now more defined – especially as seen from the frontal view. Just look for yourself how light now shadows in a much more pleasing manner along the sides of her nose. Her nasal tip has also been reshaped to provide a more narrow, less bulbous look. From her base view, you can also readily appreciate how the nasal tip has been refined and the base has been narrowed. The overall effect is achievement of beautiful, soft triangle-shaped nasal tip. Yet, she still has a strong ethnic nose that is consistent with her inherent African-American features.

African-American Cosmetic Nose Surgery

African-American nose job surgery is a very challenging subset of rhinoplasty that should only be attempted by expert nose surgeons, like myself, who have dedicated experience in managing this particular patient population. If you are African-American and considering cosmetic nose surgery, please do not hesitate in contacting my San Diego office today to discuss your options.

#### African American Rhinoplasty
African American Rhinoplasty with Dr. John Hilinski: Specialized Nose Reshaping in San Diego, CA

African American rhinoplasty is a specialized form of nose reshaping surgery designed to enhance the appearance of the nose while respecting and maintaining the unique ethnic features that define African American beauty. This procedure focuses on achieving balance, refinement, and proportion, ensuring results that are both natural-looking and harmonious with the patient's facial features. Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, brings extensive experience and a deep understanding of the distinct characteristics involved in African American rhinoplasty, offering personalized care to achieve each patient's aesthetic goals.

What is African American Rhinoplasty?

African American rhinoplasty is tailored specifically to address the nasal concerns of African American patients, who may seek to refine the shape or size of their nose while preserving their ethnic identity. Common goals of this procedure include narrowing the nasal bridge, refining the nasal tip, reducing flaring nostrils, or enhancing overall nasal symmetry. Unlike traditional rhinoplasty, which often focuses on a Westernized standard of beauty, African American rhinoplasty requires a nuanced approach that respects the patient's cultural and aesthetic preferences.

Dr. Hilinski employs advanced techniques that consider the unique anatomical differences in African American noses, such as thicker skin, wider nasal bridges, and softer cartilage. His approach ensures that the natural contours and characteristics of the nose are enhanced rather than altered beyond recognition. By combining his expertise with a personalized treatment plan, Dr. Hilinski aims to deliver results that enhance the patient's natural beauty without compromising their ethnic features.

Why Choose African American Rhinoplasty?

Patients may choose African American rhinoplasty for a variety of reasons, including:

Dr. Hilinski's patient-centered approach ensures that each individual's unique goals and expectations are carefully considered. His expertise in ethnic rhinoplasty allows him to create customized surgical plans that deliver natural-looking, culturally sensitive results.

Who Makes a Good Candidate for African American Rhinoplasty?

Good candidates for African American rhinoplasty include individuals who:

Are in good overall health and non-smokers

Have realistic expectations about the outcome of the surgery

Desire to enhance the shape, size, or symmetry of their nose while preserving their ethnic features

Have specific cosmetic or functional concerns about their nose, such as a wide bridge, bulbous tip, or nostril flare

Have completed facial growth, typically by their mid-teens

Dr. Hilinski conducts a thorough evaluation during the consultation process to determine if rhinoplasty is the right choice for each patient. He listens closely to their concerns, assesses their nasal anatomy, and discusses their desired outcomes to ensure that the procedure aligns with their aesthetic goals.

FAQ: African American Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering African American rhinoplasty and want to explore how this specialized procedure can enhance your nasal appearance while respecting your ethnic identity, schedule a consultation with Dr. John Hilinski. As San Diego's expert in ethnic rhinoplasty, Dr. Hilinski combines his extensive credentials, personalized approach, and commitment to excellence to provide exceptional care. Contact us today to begin your journey toward achieving your ideal nose.

#### African American Rhinoplasty
Management of the African American nose is a particularly challenging surgery that requires true expertise and experience in ethnic rhinoplasty. African American rhinoplasty necessitates a true appreciation of the African American nose so that the final result will look natural on the face. Unfortunately, all too often I will see African American rhinoplasty results by other plastic surgeons that look surgically overdone or have the stigma of being surgically altered. The common theme with these noses is that they appear ethnically inconsistent with the surrounding African American facial features. In order to create create a natural appearing nose on the African American face, a rhinoplasty surgeon must have a thorough understanding of the ethnic nose with dedicated experience in performing this surgery on a consistent basis.

As I have pointed out in other topics related to ethnic rhinoplasty, the goal with the African American rhinoplasty patient is not to create a Caucasian looking nose. Rather, it is to reshape the nose so that certain undesirable features are addressed while preserving other African American features in an effort to maintain ethnic consistency.

African American Rhinoplasty Evaluation

The following list includes a variety of features that are commonly seen in the African American patient seeking rhinoplasty surgery. As you will note, not all African American rhinoplasty patients exhibit all of these features. In some African American rhinoplasty candidates several of these features are more prominent than in others. That is precisely why it is so important to evaluate every African American rhinoplasty patient on an individual basis.

Thicker than average skin (particularly above the nasal tip) in combination with softer/weaker than average cartilage

Flatter, broader bridge with a low nasal starting point

Variable presence of a dorsal hump or bump as seen from the side view

Poor tip definition with a more rounded and bulbous tip shape

Wide nasal base that includes alar flaring as well as a wide sill with horizontally oriented nostril openings

Columella tends to be shorter than average with poor tip projection

So what do these features look like in real life? The following is provided to highlight the various African American nose features using actual patient photographs.

African American Nose Job Surgery

In a majority of African American patients, an open rhinoplasty approach is indicated in order to gain adequate exposure and visualization of the nasal framework and soft tissue. In some cases, a closed rhinoplasty approach can be used for African American rhinoplasty if there is mostly nasal bridge work being done.

Given the various issues noted in the list above, African American rhinoplasty usually involves one or more of the following maneuvers to achieve the desired outcome.

One of the first things that needs to be addressed when doing African American rhinoplasty surgery is the relatively thicker nasal skin and soft tissue. In some cases, the thicker skin requires more deliberate contouring of the underlying cartilage in order to reveal more definition and shape to the nose. In other cases, the skin might actually need to be carefully thinned in certain areas in order for the nose to become more defined.

In many African American nose job procedures, the nasal bridge usually requires reshaping. In some patients, the hump or bump is taken down to provide a straighter profile. In others, the nasal bridge is augmented (lifted) to bring the bridge higher on the face so that it appears more narrow when seen from the frontal view. Still in other African American noses, the nasal bones are so wide they need to be brought in closer to one another – also to give a more narrowed appearance. In the midst of these procedures, the nasal starting point may also be moved to a higher position.

In a good majority of African American nose jobs, the nasal tip requires reshaping to address the more rounded, poorly defined contour. Since the underlying cartilage structure is usually weaker than the average nose, this means that cartilage repositioning and grafting is typically necessary in order to achieve even moderate improvement in tip definition. Given the fact that most African American noses do not have a generous amount of septal cartilage that can be used for grafting, other sources of cartilage might be needed. This includes possible use of ear cartilage (also known as auricular cartilage) and even rib cartilage in some rare instances.

When considering the African American nasal base, you have to look at two different issues. The first is whether or not the alar base area is flared. The second is the width of the actual nasal sill region. Alar base flaring refers to how curved the nostril base might be, while sill width simply refers to how wide the nasal sill is between the columella and the outer border of the nostril. In a good number of African American rhinoplasty patients, both areas require narrowing. In some patients, only one or the other has to be reshaped. Regardless of what is being done to narrow the nasal base, it is vital that this area is not overdone during the rhinoplasty surgery. It happens to be one of the most unforgiving areas of the nose when it comes to cosmetic reshaping. Therefore, it is best to approach this area in a conservative manner. It must also be kept in mind that it is normal to have a slightly wide nasal base when you are dealing with an African American nose. Careful attention should be paid to preserve at least some of this ethnic identity when reshaping the African American nasal base. Yes, an excessively flared and wide nasal base is undesirable – but some of this is also what contributes to the beauty of the African American face.

With regard to a potentially short columella in the African American nose, this often times requires reshaping in order to help with nasal tip projection. In many African American rhinoplasty patients, the tip is underprojected – meaning, it does not stick out far enough. The consequence of this (in combination with the other tip issues) is a nasal tip that does not appear as narrow as desired. Therefore, restructuring the columella in conjunction with reshaping the nasal tip will aid in providing a more defined African American nose.

African American Rhinoplasty Examples

The following are case examples of African American rhinoplasty (nose job) surgery performed by me. These patients represent what is considered fairly typical results in my practice when it comes cosmetic nose reshaping in African American patients.

What you will notice when you review these cases is the fact that my patients look quite natural following their nose job surgery. In each case, there were maneuvers done to reshape certain features of the nose that were disliked or unwanted. But many of the African American features were preserved to maintain a natural looking nose. Could you opt for more tip definition, for instance, in some cases? You could. However, you then run the risk of making the nose appear too done and surgically altered – not the kind of change that most African American rhinoplasty patients are looking to achieve.

Case 1 Frontal Photos

Case 1 Oblique Photos

Case 1 Lateral Photos

Case 2 Frontal Photos

Case 2 Oblique Photos

Case 2 Lateral Photos

Case 3 Frontal Photos

Case 3 Oblique Photos

Case 3 Lateral Photos

African American Rhinoplasty Photos

To see additional examples of African American cosmetic nose job surgery results, visit our rhinoplasty gallery.

#### Alle
We strongly encourage all of our Botox and Juvederm patients in San Diego to join the Alle rewards program offered by Allergan. This was previously referred to as Brilliant Distinctions. Alle was established to help reward Botox and Juvederm patients for their loyalty to Allergan cosmetic products and services.

The following diagram highlights the various skin care products and cosmetic services that fall under the umbrella of Alle. As you can see, there is a tiered system that allows you to earn different points for different levels of products and services. So don’t miss out on any opportunity to get credit when you receive any of the following from Dr. Hilinski’s

New to Alle?

Are you new to Alle? Sign up now by following the link provided here.

Already an Alle Member?

Are you already a Alle member? Use this link here to sign into your membership account to earn or redeem points.

#### Ariessence PDGF
Experience the Benefits of Platelet Derived Growth Factor (PDGF) with Dr. John Hilinski, a Renowned Facial Plastic Surgeon

Dr. John Hilinski, a leading facial plastic surgeon based in San Diego, is proud to offer Ariessence PDGF as part of his comprehensive suite of skin rejuvenation and hair restoration treatments. Ariessence is a groundbreaking product that harnesses the powerful biological protein, Platelet Derived Growth Factor (PDGF), to stimulate cell growth and tissue regeneration. This means faster healing, enhanced collagen production, and improved cosmetic outcomes for our patients.

What is Ariessence PDGF?

Platelet Derived Growth Factor is a naturally occurring protein within our bodies that plays a vital role in wound healing and tissue regeneration. Ariessence is a synthetic, pharmaceutical-grade version of PDGF designed for topical application. When used during cosmetic procedures, it significantly enhances the regenerative process, resulting in smoother, healthier skin and soft tissue.

How Does PDGF Compare to PRP and Exosomes?

FDA Approved and Proven Safe

Ariessence PDGF has been FDA-approved for multiple medical applications and has been used in over 5 million successful treatments worldwide. Unlike some exosome treatments that lack FDA recognition, Ariessence has established its safety and efficacy, offering patients peace of mind.

Benefits of Ariessence for Cosmetic Treatments with Dr. Hilinski

Dr. Hilinski and his experienced staff recommend Ariessence in combination with a variety of cosmetic procedures, such as RF microneedling and laser skin treatments. When used together, patients experience:

Case Example

Ariessence for lower eyelid hollows and shadows. These results here are after just one (1) treatment. 

Before

After

Ariessence for Hair Growth

Ariessence is not just for skin; it is also a powerful tool in hair restoration. The growth factor in PDGF targets receptors in the hair follicles, stimulating thicker and fuller hair growth. It’s an ideal solution for patients experiencing early signs of hair thinning who are looking for an effective, minimally invasive way to enhance their hair growth.

Case Example: Chemotherapy-Related Hair Loss and Recovery with Ariessence + Nutrafol

Before

After

Before

After

Patient Profile: 

A woman in her early 70s, recently completing chemotherapy, presented with significant diffuse hair loss and thinning.

Treatment Approach:

Initiated Ariessence scalp injections, an advanced biologic therapy designed to stimulate follicular recovery and enhance scalp health.

Complemented with daily Nutrafol supplementation, providing targeted nutraceutical support for hair regrowth through key botanicals, vitamins, and minerals.

Timeline of Results

6 weeks post-treatment: Patient demonstrated remarkable visible improvement in hair density and coverage. New growth was observed across the frontal and crown regions, with a noticeable return of thicker, healthier hair shafts.

Patient reported increased confidence and satisfaction with progress.

Clinical Significance:

This case underscores the potential of combining biologic scalp injections with nutraceutical support as a non-surgical restorative option, particularly valuable for individuals recovering from chemotherapy-induced alopecia.

Rapid recovery within six weeks illustrates how follicular activity can be reactivated even in older patients, highlighting the regenerative potential of modern therapies.

Frequently Asked Questions About Ariessence PDGF

Schedule Your Ariessence Consultation with Dr. Hilinski Today

If you’re interested in learning more about how Ariessence can enhance your cosmetic or hair restoration treatments, schedule a consultation with Dr. John Hilinski in San Diego today. With his expertise and dedication to utilizing the latest advances in aesthetic medicine, you can achieve your beauty goals with natural, long-lasting results.

#### Artistry or Engineering?
We have so many of our San Diego patients who comment on how much of an artist Dr. Hilinski is when it comes to rhinoplasty and nose job surgery. But there are also those patients who ask how the nose can be re-engineered to be structurally sound and functional.

So the question arises – is there more artistry or engineering involved when it comes to reshaping noses during rhinoplasty and revision rhinoplasty surgery? The answer that Dr. Hilinski gives so often is – it’s both!

Regardless of so many plastic surgeons out there claiming they are artists by nature, the reality is that rhinoplasty is both artistry and engineering – with some noses needing a bit more of one or the other based on individual needs and desires.

Rhinoplasty Artistry

Is there some degree of artistic expression when it comes to rhinoplasty reshaping of the nose? Absolutely. You certainly have to have a keen eye for beauty and balance, which clearly comes from having an artistic bend. And most plastic surgeons have a natural affinity to art.

Rhinoplasty Engineering

But make no mistake about it, rhinoplasty is not all artistry and creativity. In fact, all rhinoplasty surgeons have to work within the confines an individual person’s skin, cartilage and bone. Whereas artistry has no limit in terms of creativity – there are real limitations when it comes to reshaping anyone’s nose. For instance, the thickness of someone’s skin is a huge limiting factor in some rhinoplasty procedures. The same goes for cartilage framework support. In some rhinoplasty patients, their cartilage is inherently so weak that grafting has to be done to help create a stronger framework for their nose. This all falls under engineering and has much less to do with artistic expression of the rhinoplasty surgeon. Yes – the rhinoplasty expert has to try and create a beautiful looking nose that is in harmony with the rest of the face. But they can only really accomplish this if they know how to build a nose – which truly requires more of an engineering mind.

#### Asian Eyelid Surgery
Asian Eyelid Surgery with Dr. John Hilinski: Expert Double Eyelid Surgery in San Diego

Asian eyelid surgery, also known as double eyelid surgery or Asian blepharoplasty, is a specialized cosmetic procedure designed to create a more defined upper eyelid crease. This procedure is popular among individuals of Asian descent who desire a more prominent eyelid fold while maintaining their ethnic appearance. San Diego-based facial plastic surgeon Dr. John Hilinski, a double board-certified facial plastic surgeon, offers expert Asian eyelid surgery, using advanced techniques to achieve natural, balanced results tailored to each patient's unique goals.

Why Consider Asian Eyelid Surgery?

Many individuals seek Asian eyelid surgery for both cosmetic and functional reasons. Some people naturally lack an upper eyelid crease or have a less defined crease, which can cause their eyes to appear smaller or more tired. Others experience eyelid ptosis or drooping, which can obstruct vision.

The goals of Asian blepharoplasty include:

Creating or enhancing the upper eyelid crease

Achieving a natural, symmetrical appearance

Improving eyelid functionality, especially for those experiencing drooping or hooded eyelids

Enhancing the overall aesthetic of the eye, leading to a more youthful, awake, and refreshed appearance

Asian eyelid surgery can create a subtle but significant enhancement to the appearance of the eyes, providing better contour and symmetry while maintaining the patient's ethnic identity.

The Asian Eyelid Surgery Procedure

Asian blepharoplasty is a customized procedure that involves creating a natural-looking crease in the upper eyelid. Dr. Hilinski uses two primary techniques depending on the patient's unique anatomy and goals:

Incisional Method: The incisional method is recommended for patients with thicker eyelids, excess skin, or fat. A small incision is made along the upper eyelid, allowing Dr. Hilinski to remove excess tissue and create a defined crease. The incision is discreetly hidden in the new fold for minimal visible scarring.

Non-incisional Method: This technique, also known as the suture method, is suitable for patients with thinner skin and minimal excess tissue. Small sutures are placed within the eyelid to create the desired fold without the need for an incision. This method typically results in a faster recovery time.

Both techniques are designed to achieve a natural, aesthetically pleasing result that enhances the eyes while preserving the patient's ethnic characteristics.

Benefits of Asian Eyelid Surgery

Creates a natural-looking upper eyelid crease

Enhances the appearance of the eyes for a more youthful, alert look

Improves symmetry and balance between the eyes

Helps resolve functional issues related to eyelid ptosis

Minimal scarring and downtime

Long-lasting results with a personalized approach

Recovery from Asian Eyelid Surgery

Recovery from Asian eyelid surgery is generally quick and involves minimal discomfort. Patients can expect some swelling and bruising in the first week following surgery. Most individuals can return to normal activities within 7 to 10 days. Dr. Hilinski will provide personalized aftercare instructions to ensure optimal healing and long-lasting results.

Why Choose Dr. Hilinski for Your Asian Eyelid Surgery?

Dr. John Hilinski is renowned for his expertise in facial plastic surgery, particularly in procedures involving the delicate structures of the eyes. He has extensive experience working with patients of diverse ethnic backgrounds and is skilled in tailoring his techniques to achieve the most natural, aesthetically pleasing outcomes. Dr. Hilinski's commitment to patient care, combined with his ability to achieve beautifully subtle results, has earned him a reputation as one of the top plastic surgeons in San Diego.

Double board-certified in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery

Extensive experience in performing eyelid surgeries, including specialized Asian blepharoplasty

Focus on delivering natural, long-lasting results with minimal scarring

Comprehensive, personalized care from consultation through recovery

Asian Eyelid Surgery FAQ

Schedule Your Asian Eyelid Surgery Consultation

To learn more about how Asian eyelid surgery can enhance your appearance while maintaining your natural features, schedule a consultation with Dr. John Hilinski in San Diego. With his expert skills and commitment to patient satisfaction, Dr. Hilinski is dedicated to helping you achieve the look you desire.

#### Asian Nose Case
Asian rhinoplasty is just one of the many subtypes of ethnic rhinoplasty surgery that I happen to perform on a regular basis. I have previously written a general overview of the Asian nose job patient to give a broad perspective on some of the thoughts that go into this type of cosmetic nose reshaping. To complement this Asian rhinoplasty discussion, I have provided this particular case example using a real Asian nose job patient of mine.

Asian Rhinoplasty Consult

This patient presented to my office with a chief complaint of having a poorly defined Asian nose. On her examination, one can appreciate that her nose has some of the more classic features of the Asian rhinoplasty patient. This includes a somewhat wide nasal bridge as shown in the adjacent photo diagram (click on the image to enlarge). The blue arrows indicate where the upper and middle portions of the bridge appear poorly defined and washed out. On this frontal view you can also appreciate how her nasal tip is rounded – consistent with many Asian rhinoplasty patients who present for cosmetic nose reshaping.

On her oblique view (click on the image to enlarge), you can see more signs of the nasal tip being too rounded for her desires (indicated by the blue curved outline of her bulbous nasal tip). In addition, you can see how she demonstrates a relatively rounded alar base as shown by the red arrow. This is a classic finding in many ethnic rhinoplasty patients that contributes to the base of the nose looking excessively wide. In many cases, Asian rhinoplasty patients describe this area as looking too thick or being too prominent for their desires. This type of finding is entirely consistent with the average Asian nose having much thicker skin than, for instance, a Caucasian nose.

On the side view of this patient’s nose, you can see, again, how her nasal tip does not appear very well defined. In fact, it appears more rounded than anything. This is shown in the blue outline of her nasal tip as shown to the left (click image to enlarge). As noted in our Asian rhinoplasty general discussion, it is fairly common for Asian nose job patients to have more of a bulbous tip shape due to the thicker overlying soft tissue. In addition to the rounded nasal tip, this patient also had a slight hump along the bridge. This is also shown in blue in the adjacent diagram. This particular finding is somewhat unusual in the Asian rhinoplasty patient population where having a lower than average bridge height is more the norm.

Asian Rhinoplasty Surgery

Overall, this Asian rhinoplasty patient simply desired to have a more refined looking nose. In other words, she wanted her nose to look more defined. However, we both agreed that these changes would be made while all the while maintaining the natural appearance of an Asian nose. As we discussed, the goal in Asian cosmetic nose surgery is to create a nose that is more refined, yet still looks like an Asian nose. I have said this elsewhere, and I will say it again here – the goal in Asian rhinoplasty is not to create a Caucasian nose on an Asian face. Many people have referred to this type of surgery as ‘westernization rhinoplasty’ or ‘westernizing’ the Asian nose. But, again, the aim is not to create a western appearing nose on an Asian rhinoplasty patient’s face. After all, this would look pretty unnatural.

In this particular case example. I recommended the we try and create a straighter bridge profile mainly to address the dorsal hump deformity. This was accomplished by sanding the bump down in a conservative manner. At the same time, I recommended that we create a more narrow nasal bridge. In this instance I performed bilateral osteotomies – in other words, I broke the bones – to narrow the bridge. This was done in an attempt to create better shadowing along the sides of the nose, thus creating more definition as seen from the frontal view. In addition, I recommended we reshape her nasal tip to give it a more refined look. In her case, this also involved making her nose longer – also described as lengthening the nasal tip. In this process, we would also reshape the nasal tip cartilage to make it appear more narrowed and defined. During surgery, I ended up using suture technique to make her tip cartilage extended out slightly further. In addition, I used portions of her septal cartilage (the middle wall inside of the nose) and recycled them as grafts. In other words, I took cartilage from inside of her nose and used it to add shape to the nasal tip. Furthermore, I did end up thinning her nasal tip skin in a conservative manner. This was done to account for the fact her overlying skin was relatively thick. Had I not done this, it would have been even more difficult for her skin to mold to the new underlying cartilage framework. Although thinning the nasal skin can be fraught with complications if done in an aggressive manner, careful thinning of the nasal tip skin can be performed without much risk. Ultimately, this one maneuver was necessary in order to create more refinement while maintaining a natural looking tip. Finally, I narrowed her nasal base using a wedge resection technique to remove some of excess bulk where the nose junctions with the upper lip-cheek region. This was done to make the nasal base appear more narrowed with an overall less rounded appearance.

Asian Rhinoplasty Before & After Photos

The following Asian rhinoplasty results represent this patient’s nose nearly two years after surgery. Although you will hear many surgeons say it takes one year for the nose to heal, this is not always the case. For instance, in this particular case example, her nose continued to evolve upwards of two years after Asian rhinoplasty surgery. This was largely due to the thick overlying skin requiring more time to mold and reshape. In addition, she required a series of nasal steroid injections under the skin to help guide the healing process. In the end, you can see that she still has an Asian looking nose – but one that is more refined and defined.

Asian Rhinoplasty Expert in San Diego, CA

If you are an Asian patient considering cosmetic nose reshaping, feel free to contact one of San Diego’s most experienced experts in Asian rhinoplasty surgery – Dr. John Hilinski.

#### Asian Revision Rhinoplasty
Revision Asian rhinoplasty is truly one of the most challenging types of cosmetic nose surgery to perform correctly and should only be attempted by plastic surgeons with dedicated rhinoplasty experience. Primary Asian cosmetic rhinoplasty is a challenge in and of itself. When a rhinoplasty surgeon is faced with revising an Asian nose that has already been operated on by someone else, the complexities of the surgery increase considerably. This is largely because the native cartilage and bone have already been distorted, there is abnormal scar tissue that limits the type of reshaping that can be accomplished and there is usually a relative lack of cartilage remaining for grafting of the nose. These issues are above and beyond the fact the patient is already unhappy with their prior cosmetic result and hesitant about having more surgery performed. I present here a case example of Asian revision rhinoplasty surgery to discuss some of these considerations using a past patient of mine.

Asian Rhinoplasty Presentation

This young Asian lady presented to my office seeking revision cosmetic nose surgery following two prior unsuccessful rhinoplasty procedures performed by another plastic surgeon. Initially, the other surgeon placed an implant in the nose, but it created too much of an artificial look for her desires. The nasal implant was eventually removed by the same surgeon. However, it left her nose close to what she originally had in terms of the bridge height and shape, which was too broad and flat. In addition, the nasal tip reshaping that was performed by this other plastic surgeon left her asymmetrical and more rounded than she desired. After researching Asian rhinoplasty surgeon online, she flew out to my office in San Diego, CA for consultation.

Asian Rhinoplasty Evaluation

One of her main concerns on the frontal view of her nose was a relative lack of definition along the bridge. Typically, this visually translates into poor shadowing along the sides of the bridge. In the Asian rhinoplasty patient population, this finding is commonly seen because the bridge of the nose is too low. In general, any structure that has a low profile will appear somewhat wide when viewed from the front. The same principle applies to a nasal bride that is low in profile – when seen from the front it looks wider in comparison to a nasal bridge that is much higher. For other Asian rhinoplasty patients, the shadowing seen here would be just fine. However, in this particular Asian rhinoplasty patient, her bridge was just too wide for her desires. This partially had to do with the fact she had a prior implant that was placed giving her a more defined bridge. Unfortunately, the implant also gave her an unnatural look to her nose and had to be removed by her previous rhinoplasty surgeon. Because of this, she was seeking to have revision rhinoplasty to create more definition along the entire bridge.

Examination of her nasal tip from the frontal view revealed a fair amount of tip asymmetry – meaning a moderate difference between the right and left sides of her tip. To show you this more visually, I provided a diagrammed photo seen here with a vertical red line drawn essentially in the midline of her face. If you look closely, you can see there is a greater amount of her nasal tip positioned off to her right side. Now keep in mind – everyone is asymmetrical to some degree – even after having had plastic surgery. There is no such thing as the perfect face. But in this particular case, it was more obvious that her nasal tip was displaced to her right side.

In addition, her nasal tip was more rounded than she desired as seen from the frontal view. When considering Asian rhinoplasty surgery, it is important to note that it is completely acceptable (and desirable) to maintain a slightly rounded appearance to the nasal tip region. All too often you see Asian rhinoplasty patients who have had their tip reshaped to the point it appears very artificial and surgical. In many of these cases, the nasal tip has been excessively sculpted and/or narrowed – leaving the patient with a completely unnatural looking nose. In other cases, an L-shaped silicone implant was placed causing the nasal tip to also appear quite unnatural. The goal in Asian rhinoplasty really should be to give the nasal tip more definition while maintaining some degree of convexity around the tip – in essence preserving some of the ethnic Asian features of the nose while making it appear more refined.

On her lateral view of the nose, the patient also desired slightly more definition. From this perspective this translated into the tip being less rounded as well. But this also included rotating the tip of her nose upward. If you look at the adjacent preoperative lateral view of her nose, you can see that her nasolabial angle is just under 90 degrees. This translates into the tip of the nose appearing as if it droops down too much. Combine this with her tip being more rounded and her overall nose appears less refined. Ideally, in female rhinoplasty patients this angle should be more open. This does not mean her nose should be rotated upward considerably – we are talking about rotating her tip modestly just to create a more feminine contour and shape.

Asian Revision Rhinoplasty Surgery

After consulting with her, we both decided that she was a good candidate to undergo cosmetic revision rhinoplasty. The plan was to re-raise her bridge height while narrowing and rotating the nasal tip. In doing so, the goal was to create a more narrow looking bridge and tip as seen from the front view. The goal was also to create additional nasal tip symmetry so that her nose appeared to sit in a more midline orientation.

The real question going into her revision rhinoplasty procedure had to do with the technique used to re-raise her nasal bridge. This is a maneuver we rhinoplasty surgeons refer to as augmentation of the nasal bridge, or dorsal augmentation. There are many options when it comes to nasal bridge augmentation, which include using the patient’s own cartilage (septum, ear or rib) versus an implant. In most Asian rhinoplasty patients, there is an insufficient amount of septal cartilage to augment the entire bridge. Ear cartilage can be used instead, but usually requires it being wrapped in fascia – a technique called diced cartilage fascia (DCF) grafting. Rib cartilage can also be used, but many patients are not as keen about having a separate incision made along their chest. More detailed discussion of these grafting options can be found here in another of my online rhinoplasty tutorials.

In this particular case, it was decided between the patient and myself that a nasal implant would be the best option for her situation. This was partially based on the fact that she already had a prior silicone nasal implant placed during her first rhinoplasty performed by another plastic surgeon. Therefore, the notion of placing an implant in her nose was not new to her. Unfortunately, the previously used silicone nasal implant was placed such that her nose simply looked too artificial and, thus, it was removed. In my opinion, these silicone nasal implants are commonly associated with an unnatural appearance to the nose, which is why I am not a big proponent of their use in rhinoplasty. Ultimately, we agreed that use of a Goretex nasal implant would be more suitable for dorsal augmentation in her case. Goretex is actually used quite frequently in Asian rhinoplasty surgery as a fairly predictable choice for augmenting the nasal bridge. I much prefer the use of Goretex over silicone as a nasal implant in Asian rhinoplasty as I feel the aesthetic results are better and there is less risk of potential complication in my experience. After thorough discussion, the patient and I decided to proceed with this option in terms of trying to re-elevate her nasal bridge.

I ended up performing an open revision rhinoplasty to allow me optimal exposure to her nasal tip and bridge. As was planned, her nasal bridge was augmented with a layered Goretex nasal implant. Her nasal tip was then reshaped using a series of septal cartilage grafts. In many Asian rhinoplasty patients, the amount of septal cartilage present is insufficient for grafting purposes. However, in some Asian rhinoplasty patients we are fortunate enough to find an adequate amount of septal cartilage that precludes having to look elsewhere, like the ear. That was the case here where I was able to utilize septal cartilage to reshape her nasal tip. In particular, tip grafting was performed to provide her tip with improved definition while increasing rotation slightly. In this process, additional septal cartilage was placed along the sides of the nasal tip to try and maintain a natural look. Because of how asymmetrical her tip was going into surgery, several maneuvers were also required to try and bring the entire nasal tip more toward the midline. As does happen in some cases of rhinoplasty, a limited revision of her nasal her nasal tip was ultimately performed many months later using a small segment of ear cartilage in order to provide even more symmetry.

Asian Revision Rhinoplasty Results

Below you will find this Asian rhinoplasty patients before and after photos demonstrating the type of cosmetic changes that are possible with revision rhinoplasty surgery.

As you can appreciate on the frontal view, there is a marked improvement in terms of definition that can be seen along the bridge. This is largely a direct result of the Goretex nasal implant that was placed over her dorsum. You can readily see how there is better shadowing on both sides of her bridge – giving the illusion of a more defined, shapely nose.

Looking more specifically at her nasal tip, you can also appreciate how there is improved symmetry following the revision procedure. In addition, her tip is more defined and in a better position in terms of having been rotated up slightly.

Is her nasal tip as defined as a thinned-skin Caucasian rhinoplasty patient? No, but that was not the aesthetic goal in this case. Asian noses should still look Asian following rhinoplasty reshaping, which means they should maintain a nice convex overall shape without excess angulation and sharpness. In this case, her nose still looks quite natural, in my opinion, and is aesthetically in balance with her underlying Asian facial features.

Asian Revision Rhinoplasty Consult

Are you an Asian rhinoplasty patient who had previous surgery and wants to consider more changes to the shape of your nose? If so, contact my San Diego office today to schedule a personalized consultation with me. I have extensive experience in performing Asian cosmetic nose surgery and can hopefully provide you with a successful surgical result.

#### Asian Rhinoplasty
Asian rhinoplasty is a form of cosmetic nose reshaping that is very specific to this ethnic group. In fact, Asian rhinoplasty surgery is so different than other types of nose reshaping that a distinct esthetic ideal is often used in the surgical planning. The following rhinoplasty tutorial chapter focuses on the nuances of performing Asian rhinoplasty and hopefully provides an educational foundation for those considering possible Asian nose reshaping surgery.

What Is The Goal in Asian Rhinoplasty Surgery?

So what are we striving to achieve in Asian rhinoplasty? In summary, the goal of Asian rhinoplasty is to create a nose that does not look like it belongs on a Caucasian face. Well performed cosmetic Asian nose reshaping is able to create a look that is ethnically consistent with the Asian face and does not appear as if it was surgically done.

It should be pointed out that a reasonable number of Asian rhinoplasty patients request elevation of their bridge height in order to better accommodate eyeglasses. This is an issue that is directly related to a deficiency in their bridge height at the upper end of the dorsum where eyeglasses normally rest. In the Asian nose, eyeglasses can tend to slip down on the bridge since there is a relative lack of support to hold the glasses up. By elevating, or augmenting, the nasal bridge in the Asian nose, eyeglasses can potentially fit more appropriately.

What Makes Asian Noses Different?

There are a variety of differences between an Asian and Caucasian nose with many of these distinctions highlighted below.

Overall Shape

One of the key distinctions on first glance of the Asian nose is that it should maintain an overall more triangular shape. In the below photo diagrams, you can see that the Asian nose on the left has more of a triangular outline versus the Caucasian nose. This more triangular shape to the Asian nose is a result of several factors that will be discussed in more detail below. It is real important when performing Asian rhinoplasty that your nose reshaping specialist be cognizant of this overall shape and careful to maintain this key ethnic feature.

Bridge Height

In many Asian noses, there is a deficiency in bridge height, which creates a wider, flatter looking nose. The goal in Asian rhinoplasty is to reshape the bridge so there is improved shadowing along the dorsum. The goal should not be to replicate the bridge height seen in a Caucasian nose. The aim in Asian rhinoplasty bridge reshaping is to elevate the dorsum an appropriate amount without distracting from the ethnic appearance. If your surgeon elevates the bridge height as if it were a Caucasian nose, they will risk making the nose look more Romanesque. Therefore, bridge augmentation, or elevation, in Asian rhinoplasty has to be done in a more conservative fashion to preserve the ethnic features of the face.

When augmenting the nasal bridge in Asian rhinoplasty, you typically need a fairly long piece of material (cartilage or implant) to span the desired distance of the bridge to be elevated. In the adjacent photo diagram, you can see this indicated by the red line along the bridge. Using a single, continuous graft or implant will maximize chances of a smoother bridge contour while minimizing chances of postoperative contour irregularities. You can imagine trying to create one long graft by sewing together, for instance, several smaller pieces of septal or ear cartilage. The chances of each individual piece of cartilage absorbing prematurely is moderately high. Therefore, the likelihood that you will be able to create one single, symmetrical, smooth graft that maintains the desired size and shape is very low. Therefore, choice of material is critical when deciding on how to augment the Asian nasal bridge.

There are several options available that satisfy this requirement to augment the bridge in Asian rhinoplasty. These include using (1) the patient’s own cartilage, (2) tissue banked cartilage, (3) diced cartilage fascia, and (4) a variety of nasal implants.

Patient’s Own Cartilage (Autogenous Cartilage)

It is always the preferred choice to use the patient’s own natural cartilage when it comes to augmenting the nasal bridge. When using the patient’s own cartilage, it is referred to as autogenous cartilage grafting. In Asian noses, however, there is a relative lack of cartilage available for this purpose. In the average Caucasian nose, the septum has sufficient amounts of cartilage to use for grafting the bridge. Unfortunately, in a great majority of Asian rhinoplasty patients their septum has an inadequate amount of septal cartilage to use for building the bridge up. Even if there is a sufficient amount, the cartilage is often times too thin to be work well for bridge augmentation. Although ear cartilage grafting to the nasal bridge is a viable option in some rhinoplasty patients, Asian noses often times need a significantly greater amount to achieve the desired effect. So this usually leaves costal (rib) cartilage as the only good choice for autogenous bridge augmentation in the Asian nose. Costal cartilage grafting allows the rhinoplasty surgeon to harvest a sufficient amount of resilient cartilage that can be used effectively to elevate the bridge height to the desired level. One downside to performing autogenous costal cartilage grafting in the Asian nose is the fact that rib cartilage harvesting can add more pain to the recovery process (since there is a second operative site besides the nose) while also extending the amount of time it takes to complete the surgery. Despite this, most nose specialists will agree that costal cartilage grafting in the Asian patient is considered well worth the additional time and effort to achieve the best possible rhinoplasty result.

Tissue Banked Cartilage

An alternative to using the patient’s own rib cartilage is obtaining rib cartilage from a tissue bank. This is also referred to as irradiated cadaveric rib cartilage grafting since the cartilage is treated with gamma radiation prior to use. This process of irradiating the cartilage is done to essentially sterilize the graft before being used in surgery. This is a nice option for Asian rhinoplasty patients who simply do not want to have their own rib cartilage taken. With tissue banked cartilage, a sufficiently large size of rib cartilage is obtained from the tissue bank and used in a similar manner as autogenous rib cartilage would be for bridge augmentation. The tissue banked cartilage is reshaped in a similar manner as would be done with autogenous rib and placed in the same fashion as would be done with the autogenous cartilage. A huge advantage of using tissue banked cartilage is not having to undergo a surgical procedure involving the chest wall. As a result, there is no painful recovery in terms of the cartilage donor site. One potential disadvantage of the tissue banked cartilage is the rare and remote possibility of developing an infection from the cartilage graft. Thankfully, federal law requires the strictest screening guidelines for cadaveric rib cartilage use and the irradiation process to treat the graft helps significantly reduce the possibility of having an adverse tissue reaction. Furthermore, surgical studies have proven the long-term safety and efficacy of using tissue banked rib cartilage grafting in cosmetic nose reshaping.

Diced Cartilage Fascia (DCF)

Diced cartilage fascia, or DCF, grafting is another method for augmenting the Asian bridge in rhinoplasty. Like autogenous and tissue banked costal cartilage grafting, you can create a fairly smooth, continuous graft using DCF technique. This specialized method offered by rhinoplasty specialists involves a combination of cartilage and temporal fascia grafting. The temporal fascia refers to a smooth, thin sheet of soft tissue that can be taken from under the scalp, just above the ear. The cartilage source can be the septum and/or ear in Asian rhinoplasty patients. However, when using this type of cartilage it has to be wrapped in a sleeve of temporal fascia in order to create a single graft for bridge augmentation. The cartilage is first diced into hundreds of small pieces. 

This is analogous to dicing larger pieces of fruit into much smaller individual pieces (see adjacent photo). The diced pieces of cartilage are then wrapped in a sleeve of temporal fascia so that you have effectively created one long, continuous piece for grafting. Keeping with the food analogies, this is much like a seaweed roll as shown in the adjacent photo diagram. The diced cartilage is like the center of the roll and the temporal fascia is akin to the seaweed sleeve. Depending on how high you wish to augment the nasal bridge, you can add more or less diced cartilage into the DCF graft. The entire piece of DCF is then placed over the nasal bridge to elevate the height. With time, the DCF graft gets incorporated into the nose by natural ingrowth of the surrounding tissues. In many studies, the DCF graft has been shown to be an equivalent method to costal cartilage grafting for augmentation of the nasal bridge.

Nasal Implants

Nasal implants refer to one of many biological materials that can be used to augment the Asian nasal bridge. Some implants are more popular than others amongst rhinoplasty surgeons. One of the huge benefits of using an implant is not having to obtain cartilage from another source. Nasal implants are preformed and in plentiful supply. Plus, they can be customized on the operating room table and readily used in the midst of the rhinoplasty procedure. Unfortunately, one of the downsides of nasal implants is the fact they can be rejected or get infected due to the body reacting to the implant as a foreign object. This is not a concern at all when using autogenous cartilage grafts. Fortunately, this risk with nasal implants is quite low when they are placed by an experienced rhinoplasty specialist in the appropriate patient. This usually means an ethnic rhinoplasty patient who has fairly thick skin overlying the bridge, which can provide a significant soft tissue buffer that reduces chances of rejection and infection. Asian noses tend to fit this description and, therefore, are a reasonable choice when considering nasal implants. Among the various nasal implants, each has its advantages and disadvantages. Goretex happens to be one of the more viable options when performing Asian rhinoplasty. The Goretex can be individualized in terms of height and width to achieve the desired level of augmentation. With healing, the Goretex can also become fixated in position, which minimizes chances of postoperative movement. The same cannot be said for other nasal implants like silicone rubber. This is a popular nasal implant, especially in Asia. But, unfortunately, the implant commonly becomes displaced and moves after surgery because it never really gets fixated in position. Another problem with silicone nasal implants is they can potentially be seen as a translucent area inside of the nose when there is light shining across the face. Other nasal implants, such as Porex, are even less desirable for Asian bridge augmentation. This is primarily because the Porex implants can stimulate an overly aggressive tissue response by the body and become excessively hard in some patients.

Bridge Width

The width of the nasal bridge in Asian rhinoplasty patients is more often a function of the bridge height mentioned above. Meaning, the nasal bridge can be made to look more narrow by elevating the bridge height to a sufficient degree. The higher the bridge, the more shadowing effect will be seen on each side and the more refined the nose will appear. In some cases, however, the bridge can also look excessively wide or flat because of the underlying nasal bones. This type of anatomical issue is much less frequently encountered when compared with Caucasian rhinoplasty patients. In these rare cases of Asian rhinoplasty where the nasal bones are too wide, they have to be narrowed during surgery in addition to augmenting the nasal bridge. Thankfully, this is much more the exception than the rule in Asian rhinoplasty.

Tip Shape

The average Asian nose has a tip that naturally is more rounded than a Caucasian nose. This usually results from Asian noses having much thicker skin in combination with inherently thinner, weaker underlying cartilage. The thicker nasal skin does not show refinement as easily as thinner nasal skin. And thinner, weaker tip cartilage is also less likely to show proper definition. When these two issues coexist in the same nose, the end result is a more rounded, less refined appearing nasal tip. Other common issues with the Asian nasal tip include a lack of projection (how far the nose sticks out from the face) and under-rotation of the tip.

Traditional rhinoplasty techniques used to refine the nasal tip, such as suture reshaping, are simply not as effective in the Asian rhinoplasty patient. Instead, most Asian rhinoplasty patients require some form of cartilage grafting to the tip in order to realize any significant improvement in definition. This includes placement of shield-shaped tip grafts and alar rim grafts where appropriate. In some patients who require lengthening of the nasal tip, this might even necessitate more complex grafting of the nose. And even then, the goal should be to provide improved tip refinement without appearing too narrow or angulated. Preservation of some roundness in the nasal tip is one of the keys to achieving successful results in the Asian rhinoplasty patient population.

Base Width

One of the more common maneuvers in Asian rhinoplasty is alteration of the nasal base width. In a good majority of Asian rhinoplasty patients, the nasal base is excessively wide and/or flared. A wide base refers to the actual linear measurement of the bottom of the nose being excessive. Flaring is in reference to an excessively curved nostril contour outside of the attachment of the base. In many Asian rhinoplasty patients one or both of these issues need to be addressed to refine the nose. Some of this is improved with projection of the nasal tip outward from the face. It should be emphasized, however, that the goal in Asian rhinoplasty is to maintain some width at the nasal to preserve the desired overall triangular shape to the nose. Overly aggressive base reduction in the Asian nose can unfortunately be quite obvious leading to a nostril base that literally looks like it was cut and pasted.

Asian Rhinoplasty Photo Examples

The following is a great example of Asian rhinoplasty in this female patient from San Diego, CA who desired refinement of her nose. She exemplifies many of the issues discussed above with regard to cosmetic reshaping of the Asian nose. For instance, you can see that her bridge height was elevated during the rhinoplasty procedure, but was done without creating an excessively high bridge as seen on her profile view. She now has improved shadowing with a more narrow looking bridge as seen from the front, yet still looks like she has an Asian nose. In the tip area, you can appreciate more refinement and definition of her nasal tip, but it still appears slightly rounded as an Asian nose should look. And you can see that her nasal base was also narrowed during the rhinoplasty, however, not excessively so. Overall, her nose still very much possesses the key features of an Asian nose, but has been refined sufficiently to address those issues that were bothering her.

#### Asian Rhinoplasty
Asian Rhinoplasty with Dr. John Hilinski: Specialized Nose Reshaping in San Diego, CA

Asian rhinoplasty is a tailored form of nose reshaping surgery designed to address the unique anatomical and aesthetic considerations of Asian patients. This specialized procedure focuses on enhancing the appearance of the nose while preserving the ethnic characteristics that define facial harmony. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, offers expert Asian rhinoplasty with a personalized approach, helping patients achieve their desired look while maintaining their cultural identity.

What is Asian Rhinoplasty?

Asian rhinoplasty is a specific type of rhinoplasty that caters to the anatomical features and aesthetic preferences of Asian patients. Many individuals of Asian descent may seek rhinoplasty to refine the nasal bridge, augment the nasal tip, or narrow the nostrils, all while maintaining a natural, balanced appearance. This procedure often involves augmenting the nasal bridge with cartilage grafts or implants, refining the nasal tip for better definition, and narrowing the nostrils to create a more streamlined look.

Unlike traditional rhinoplasty, which often focuses on reducing the size of the nose, Asian rhinoplasty frequently emphasizes augmentation and reshaping to create a nose that complements the patient's facial features while respecting their ethnic heritage. Dr. Hilinski utilizes advanced techniques, combining precision with an artistic approach to deliver subtle, natural-looking results that enhance the patient's appearance without compromising their identity.

Why Choose Asian Rhinoplasty?

Patients may choose Asian rhinoplasty for a variety of reasons, including:

Dr. Hilinski's deep understanding of Asian nasal anatomy allows him to customize each procedure, taking into account the unique features and aesthetic goals of the patient. By offering personalized care, he ensures that the final results are harmonious with the patient's overall appearance.

Who Makes a Good Candidate for Asian Rhinoplasty?

Good candidates for Asian rhinoplasty include individuals who:

Are in good overall health and non-smokers

Have realistic expectations about the outcome of the surgery

Desire to enhance the shape, size, or symmetry of their nose while maintaining their ethnic features

Are seeking nasal bridge augmentation, nostril narrowing, or nasal tip refinement

Have completed facial growth, typically by their mid-teens

During your consultation, Dr. Hilinski will carefully evaluate your nasal anatomy and discuss your goals for the procedure. He will create a customized surgical plan that addresses your specific needs and helps you achieve a refined, natural result.

FAQ: Asian Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering Asian rhinoplasty and want to explore how this specialized procedure can enhance your nasal appearance while preserving your ethnic identity, schedule a consultation with Dr. John Hilinski. As San Diego's expert in ethnic rhinoplasty, Dr. Hilinski combines his extensive credentials, personalized approach, and commitment to excellence to provide exceptional care. Contact us today to begin your journey toward achieving your ideal nose.

#### Asian Rhinoplasty Silicone Implants
This is a great case example of why I do not like using silicone nasal implants in Asian rhinoplasty patients. This particular Asian patient originally desired to have her nose reshaped for cosmetic reasons to provide a higher bridge and improved tip definition. Unfortunately, her original cosmetic nose surgeon chose to use a solid silicone nasal implant for reshaping, which resulted in a less than desirable outcome. She then consulted with our office to have a revision rhinoplasty performed to help restore a more natural overall shape and appearance.

Nasal Silicone Implants

So what is a silicone implant? Solid silicone nasal implants are also commonly referred to as silastic nasal implants (combining the terms silicone and plastic). They are frequently placed by rhinoplasty surgeons to augment the nasal bridge height with or without providing more projection of the nasal tip. Silicone nasal implants are considerably more popular in the Asian rhinoplasty population given the fact that Asian noses typically have an insufficient amount of native cartilage support to provide even moderate definition. For many rhinoplasty surgeons, choosing a silicone nasal implant is an easy option that helps them avoid having to perform more complex rhinoplasty technique. An example of a silicone nasal implant is shown here in the adjacent photo to give you a better idea of what these particular nasal implants look like. As you can see, they are generally shaped like an “L” with the elbow (or angle) of the implant corresponding to the region of the nasal tip. The longer segment of the implant corresponds to the nasal bridge as shown. When placed inside of the nose (just over the nasal framework and under the skin), this type of silicone implant can help raise the height of the nasal bridge while also giving the nasal tip more definition.

Problems with Nasal Silicone Implants

One of the main concerns with use of solid silicone nasal implants is that they do not become incorporated into the surrounding tissue of the nose. Instead, a capsule (like a smooth wrapping) is formed by the body around the implant. This encapsulation process by the body is an attempt to keep the nasal implant in place. Unfortunately, while encapsulation can keep the implant in the general vicinity, it does not prevent the implant from moving around during the healing process of rhinoplasty. When this occurs, the displaced silicone implant can result in an undesirable cosmetic appearance. In other cases, the silicone implant is outright rejected by the body and can even be pushed out through the skin.

Asian Rhinoplasty – Nasal Silicone Implant

This particular Asian rhinoplasty patient presented to our office complaining that her previously placed silicone nasal implant (done by a different plastic surgeon) had moved. It was now causing an undesirable cosmetic appearance. As you can see in the photos below, the implant was contributing to an unwanted shadow cast across the upper nasal bridge. This can be seen on her frontal view as indicated by the shaded gray curve corresponding to where the upper edge of the silicone implant stopped. Early after her original rhinoplasty surgery, this area looked fine according to the patient. However, a year or so later the implant began to move resulting in this abnormal contour. On her oblique (45 degree angle) view, the white arrow highlights the same abnormal bump caused by the edge of the silicone nasal implant. And on her profile view, the white arrow is almost unnecessary, as the abnormal bump can be easily seen near the top of her nasal bridge. Overall, the displaced silicone nasal implant resulted in a nose that had obvious signs of prior rhinoplasty reshaping.

Asian Revision Rhinoplasty

This particular patient simply wanted to have a nose that looked more natural on her face without the stigma of having had prior cosmetic nose work done. During her consultation with us in our San Diego office, we discussed in detail the recommended changes to her nose. We specifically talked about removing the nasal implant and reshaping the nose in a more natural manner. That is ultimately what she chose to have done. Her surgery was performed in our own accredited ambulatory surgery center under a general anesthetic using an open revision rhinoplasty approach. The previously placed silicone implant was removed and the upper bridge was reshaped to provide her with a smoother profile. At the same time, the nasal tip had to be reshaped once the silicone implant was moved away from this area.

Her before and after revision rhinoplasty photos are shown here.

On her frontal view, you can see that the irregular shadow across the upper bridge is now gone. Her frontal appearance is now much smoother along both sides of the bridge extending from the brow region all the way down to the nasal tip. On her oblique view, you can see that the previously noted bump is now gone – replaced by a more continuous bridge outline. And on the profile view, you can really appreciate the improvements noted in the bridge area. No longer is there an unusual drop off, or step off, from the displaced silicone nasal implant. Now her profile looks much more natural and consistent with most Asian noses you see in public. And if you look closely at her nasal tip, there is a natural looking convexity (roundness) to the tip despite having to remove the nasal implant and replace it with cartilage grafting.

Asian Revision Rhinoplasty Consult in San Diego, CA

Learn more about possible cosmetic revision Asian rhinoplasty by contacting our San Diego office today to consult with revision rhinoplasty and ethnic rhinoplasty expert, Dr. John Hilinski.

#### Aspire Galderma Rewards
We encourage all of our Dysport, Restylane and Sculptra patients here in San Diego to join the Aspire Galderma Rewards program. Aspire Galderma Rewards was started several years ago to help reward San Diego patients for their loyalty to Galderma’s suite of cosmetic services. This mainly includes injectable cosmetic treatments such Dysport, Restylane, and Sculptra.

New to Aspire Galderma?

Are you new to Aspire Galderma Rewards? Use this link provided here to sign up for a new account

Already Have Aspire Galderma Rewards?

If you already have an Aspire Galderma Rewards membership, use this link here to sign in.

#### Asymmetric Tip Collapse
This is a case example of a patient who desired to have her nose reshaped following two prior unsuccessful attempts performed by a different plastic surgeon. Her surgeries were performed over 10 years prior. Since then, her nose developed asymmetric collapse of the tip region – with more collapse seen on her right side. This was bothering her enough that she wanted to have the tip reshaped to be more symmetrical. In addition, she desired to have the bridge brought down just a bit.

Rhinoplasty Exam

Her preoperative examination demonstrated an asymmetric nasal tip with more collapse seen on her right side. You can see this best on her frontal view as more shadowing through the right tip region. In the adjacent photo diagram, this is indicated by the arrow pointing to the specific area of collapse. This indentation results in more shadowing on her right side – an area commonly referred to as the soft triangle of the nose. In addition, this type of collapse can negatively impact nasal function since the nostril rim is also compromised in terms of structural integrity. The patient and I discussed in detail what might be contributing to this type of nasal tip deformity following prior rhinoplasty. We also reviewed my recommendations for a revision rhinoplasty procedure to include an open approach (where the skin is reflected upwards) for optimal exposure. In addition, she would likely need cartilage grafting to help restore proper structural support of the nasal tip.

Rhinoplasty Surgical Findings

These photos provided here show what I saw after opening her nose up during the actual surgery. This photo, taken from underneath the nose, highlights the lower lateral cartilages, which largely dictate what the tip of the nose looks like in real life. As you can see here, there is a difference between the right and left sides where her left lower lateral cartilage is wider than her right one. This is because the prior surgeon had resected, or cut out, more cartilage on the one side – leaving her nasal tip with two different lower lateral cartilages. The yellow outlined polygon shows approximately what is missing from her right lower lateral cartilage when compared to the opposite side. In some rhinoplasty patients, such a difference between the two sides may not be significant. But in this case, the relative lack of cartilage on the one side translated into a notable clinical difference in terms of shape and contour.

When you look at the same two lower lateral cartilages from above, you can more readily appreciate the differences just pointed out. As you can see in the adjacent photo diagram, her right side is much thinner than her left side. The relative difference is indicated by the yellow outlined polygon, which, again, is a significant portion of cartilage to be missing from her tip region. Now that you can visualize it (as I did in surgery), you gain a better understanding of how asymmetrical her two lower lateral cartilages are in size and shape.

Rhinoplasty Changes Made

So what did I do to help reshape her nasal tip during the rhinoplasty? First, I strategically placed several permanent sutures into the tip cartilage to help make the overall shape of the nasal tip more defined. These are technically called ‘dome binding sutures’ in rhinoplasty parlance. This is represented in the adjacent photo by the blue threads that can be seen sticking out of the cartilage. The darker purple indicates the surgical markings that were made to help guide placement of the sutures. If you compare the overall shape of the lower lateral cartilages to what they looked like before reshaping, you can readily appreciate the change in conformation. Meaning, the cartilage is now less rounded and more angulated. This was done to give her nasal tip a more refined shape.

But what about the missing cartilage segment noted previously? In order to address this, I ended up performing a septoplasty to get some cartilage that could be used to help reconstruct the missing segment of the lower lateral cartilage. This septal cartilage was repurposed to restore proper support of the lower lateral cartilage. As is shown in the adjacent photo diagram (by the yellow outlined arrows), cartilage grafting was performed. The septal cartilage was sewn into the area where there was missing cartilage to help provide a more symmetrical framework to the nasal tip. Combining the dome binding sutures with septal cartilage grafting, I was able to completely reconstruct her nasal tip.

Beyond the nasal tip changes made, I also performed reduction of her nasal bridge height along with narrowing of her nasal bones.

Rhinoplasty Before and After

Here are her rhinoplasty before and after photos that show the overall visual change. As you can see, she no longer has the abnormal shadowing through her soft triangle region, which was seen prior to surgery. Her nasal tip is now more symmetrical with proper support and structure on both sides. In addition, her nasal tip now is more defined and refined. Of utmost importance, her nose has been improved while still looking quite natural for her face.

#### Baby Botox
Baby Botox at Hilinski Medspa

Experience subtle, natural-looking rejuvenation with Baby Botox at Hilinski Medspa. Perfect for those seeking a softer, more refined approach to wrinkle reduction, Baby Botox is a popular non-surgical cosmetic treatment designed to provide youthful, refreshed results without the "frozen" look.

At Hilinski Medspa, we specialize in advanced Botox treatments, including Baby Botox, which offers a lighter dose of the neuromodulator for a delicate and nuanced transformation. Overseen by renowned facial plastic surgeon Dr. John Hilinski, our experienced team ensures that every treatment is tailored to meet your unique aesthetic goals.

What is Baby Botox?

Baby Botox is a cosmetic procedure that involves the use of smaller doses of Botox to achieve more subtle, natural-looking results. This treatment is ideal for patients who are seeking wrinkle prevention or a softer approach to facial rejuvenation. By using fewer units of Botox, Baby Botox smooths fine lines and wrinkles while still allowing for natural facial movement, making it a popular option for younger patients or individuals who want to maintain a more expressive appearance.

Why Choose Baby Botox?

Many people want the benefits of Botox but are concerned about looking “overdone.” Baby Botox offers the perfect solution by providing a more natural enhancement that helps to soften wrinkles without fully paralyzing the muscles. It’s also an excellent preventative treatment for individuals in their 20s and 30s looking to stave off the deeper lines that come with aging. Baby Botox is frequently used to treat the following areas:

Forehead lines

Crow’s feet

Frown lines (the “11s” between the brows)

Fine lines around the mouth

Subtle lip enhancement (Botox Lip Flip)

Benefits of Baby Botox

A softer, more natural appearance

Reduced risk of looking “frozen”

Prevents deep lines from forming

Shorter recovery time and fewer side effects

Ideal for first-time Botox patients or younger individuals

What to Expect During Baby Botox Treatment

The Baby Botox procedure is quick, often taking only 10-15 minutes to complete. Dr. Hilinski or one of our experienced injectors will assess your facial features and discuss your desired results before carefully administering the Botox injections in key areas. Most patients report feeling minimal discomfort during the procedure, with some describing a slight pinching sensation.

Baby Botox Results and Recovery

Results from Baby Botox typically appear within 3-7 days after treatment, offering a more youthful and refreshed look. Unlike traditional Botox, the smaller doses used in Baby Botox allow for more natural facial expressions while still smoothing fine lines and wrinkles. The effects generally last between 2-4 months, depending on the individual.

There is little to no downtime with Baby Botox, and most patients return to their regular activities immediately following the procedure. Minor swelling or bruising may occur at the injection sites, but this typically resolves within a day or two.

FAQ: Baby Botox

Schedule Your Baby Botox Consultation

If you're interested in achieving a naturally refreshed look with Baby Botox, schedule a consultation at Hilinski Medspa. Dr. Hilinski and his expert team are here to guide you through the process and ensure you receive the highest level of care.

Contact us today to learn more about Baby Botox and how it can help you maintain a youthful, radiant appearance.

#### Base Reduction Narrowing
Our San Diego office gets inquiries all the time from patients wanting to know whether or not they can have isolated nasal base reduction or narrowing. The answer is – yes. In some cases, patients can have only nasal base narrowing surgery, which is often times called a Weir reduction – or alar wedge excision.

The key thing to watch out for is the nasal tip. If someone starts off with a nasal tip that is excessively wide or bulbous, narrowing the nasal base can make the tip look even wider – relatively speaking. In rhinoplasty patients like this, it may be recommended by Dr. Hilinski that you also undergo a tip rhinoplasty procedure at the same time. In addition, isolated Weir incisions are best used when a more moderate amount of nasal base narrowing is going to be performed – as is seen here.

This young lady from the San Diego area consulted with Dr. Hilinski given his reputation as one of San Diego’s best rhinoplasty surgeons. She was hoping to just narrow the base of her nose – meaning she wanted her nostrils to be narrowed on each side. Although her nasal tip wasn’t exactly narrow – Dr. Hilinski felt that he could narrow her nasal base without making her nose tip stick out even more.

Ultimately, this patient underwent the nasal base reduction – sometimes referred to as alar base narrowing – under just local anesthesia in the office setting. Dr. Hilinski cut out a wedge of soft tissue from where the nostril meets the cheek/upper lip region – then sutured the two edges together – thus bringing the nostrils in closer together. She recovered quite nicely with minimal swelling and a quick recovery from the Weir incisions. Here are her before and after photos showing a beautiful cosmetic outcome as a result of the alar base narrowing procedure. And she still looks very natural from the frontal view.

#### Bellafill
Bellafill Injections at Hilinski Medspa in San Diego

Looking for a long-lasting solution to wrinkles and acne scars? At Hilinski Medspa in San Diego, board-certified facial plastic surgeon Dr. John Hilinski offers Bellafill injections, a revolutionary dermal filler designed to deliver natural-looking results for up to five years. Whether you want to smooth nasolabial folds, reduce smile lines, or improve acne scars, Bellafill can help you achieve a more youthful, rejuvenated appearance without the need for frequent touch-ups.

What is Bellafill?

Bellafill, previously known as Artefill, is a unique dermal filler made from a combination of purified bovine collagen, PMMA (polymethylmethacrylate) microspheres, and lidocaine to ensure comfort during the procedure. Bellafill is the only FDA-approved filler proven to stimulate long-lasting collagen production, offering results that last up to five years. Unlike traditional fillers that dissolve over time, Bellafill's PMMA microspheres create a lasting scaffold for your skin to produce its own collagen, keeping your skin smooth, vibrant, and youthful.

How Does Bellafill Work?

Bellafill works in two phases:

Immediate Volume & Smoothing

The collagen gel in Bellafill provides an instant lift, filling in wrinkles and smoothing lines like nasolabial folds and smile lines.

Long-Term Collagen Production

The PMMA microspheres in Bellafill act as a support structure, encouraging your skin to naturally produce collagen over time. This process gives long-lasting results as your body’s collagen helps maintain youthful skin texture and volume.

Preparing for Bellafill

Your journey to youthful, smooth skin begins with a consultation at Hilinski Medspa. During this session, Dr. Hilinski will assess your skin, discuss your aesthetic goals, and determine if Bellafill is right for you. It's important to disclose any allergies, especially to bovine collagen, during this consultation. The procedure is generally well-tolerated, and with the addition of lidocaine, most patients experience little discomfort.

The Bellafill Treatment

Bellafill injections are performed in the office with a fine needle for precise application. The treatment typically takes about 30 minutes, depending on the number of areas being treated. Results are immediate, and you'll leave the office with smoother, more youthful skin.

Bellafill Recovery & Results

You may experience slight swelling or bruising after the treatment, but this should subside within a few days. Most patients resume their normal activities immediately following the procedure. As your body produces new collagen, you'll notice continued improvement in skin texture and volume over the coming months. Bellafill's results last significantly longer than other dermal fillers, with improvements lasting up to five years.

FAQs About Bellafill

Schedule Your Bellafill Consultation

Take the next step toward long-lasting rejuvenation. Contact Hilinski Medspa in San Diego today to schedule a personalized consultation with Dr. John Hilinski and learn how Bellafill can help you achieve your aesthetic goals.

We are committed to making your experience comfortable and ensuring that you feel confident in your treatment choices. From the initial consultation to post-procedure care, our team is here to support you every step of the way.

#### Blog
URL: https://www.drhilinski.com/blog/

#### Botox & Dysport
Botox & Dysport Neuromodulator Injections at Hilinski Medspa

At Hilinski Medspa, we offer Botox and Dysport injections to help you achieve a smoother, more youthful appearance without the need for surgery. Neuromodulator injections like Botox Cosmetic and Dysport are FDA-approved treatments that work by temporarily relaxing facial muscles that cause fine lines and wrinkles. These non-surgical treatments are highly effective for reducing the appearance of dynamic wrinkles, such as crow's feet, forehead lines, and frown lines. Under the supervision of Dr. John Hilinski, a board-certified facial plastic surgeon, you can trust that your treatment will be administered with precision and expertise for optimal, natural-looking results.

Botox & Dysport Menu at Hilinski Medspa:

Why Choose Botox & Dysport Injections?

Both Botox and Dysport are neuromodulators that work by temporarily blocking nerve signals to specific facial muscles, preventing them from contracting. This reduction in muscle activity smooths out wrinkles and fine lines, giving you a refreshed, rejuvenated appearance. The treatment is quick, minimally invasive, and requires no downtime, making it one of the most popular non-surgical options for facial rejuvenation.

At Hilinski Medspa, you'll benefit from our team's expertise in facial aesthetics, along with the personal oversight of Dr. John Hilinski, who is known for his skill in facial plastic surgery and non-surgical facial treatments. Whether you are looking for subtle wrinkle reduction or a more noticeable rejuvenation, our team is dedicated to delivering results that leave you looking naturally refreshed.

Benefits of Neuromodulator Injections at Hilinski Medspa:

Reduce the appearance of fine lines and wrinkles

Achieve a more youthful and relaxed appearance

Quick, minimally invasive procedure with no downtime

Custom treatment plans for natural-looking results

Performed by experienced professionals under the supervision of a facial plastic surgery expert

What to Expect from Your Botox & Dysport Treatment

At Hilinski Medspa, our team will work closely with you to understand your goals and develop a customized treatment plan. The injection process typically takes only 10 to 15 minutes, and most patients experience minimal discomfort. The results from Botox and Dysport injections are visible within a few days, and improvements can last three to six months. Regular maintenance treatments can help you sustain your rejuvenated appearance long-term.

Schedule Your Consultation

If you are ready to explore Botox or Dysport treatments, contact Hilinski Medspa today to schedule your personalized consultation. Our experienced team, guided by the expertise of Dr. John Hilinski, is committed to helping you achieve the youthful, refreshed look you desire.

#### Botox & Forehead Movement
Botox and Forehead Movement Treatments at Hilinski Medspa

Are you looking for an effective, non-surgical way to reduce forehead wrinkles and fine lines? Botox treatments at Hilinski Medspa in San Diego are an excellent solution for smoothing away unwanted facial wrinkles while maintaining natural facial expressions. Dr. John Hilinski, a renowned board-certified facial plastic surgeon, offers expert Botox treatments that leave you looking refreshed and youthful without the "frozen" appearance.

With extensive training and experience in facial anatomy, Dr. Hilinski provides personalized Botox treatments to specifically address forehead movement and wrinkles, ensuring optimal results for each patient.

Understanding Botox and Forehead Movement

Forehead wrinkles and fine lines are often caused by repetitive facial movements, such as raising your eyebrows or frowning. Botox works by temporarily relaxing the muscles responsible for these movements, smoothing out the skin, and preventing the formation of new lines.

When addressing forehead wrinkles, understanding the anatomy of forehead movement is crucial. The forehead is composed of two opposing muscle groups:

Dr. Hilinski's approach to Botox focuses on balancing these two muscle groups to create a smoother, youthful appearance while retaining natural expression.

Botox for Forehead Wrinkles: How It Works

Botox is strategically injected into specific areas of the forehead to target muscles responsible for unwanted wrinkle formation. The injections relax these muscles, reducing movement and allowing the overlying skin to smooth out. The entire treatment takes just 5-10 minutes and involves minimal discomfort.

After the procedure, you can expect noticeable results within 48 hours, with optimal improvements visible over the next two weeks. Botox treatments last for approximately 3-4 months, after which follow-up treatments can maintain your refreshed look.

Benefits of Botox for Forehead Wrinkles

Smoother forehead with fewer lines and wrinkles

Balanced and natural results that maintain facial expressions

Quick, minimally invasive treatment with no downtime

Long-lasting results, typically 3-4 months

FAQ: Botox and Forehead Movement

Schedule Your Botox Consultation Today

If you're interested in smoothing forehead wrinkles and achieving a more youthful appearance with Botox, Hilinski Medspa is here to help. Contact us today to schedule a personalized consultation with Dr. John Hilinski, one of San Diego's top facial plastic surgeons. Rejuvenate your skin and refresh your appearance with expert Botox treatments.

#### Botox Cosmetic
Botox Injections at Hilinski Medspa: Restore a Youthful Appearance

Looking for an effective non-surgical solution to combat visible signs of aging like crow's feet and forehead creases? Botox Cosmetic is one of the most popular and minimally invasive procedures to smooth away unwanted facial wrinkles. Botox, when administered by an expert injector, delivers natural-looking results, leaving you refreshed and revitalized. At Hilinski Medspa, San Diego facial plastic surgeon Dr. John Hilinski and his skilled team provide personalized Botox injections, ensuring the highest quality results.

Why Choose Botox at Hilinski Medspa?

Botox is a simple, office-based procedure that can smooth fine lines and wrinkles, providing fast results with little downtime. Dr. Hilinski, a double board-certified facial plastic surgeon, leverages his expertise in facial anatomy to perform precise injections that avoid the "frozen" look, delivering natural rejuvenation.

How Does Botox Work?

As skin ages, it loses elasticity, and repetitive facial movements can lead to wrinkles. Botox works by temporarily relaxing the muscles responsible for skin creases, softening lines on the forehead, around the eyes, and between the brows. The procedure involves small, strategically placed injections into the muscles, and most sessions take only 5 to 10 minutes.

Results and Recovery

Botox begins to smooth fine lines within 48 hours, and results improve over the following weeks. Patients can expect smoother, more youthful skin for 3 to 4 months. Botox has minimal downtime, and most patients can resume normal activities a few hours after the procedure.

Benefits of Botox Injections:

Diminishes wrinkles and fine lines

Restores youthful facial contours

Quick procedure with no recovery downtime

Natural, refreshed results

Botox Treatment Areas:

Forehead: Smoothes horizontal creases for a youthful appearance.

Crow's Feet: Softens lines around the eyes caused by smiling.

Brow Lines: Targets the frown lines between the eyebrows.

Visit These Pages for More Information About Botox Injections:

About Us
Accessibility Policy
Blog
Contact
Hilinski Foundation for Surgery
Home
Links
Lop Ear Surgery with Dr. John Hilinski
Macrotia Ear Reduction Surgery with Dr. John Hilinski
Medspa
Newsletter
Notice of Open Payments Database
Patient Info
Privacy Policy
Revision Skincare Products
Rhinoplasty Tutorial
Sitemap
Stahl’s Ear Correction
Surgical
Terms of Use
Thank You

Why Choose Dr. John Hilinski for Botox Injections?

Dr. Hilinski is a board-certified facial plastic surgeon renowned for his meticulous approach and deep knowledge of facial anatomy. His goal is to achieve the most natural, refreshed results tailored to each patient's unique facial structure. His dedication to patient safety and satisfaction makes Hilinski Medspa a top choice for Botox treatments in San Diego.

FAQs About Botox at Hilinski Medspa

Get Non-Surgical Rejuvenation with Botox

Contact Hilinski Medspa today to schedule your personalized consultation with Dr. John Hilinski. Discover how Botox can refresh your appearance and restore youthful vitality without surgery.

#### Botox for Bunny Lines
Botox for Bunny Lines at Hilinski Medspa: Smooth Your Facial Wrinkles with Expert Care

At Hilinski Medspa, we offer targeted Botox treatments to address specific concerns such as bunny lines. These fine lines and wrinkles appear on the sides of the nose and can become more pronounced with facial expressions such as smiling or frowning. Bunny lines, while subtly named, can detract from your overall facial harmony. Fortunately, Botox offers an effective, non-surgical solution to smooth these wrinkles and refresh your appearance.

Dr. John Hilinski, a double board-certified facial plastic surgeon, brings his extensive experience and knowledge of facial anatomy to every Botox treatment. Whether you're looking to address bunny lines or other facial wrinkles, Dr. Hilinski and his expert team at Hilinski Medspa are committed to delivering natural-looking results tailored to your aesthetic goals.

What Are Bunny Lines?

Bunny lines are wrinkles that develop on the sides of the nose due to repeated facial movements, such as wrinkling the nose during smiling, laughing, or other expressions. These lines can become deeper over time as the skin loses elasticity, contributing to an aged or tired appearance.

Botox for Bunny Lines: How It Works

Botox works by relaxing the muscles responsible for causing bunny lines, preventing further contraction and reducing the appearance of the wrinkles. Dr. Hilinski uses a precise approach to inject Botox into the nasalis muscle on the sides of the nose. By limiting the muscle's movement, the skin appears smoother, and bunny lines are softened.

This simple, non-invasive procedure takes only a few minutes, and most patients see results within a few days. The effects of Botox typically last for three to four months, after which maintenance treatments may be recommended.

Why Choose Dr. John Hilinski for Botox?

Dr. Hilinski is a renowned expert in both cosmetic and reconstructive facial procedures. As a double board-certified facial plastic surgeon, he understands the importance of facial harmony and precision when it comes to Botox injections. His in-depth knowledge of facial muscles allows him to create natural, balanced results that leave you looking refreshed rather than overdone. Dr. Hilinski's goal is to provide subtle improvements that enhance your appearance while maintaining your unique features.

Benefits of Botox for Bunny Lines

Smooths fine lines and wrinkles around the nose

Prevents deepening of bunny lines over time

Non-surgical and minimally invasive

Quick treatment with no downtime

Long-lasting results that can be maintained with regular treatments

Natural-looking improvements

What to Expect During Botox for Bunny Lines Treatment

The Botox procedure for bunny lines is quick and easy. After a brief consultation, Dr. Hilinski will strategically place injections into the nasalis muscles on both sides of your nose. The procedure is virtually painless, with most patients only feeling a slight pinch. There's no need for anesthesia, and the entire treatment typically takes just 10 to 15 minutes.

After the procedure, you can resume your daily activities immediately. Minor redness or swelling may occur around the injection site, but this typically resolves within a few hours. Results will start to appear within a few days, with full effects visible within one to two weeks.

Recovery and Results

Botox for bunny lines requires no downtime, allowing you to return to work or social activities right away. Results typically last three to four months, and regular maintenance treatments can help preserve your smooth, wrinkle-free appearance. Dr. Hilinski will work with you to develop a personalized treatment plan that fits your goals and lifestyle.

FAQ: Botox for Bunny Lines

Schedule Your Consultation at Hilinski Medspa

If you're ready to smooth away bunny lines and restore a more youthful, refreshed appearance, schedule your Botox consultation at Hilinski Medspa today. Dr. John Hilinski and his skilled team are dedicated to helping you achieve natural-looking results with the highest level of care.

#### Botox Lip Flip
Botox Lip Flip at Hilinski Medspa: Achieve a Fuller, Natural-Looking Smile

A Botox Lip Flip is a popular, non-surgical procedure that offers patients a subtle enhancement to their upper lip without the need for fillers. If you're looking for a natural way to achieve a fuller, more defined smile, a Botox Lip Flip at Hilinski Medspa may be the perfect option for you.

Led by renowned facial plastic surgeon Dr. John Hilinski, Hilinski Medspa specializes in advanced cosmetic treatments, including the Botox Lip Flip. With Dr. Hilinski's extensive expertise and the skilled team at Hilinski Medspa, you can enjoy a beautifully enhanced smile with minimal downtime and long-lasting results.

Why Consider a Botox Lip Flip?

The Botox Lip Flip is ideal for individuals who want to enhance the shape and fullness of their lips without the use of dermal fillers. This treatment works by relaxing the muscles around the upper lip, allowing the lip to "flip" slightly upward and outward, creating the appearance of a fuller, more defined upper lip.

You might want a Botox Lip Flip if:

You feel your upper lip disappears when you smile.

You desire a fuller upper lip without adding volume through fillers.

You want a more subtle enhancement compared to lip fillers.

You're looking for a cost-effective and temporary way to improve your smile.

With the Botox Lip Flip, you can achieve a naturally enhanced upper lip and more balance between your upper and lower lips. The results are subtle, ensuring your lips look plump but not overdone.

How Does the Botox Lip Flip Work?

The Botox Lip Flip involves injecting a small amount of Botox into the orbicularis oris muscle, which is responsible for controlling lip movement. By relaxing this muscle, the upper lip gently flips outward, creating a more defined, fuller appearance. Unlike dermal fillers, which add volume to the lips, the Botox Lip Flip relies on muscle relaxation to enhance the lip’s natural shape.

The procedure typically takes less than 15 minutes and requires no downtime. You can see initial results within a few days, and the full effect is usually visible within one to two weeks. Results typically last 2-3 months, making the Botox Lip Flip an excellent option for those looking for a temporary lip enhancement.

Benefits of a Botox Lip Flip at Hilinski Medspa

What to Expect During Your Botox Lip Flip Procedure

The Botox Lip Flip procedure at Hilinski Medspa is quick and virtually painless. Dr. Hilinski or one of our experienced injectors will carefully administer a few small injections of Botox into the muscles around the upper lip. This relaxes the muscle, allowing the upper lip to gently flip outward.

The entire procedure takes less than 15 minutes, and patients can return to their normal activities immediately afterward. You may experience mild swelling or bruising at the injection site, but these side effects are temporary and typically subside within a day or two.

Botox Lip Flip Results

Patients typically start to notice results within a few days of treatment, with the full effects becoming visible after one to two weeks. The Botox Lip Flip enhances the upper lip's shape and definition, creating a fuller, more attractive smile. Results typically last about 2-3 months, and maintenance treatments can be scheduled to maintain your enhanced lip appearance.

FAQ: Botox Lip Flip

Schedule Your Botox Lip Flip Consultation at Hilinski Medspa

If you're interested in enhancing your smile with a Botox Lip Flip, schedule a consultation at Hilinski Medspa. Dr. Hilinski and his expert team will help you determine if this treatment is the right option for achieving your aesthetic goals. Contact us today to learn more about the Botox Lip Flip and our other non-surgical facial rejuvenation treatments.

#### Bridge, Tip and Base Narrowing
This is a great case example of how an ethnic, female nose can be narrowed throughout – meaning the nasal bridge, tip and base – while maintaining a natural appearance.

I saw this female patient for rhinoplasty consultation on several different occasions – mostly because we both wanted to be very open and in agreement with the intended goal in terms of cosmetic nose reshaping. One of the most important factors in her case – as in many ethnic rhinoplasty patients – was the skin thickness. She happened to fairly thick nasal skin. So why does this matter? Thicker nasal skin simply doesn’t want to become smaller. Meaning, if you reduce the size of the underlying framework (cartilage and bone) of the nose, thick nasal skin simply doesn’t ‘shrink down’ to the new, smaller size. Therefore, you have to be very careful when trying to make a nose like this appear more defined and refined. And even when you opt to use other rhinoplasty techniques – expectations need to be tempered so that patients realize way up front that their nose can be improved – but only to a certain degree.

In this particular rhinoplasty patient, she wanted to have a nose that just looked smaller on her face. That included wanting to (1) narrow the wider nasal bones, (2) defining the wide, broad nasal tip, and (3) narrowing the flared nostril base. I counseled her repeatedly that – although I was confident I could improve the appearance of her nose – her thick skin was a significant limitation in terms of just how much improvement I could make. She was quite accepting of this notion and understood why this was the case. Given the fact she was realistic in terms of her expectations, we both decided to proceed with a planned open septorhinoplasty surgery.

Open Rhinoplasty

I ended up performing an open rhinoplasty with septal cartilage harvesting because this provided me with optimal exposure of her tip and bridge – which was needed in order to maximize the changes being made.

Although you can tell how wide her nose was overall on the frontal view provided above, her oblique (or 45 degree) view revealed other issues that contributed to her dissatisfaction with the nose. For example, her nasal bridge looked even wide on this view (A) because the middle one-third of her nose (termed the middle nasal vault) was a bit narrowed. In addition, this view confirmed the bulbous, wide nasal tip (B) that can be easily seen on her frontal view. And finally, the heavy columella (C) further contributed to her nose looking less than optimally defined.

Given the fact all of these areas would need surgical attention and reshaping – we decided to proceed with the open rhinoplasty approach.

Rhinoplasty Before & After

Shown here are the results of her open rhinoplasty procedure.

Frontal Views

On her frontal view, you can readily see how the entire nose looks smaller and more defined. This includes the nasal bones that have now been brought closer together to shadow better from this view. This was accomplished by breaking the bones – also termed osteotomies – and moving them inward. In cases like this, the goal is to narrow the bones without making the nose look to skinny. It also includes a smaller looking and more refined nasal tip shape. Instead of the broad, boxy tip she once had – there is now a nicely defined, slightly convex shape to her nasal tip – without looking overly pinched or fake.

Nostril Base Narrowing Weir Excision

If you look closely at her nasal base, you will see the nostrils are now closer together (and more symmetrical). Looking back at her preoperative rhinoplasty photos, you can see just how wide the nostril base was prior to surgery. The red vertical lines correspond to the width of her nasal base. If you follow them up toward the eyes – you will see the distance between the two lines (corresponding to the width of her nostril base) is wider than ideal. In an ideal world, this distance should be equivalent to the width between the two corners of the eyes. In this case, she is a bit wide by nearly 3-4 millimeters on each side. The only way to help correct this is to perform a nasal base reduction – or nostril narrowing procedure as part of the rhinoplasty reshaping. In this rhinoplasty case example, this meant removing a wedge-shaped segment of skin and soft tissue where the nostrils met the cheek. This is often referred to as a Weir excision by rhinoplasty and revision rhinoplasty experts.

In the end, the nostril base was brought in by several millimeters on each side. As you can see here in the adjacent diagrammed photo, she is now much closer to an ideal width in terms of the base of the nose. The blue vertical lines correspond to her new nasal base width. If you look closely, you will appreciate how they now intersect very near to the corner of the eye on each side – certainly an improvement from where she was prior to the rhinoplasty. But the nasal base wedge reduction was not so aggressive that her nasal base appears to have been surgically altered – meaning this region still appears to have a gentle curvature as it rounds the nostril base and joins the cheek.

Oblique Views

In terms of her other views, the oblique view shown early also demonstrates an overall nice improvement. In fact, you can see even on this angled rhinoplasty view that her nose looks more refined with less curves and undulations. If you look closely at the oblique view, you will notice how her nasal tip even looks more narrow and defined.

Lateral Views

Although her lateral view did not change much – that was the intention – to try and maintain her overall look. I did lift her nasal tip up slightly – called increasing her nasal tip rotation. But this was done very carefully so as to avoid an unnatural rhinoplasty result. In the process of these changes. the columella was made to be less heavy and her bridge was reshaped in a finesse manner.

#### Browlift
Brow Lift Surgery with Dr. John Hilinski

A brow lift, also known as a forehead lift or eyebrow lift, is a cosmetic procedure designed to elevate and reshape the brow area to create a more youthful, refreshed appearance. As we age, gravity and loss of skin elasticity can cause the brows and forehead to descend, creating a heavy, tired look with deep forehead wrinkles. Drooping brows can also cause the eyelids to sag or look crowded, further aging your appearance.

San Diego-based facial plastic surgeon, Dr. John Hilinski, specializes in advanced brow lift techniques that provide natural-looking, rejuvenated results. With dual board certification in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery, Dr. Hilinski offers expertise in both cosmetic and reconstructive procedures, making him one of the most sought-after facial plastic surgeons in Southern California.

Types of Brow Lift Procedures

Dr. Hilinski offers a variety of brow lift techniques tailored to each patient's unique needs. Whether you're looking for a subtle lift or a more dramatic change, he will recommend the best approach to achieve optimal results.

What to Expect During a Brow Lift

During your consultation, Dr. Hilinski will discuss your aesthetic goals and assess your facial structure to recommend the best brow lift option for you. Brow lift surgery is performed on an outpatient basis and typically takes between two and three hours to complete. Dr. Hilinski uses deep sedation or general anesthesia to ensure patient comfort, and some less invasive lifts may be performed under local anesthesia.

Brow Lift Results

Patients who undergo brow lift surgery with Dr. Hilinski are often thrilled with their refreshed, youthful appearance. By raising the eyebrows and smoothing forehead wrinkles, this procedure can significantly rejuvenate the upper face. Dr. Hilinski's skill and attention to detail ensure that your results look natural and complement your facial features.

Recovery After Brow Lift Surgery

Recovery from a brow lift typically involves swelling and bruising for the first 7-10 days, especially around the eyes. Dr. Hilinski will remove your bandages and stitches within 5-7 days post-surgery. Most patients feel comfortable returning to work and social activities within a week, with makeup able to conceal any residual bruising. Full healing and final results continue to improve over several weeks.

FAQ: Brow Lift Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you're considering a brow lift, schedule a consultation with Dr. John Hilinski to explore your options and develop a personalized treatment plan. His expertise and attention to detail ensure the best possible outcomes for patients seeking brow and forehead rejuvenation.

#### Bulbous Tip Rhinoplasty
Bulbous Tip Rhinoplasty by Dr. John Hilinski: Expert Nose Refinement in San Diego, CA

A bulbous nasal tip is a common cosmetic concern characterized by a round, wide, or poorly defined nasal tip that can disrupt the overall balance and harmony of the face. Bulbous tip rhinoplasty is a specialized procedure designed to refine and reshape the nasal tip, creating a more elegant and proportionate appearance. As a leading facial plastic surgeon in San Diego, Dr. John Hilinski is renowned for his expertise in addressing bulbous nasal tips, offering personalized treatment plans that deliver natural-looking results.

What is Bulbous Tip Rhinoplasty?

Bulbous tip rhinoplasty is a surgical procedure that targets the nasal tip to reduce its size, refine its shape, and enhance its definition. This type of rhinoplasty typically involves reshaping the alar cartilages--the structures that form the nasal tip--by adjusting their position, reducing excess cartilage, or employing suturing techniques to create a more refined contour. The goal is to achieve a nasal tip that is well-proportioned to the rest of the nose and facial features, resulting in a more balanced and attractive appearance.

A bulbous tip can result from several factors, including thick or excessive cartilage, a rounded or boxy shape, or thick nasal skin. Dr. Hilinski customizes his approach based on the individual anatomy and aesthetic goals of each patient, using advanced techniques to ensure precise and long-lasting results.

Benefits of Bulbous Tip Rhinoplasty

Improved Nasal Definition

Refines the nasal tip to create a more defined and elegant shape.

Enhanced Facial Balance

Adjusts the proportions of the nasal tip to better align with other facial features.

Natural-Looking Results

Dr. Hilinski’s expertise ensures results that are subtle and harmonious, avoiding an overdone or unnatural appearance.

Boosted Confidence

A refined nasal tip can enhance self-esteem and overall satisfaction with your appearance.

How is Bulbous Tip Rhinoplasty Performed?

Bulbous tip rhinoplasty can be performed using either an open or closed surgical approach, depending on the patient's needs and the extent of refinement required.

During the procedure, Dr. Hilinski may employ various techniques such as cartilage reshaping, suture techniques, and cartilage grafting to achieve the desired tip definition. The surgery typically takes about one to two hours and is performed under sedation or general anesthesia in an outpatient setting.

Recovery from Bulbous Tip Rhinoplasty

Recovery from bulbous tip rhinoplasty varies depending on the surgical approach and the extent of the reshaping. Most patients experience mild to moderate swelling and minimal bruising, with initial recovery taking about one to two weeks. Patients are generally able to return to work or normal activities within a week, although strenuous activities should be avoided for several weeks. Full refinement of the nasal tip may take several months as residual swelling gradually subsides.

Who is a Good Candidate for Bulbous Tip Rhinoplasty?

Ideal candidates for bulbous tip rhinoplasty include individuals who:

Are in good overall health and non-smokers

Have a rounded, wide, or poorly defined nasal tip

Desire a more refined and proportionate nasal appearance

Have realistic expectations for the outcome of the surgery

Dr. Hilinski will perform a thorough evaluation during your consultation to determine if bulbous tip rhinoplasty is the right option for you.

FAQ: Bulbous Tip Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering bulbous tip rhinoplasty and want to learn more about how this specialized procedure can enhance your nasal appearance, schedule a consultation with Dr. John Hilinski. As San Diego's expert in nasal refinement, Dr. Hilinski combines his extensive credentials, personalized approach, and commitment to excellence to deliver natural-looking results. Contact us today to begin your journey toward achieving your ideal nose.

#### Bulbous Wide Nasal Tip
This is another example of cosmetic nose reshaping, or rhinoplasty, to correct a bulbous, wide nasal tip. This very pleasant young lady consulted with me to discuss options for her bulbous appearing nasal tip. Although she also desired to address a bump on her nasal bridge, the bulbous nasal tip was considered a priority for her.

Bulbous Wide Nasal Tip Consult

During her examination in the office, we discussed in detail the desired changes to be made. More specifically, we discussed the fact her nasal tip did indeed appear somewhat bulbous as seen on her frontal view. Many patients and rhinoplasty surgeons would also describe this type of nasal tip as being broad or rounded in shape. As you look at her oblique, or 45 degree, angle the nasal bridge starts to come into view partially revealing the dorsal hump, or bump. This then becomes much more obvious as you look at the true lateral view of her nose. On her lateral view, you can also appreciate that her nasolabial angle (the angle formed by the bottom of the nose and the upper lip) is near 90 degrees. Ideally this angle would be closer to 95-105 degrees in a female.

Bulbous Wide Nasal Tip Imaging

As is done with a great majority of my cosmetic rhinoplasty procedures, digital imaging was performed using a specialized software program that allowed her photos to be morphed. In doing so, the patient and myself were able to get an idea of how the nose may look following surgery. The morphed photos are by no means a guarantee or warranty of what the nose will look like after rhinoplasty surgery. Instead, the morphed images are intended to be a guide in terms of the desired direction and degree of change.

It deserves mention that all the imaging in my office is performed by me – the surgeon. This is because I am the one who has been trained to do this type of surgery and is ultimately performing your surgery. In many other plastic surgery practices, a patient consultant (or some other staff member) is the one performing your imaging, which has never made sense to me. How can someone who has never performed a rhinoplasty procedure be qualified to show you realistic changes that will occur with very specific surgical maneuvers? This does not even touch on the wide variability in, for example, skin type and cartilage thickness that is seen across every individual.

In this particular case, I performed digital imaging to produce the photos shown below. As you can appreciate, the surgical goal was to make her nasal tip more narrowed. However, we wanted to maintain some degree of roundness, or convexity, to the nasal tip. On the side view, the goal was to reduce the dorsal hump, or bump, while creating a relatively straight profile. The desire was not to create a bridge that appeared excessively done or scooped on the side view. This was particularly important given the fact she has moderately strong ethnic features.

Bulbous Tip Reshaping

Once we had agreed on the desired surgical goals based largely on the software imaging, the surgery was scheduled and completed at our own ambulatory surgery center.

A reproduction of the ‘rhinoplasty diagram’ for this case is shown here. Rhinoplasty diagrams are typically done for each rhinoplasty surgery performed in my practice. These are essentially intra-operative ‘notes’ that are made to graphically show what was done to the nose during the rhinoplasty procedure. Although an actual operative report is dictated for each case, these rhinoplasty diagrams provide a valuable record that can be easily referenced to ‘see’ what was done. Why is this needed you may ask? Here is an example of why a rhinoplasty diagram may be helpful. Let’s say a patient is being seen 9-12 months out from surgery and notes a small visible bump near the middle portion of the nasal bridge that developed over the prior 4 weeks. In this situation I can easily reference the rhinoplasty diagram to check and see if this area corresponds to a graft or suture that was placed during surgery. Although the operative dictation may mention this, the graphical diagram is a more helpful reference.

In this particular patient, an open rhinoplasty approach was used because it provided a marked advantage in terms of access and exposure from the nasal tip up to the radix. The excess bridge height was addressed by rasping the bone and shaving down the cartilage. This is represented by the red dotted line seen on the profile view of the diagram. Once this was ‘sanded down’ as patients often say, the nasal bones (essentially the upper one-third of the nose) were narrowed to help maintain a nice narrowed bridge. This is shown in the diagram as the curved yellow broken lines.

Attention was then focused on her bulbous, wide nasal tip. As mentioned in other rhinoplasty tutorials, there are a number of options available when dealing with a bulbous nasal tip. In this case, a decision was made to address the wide supra-tip region using cephalic trimming technique. In a majority of cases, I try and avoid this type of maneuver if possible. However, there are those cases, such as this one, where you simply have to reduce the amount, or volume, of excess cartilage that is contributing to nasal tip appearing bulbous and wide. Cephalic trimming essentially involves cutting out a narrow segment of the offending cartilage contour. The cephalic trimming of the supra-tip is represented in the diagram by the red shaded areas along the upper border of the lower lateral cartilages. Once this was done, a spanning suture was placed as shown by the green oval in the diagram. This special permanent shaping suture help to stabilize the cut edges of cartilage while also providing additional narrowing in the supra-tip.

Although these maneuvers certainly helped, additional reshaping of the nasal tip was warranted. This was performed with use of cartilage grafting technique. This means that cartilage is taken from one area and relocated to another area in order to change the shape of the nose. In this case example, cartilage was harvested from the septum as shown by the partially transparent red shaded outline. Septal cartilage is a common source of grafting in rhinoplasty since it is readily available inside of the nose. In rhinoplasty cases where the septum has been previously operated on, other sources of cartilage need to be sought out, such as the ear and rib. Fortunately, in this patient, the septum provided an adequate amount of cartilage to create the desired grafts. Using this cartilage, a cap graft was sewn over the native tip cartilage (as shown by the orange shaded area) to create improved projection and refinement. The overall effect of this type of reshaping was to provide a more narrow, defined look while also rotating the nasal tip (see yellow curved arrow).

In order to fine tune her profile, a small radix graft was also placed as shown by the orange shaded area near the top of the nasal bridge.

Bulbous Wide Tip Rhinoplasty

The results of her rhinoplasty surgery are shown here. As you can see on the frontal view, the nose has now been narrowed nicely to erase signs of her prior bulbous, wide nasal tip. But notice how her nasal tip remains slightly convex in shape without any hint of being pinched on the sides. If you look closely at her bridge on the frontal view you can also tell that her native width has been appropriately preserved.

On her oblique view you can start to see how the dorsal hump deformity (bump) has now been corrected. As you look from this angle you can now appreciate that her nose has been reshaped to give a more feminine contour overall. This includes narrowing of her bulbous tip and increasing the rotation of the nose.

On her lateral, or profile, view, you can see even more dramatic changes to the shape of the nose. Most obvious is improvement in the dorsal hump deformity. Her bridge is now much straighter without any stigma of being over-reduced, or scooped. Her nasal tip is also not as droopy as it appeared prior to the rhinoplasty.

Most importantly, this patient still looks like herself following rhinoplasty. Patients are so often concerned and worried about look too different after cosmetic nose reshaping. In cases like this one, the underlying ethnicity must also be respected in terms of any changes made to the nose. The end result and goal should be a nose that simply does not draw any unwanted attention to it any longer. In this particular case example, I happen to think that goal was certainly achieved as she now has a beautiful new nose that simply looks natural on her face.

Comparing Morphed Imaged Photos

Comparing her preoperative morphed images with the actual surgical results, you can see that the real-life outcome is fairly close to the predicted shape. It is unrealistic to think the actual result will be exactly like the morphed image. However, in a good majority of my rhinoplasty cases, the actual result can be considered fairly close to what was imaged prior to the planned surgery.

Consult for a Bulbous Wide Nasal Tip

If you have concerns with a bulbous, wide nasal tip and desire to have cosmetic rhinoplasty to reshape your nose, contact my office today for a personalized consultation.

#### Bulbous, Rounded Nasal Tip
The bulbous or rounded nasal tip is one of the more common reasons that patients seek rhinoplasty, or nasal reshaping, surgery. A bulbous nasal tip is one that simply looks more rounded – almost like a ball positioned on the end of the nose. Most rhinoplasty patients with a bulbous nasal tip describe their nose as being too wide or too big. Others describe the nose as being poorly defined without shape. To gain a thorough understanding of what the ideal nasal tip shape should be, refer to our rhinoplasty tutorial section on nasal analysis. In short, the nasal tip should simply not draw attention to it. It should be proportional in terms of size and width such that the bridge gently blends or transitions into the nasal tip. Overall, the nasal tip should be triangular shaped as seen from below, but without any sharp angles. We call this a soft triangle, which means it gently slopes in a convex orientation from the midline out to the sides.

What Causes A Bulbous, Rounded Nasal Tip?

A bulbous, round nasal tip is a direct result of the shape of the lower lateral cartilages. The lower lateral cartilages refer to a pair of cartilage structures as depicted in the adjacent diagram. The lower lateral cartilages are shaded red and are typically fairly similar in shape and size. The two lower lateral cartilages merge in the midline to help form the support of the nasal tip. They then diverge from one another to form the structural support of the nostril rim on each side. The point at which the two cartilages diverge away from one another is called the dome region and significantly impacts the shape of the nasal tip. If the dome cartilage is appropriately oriented (as shown below left) the nasal tip will approximate the desired soft triangular shape. A bulbous nasal tip results when the domal cartilage is excessively wide and rounded (as shown below middle and right). If you compare the normal nasal tip cartilage with the bulbous tip cartilage you can see an obvious difference in terms of width.

What Does a Bulbous Nasal Tip Look Like?

So what does a bulbous, rounded nasal tip look like in the typical rhinoplasty patient? The attached patient photo is a great example of a bulbous, rounded nasal tip. If you look at this patient’s frontal view, one of the first things you notice about her nose is the nasal tip region. It looks excessively large for her nose and is more rounded in shape. Some people would say it simply does not have much definition. If you remember from our online rhinoplasty tutorial nasal analysis page, the nasal tip should be just slightly wider than the upper bridge. In the bulbous nose, the tip is much wider than the nasal bridge.

Management Of The Bulbous, Rounded Nasal Tip

Rhinoplasty to correct a bulbous, rounded nasal tip is directed at reshaping the lower lateral cartilage to approximate more of a soft triangular appearance.

Suture Reshaping

The photo below is an example of the suture technique to reshape a bulbous, rounded nasal tip. In this male rhinoplasty patient from San Diego, I reduced the bulbosity of his tip with careful placement of permanent sutures within the lower lateral cartilage on both sides. In doing so, I was able to significantly reduce the prominent arch along the nasal tip and provide him a more refined nasal tip appearance. You can really appreciate this change on his oblique view, which truly highlights the amount of bulbosity in his nasal tip.

Cephalic Trimming

An alternative rhinoplasty technique is to perform what is called a cephalic trim maneuver. The cephalic portion of the lower lateral cartilage refers to the upper edge, or margin, of the cartilage (the side that is opposite the nostril rim) when looking directly at the nose from the frontal view. In the adjacent photo diagram the arrows are pointing to the cephalic margin of the lower lateral cartilage. As you might imagine, if this portion of the lower lateral cartilage is excessively prominent, it can contribute to a wider, more bulbous looking nose. If this is indeed the case in a particular rhinoplasty patient, then they may benefit from a cephalic trim maneuver during the nasal reshaping process. This involves trimming, or removal, of the overly prominent cartilage along the cephalic edge. In doing so, the lower lateral cartilage is made less bulbous and the nasal tip begins to appear more refined, or defined. A cephalic trim maneuver must be done very carefully to ensure proper symmetry of the nasal tip. You must also avoid taking too much cartilage when performing cephalic trimming. In fact, you should leave the lower lateral cartilage approximately 8-10 mm wide in order to maintain adequate structural support for the nasal tip. If you take too much cartilage away during a cephalic trim, you risk subsequent collapse of the nasal tip as there is insufficient cartilage to maintain the natural shape of the tip. This mistake is often manifested as a pinched nasal tip that can appear many months or years after overly aggressive cephalic trimming. When done properly in the right patient, cephalic trimming can result in marked improvement in the nasal tip shape while preserving sufficient structural support.

The photo below visually demonstrates an example of cephalic trimming to help address a bulbous nasal tip. This patient’s lower lateral cartilage was quite bulbous and necessitated some degree of reduction of the excess volume. Using an open rhinoplasty approach, I exposed her tip cartilage and performed a cephalic trim on both sides. A sufficient amount of cephalic cartilage was trimmed off to create a more defined, shapely nasal tip. At the same time, I was careful to preserve enough of her native cartilage structure to maintain adequate support of her nasal tip. Her after rhinoplasty photo was taken years later, further demonstrating how cephalic trimming, when done properly, can provide a nice cosmetic nasal enhancement without creating the dreaded pinched nasal tip.

Cartilage Grafting of the Tip

Another alternative in management of the bulbous, rounded nasal tip involves cartilage grafting of the nose. Grafting means that the patient’s own cartilage (usually taken from the septum, ear or rib) is taken from one area and placed in another for added support or reshaping of the nose. In this particular case, we would use cartilage grafting to reshape the bulbous, rounded nasal tip. Some rhinoplasty surgeons refer to this technique as a “lateral crural underlay” maneuver. All this really means is that a segment of cartilage is placed under the lateral crus (another term for the lateral portion of the lower lateral cartilage) to reshape the nasal tip region. As is seen in the adjacent diagram, a linear, stiff cartilage graft (white rectangle) can be placed on the undersurface of the lateral crus and sutured to the patient’s own cartilage. By suturing the cartilage against the crural underlay graft, the rounded contour of the nasal tip now becomes straighter on each side. The end result is a more triangular shaped nasal tip that looks much more refined.

Below is an example of a lateral crural underlay technique for a bulbous, rounded nasal tip in this San Diego rhinoplasty patient. This particular patient had overly prominent lower lateral cartilages that was distracting in light of her remaining facial features. Her cartilage was also notably fairly stiff once evaluated in the operating room. I chose to perform a lateral crural underlay technique to reshape her nose. Cartilage was taken from her septum and the grafts created in an equivalent fashion. The grafts were sewn to the undersurface of her lower lateral cartilage on each side thus helping to draw the cartilage inward. The end result was a more refined appearance nasal tip that no longer looks rounded. Overall, she now has a more feminine looking nose with better definition.

Below is another example of bulbous nasal tip reshaping in this female patient from San Diego, CA. Notice how prior to surgery her nasal tip appears rounded and broad for her face. Following cosmetic nose job surgery, her nasal tip now appears much less bulbous with more definition. Looking closely, you will appreciate that the tip is not overly done – avoiding any signs of looking surgically pinched or collapsed.

Combined Techniques

In some rhinoplasty patients, we use a combination of these techniques in order to accomplish our desired cosmetic goal. For instance, we might combine the suture technique with cephalic trim of the lower lateral cartilage. And in other rhinoplasty patients we might place a lateral crural underlay graft after performing a cephalic trim maneuver. The most important consideration is choose a rhinoplasty specialist who has the knowledge and experience to use one or a combination of these techniques when reshaping the bulbous, rounded nasal tip.

To see more examples of our rhinoplasty work visit our online rhinoplasty gallery. To see examples of our revision rhinoplasty work visit our online revision rhinoplasty gallery.

#### Calvarial Bone Graft Revision
This is a great case example of revision rhinoplasty that highlights one of the problems with use of calvarial bone grafts in nose reshaping surgery. This particular patient had undergone a rhinoplasty procedure performed by a different plastic surgeon when she was quite young. She had originally developed a problem with her nose following a traumatic injury. She consulted with a plastic surgeon many years ago outside of California who performed a surgery on her that included use of a calvarial bone graft to reshape the nose.

A calvarial bone graft is a somewhat dated choice for reconstructive rhinoplasty surgery, which involves taking a segment of the outer skull to rebuild the nose. The reason this type of grafting has fallen out of favor in the world of rhinoplasty surgery is because the bony material will commonly calcify (harden in an unusual manner), warp (distort) and dissolve (disappear) after placement. Although other methods of grafting, such as septal and rib cartilage, have these same potentials, they do not occur as frequently as they do with calvarial bone grafting.

Following this patient’s original rhinoplasty procedure, the calvarial bone graft began to shift from its original position. She then underwent a follow-up revision rhinoplasty surgeon by another plastic surgeon who tried to adjust the orientation of the graft. Unfortunately, this secondary rhinoplasty procedure was unsuccessful. Because the two failed rhinoplasty procedures were performed by credible board certified plastic surgeons, the patient walked away feeling as if there was little hope with pursuing any additional surgery for her nose. As the years went on, her nose became increasingly distorted in terms of its shape. This was primarily due to calcification of the calvarial bone graft with significant displacement of the bone graft.

She lived with the problem for literally decades before she revisited the whole notion of further revision rhinoplasty surgery. After doing her research, she discovered our office here in San Diego and realized that facial plastic surgeons, like myself, have dedicated revision rhinoplasty expertise in helping patients just like her. She came in for a revision rhinoplasty consultation, which included a thorough evaluation of her nose and discussion of possible corrective measures that might be taken.

Revision Rhinoplasty Consultation

On her examination, it was quite obvious that her calvarial bone graft had slipped off to the side of her bridge. In fact, it had moved over so much that it was displaced toward her right eye. This can be seen in the adjacent photo diagrams. On the frontal view, you can see how the calvarial bone graft was pushed off of the midline, particularly along the upper portion of the graft (near the root of the nose). The inset photo outlines the portion that corresponds to the outline of the calvarial bone graft as seen from the frontal angle. Unfortunately, as time passed on, the overlying skin of the nose began to shrink wrap down around the calvarial bone graft so much so that you can now literally see the borders of the graft. You can easily tell from this frontal view that the calvarial bone graft was excessively thin near the top, thus creating a very unnatural looking nose.The dark hue that can seen coursing across the graft corresponds to a collection of veins that were very near the skin surface. Because the skin was thinned out so much, these veins were much more visible.

On her oblique (45 degree) view of the nose, you can also readily appreciate the abnormal contour that resulted from the calvarial bone graft. From this perspective, you can see how the graft was creating a bridge contour that was abnormally high for the nose. Consequently, the middle portion of her nasal bridge appeared scooped out. The inset photo outlines the portion that corresponds to the outline of the calvarial bone graft as seen from the oblique angle. As you can see, the bone graft was shifted away from us near the top border. You can also appreciate from this angle how one’s eyesight may be impaired as a result of the graft obstructing normal peripheral vision.

On side view (profile) of her nose, you get can another perspective of where the bone graft is positioned. As you can see from the diagrammed photo, the graft almost looks as if it had slipped upward as well (toward the forehead). You can also better appreciate how this displaced graft gave the appearance the middle portion of the bridge was scooped out. The red arrow indicates where the nose normally starts – also referred to as the nasofrontal angle. To remind yourself of this anatomical landmark, use this link here to refresh your memory on rhinoplasty analysis. In this particular case, the nasofrontal angle has essentially been obliterated as a direct result of the calvarial bone graft being displaced upward. On first glance of this nose, you quickly realize that there is something wrong with the overall shape – even if you are not an experienced rhinoplasty surgeon.

Revision Open Rhinoplasty Surgery

After reviewing the options available to her, this patient elected to undergo another very complex, challenging revision rhinoplasty surgery. I decided to perform the surgery with an open rhinoplasty approach so that I could have maximum exposure to the bridge area.

Once the revision rhinoplasty procedure began, it became quite clear that the bone graft was densely calcified up against the surrounding tissues. This means that the graft almost felt as if it was cemented into place after all of these years of healing. It was like the difference between carving your initials into a petrified tree trunk versus a normal tree trunk. Unfortunately, the graft could not be removed easily. Thus, I had to begin reshaping the graft with secondary techniques that involved extensive sanding. Ultimately, the calvarial bone graft was able to be reduced in terms of its size such that a more normal bridge contour could be achieved. At the same time, an attempt was made to improve the transition from the upper bridge to the mid dorsum. This required auricular (ear) cartilage grafting in addition to more reshaping of the calvarial bone graft. Once these changes were accomplished, a temporal fascia graft was then placed over the newly shaped cartilage and bone (including the residual portions of the calvarial bone graft). The fascia graft was placed in order to create a thicker overlying soft tissue layer and to help minimize chances of visible contour irregularities following surgery.

Before & After Calvarial Bone Graft Revision Rhinoplasty

Herein are the before and after photos following my revision rhinoplasty procedure.

As you can see from the comparisons, her nose now looks much more normal overall. No longer does she have as much unwanted attention being drawn to this portion of her face. On the frontal view, we have restored a much more natural looking bridge contour and shape with significant improvement seen in terms of symmetry. The bridge width is also now much more appropriate for her face with better balance when compared to her overall facial structure. This is a patient who has a generally rounded facial shape, therefore, a thin nasal bridge looks inappropriately out of balance on her face. You can also see on this frontal view that her nasal skin is much healthier looking now that the fascia graft has been placed. Furthermore, the previously visible, discolored veins are now much less obvious. On the oblique view of her nose, you can see how the bridge height has been taken down quite a bit. The nasal bridge contour is also much more pleasing as it transitions from the new nasofrontal angle all the way down to her tip. On side view of the nose, you can also see how the nasofrontal angle has been reestablished to create a much more natural look.

Final Thoughts

It should be noted that some people might look at these revision rhinoplasty results and criticize them for not showing even more change and refinement. But, anyone who knows anything about the true complexities of revision rhinoplasty will appreciate the overall changes that were made. The global transformation of this nose was incredibly difficult, and that is coming from a surgeon who has a highly specialized practice with dedicated experience in managing some of the most difficult rhinoplasty cases in the region. The reality is that not all noses that were previously operated on can be restored completely due to extensive scarring and tissue distortion. In many cases, just like this one, the expectations need to be tempered. The most important point is that this particular patient is ecstatic with her results and is no longer inhibited by the appearance of her nose.

#### Caudal Septum Deviation
One of the more challenging types of reconstructive rhinoplasty involves repair of a caudal septum deviation.

Caudal Septum

So what is the caudal septum you might ask? The caudal septum refers to the portion of the nasal septum that sits right behind the columella – which is the column that separates the two nostril openings. The caudal septum can also refer to the anterior most segment of the nasal septum – meaning the segment that is closest to the bottom of the nose.

The caudal septum is shown diagrammatically in the adjacent image and is indicated by the green shaded area. The slightly curved segment of cartilage right in front of the shaded green area corresponds to one of the medial crura. Both medial crura attach very closely to the caudal septum and are important in determining the location and position of the actual nasal tip.

So what is the big deal about the caudal septum? Because it is so critical in helping to support the nasal tip cartilage, it is vital that rhinoplasty surgeons be mindful of the caudal septum. For example, if the caudal septum is removed, or resected, the medial crura cannot be adequately supported. Therefore, the medial crura essentially fall down. This then compromises the support of the entire nasal tip. In most cases, the nasal tip will droop down, or drop, if the caudal septum support is not sufficient. This is shown in the adjacent diagram as indicated by the red arrow.

In other cases, a compromised caudal septum will result in severe nostril asymmetry since the medial crura are not attached to anything that is supportive. This will lead to subjective difficulty breathing through the nose as the airway becomes blocked on one or both sides.

A Deviated Caudal Septum

This case example highlights the importance of the caudal septum and the need to find a qualified surgeon in San Diego that has knowledge and experience in correcting a deviated caudal septum. This male patient presented to Dr. Hilinski noting trouble breathing through his nose. On examination it was quite clear why he was having nasal obstruction.

You can see in the adjacent photo of the patient from below just how abnormal his nostrils are in terms of shape and size. Particularly on the patient’s left side (right side in the photo), you can see how much blockage there is in terms of airflow. When the patient pulls the tip slightly over to the side, you can see even more readily how much nasal blockage there is on that side. In fact, he has barely a ‘slit-like’ opening to breathe on his left side.

This is all primarily due to an abnormality with his caudal septum. Facial plastic surgeons and rhinoplasty surgeons would also refer to this as a deviated caudal septum, a displaced caudal septum and a caudal septum deformity. No matter how you label it, there is an anatomical problem with how the caudal septum is shaped and positioned.

Exposing the Caudal Septum

It was recommended by Dr. Hilinski that he undergo a complex nasal reconstruction using an open rhinoplasty approach. This was going to be the best way to expose all the pertinent anatomy in the region of the caudal septum. It was also going to allow Dr. Hilinski prime exposure for repairing the caudal septum with planned cartilage grafting.

Here attached are several intraoperative photographs from this patient’s actual reconstructive septorhinoplasty surgery. The adjacent base view is taken from a similar angle as the clinical photos shown above. The metal nasal speculum can be seen spreading the paired medial crura apart to help expose the caudal septum as seen from below. A well-trained rhinoplasty surgeon would be able to see immediately just how abnormal this caudal septum is compared to a normal nose. Normally, one would see just the thin edge or end of the caudal septum. In this case, the caudal septum was so severely bent, it looked like Dr. Hilinski was staring at a wall.

When this area of the caudal septum was then viewed from above – called the aerial view in rhinoplasty – you could see even more readily what the problem was with his nose. As the nasal speculum spreads the medial crura apart, you can appreciate how his caudal septum was actually forming a right angle! This is indicated by the superimposed ‘L’ as shown here. In fact, rhinoplasty surgeons will sometimes refer to this type of severe caudal deviation as being an L-shaped deflection of the caudal septum. But now you can see how and why this patient’s caudal septum was so displaced as to cause him severe trouble breathing through his nose.

Repairing the Caudal Septum

In this type of septal deviation, a surgeon cannot simply cut out the displaced cartilage. Why? Because we mentioned above how critical the caudal septum is to proper nasal tip support. If the caudal septum was just cut out and nothing else was done, his nasal tip wouldn’t have anything to properly support it – leading to collapse of the nasal tip after surgery.

In order to adequately and reliably address the caudal septum deviation shown above, Dr. Hilinski had to remove the deviation – but he had to replace this segment with a straighter piece of cartilage that could then proper nasal tip support. This is NOT your routine type of septoplasty surgery. This type of septal reconstruction is something that only true experts in septoplasty and rhinoplasty are trained to do. Meaning, most ENT surgeons in San Diego would not feel comfortable performing this type of septoplasty. That is why so many San Diego ENT doctors refer this type of septoplasty to an expert septal surgeon like Dr. Hilinski.

This type of septoplasty surgery is termed a subtotal septal resection procedure – since nearly all of the septal cartilage has to be removed before the caudal septum is reconstructed or repaired. The actual cartilage that was removed from this patient is shown here in the adjacent photo taken during his surgery. As you can see – now in all of its glory – the cartilage was indeed quite deviated. Why is the deviation not at a 90 degree angle as it was while in the nose? This is because the cartilage was attached to surrounding structures inside of the nose. Once the cartilage was removed, there was some relaxation noted.

So how did Dr. Hilinski go about repairing the caudal septum? If you look at the rest of the cartilage taken out along with the caudal deviation, there was plenty of viable, straight cartilage behind it. This is seen here in the adjacent photo to the right. You can actually see the L-shaped displacement – along with the remainder of the cartilage harvested with it. Again, this is not the type of cartilage harvesting that is usually seen with routine, traditional septoplasty surgery performed by ENT surgeons. But that is another reason why this type of septal reconstruction surgery is only performed by specialists such as Dr. Hilinski.

Ultimately, Dr. Hilinski ended up using this other segment of cartilage to help rebuild a new nasal tip support mechanism. What this means is that Dr. Hilinski made a new caudal septum from this harvested septal cartilage and attached it to the nose. In doing so, he was able to replace the L-shaped deviation with a solid, straight, supportive new caudal septum. This new caudal septum is shown in the adjacent photo of this patient taken during surgery. Whereas his caudal septum was previously angled off 90 degrees as shown above – it is now appropriately positioned and shaped – coming straight out of the photo right at you. The cartilage was sewn to the surrounding cartilage and bone – and would eventually scar into place long-term.

The medial crura would then be sewn to the new caudal septum so that the proper tip position could be established. Now that the caudal septum has been correctly repaired by Dr. Hilinski, the nostril openings should be much more symmetrical. In turn, there should be a much better nasal airway on both sides – leading to a marked improvement in subjective breathing for this patient.

Before & After Caudal Septum Repair

Here are stable results showing before and after photos following repair of the caudal septum deformity in this patient. As you can see, Dr. Hilinski was quite successful in repairing the structural abnormalities noted above. In fact, the patient’s nostrils are now about as symmetrical as they come in terms of rhinoplasty reconstruction. This translated into a marked improvement in nasal breathing for this very fortunate rhinoplasty patient from San Diego. And as can be seen in his frontal views, his nose also looks aesthetically much better as a result of Dr. Hilinski’s surgery.

#### Cauliflower Ear
Restore the Natural Shape of Your Ear with Otoplasty

Cauliflower ear can leave the ear looking swollen, uneven, and misshapen after repeated trauma or injury. The condition is common among athletes—especially wrestlers, boxers, MMA (mixed martial artists), and jiu jitsu practitioners—but can affect anyone who’s suffered an ear injury.At John Hilinski, MD Facial Plastic Surgery in San Diego, California, Dr. John Hilinski, a double board-certified facial plastic surgeon and reconstructive ear surgeon, performs advanced otoplasty procedures to repair cauliflower ear and restore a more natural, balanced appearance.

What Is Cauliflower Ear?

Causes and Risk Factors

Why Prompt Treatment Matters

Otoplasty for Cauliflower Ear

Who Is a Candidate for Cauliflower Ear Repair?

Recovery After Otoplasty

Expected Results

Preventing Cauliflower Ear

Why Choose Dr. John Hilinski

FAQs About Cauliflower Ear

What Is Cauliflower Ear?

Cauliflower ear is a deformity that develops when the ear sustains a blunt injury or repeated friction, leading to a collection of blood or fluid (auricular hematoma) between the ear cartilage and the overlying skin. When left untreated, this separation cuts off the blood supply that keeps the cartilage healthy. Over time, the cartilage hardens, thickens, and develops the bumpy, irregular shape that gives cauliflower ear its name.1,2 

The condition is typically permanent unless corrected surgically, making early evaluation and treatment important.

Causes and Risk Factors

Cauliflower ear can result from many forms of trauma or irritation. Common causes include:

Contact sports injuries such as wrestling, boxing, MMA, or jiu jitsu.

Untreated or poorly drained ear hematomas.

Repetitive friction or pressure from tight headgear.

Blood-thinning medications that increase the risk of bleeding after injury. 

Why Prompt Treatment Matters

Immediate treatment following an ear injury can prevent long-term deformity. When swelling or hematoma is present, draining the blood and applying compression allows the cartilage to heal correctly. Without timely care, fibrous scar tissue forms, distorting part of the ear permanently.3 

Prompt treatment helps:

Preserve the ear’s normal contour and prevent damage to ear cartilage.

Reduce the risk of infection or abscess formation.

Maintain proper ear function and comfort.

Untreated cauliflower ear can make patients feel self-conscious about their appearance and may even impact self-esteem, making timely care essential.

Otoplasty for Cauliflower Ear

Once a cauliflower ear deformity has formed, otoplasty (ear reshaping surgery) is often the most effective way to correct it.

During the procedure, small incisions are made behind the ear or within its natural folds to access the cartilage. Dr. Hilinski carefully removes or reshapes excess scar tissue and/or cartilage, then repositions the skin for a smoother, more natural contour. The sutures are placed precisely to secure the new shape and minimize visible scarring.

His meticulous approach focuses on symmetry, proportion, and subtle, natural-looking results. Some patients combine cauliflower ear repair with procedures like ear pinning, rhinoplasty, or a face lift to achieve balanced facial harmony.

Dr. Hilinski’s reconstructive training allows him to address even complex cases—restoring both the appearance and integrity of the ear while minimizing visible scarring on the earlobe and surrounding tissue.

Who Is a Candidate for Cauliflower Ear Repair?

You may be a good candidate for cauliflower ear correction if you:

Have a persistent deformity after trauma or untreated hematoma.

Are in good overall health and can safely undergo minor surgery under local or general anesthesia.

Have realistic expectations about the outcome of surgery.

Have stable ear tissue (the injury has fully healed).

During your consultation, Dr. Hilinski will examine the extent of damage and create a personalized surgical plan based on your anatomy and goals.

Recovery After Otoplasty

Recovery from cauliflower ear surgery is generally straightforward. Patients can expect:

Mild swelling or soreness for one to two weeks.

A protective dressing or headband for several days to support the new ear shape.

Limited activity for several weeks—especially avoiding contact sports or activities that could impact the ear.

Dr. Hilinski provides detailed aftercare and post-operative care instructions, including how to care for your sutures and reduce swelling. Follow-up visits allow him to monitor healing and make sure your results continue to improve over time.

Expected Results

After otoplasty for cauliflower ear, most patients notice:

A smoother, more symmetrical ear shape.

Improved facial balance and confidence.

Permanent correction of the deformity, provided future trauma is avoided.

While minor differences between ears are natural, most patients find the improvement both noticeable and long-lasting.

Preventing Cauliflower Ear

Because cauliflower ear is often preventable, taking precautions is essential:

Wear protective headgear during contact sports.

Seek medical attention immediately after any ear trauma or swelling.

Have hematomas drained promptly by a qualified professional to prevent cartilage damage. 

Schedule a Consultation with Dr. Hilinski

If you're considering earlobe reshaping to correct torn, stretched, or enlarged earlobes, schedule a consultation with Dr. John Hilinski, San Diego's leading expert in ear surgery. With his extensive experience and commitment to patient satisfaction, Dr. Hilinski can help you achieve natural-looking, balanced results. Contact our office today to learn more about your options for earlobe reshaping.

FAQs About Cauliflower Ear and Otoplasty

Ready to Restore Your Ear’s Natural Shape?

If you’re living with the effects of cauliflower ear, surgical repair can help you regain a balanced, natural look—and your confidence. Dr. John Hilinski combines advanced reconstructive techniques with an artistic approach to restore symmetry and improve ear contour.

Schedule your personalized consultation at John Hilinski Facial Plastic Surgery in San Diego to learn more about otoplasty for cauliflower ear. Dr. Hilinski will evaluate your condition, discuss your treatment options, and design a plan tailored to your goals.Take the next step toward feeling comfortable and confident again. Book your consultation today.

Sources

 1 Cleveland Clinic. Cauliflower Ear. Available: https://my.clevelandclinic.org/health/diseases/23146-cauliflower-ear. Accessed October 20, 2025.

 2 Patel BC, Hohman MH, Hutchison J, et al. Cauliflower Ear. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470424/. Accessed October 20, 2025.

 3 Cleveland Clinic. Cauliflower Ear. Available: https://my.clevelandclinic.org/health/diseases/23146-cauliflower-ear. Accessed October 20, 2025.

#### Cephalic Orientation of Tip Cartilage
Many rhinoplasty candidates may hear they have what are called cephalically oriented lower lateral cartilages, or cephalic orientation of their tip cartilage. Cephalic orientation of the nasal tip cartilage is a common occurrence and source of patients seeking rhinoplasty surgery. In fact, this problem accounts for a significant number of patients who have a bulbous nasal tip. This case example presented here demonstrates features of this very common abnormality and highlights one of the more usual techniques I use to address this issue while creating a natural looking nasal tip.

Cephalic Orientation of Cartilage Assessment

This young lady from San Diego presented to my office requesting primarily reshaping of her nasal tip region. Her main complaint was that her nose appeared poorly defined in the tip region. She also desired to have her bridge reshaped. But her main concern at the time was how her nasal tip lacked definition.

On examination, if you look at her frontal view, you can see that her tip region is, indeed, quite bulbous. In other words, it is more rounded and lacking in terms of definition. In this particular case, the tip appeared more bulbous because she had cephalically oriented lower lateral cartilages. The lower lateral cartilage (or lateral crus cartilage) refer to the side wings of the paired cartilage structures that largely comprise the nasal tip. These are referenced as LLC in the adjacent diagram. As you can see in the diagram, normally the lateral crus extends out to the side of the tip in a more horizontal vector or direction. In doing so, this provides the tip with proper shape and definition. A more cephalic orientation means that the lateral crus instead is directed in a more vertical orientation (cephalic referring to the top of the head) as it leaves the midline of the nose. You can see this more visually in the adjacent diagram where this patient’s lateral crus cartilage extends upward instead of going out to the side. Consequently, there is more cartilage volume in this area of the tip that makes it appear more bulbous and less defined. In addition to the bulbous nasal tip, her columella (the column that is positioned between the nostrils) is somewhat heavy – meaning it is somewhat prominent. Overall, she desired to have a more feminine looking nasal tip, which is a very common request among cosmetic rhinoplasty candidates in my practice.

Her preoperative side view reveals a slight convexity (roundness) to the bridge contour as indicated by the red curved line over the dorsum. In addition, this view confirms the somewhat heavy columella as indicated by the red curved line under the tip of the nose. Granted, the convexity of the bridge is not real dramatic. Yet, this was enough to bother the patient and warrant some type of cosmetic change. In terms of the heavy columella, this type of deformity contributes to what is often referred to as ‘excess columella show’ – which means you can see more of the inner lining of the nose than desired from this side view.

When combined with a bulbous nasal tip, these cosmetic issues can add up – really prompting patients to seek out some type of change in the form of rhinoplasty surgery.

Natural Bulbous Tip Surgery

After consulting with her in my office, we decided to proceed with an open cosmetic rhinoplasty approach with the main emphasis on reshaping her cephalically oriented cartilage and bulbous nasal tip. The open rhinoplasty approach afforded me optimal exposure of her nasal tip cartilage, which was the crux of what we were doing in terms of surgical reshaping. In the process, I did perform some bridge reshaping in the form of conservative hump reduction. Because the bridge height was reduced, I ended up breaking her bones to move them in slightly – not necessarily to narrow her nose but more to maintain a natural bridge width. I then focused on her nasal tip region.

It should be pointed out, there are a wide variety of rhinoplasty techniques that can be used to correct a bulbous nasal tip. In fact, these different techniques are reviewed in my other rhinoplasty tutorial chapters. Ultimately, the choice of technique really distills down to your surgeon’s experience and preference in terms of what works best in their hands. In this case example, I chose to deconstruct (take apart) her nasal tip, move it into a new location, and reconstruct the cartilage to create a new tip. In doing so, I first had to detach the lateral crus from its current location, which involves meticulous technique in separating the delicate cartilage wings from the surrounding structures. The cartilage is then moved down and outward to approximate a more normal configuration and position. This is shown more visually in the adjacent diagram where you can see how one side of the lateral crus cartilage was detached and reoriented out to the side (see green-bordered arrow). Comparing the two sides, you can really see the difference in terms of cephalic orientation and normal positioning of the lower lateral cartilage. The lateral crus cartilage is then anchored in the new location with use of fine sutures to help hold it in place long-term. In this case, I also had to narrow the distance between the lower lateral cartilages in order to provide even more tip definition. During these maneuvers, I also reshaped the front edge of her septum and reoriented the adjacent cartilage to correct her heavy columella.

In situations like this where the patient had no prior history of rhinoplasty surgery, it is important to choose a technique that largely preserves the native cartilage framework of the nose. In other words, it is preferable to avoid techniques that involve cutting the cartilage, or even worse, removing a lot of the lower lateral cartilage for the sake of trying to create a more defined tip. By avoiding cutting the cartilage, you can often times maximize chances you will create a more natural looking nasal tip.

This concept is reinforced in the adjacent diagram that shows what happens when a rhinoplasty surgeon comes in and simply cuts the perceived ‘excess’ cephalic cartilage. If you transect or cut this cartilage out as shown by the dashed red line, you now leave only a fraction of the lower lateral cartilage intact to provide support to the sides of the tip. As you can easily appreciate, there is now a fair amount of cartilage missing (indicated by the outlined oval region that should be the repositioned segment of cartilage) that should normally be there. The remaining amount of cartilage left over is grossly insufficient to maintain proper support and shape of the nasal tip. This means that the sides of the nasal tip will begin to slowly collapse as time goes on. This unfortunate outcome is not something that is typically seen within the first few months of rhinoplasty recovery. It actually takes more time – on the order of many months – to become more visible. By that time, scarring has taken place and the dreaded pinched nasal tip becomes more apparent. In many cases, this type of problem forces patients to have a complex revision rhinoplasty to correct the defect.

But why would a rhinoplasty surgeon simply cut out the cartilage instead of reorienting it? In some cases, it is because the rhinoplasty surgeon is just not experienced enough in this type of surgery to know any better. In other cases, it is because they are not using an open approach – instead, they are using a closed rhinoplasty approach, which means they do not have the type of exposure necessary to perform this type of repositioning and reorientation of the lower lateral cartilage. The only alternative they have with a closed approach is to reduce the cartilage contributing to the bulbous look – by cutting it out. This is why it is so important that patients only seek out experts in rhinoplasty surgery when they are dealing with a bulbous nasal tip related to cephalic orientation of the lateral crus cartilage. Experts who perform this type of cosmetic nose reshaping on a regular basis, like myself, are much better prepared to offer you a more reliable method of surgical correction that will minimize chances of you having to undergo a revision rhinoplasty procedure.

Bulbous Tip Rhinoplasty Photos

This patient’s actual before and after photos are provided here for a comparison view.

As you can see, this patient now has a nasal tip that does not appear bulbous. In fact, her nasal tip now looks well defined with a much more feminine overall shape. Her cephalically positioned cartilage has been successfully contoured to be more horizontally oriented with improved shape. You can also appreciate how the columella has been lifted up to create a less heavy look. Furthermore, as seen best on the oblique and side views, her bridge has been smoothed out as a result of reducing the bridge height. Collectively, these very careful surgical changes have resulted in a nose that appears much more shapely and defined – yet looks quite natural and fitting for her facial features.

Bulbous Tip Rhinoplasty Consult

If you have a bulbous nasal tip with cephalic orientation of the lower lateral cartilages, contact my office today to schedule a personalized consultation with one of the regions best rhinoplasty experts.

#### Challenges Involved in Rhinoplasty
Historically, many plastic surgeons have discounted the complexities and challenges involved in rhinoplasty and, in particular, revision rhinoplasty. The reality is, rhinoplasty and revision rhinoplasty are among the most difficult procedures to perform while achieving stable, long-term cosmetic and functional results. For instance, many patients interested in nose surgery to remove what is perceived as ‘only a bump’ along the bridge are often mistakenly told the operation involves a ‘simple procedure’ to shave down the hump. In actuality, rhinoplasty that involves removal of a hump (see section on Dorsal Hump Deformity) demands careful planning and delicate surgical technique to achieve optimal results. This is due to the fact that rhinoplasty involving the middle one-third (see section on Nasal Analysis) of the nose (where most bumps exist) can significantly alter the appearance and function of the nose. If careful attention is not given to potential collapse of this area after removal of the bump, patients can develop unwanted pinching of the nose and difficulty breathing.

These undesirable changes are often not seen within the first few months following rhinoplasty when swelling in this area helps camouflage the underlying deformity. After 6-9 months, however, pinching and collapse can begin to appear and often lead to a revision rhinoplasty procedure. Because of false perceptions such as this and others, we have developed the Rhinoplasty Tutorial in an attempt to educate our patients on common topics in rhinoplasty and revision rhinoplasty.

We hope you take the time to review the available topics that are pertinent to your nose and personal decision to undergo cosmetic and/or functional nose reshaping.

#### Changes to the Upper Lip
In some cases of rhinoplasty, you will come across a situation where the bottom part of the nose – primarily the columella – will contribute to displacement and disfigurement of the upper lip. That is precisely the situation in this case example presented here. This female rhinoplasty patient from San Diego desired to have her nose reshaped in order to make her nasal tip more symmetrical – and less distracting. In addition, she had trouble breathing through her nose, which was not surprising given how much her nasal tip and septum were deviated.

When Dr. Hilinski first examined her nose, one of the first things noted was just how far her columella was displaced. It was so displaced that her philtrum was being pulled off to her left side. This is highlighted in the adjacent photo diagram where the philtrum is outlined in red. The philtrum is the shallow depression that runs vertically along the upper lip in between the nose and the pink lining of the lip. Normally, the philtrum is relatively in the middle of the face. In this case, you can see how it has been displaced, or pulled, over to her left – which is a direct result of the nasal columella being so crooked. It is not often that you see this type of nose issue that can have such an impact on the upper lip as well.

Most of what you see in this 2 x 2 centimeter area is directly attributed to the nasal septum being overly developed. The distal end of the septum (called the caudal septum) was so overgrown, it jutted down and to the side. The two medial crura that are normally sitting adjacent to the end of the septum were displaced in a similar manner.

Dr. Hilinski ended up recommending an open septorhinoplasty approach to address her anatomical issues. He opened the nose by making an incision across the columella in between the two nostril openings. Ultimately, her nose required him to reposition and reshape the end of the nasal septum. This was NOT a finesse-type rhinoplasty surgery. Her nose required extensive and drastic changes to the shape of her nose to attain the desired goal. In the process of doing this, the septum had to be brought back into a more midline orientation. Only after this was accomplished was Dr. Hilinski able to rebuild her entire nasal tip. The medial crura had to be reset onto the septum and sewn into a new position. Then, the actual cartilage that comprises the nasal tip had to be reorientated and reshaped. In doing so, the nasal tip was made more symmetrical and the nostril openings were secured so she could breathe much better.

Rhinoplasty Upper Lip Reshaping

The dramatic end result of this very complex type of reconstructive septorhinoplasty is shown here. The patient is now about 3 years out from her rhinoplasty with Dr. Hilinski and has a markedly improved nasal airway. But look at the changes that have occurred with her upper lip. The philtrum is now positioned in a much more midline orientation and looks quite normal. And this was a passive change that happened only because of the alterations made to the caudal septum and columella. In addition, her nose now looks much more normal – yet natural and fitting for her face.

#### Cheek Reduction (Buccal Fat Removal)
Buccal Fat Removal (Cheek Reduction) Surgery with Dr. John Hilinski

Buccal fat removal, also known as cheek reduction surgery, is a cosmetic procedure designed to reduce the fullness of the cheeks by removing excess buccal fat pads. This procedure helps create a more contoured, slimmed-down appearance, enhancing facial definition and balance. For patients who desire a more sculpted look or feel that their cheeks appear overly round or chubby, buccal fat removal can provide a refined aesthetic result.

Why Choose Buccal Fat Removal?

Some patients naturally carry more buccal fat, giving their face a rounded or "baby face" appearance even as adults. Buccal fat removal is ideal for individuals looking to achieve:

A more defined cheek and jawline

A slimmer, more contoured facial appearance

Improved facial harmony and balance

A more mature, angular appearance

If you have a round face due to genetics or are dissatisfied with the appearance of your full cheeks, buccal fat removal can help refine your facial contours without the need for invasive procedures like facelifts.

What is Buccal Fat Removal?

Buccal fat removal is a straightforward procedure in which Dr. John Hilinski removes a portion of the buccal fat pad located in the cheeks. This fat is found between the muscles of the lower face, and once reduced, it results in a more sculpted and slimmer look.

The procedure is typically performed under local anesthesia with minimal downtime. Through a small incision inside the mouth, Dr. Hilinski carefully extracts a portion of the buccal fat pad. The result is a subtle yet impactful reduction in cheek fullness, enhancing the natural contours of the face.

Dr. John Hilinski - A Facial Plastic Surgery Expert

Dr. John Hilinski is a double board-certified facial plastic surgeon, specializing in cosmetic and reconstructive facial procedures. With his extensive training and years of experience, Dr. Hilinski is highly skilled in buccal fat removal surgery, focusing on delivering natural-looking results that enhance each patient's unique features.

Dr. Hilinski earned his medical degree from Harvard Medical School and completed his residency at the University of California, San Diego. He also trained under the mentorship of Dr. Dean M. Toriumi, a world-renowned facial plastic surgeon. His advanced training and experience have made him a leading expert in facial contouring, including buccal fat removal. Patients in San Diego and beyond trust Dr. Hilinski for his ability to create beautifully sculpted results with precision and care.

In addition to his clinical practice, Dr. Hilinski is a respected contributor to the field of facial plastic surgery, with numerous publications in medical journals and book chapters on surgical techniques. His dedication to patient education, safety, and comfort is evident in every step of the treatment process, from the initial consultation to post-operative care. Patients consistently praise Dr. Hilinski for his honest, transparent approach and his commitment to delivering natural-looking, long-lasting results.

Benefits of Buccal Fat Removal

Am I a Candidate for Buccal Fat Removal?

Good candidates for buccal fat removal surgery are individuals who:

Do not have overly thin faces or a narrow jawline, as further fat reduction could create a gaunt appearance over time

Have round or chubby cheeks due to excess buccal fat

Desire a slimmer, more sculpted face

Are in good health and have realistic expectations for the outcome

The Buccal Fat Removal Procedure

The buccal fat removal procedure is typically performed under local anesthesia in Dr. Hilinski's state-of-the-art surgery center. The surgery takes about 30 minutes to complete.

Anesthesia: Local anesthesia is administered to ensure patient comfort.

Incision: A small incision is made inside the mouth, which leaves no visible scarring.

Fat Removal: Dr. Hilinski carefully removes the excess buccal fat from each cheek.

Closing: The incision is closed with dissolvable sutures, and patients can return home shortly after the procedure.

Recovery from Buccal Fat Removal

Following buccal fat removal surgery, patients can expect mild swelling and discomfort for a few days. However, most patients are able to return to normal activities within a week. The final results of the procedure will become more visible as swelling subsides, typically within a few weeks. Dr. Hilinski provides detailed aftercare instructions to ensure a smooth recovery and optimal results.

FAQ: Buccal Fat Removal Surgery

Schedule a Consultation with Dr. Hilinski

If you are considering buccal fat removal surgery to achieve a slimmer, more contoured face, schedule a consultation with Dr. John Hilinski today. During your consultation, Dr. Hilinski will assess your facial anatomy and discuss your aesthetic goals to create a personalized treatment plan tailored to your needs.

#### Chin Augmentation / Implants
Chin Augmentation by Dr. John Hilinski: Achieving Facial Harmony

Chin augmentation, or mentoplasty, is a cosmetic surgery designed to improve the definition and shape of the chin and jawline. Using a chin implant, this procedure helps enhance facial balance, especially for those with a weak or recessed chin. Dr. John Hilinski, a highly skilled facial plastic surgeon, specializes in chin augmentation, offering personalized treatments to restore harmony to your facial features.

Why Consider Chin Augmentation?

Many individuals seek chin augmentation because they feel their chin is too small or recessed, making their face appear imbalanced. The face is naturally divided into three parts: the upper, middle, and lower thirds. When the chin is underdeveloped, it disrupts this balance, especially when viewed from the side. This imbalance may be more noticeable for those with a larger nose or a shorter neck, further accentuating the recessed chin.

Chin augmentation addresses this issue by projecting the chin forward, creating a more defined and balanced lower face. Patients often notice a significant improvement in their profile and overall facial harmony after surgery.

Comprehensive Evaluation for Chin Implant Surgery

Before undergoing chin implant surgery, Dr. Hilinski conducts a thorough evaluation of your facial structure. This evaluation typically focuses on your profile view, which reveals the degree of chin recession. Dr. Hilinski also examines the oblique and frontal views of the face to ensure a comprehensive assessment of facial balance.

To determine the ideal chin projection, Dr. Hilinski uses an imaginary vertical line drawn from the most forward point of the lower lip (red-white junction). In men, the chin should align close to this line, while in women, it should be slightly behind it. If the chin falls too far behind this point, chin augmentation can provide the necessary correction to achieve a more proportional appearance.

Chin Implant Surgery Techniques

Chin implants can be placed using one of two main techniques:

Trans-oral Approach: This method involves making an incision inside the mouth. While it avoids external scarring, the risk of infection is higher because the mouth cannot be fully sterilized.

Submental Approach: The more commonly recommended technique involves making a small incision under the chin (submental). This incision is hidden in a natural crease, making it barely visible once healed. This method reduces the risk of infection and allows for more accurate implant placement. The submental approach also provides direct access to the jawline, ensuring precise positioning of the implant.

Once the incision is made, the chin implant is placed securely along the lower jaw. The implant is designed to increase chin projection and blend smoothly with the natural contours of the face, providing a balanced and natural-looking result.

FAQ: Chin Augmentation

Schedule a Consultation with Dr. John Hilinski

Embarking on the journey to enhance your facial harmony is a significant decision, and choosing the right surgeon is crucial to achieving the results you desire. Scheduling a consultation with Dr. John Hilinski is the first step towards transforming your appearance and boosting your confidence through expert chin augmentation.

.

#### Chin Implant with Rhinoplasty
Rhinoplasty and chin implant are often times recommended to be done together in order to help give someone even better overall facial harmony and balance. This is a great case example of this concept where a nose job was done at the same time as chin augmentation with an implant.

When looking at his preoperative frontal photo you can see how the tip of his nose was quite wide in comparison to the rest of his nose. This is what gave him the appearance of having a bulbous nasal tip.

On his side view, you can see that he had a small bump or prominence just above the tip – giving him the appearance of having a slight hump deformity. In addition, if you look very closely, you will see how his nasal tip was even a bit rounded on the side view.

The other issue that was noted on his side view was under projection of the chin. Some people refer to this as a ‘weak’ chin or ‘recessed’ chin. No matter how you label it, this patient’s chin was not as prominent as it should be – and would benefit from augmentation using a chin implant.

The patient consulted with Dr. Hilinski based on his qualifications as one of San Diego’s best cosmetic nose and chin implant surgeons.

Chin Implant & Rhinoplasty

Dr. Hilinski recommended a combined chin implant and rhinoplasty procedure under the same anesthetic. This patient ended up undergoing an open septorhinoplasty procedure to reshape his nasal tip while smoothing out the bridge of his nose. In addition, he underwent placement of a chin implant using a submental approach. This means an incision was made under the chin for placement of the silicone chin implant. Dr. Hilinski prefers this chin implant technique as it is considered to have less of a risk of infection compared with placement of a chin implant through the inside of the mouth.

The overall goal of doing a chin implant with a rhinoplasty procedure is to give the patient a more harmonious profile view. In essence, the goal is to create better facial balance in terms of the midface (nose) versus the lower face (chin). It is actually quite common to see patients undergoing these two procedures together.

Bulbous Tip Rhinoplasty

For the bulbous nasal tip issue, Dr. Hilinski ended up performing primarily a suture reshaping of the cartilages. Specifically, Dr. Hilinski targeted the lower lateral cartilages to make the tip go from being broad and wide to being more narrow and defined. You can see those changes here in the adjacent intraoperative photos that were taken during the actual rhinoplasty surgery. The photo on the left is how his nose appeared at the start of the operation. The photo on the right shows what it looked like after Dr. Hilinski reshaped his bulbous tip.

Just look at the overall position and shape of the cartilage before Dr. Hilinski placed the dome binding sutures. You will notice that the tip cartilages were reshaped and customized to be closer together (narrowing the tip) while also assuming a different shape (that helped to address the bulbosity of the nasal tip).

Using this particular tip rhinoplasty technique. there was minimal cutting of the cartilage to remove so-called excess. Therefore, there was little risk to the patient that his nose would end up being pinched and collapsed as a result of the rhinoplasty.

Chin Implant & Rhinoplasty Photos

Here are the actual before and after photos showing results of Dr. Hilinski’s cosmetic rhinoplasty procedure and chin implant placement. One thing you will notice is just how natural this male patient still looks after plastic surgery. That is truly the goal of nearly all types of facial plastic surgery – to address specific cosmetic concerns while still maintaining an overall, natural looking result. He now has a stronger looking male nose and a profile that is more masculine appearing.

#### Chondrodermatitis Nodularis Helicis (CNH) Treatment in San Diego, CA
Understanding CNH and Protecting the Natural Shape of Your Ear

Chondrodermatitis Nodularis Helicis (CNH) is a painful inflammatory condition that affects the cartilage of the ear, often appearing as a sore, crusted, or raised lesion. Many patients first visit a dermatologist for this issue—only to be left with a noticeable ear deformity after it’s surgically removed. At his San Diego facial plastic surgery practice, Dr. John Hilinski, who specializes in cosmetic and reconstructive ear procedures, treats CNH with a meticulous approach that not only relieves discomfort but also preserves the ear’s natural shape and contour.

What Is Chondrodermatitis Nodularis Helicis?

What Causes CNH?

Symptoms of Chondrodermatitis Nodularis Helicis

How Is CNH Treated?

When CNH Surgery Leads to Ear Deformity

Why Choose Dr. John Hilinski to Treat CNH?

Preparing for Treatment

The Procedure

Recovery and Results

FAQs About CNH Treatment

What Is Chondrodermatitis Nodularis Helicis?

CNH is a benign yet painful lesion that forms on the helix or antihelix (the outer rim) of the ear. It develops when pressure and inflammation compromise the thin skin and cartilage in this area. While CNH is not a form of skin cancer, it can look similar, which is why it is often misdiagnosed or overtreated by excision alone.1

What Causes CNH?

CNH usually results from a combination of pressure, friction, and poor blood supply to the ear cartilage. Contributing factors may include:

Sleeping on one side of the head repeatedly

Wearing tight hats, helmets, or headgear

Chronic sun exposure

Cold weather or trauma to the ear

Age-related thinning of the skin over the cartilage

When these factors irritate the area over time, the skin and cartilage break down, leading to pain, redness, and the development of a small but tender nodule.

Symptoms of Chondrodermatitis Nodularis Helicis

Common signs and symptoms of CNH include:

Tenderness or pain on the outer ear, especially when sleeping on that side

A raised bump or sore that may crust, bleed, or fail to heal

Redness or swelling around the affected area

Sensitivity to touch or pressure

Discomfort while wearing glasses, masks, or earbuds

Although CNH is non-cancerous, it can mimic more serious conditions. Evaluation by a qualified physician experienced in ear reconstruction is essential for an accurate diagnosis and effective treatment.

How Is CNH Treated?

Treatment depends on the severity of the lesion and whether previous surgeries have altered the ear’s structure. Options may include:

Pressure relief devices to reduce irritation while sleeping

Topical or injectable anti-inflammatory medications

Surgical removal with reconstructive repair, performed by Dr. Hilinski to preserve ear contour and symmetry2

Unlike standard excision, Dr. Hilinski’s surgical approach carefully reshapes the ear, addresses the underlying cartilage inflammation, and minimizes the risk of deformity or recurrence.

When CNH Surgery Leads to Ear Deformity

Many patients initially turn to dermatologists who treat CNH by simply cutting out the lesion. Unfortunately, this approach often fails to account for the complex shape and thin cartilage of the ear, leaving patients with:

Notched or misshapen ear edges

Visible depressions or scars

Asymmetry between the ears

Persistent pain or recurrence of the lesion

Dr. Hilinski frequently sees patients who have experienced these complications and now seek his expertise to repair the damage and restore the ear’s natural appearance. His reconstructive training allows him to treat CNH while maintaining both the function and aesthetics of the ear.sed on your anatomy and goals.

Preparing for Treatment

During your consultation, Dr. Hilinski will:

Review your medical history and prior treatments

Examine both ears and assess any existing deformities or scarring

Discuss your symptoms, sleeping habits, and lifestyle factors

Explain your treatment options and expected results

Patients with previous CNH surgery can also review before-and-after photos of similar cases to better understand what reconstruction can achieve.

The Procedure

If surgery is recommended, Dr. Hilinski performs the procedure using local anesthesia in a precise, minimally invasive manner. The affected tissue is carefully removed, and the surrounding cartilage is reshaped or reinforced to restore smooth, natural ear contours. When necessary, he uses reconstructive techniques to correct prior surgical defects and enhance symmetry.

Recovery and Results

Most patients experience mild tenderness or swelling for a few days following surgery. Dr. Hilinski provides detailed post-care instructions to help protect the ear and prevent recurrence, including:

Avoiding direct pressure on the treated ear

Sleeping on the opposite side for several weeks

Protecting the ear from trauma or cold exposure

Patients typically notice significant relief from pain and see a natural, well-contoured ear appearance once healing is complete.

FAQs About CNH Treatment

Contact Dr. John Hilinski in San Diego, CA

If you’re experiencing painful ear lesions—or have been left with an ear deformity following CNH surgery—schedule a consultation with Dr. John Hilinski, San Diego’s expert in ear reconstruction and CNH treatment. Relief and restoration are within reach.

Sources

 1  Hohman MH, Winters R. Chondrodermatitis Nodularis Helicis. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482507/. Accessed November 3, 2025.

 2 Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J. Therapeutic Options of Chondrodermatitis Nodularis Helicis. Plast Surg Int. 2016;2016:4340168. doi: 10.1155/2016/4340168. Epub 2016 Jan 27. PMID: 26925262; PMCID: PMC4748103. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC4748103/. Accessed November 3, 2025/

#### Classic Hump/Bump Reduction
If there were ever a classic rhinoplasty case – it would be reduction of a dorsal hump/bump deformity. Many patients erroneously think that it is super simple to remove a bump off a nasal bridge. In reality, shaving a bump down is fairly easy in terms of the surgical technique. The real challenge is making that nose look good long-term without creating a number of other cosmetic issues once the bump has been removed. This is why taking a bump off a nose is one of the most challenging types of rhinoplasty.

Taking a Bump Off the Nose

Why is it that taking a bump off the nose is so challenging you ask? This is because once you take a bump off the nose, a domino effect takes over where a sequence of other maneuvers are then required to ensure a successful cosmetic and functional outcome. The sequence of events that occurs when a bump is taken down includes the following:

Hump removal

You then need to perform osteotomies (breaking the bones) because the nose would like wider if you don’t

You then need to often times place spreader grafts through the middle vault of the nose (which is arguably the toughest part of the nose to get symmetrical)

You have to then set the proper tip position to match the new bridge height

What all this means is that taking a bump off a nose is not just a simple one-step maneuver. It frequently calls for a number of other maneuvers that are needed to be done to the nose in order for it to look cosmetically pleasing and balanced. And this brings in a whole new set of variables that need to be minded when it comes to achieving a nice surgical outcome.

Nasal Bump Removal Photos

Dr. Hilinski preaches about this issue all the time to patients consulting with him in San Diego for cosmetic rhinoplasty. A testimony as to why hump removal rhinoplasty is so challenging is the fact that so many plastic surgeons will show you before and after photos of their bump reduction patients – but they only show you the side view of the nose! Why is this? Simple. Because getting the nose to look great from the side view is the easy part. Getting the nose to look great from the front view is truly the hardest part of rhinoplasty. Once you start to look at front view of the nose, you then have to deal with a right and left side. This issue of symmetry is something you just don’t have to deal with on a single side view of the nose. Plus you have to make sure the nose is in balance with the whole context of the face – also something you don’t have to worry about on the side view.

The reason so many plastic surgeons only show you their side views of a bump removal is because there is something not right about the front view. If their front view of that same nose looked pretty good after their rhinoplasty (or even looked the same), they would readily put it up on their website rhinoplasty gallery! More than likely, that same nose on the front view shows a number of irregularities and asymmetries they don’t want you to see.

If you don’t believe me – go ahead and call that particular plastic surgery office and ask to see the front view of that same rhinoplasty patient. My guess is they won’t provide it to you!

Video of Bump/Hump Removal

Here is a quick video of Dr. Hilinski actually removing a bump off the above patient’s nose. First, he uses a scalpel to cut the excess cartilage. A segment of this is then removed. Once the cartilage has been trimmed, the bone is then sanded down using a surgical rasp.

Before & After Bump/Hump Removal

Photos of this particular primary hump removal rhinoplasty patient are shown here. Overall you can see that her nose bump/hump has been removed very nicely to produce a much straighter nasal bridge. But, just as important, her front view has been relatively preserved. Meaning, her nose still looks quite good from the front view. In fact, her tip looks more narrow and better defined. Plus it looks symmetrical. And these are long-term, sustained results following rhinoplasty.

#### Complete Overhaul
Check out this amazing transformation for this young lady who came to Dr. Hilinski to have her nose completely overhauled.

When Dr. Hilinski first examined her, one of the most immediate findings noted was her abnormally shaped nasal base. As you can see her nostrils were very asymmetric with her right side being nearly closed. This was primarily due to the fact that her nasal septum was very crooked and displaced – extending all the way down into her nostril opening.

When you looked at her nose from the front, you could see the translation of this asymmetry as you followed her nasal bridge down from the brow region. From this angle, her nose was displaced, or crooked, off to her right side. This was also a direct reflection of her deviated septum extending all the way up to the bridge. But her nasal bones were also crooked and contributing to the problems.

Dr. Hilinski told her that her nose essentially needed a complete overhaul. This meant that she needed to have the bones repositioned, the bridge of the nose moved over, the septum completely reshaped, and the nostrils reconstructed to be oriented more in a midline fashion. So from top to bottom, her nose required total reshaping.

Scarless Rhinoplasty

Dr. Hilinski ended up performing her surgery using a closed rhinoplasty approach. This means that all of the access incisions were made inside of the nostrils. Many plastic surgeons are now referring to this approach as a ‘scarless rhinoplasty’ since the scars are essentially hidden from the naked eye. The reality is that you cannot perform surgery without scars. But if you can really hide the scars during a rhinoplasty surgery like this, it can basically appear as if it was done in a scarless manner.

As part of the reconstructive effort, her entire septum was completely reshaped to help open up the nasal airway so she could breathe better. Much of this effort was directed at the bottom of her nose so that Dr. Hilinski could completely reorient her nostril openings. This involved moving the bottom edge of her septum – termed the caudal septum – more toward the middle of her face and re-establishing proper support. Once this was successfully completed, her was then able to move her nasal tip and bridge alignment more toward the middle – creating a much improved frontal view.

As part of the surgery, Dr. Hilinski also reduced her nasal bridge height – essentially taking down her dorsal hump to give her a straighter profile view.

Scarless Rhinoplasty Results

Below are her scarless rhinoplasty surgical results. As you can see she has quite a dramatic improvement in the overall appearance of her nose. Of note, her nose also functions much better than it did before. From the frontal view, you can see just how much better her overall alignment is. Yes – she still has some residual asymmetries. But this is quite normal for this type of incredibly complex facial plastic surgery. But you really can’t argue whether or not her nose looks better. As you begin to turn her face to the side, her oblique and lateral views confirm a beautiful cosmetic improvement in her profile. Her nasal bridge height has been taken down to a more appropriate level while avoiding the dreaded scooped nose that is still so often seen after rhinoplasty surgery. And when you peek at her nasal base – wow – check out the improvement in her nostril shape and size! She now has much more symmetry with tip support that is dramatically better. And all of this was able to be accomplished using a scarless rhinoplasty approach. We are just so happy for her and her results!

#### Composite Ear Grafts to the Nose
Composite ear grafts are used in rhinoplasty and revision rhinoplasty surgery primarily to adjust and reshape the nostril rim. More specifically, composite grafts are employed in cases where the nostril rim is excessively arched. For example, the adjacent photo shows an actual patient who presented to my office for revision rhinoplasty following prior cosmetic nose surgery performed by another plastic surgeon. As you can see, the inside of her nose is quite visible from this side view. This is due in part to the nostril rim being excessively arched. Rhinoplsty surgeons also frequently refer to this problem as alar retraction, referring to the alar rim being retracted or pulled upward.

In rare cases, the appearance of alar retraction can be present congenitally in the absence of any history of prior nose surgery. However, much more commonly alar retraction is a result of prior rhinoplasty surgery.

So how does this type of problem occur? It is usually a consequence of aggressive resection of cartilage in the region of the lateral crus. But what is the lateral crus? As shown in the adjacent photo diagram, the lateral crus is the segment of cartilage located just below the skin and above the nostril opening. The lateral crus essentially provides the nostril with an underlying framework of support, which gives it the shape that you ultimately see. Ideally, this shape is a gentle arch that allows you to see into the nose only a few millimeters (termed ‘columellar show’ by us rhinoplasty surgeons). The adjacent photo example provided is actually the post-operative profile photo of a rhinoplasty patient of mine, which demonstrates a very natural nostril contour without any evidence of alar retraction.

A very common maneuver in rhinoplasty is called cephalic trimming, which refers to the act of cutting, or resecting, the cephalic margin of the lateral crus. The cephalic margin is the upper edge of the cartilage. This is frequently done to reduce unwanted fullness in this area of the nasal tip with the goal of creating a more defined and narrowed nasal tip. In many cases when this is done in a conservative manner (leaving behind an adequate amount of the lateral crus cartilage), the results can be very acceptable. Unfortunately, in cases where an overly aggressive amount of cartilage is resected during cephalic trimming of the lateral crus, alar retraction is much more likely to result. What typically happens in this scenario is shown in the diagram to the left. The red shaded area represents an overly aggressive cephalic trimming of the lateral crus cartilage. When this is done, only a relatively narrow segment of the lateral crus remains. As the healing process unfolds over many months, the effects of internal scarring begin to impact the remnant of the lateral crus. Scarring is important in this situation since because it essentially equates to pulling of the tissues in a certain direction.

This is usually from an area of instability to an area of more stability. If scarring occurred equally above and below the remaining lateral crus, there would really be no issues. Unfortunately, scarring does not occur below the lateral crus because there are no forces to pull in the direction of the nostril opening. The only force of scarring that occurs is on the side where the cartilage was removed. The green arrows in the adjacent photo diagram indicate the effects of this scarring on the lateral crus after aggressive cephalic trimming. The ‘pull’ from the scarring is directed upward toward the middle of the nose where the tissues are more stable (again, going from an area of instability to an area of stability). As this occurs, the lower lateral cartilage remnant will scar upward away from the nostril opening (see arched cartilage as shown to the right). The end result clinically is a nostril rim that begins to appear excessively arched upward, or retracted.

In mild cases of alar retraction where the nostril rim has been pulled up, a procedure can be done using what is called an alar rim cartilage graft to help correct the deformity. In these cases, a relatively thin piece of cartilage can be taken from the septum (inside of the nose) or the ear and placed within a small pocket created on the inner lining of the nostril rim. In doing so, this can help give the illusion the nostril rim has been pulled down slightly.

In more severe cases of alar retraction, a different type of graft is required to make a more substantial change. We refer to this type of graft as a composite graft, or composite ear graft. It is termed a composite graft because it is comprised of not just cartilage but three different types of tissue. This includes skin, cartilage and perichondrium (soft tissue).

A composite graft is typically harvested from an area of the ear called the concha cymba. This is shown in the adjacent photo as the purple outlined area. Harvesting the graft from this specific area provides the rhinoplasty surgeon a sufficiently large composite graft that can essentially span the entire length of the nostril opening (see an actual composite graft to the right). It also allows for great concealment of the harvest site and, therefore, minimal visible scarring of the ear. In fact, in many cases I don’t even put sutures in the ear to close this donor site. If left alone, the body will slowly fill in the defect, which includes formation of a new skin layer. In many cases, the end result looks much more natural when compared with those patients who had sutures placed in an attempt to close the site.

In concept, the composite graft can be positioned along the inner lining of the nostril to help ‘pull’ the rim downward in an attempt to restore a more natural looking contour. This is shown diagrammatically in the adjacent photo where the green ellipse represents placement of a composite ear graft. Before the composite graft can be placed, an incision, or cut, has to be made along the inner surface of the nostril. This incision is then widened in a vertical direction, thus creating a precise pocket where the graft can be placed. The graft is positioned such that the skin is left facing into the nose. The skin layer is a really important component of the composite graft that helps to re-expand the contracted, or shrunken, inner lining of the nostril that results from alar retraction. The middle layer of the composite graft is made of cartilage, which provides the necessary rigidity to keep the nostril rim in its new, desired position. The deep perichondrium layer helps optimize blood supply to the graft while also providing for some degree of added internal cushioning.

So what does this look like in real life? The adjacent photo is an intraoperative view of what a real composite ear graft appears like going into the defect (left) and when finally positioned and sewn into the inner lining of the nostril (right). The skin layer of the composite graft is whiter than the surrounding, natural skin color because there is no blood circulating in the graft at this time. It will actually take hours to days before the composite graft has any significant amount of blood supply coming in to it from the surrounding nostril tissue. Fortunately, this occurs very predictably in most cases. As you can see, the height of the composite graft largely dictates how much the nostril rim can be brought down. So in cases where there is more severe alar retraction, a much larger composite graft is necessary to make more substantial, visible changes in nostril rim position.

Composite Ear Graft Photo Examples

Case Example 1

The first example below demonstrates a milder case of alar retraction. This particular female patient had prior surgery performed by another plastic surgeon. Unfortunately, changes were made to her nostril resulting in mild arching of the nostril contour. Like many patients who are candidates for a composite graft, this one disliked the fact you could see more of the inside of her nose – what we refer to as ‘excess nostril show’ in the world of rhinoplasty. I performed bilateral composite ear grafts with delicate placement along the inner surface of the nostril on both sides. As you can see from her before and after photos, the nostril rim has been brought down a few millimeters, which is all she really needed to provide a more natural looking contour. There is now less nostril show and unwanted arching as the alar retraction has been corrected.

Case Example 2

This second example of a composite ear graft shows a patient with more severe alar retraction. This female patient from San Diego underwent prior rhinoplasty by a different plastic surgeon. Unfortunately, she ended up with rather marked alar retraction after the lateral crus segment of cartilage was removed with over-aggressive surgical technique. As part of a more formal revision rhinoplasty procedure, I was able to place bilateral composite ear grafts to draw the nostril rim downward on both sides. The end result in terms of the nostrils, is a much more natural looking contour and position with minimal residual signs of unwanted alar retraction.

Composite Ear Graft Consult

If you have issues with alar retraction with excessively arched nostril rims, contact my San Diego office today to discuss options in terms of possible composite ear graft surgery.

#### Confirming Septoplasty Repair
In this video, Dr. Hilinski confirms a wide open and patent nasal airway after septoplasty surgery to help improve breathing for this young female from San Diego. By passing a surgical instrument like a forcep, Dr. Hilinski ensures there is no longer any deviation of the nasal septum.

#### Consultations
Consultation Experience at John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we understand that choosing to undergo facial plastic surgery is a significant decision. Your consultation is a vital step in determining whether the procedure you're considering is right for you. Led by Dr. John Hilinski, a Harvard-trained, double board-certified facial plastic surgeon, our practice offers a unique and personalized approach to consultations, ensuring that every patient feels fully informed and confident in their choices.

Preparing for Your Consultation

To make the most of your consultation with Dr. Hilinski, we recommend preparing a list of questions ahead of time. Review our Frequently Asked Questions to help guide your preparation. Additionally, ensure you allow adequate travel time to your appointment so that you are relaxed and can fully engage with Dr. Hilinski during the discussion.

If you have undergone previous cosmetic surgery, it's essential to disclose this information. Bringing along medical records can also be helpful, especially if you're considering revision rhinoplasty, one of Dr. Hilinski's specialties.

The Plastic Surgery Consultation Process

Your consultation appointment is an opportunity to learn more about the procedure you're interested in and to assess your candidacy. During your visit, Dr. Hilinski will evaluate your health, discuss your goals, and determine whether the surgery is appropriate for you. Photos may also be taken for your medical file to assist in creating a personalized treatment plan.

Consultations typically last about 45 minutes. For surgical procedures, you'll meet directly with Dr. Hilinski, while non-surgical consultations may be scheduled with our expert aesthetic registered nurse.

Plastic Surgery Simulator Imaging

As part of our consultation process, Dr. Hilinski may use advanced imaging software to help you visualize potential results. This unique tool enables patients to see a simulation of the expected outcome, offering a clearer picture of the benefits and realistic expectations for surgery. Whether you are considering a brow lift, chin implant, or rhinoplasty, Dr. Hilinski combines his expertise and imaging technology to ensure you have a comprehensive understanding of your surgical options.

Scheduling Your Plastic Surgery

If Dr. Hilinski determines that you are a good candidate for surgery and you decide to move forward, the next step is scheduling your procedure. The wait time for surgery varies, but most procedures are scheduled 1-2 months in advance. While waiting for surgery may require patience, it is important to ensure that your surgeon is in high demand for good reason. A surgeon with no wait time may not have the expertise or reputation required for the best possible outcome.

Once your surgery is scheduled, our team will review all pre-surgical instructions with you and answer any remaining questions.

Pricing and Financing for Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are committed to providing high-quality care with transparent pricing. During your consultation, you will have the opportunity to discuss the cost of your treatment plan. We accept various payment methods and work with insurance providers whenever possible. Additionally, we offer CareCredit® financing to make your procedure more affordable and accessible.

Tips for Choosing a Plastic Surgeon

Selecting the right surgeon is crucial to achieving the best results. Here are some tips to help guide your decision:

Contact Us

We look forward to meeting you and guiding you through the life-changing process of facial plastic surgery. Whether you are interested in rhinoplasty, a facelift, or other rejuvenation treatments, Dr. Hilinski and our team are here to ensure your experience is positive and successful.

Contact us today to schedule your consultation with Dr. John Hilinski, and take the next step toward achieving your aesthetic goals. Let us help you achieve the beautiful, natural results you've been dreaming of!

#### Contact
Questions?

Learning about your treatment options and whether our team is a right fit for you is the first step to making an informed decision about your cosmetic enhancement. If you have any questions about a particular procedure, or would like to schedule a consultation with our facial plastic surgeon to get started on your journey, please fill out the contact form below. We look forward to hearing from you and will get back to you soon!

#### Cosmetic Rhinoplasty
Cosmetic rhinoplasty, commonly referred to as a "nose job," is a specialized procedure designed to enhance the aesthetic appearance of the nose while maintaining balance and harmony with the rest of the face. Whether you're seeking to correct imperfections such as a droopy tip, wide nostrils, or a prominent hump, cosmetic rhinoplasty can help refine and reshape the nose to achieve your desired look. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, brings exceptional expertise and artistry to every rhinoplasty procedure, offering personalized care that focuses on natural-looking, long-lasting results.

Explore Your Cosmetic Rhinoplasty Options

Learn more about specific rhinoplasty procedures to address your individual concerns by exploring the following subpages:

About Us
Accessibility Policy
Blog
Contact
Hilinski Foundation for Surgery
Home
Links
Lop Ear Surgery with Dr. John Hilinski
Macrotia Ear Reduction Surgery with Dr. John Hilinski
Medspa
Newsletter
Notice of Open Payments Database
Patient Info
Privacy Policy
Revision Skincare Products
Rhinoplasty Tutorial
Sitemap
Stahl’s Ear Correction
Surgical
Terms of Use
Thank You

Each of these subpages provides detailed information on the techniques used to correct these specific nasal concerns, as well as real patient before-and-after photos to help you visualize the potential results.

What Can Cosmetic Rhinoplasty Address?

Cosmetic rhinoplasty can correct a variety of nasal imperfections, enhancing the overall appearance of the nose and facial harmony. Some of the most common concerns that rhinoplasty can address include:

Droopy or over-projected nasal tip

Wide or flaring nostrils

Flat or depressed nasal bridge

Nasal humps or bumps

Pinched nasal tip

Short or over-rotated nose

Twisted or crooked nose

Wide nasal bridge

Wide or bulbous nasal tip

Each of these concerns requires a customized approach, and Dr. Hilinski is skilled at addressing them in a way that enhances both the form and function of the nose. Whether you're looking to refine the shape, reduce the size, or create a more balanced nasal profile, Dr. Hilinski will work with you to develop a treatment plan that aligns with your aesthetic vision.

Why Choose Dr. John Hilinski for Cosmetic Rhinoplasty?

Dr. John Hilinski is a highly respected facial plastic surgeon with extensive experience in performing cosmetic rhinoplasty for a wide range of aesthetic concerns. His credentials include:

With a deep understanding of nasal anatomy and facial aesthetics, Dr. Hilinski's approach to cosmetic rhinoplasty ensures that every procedure is tailored to the unique needs and goals of each patient. His focus on precision, natural results, and patient satisfaction has made him a trusted choice for those seeking rhinoplasty in San Diego.

Schedule a Consultation with Dr. Hilinski

If you are considering cosmetic rhinoplasty and want to learn how Dr. John Hilinski can help you achieve a balanced, refined nasal appearance, schedule a consultation today. As San Diego's expert in facial plastic surgery, Dr. Hilinski offers personalized care and advanced techniques to deliver the natural, beautiful results you're looking for. Contact us to begin your journey toward achieving your ideal nose.

#### Crooked Nose Correction
Correcting a crooked nose deformity is considered one of the most challenging types of rhinoplasty surgery. That is because trying to get the nose to sit in the midline of the face is incredibly difficult. There are several different ‘moving parts’ and a multitude of variables that contribute to how and why this type of nasal reshaping is considered so hard. Fortunately, in experienced rhinoplasty surgeons’ hands, such as Dr. Hilinski’s, a successful outcome can be achieved. This is evidenced in the case example provided here showing a beautiful correction of this female patient’s crooked nose.

So many patients – and plastic surgeons – mistakingly believe that all crooked noses are due to the nasal bone being out of alignment. The reality is that many crooked noses are, indeed, due to bones that are asymmetrically positioned and shaped. However, there is a good number of rhinoplasty patients who have a crooked nose that is the result of other structural abnormalities beyond the nasal bone. For instance, in many cases the cartilage framework of the nose is a key problem that needs to be addressed in addition to the crooked nasal bone.

The Philtrum in a Crooked Nose

So how can you tell whether or not it is just the bone contributing to the crooked nose alignment or if it is something else? One of the first things you should look at is the philtrum. The philtrum is the naturally trapezoidal shaped area under the nose that extends down to the upper lip. These two softly raised ridges of skin are usually not parallel, but sit at a slight angle as they go from the nose to the upper lip vermillion border. Normally, the philtrum is situated relatively in the midline of the face. In many patients with a crooked nose, the philtrum is off to the side and hints at the fact that the bone is not the only problem with the nose.

In this particular patient, if you draw a vertical line down the middle of the face from in between the eyebrows to the chin, you will readily appreciate how far off her nose sits on the face. And if you look closer at her philtrum, you can see that hers is positioned much more to her right side. As you follow her philtrum up to the nose, you will also notice that her columella (the column of tissue between the nostrils) is displaced to her right side. This corresponds to the cartilage framework supporting the tip of the nose – and really demonstrates how her crooked nose deformity is not just bony displacement of the bridge, but also involves the cartilage skeleton of the nose.

So in order to successfully correct this type of crooked nose, the entire structure needs to be reshaped from top to bottom. If one were to simply try and break the bones and move them over, the cartilage will still be far off the midline and contribute to persistent problems with her alignment.

Fixing a Crooked Nose

As part of the reconstructive effort to fix this crooked nose, Dr. Hilinski ended up breaking the nasal bones and shifting them more to the middle of her face. But he also had to deal with the displaced nasal cartilage framework. This was accomplished by detaching the septum from its current location and literally moving it to a new position more in the midline of the face. It was then sutured and anchored to provide a more proper and symmetrical shape for her nasal tip. Only by targeting both the bone and cartilage was it possible to make the nose much more symmetrical on her face. You can imagine that this combination of surgical maneuvers helped with the cosmetic appearance of her nose as well as the function of her nose. In fact, she is now enjoying a much improved nasal airway with significantly less symptoms of obstructed breathing.

Before & After Crooked Nose Repair

The results of her septorhinoplasty surgery are shown below. As you can see, her nasal alignment is so much better now! Her bones have been repositioned to a more midline location and her nasal tip has been brought over to create more symmetry. If you take a more detailed look at her philtrum, you will also see much different that area now is following surgery. The philtrum is now more centered because the nose is more centered. In fact, her upper lip is more even now too! As we tell patients all the time, the nose will never ever be perfect. But it is markedly better than it was before.

#### Crooked Nose Surgery
Crooked Nose Surgery with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A crooked nose can result from genetics, trauma, or previous nasal surgeries, leading to a nasal structure that appears misaligned or asymmetrical. Not only can this affect the overall balance of facial features, but it can also cause breathing difficulties. Crooked nose surgery, a type of rhinoplasty, aims to straighten the nose, improve facial symmetry, and restore proper nasal function. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, is highly experienced in correcting crooked noses, offering personalized surgical solutions to help patients achieve a natural, balanced appearance.

What is Crooked Nose Surgery?

Crooked nose surgery is a specialized rhinoplasty procedure designed to straighten a deviated or asymmetrical nose. This surgery may involve reshaping or repositioning both the bone and cartilage in the nose to create a more symmetrical look. For patients experiencing breathing problems due to a deviated septum or other structural issues, Dr. Hilinski combines functional nasal surgery with aesthetic rhinoplasty to improve both the appearance and function of the nose.

Why Would Someone Need Crooked Nose Surgery?

Patients choose crooked nose surgery for several reasons:

Special Considerations for Crooked Nose Surgery

FAQ: Crooked Nose Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you're considering crooked nose surgery to improve both the appearance and function of your nose, schedule a consultation with Dr. John Hilinski today. As one of San Diego's leading rhinoplasty experts, Dr. Hilinski offers personalized care and advanced surgical techniques to help you achieve a more symmetrical, functional, and confident appearance. Contact us today to start your journey toward a straighter, more balanced nose.

#### Crooked Nose Surgery
This is a patient who was referred to my office for treatment of a crooked nose deformity. The term ‘crooked nose deformity’ refers to a nose that is poorly aligned when looking at it from the frontal view. Other terms commonly used to describe this type of nose include: a misaligned nose, a malaligned nose, a shifted nose, a displaced nose, a deviated nose, a twisted nose and a broken nose. In a great number of rhinoplasty patients, a crooked nose deformity is the result of a injury (sports, accident, etc.). However, in many cases, patients are simply born with a nose that develops or grows into a crooked alignment.

In this particular case example you can see that his nose is, indeed, quite crooked when seen directly from the front view. As is shown in the adjacent diagram, there is a curvature of the nose to his left side (our right when looking at the photo). This curvature creates the illusion that his nose is, indeed, shifted or displaced to his left side.

Coincident with this deformity is the fact the nose is depressed on the opposite side (his right side). This is a direct result of the nasal bridge being displaced off of the midline.

What happens in cases like this is the normal anatomy that comprises the right side of his bridge gets pushed over to the opposite side as a result of the injury. This is visually demonstrated in the adjacent photo diagram that also tries to show the underlying anatomical details of the nose. The yellow framed inset shows you what the normal alignment should look like.

As you can see, the upper one-third of the nose is comprised of bone (white shaded segments in the photo). When the nose is broken or fractured during an injury, the bone can become displaced, or moved, to one side. In this case, the patient’s nose was struck from his right side – causing the bone to break and move to his left side. When seen from the front view, you can easily tell how the bones now almost appear twisted. You can also see in this anatomical depiction why the opposite side (his right side) becomes depressed inward contributing to an abnormal shadow in his photos. This is shown more visually in the photo to the right as indicated by the white arrow showing where the bridge has been depressed inward.

Repair of a Crooked Nose

Contrary to popular belief among many patients and even plastic surgeons, most crooked noses can be effectively repaired by surgical reconstruction to help restore a more normal alignment. I say this because many of my past reconstructive rhinoplasty patients were told at some point that a crooked or twisted nose cannot be surgically repaired because it will just drift back into the abnormal alignment. The reality is that a good number of fractured, crooked noses can be restored to a relatively normal alignment and shape.

Now do not get me wrong – fixing a crooked or twisted nose deformity is not easy. But with excellent surgical technique and experience in reconstructive rhinoplasty, patients can be left quite happy following this type of surgery. In this particular case, I used what is called a closed rhinoplasty approach to complete the surgery. A closed rhinoplasty is a term used to describe the general approach in terms of where incisions are made in and/or around the nose. Closed refers to the fact there are no incisions made on the outside of the nose – the incisions are all made inside of the nose. In this manner, there are no scars made on the external surface of the nose that might become visible. Using the closed rhinoplasty approach, a surgical instrument, called an osteotome, was employed to help me reshape the nasal bones. A nasal osteotome is a specially designed surgical tool that is used to cut the bone. In this particular rhinoplasty patient, the nasal bone needed to be cut before it could be repositioned. The osteotome has a very sharp edge at the tip that allows me to cut the bone incrementally along the top of the bridge (called a medial osteotomy – yellow dotted line) and along the side of the nose (called a lateral osteotomy – red dotted line). You can see how the osteotome is used in the adjacent photo. As is depicted, the osteotome is passed through the nostril but under the skin of the nasal bridge. It is then used to perform the medial osteotomy followed by the lateral osteotomy. In doing so, the nasal bones can then be mobilized, or moved easily, and brought back to a more midline orientation and position. In lay terms, this is essentially re-breaking the nose to try and restore the original normal position and shape.

At the conclusion of the closed rhinoplasty procedure, a cast is placed on the nose in order to keep the nasal bones in the desired position. This cast is typically removed between 5-10 days after surgery. At that point, there is usually a mild to moderate amount of swelling. But by the second week out from closed rhinoplasty surgery, most patients feel comfortable resuming normal public appearance as the swelling continues to subside.

Crooked Nose Repair and Insurance

In crooked nose cases like this, health insurance will usually provide coverage for the surgical repair. In my practice, we accept essentially all PPO insurance plans – including United Healthcare PPO, Aetna PPO, Cigna PPO, Blue Cross PPO, Blue Shield PPO, and many others that traditionally will provide coverage for nasal reconstructive surgery like this. Unfortunately, we do not accept any HMO insurance plans.

Crooked Nose Repair Photos

Take a look at his before and after crooked nose repair photos shown here. On his frontal view, you can see just how much better his nasal alignment is following the closed reconstructive rhinoplasty surgery. No longer can you see the curvature to his left side. Instead, his nasal bridge has been repositioned and reshaped to bring the bones into nearly a straight line. On his oblique (45 degree angle) views you can also readily appreciate the improvement made from the reconstructive nose surgery. Where he previously had the depressed segment on the right side of his bridge (which is best seen when looking at him from his left side), he now has a much more symmetrical oblique angle view. That is because the nasal bone has been essentially ‘lifted up’ on his right side while the entire bony structure has been moved more to the middle of his face. Look for yourself and see just how similar his oblique views are now that the surgery has been performed. Overall, I happen to think this is a great result for him. In fact, looking at his nose now one would not even imagine it was once broken and shifted to the side. In addition to all of this, the functionality of the nose is improved so there is much more equivalent airflow through both sides.

Nasal Fracture Consult

If you have broken your nose and sustained a nasal fracture that needs corrective surgery, contact our office today to schedule a consultation. My staff and I are quite proud of our reputation as one of the most respected regional referral centers for reconstructive nose surgery. I look forward to being involved in your care and recovery.

#### Croton Peel
Croton Peel Treatment in San Diego and La Jolla with Dr. John Hilinski

If you're seeking the most effective chemical peel to rejuvenate your skin, consider a Croton peel with Dr. John Hilinski, one of San Diego’s most renowned facial plastic surgeons. Dr. Hilinski, a Harvard Medical School graduate, has completed specialty training in facial plastic and reconstructive surgery. With board certifications in both Facial Plastic and Reconstructive Surgery and Head and Neck Surgery, Dr. Hilinski’s extensive expertise and his highly trained staff ensures that you’ll achieve improvements in your skin’s appearance.

What is a Croton Peel?

A Croton peel, also known as a Hetter peel or modified phenol peel, utilizes a specialized chemical mixture that deeply penetrates the skin to rejuvenate and tighten it. Dr. Hilinski, with his extensive training at UCSD Medical Center and a fellowship under world-renowned facial plastic surgeon Dr. Dean Toriumi, offers this advanced treatment for patients seeking long-lasting results.

What Can a Croton Peel Treat?

Croton peels are highly effective for treating:

Deep wrinkles (rhytids)

Aged and sun-damaged skin

Acne scars

This treatment is ideal for patients who want to restore their skin’s youthful glow and texture. The tightening effect of a Croton peel can make you appear as though you’ve undergone a facelift, providing significant improvement without the need for surgery.

Croton Peels vs. Other Peels

Compared to lighter chemical peels like TCA or glycolic acid peels, Croton peels penetrate much deeper into the skin, delivering more dramatic results. Dr. Hilinski's expertise in facial aesthetics ensures the safe and effective application of this deep peel, minimizing risks while optimizing results.

Croton Peels vs. Laser Treatments

While Dr. Hilinski also offers advanced laser treatments like CO2 and Erbium lasers, Croton peels often provide better results for those with deeper wrinkles and severe skin damage. Croton peels offer longer-lasting outcomes than even the most advanced laser treatments, making them an excellent option for patients seeking dramatic facial rejuvenation.

Preparing for Your Croton Peel

To prepare for your Croton peel, Dr. Hilinski’s staff will provide detailed pre-treatment guidelines. This often includes using Retin-A and hydroquinone to prime your skin and reduce the chances of pigmentation issues during recovery. With years of experience in facial rejuvenation, Dr. Hilinski will tailor your preparation plan for optimal results.

Recovery and Results

Most patients need 7-10 days for the initial recovery after a Croton peel. During this time, you may experience some redness, which can be concealed with makeup. Full recovery, where your new, radiant skin fully evolves, can take several months to a year, but the dramatic, long-lasting improvements are well worth it. Dr. Hilinski's expert care ensures a smooth recovery and beautiful results.

FAQs About Croton Peels

Why San Diego and La Jolla Patients Choose Dr. Hilinski

Dr. Hilinski’s San Diego practice, located in La Jolla, is dedicated to delivering exceptional facial rejuvenation results. As a leading facial plastic surgeon in the area, Dr. Hilinski’s patients benefit from his deep expertise and personal approach to care. Whether you're in San Diego, La Jolla, or the surrounding areas, Dr. Hilinski is here to help you achieve your aesthetic goals.

Schedule Your Consultation with Dr. Hilinski

Ready to transform your skin with a Croton peel? Contact our office today to schedule a consultation with Dr. Hilinski, a facial rejuvenation expert. Located in La Jolla, we serve patients throughout San Diego and Southern California.

#### Darwins Tubercle Correction
Darwin's Tubercle Correction with Dr. John Hilinski: San Diego's Expert in Ear Reshaping

Darwin's tubercle, a small congenital ear deformity, manifests as an irregular prominence or thickening on the helical rim of the ear. Recognized by Charles Darwin as an evolutionary remnant, this anomaly has been noted across various primates and is named in his honor. While typically harmless, Darwin's tubercle can cause individuals to feel self-conscious about their ear shape. Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, offers expert treatment to correct Darwin's tubercle and restore natural ear aesthetics.

How Does Darwin's Tubercle Present?

Darwin's tubercle can appear in two main forms:

At John Hilinski Facial Plastic Surgery, we most commonly see patients with inward protrusions, but many patients present with a combination of both forms.

The Benefits of Darwin’s Tubercle Correction Surgery

Improved Aesthetics

By smoothing and reshaping the helical rim, the surgery helps create a more balanced and symmetrical ear appearance.

Minimal Scarring

Dr. Hilinski’s advanced surgical techniques ensure that the incisions are well-hidden, leaving minimal visible scarring.

Boost in Confidence

Correcting this ear abnormality can help individuals feel more comfortable and confident with their appearance.

Quick Recovery

The procedure is minimally invasive, and most patients experience a smooth, quick recovery with little downtime.

The Darwin's Tubercle Correction Procedure

Dr. Hilinski's approach to Darwin's tubercle correction is meticulous and precise. This straightforward ear reshaping procedure typically involves three steps:

Revealing the Prominence: An incision is made along the inner lining of the helical rim, allowing Dr. Hilinski to access the excess cartilage. This strategic incision ensures minimal visibility of any post-surgical scars.

Reshaping the Helical Rim: The excess cartilage causing the prominence is carefully trimmed, allowing the ear to return to its natural, smooth shape.

Suturing the Incision: Once the excess cartilage is removed, the incision is sutured with precision. The result is a well-hidden incision, leaving little to no trace of surgery.

Your Personalized Consultation with Dr. John Hilinski

If Darwin's tubercle has affected your self-confidence or you simply desire a more refined ear appearance, Dr. John Hilinski, a nationally recognized expert in cosmetic ear surgery, can help. During your consultation, Dr. Hilinski will evaluate your ear anatomy and recommend a tailored treatment plan to address your concerns.

FAQ: Darwin's Tubercle Correction

Schedule a Consultation with Dr. Hilinski

If you are considering Darwin's tubercle correction to achieve a more refined and natural ear appearance, schedule a consultation with Dr. John Hilinski, San Diego's leading expert in cosmetic ear surgery. With his specialized approach and extensive experience, Dr. Hilinski can help you achieve the aesthetic results you desire. Contact our office today to learn more about your options for ear reshaping surgery.

#### Dorsal Hump Deformity
A ‘dorsal hump deformity’ refers to an undesirable bump involving the bridge, or dorsum. This is best appreciated on the lateral view of the nose and appears as a convexity over the bridge (see photo example). In some cases, a dorsal hump deformity is barely noticeable on frontal view. Most patients present stating they often see the unwanted bump in photographs of themselves taken from an oblique, or partial side, angle.

Esthetic Analysis and Goals

Rhinoplasty patients with a dorsal hump deformity usually request changes that will result in a straighter, smoother bridge as seen on lateral view. However, there are various degrees of ‘straighter’ when discussing rhinoplasty for a hump deformity. The most often requested change to a dorsal hump is to provide a straight bridge as seen on profile view. This can be done with or without what is termed a ‘supra-tip break’ (also known simply as a ‘tip break’). A supra-tip break refers to a slight angulation, or break, in an upward direction as the bridge junctions with the tip (red arrow in attached photo). This results in the tip being 1-2 millimeters higher than the remainder of the bridge. This is often considered a feminizing trait and should be avoided in the male nose.

Dorsal hump removal can also be done without leaving a supra-tip break while still achieving an esthetically pleasing profile. For example, the adjacent photo of a Dr. Hilinski patient demonstrates removal of a hump deformity without leaving a supra-tip break. The end result is an essentially straight bridge while maintaining a natural, balanced profile view. The decision to leave a supra-tip break or not is very much an individual one that should be discussed and reviewed in detail with Dr. Hilinski during your consultation.

A nasal profile with a supra-tip break should not be mistaken with the scooped, or ski slope, bridge that was popularized in the 1970s. Whereas the supra-tip break reflects a slight shift in direction, the scooped bridge is more of a continuous curve extending from the upper bridge to the tip (resembling a ski slope). The attached photo (prior rhinoplasty performed by another plastic surgeon) visually demonstrates this undesirable contour, which carries with it an obvious stigma of having overaggressive surgical removal of a hump.

In recent years, my practice has seen an increasing number of rhinoplasty patients who are now requesting partial hump removal. Instead of desiring simply a straight profile view, these patients aim to have their hump altered while leaving a residual bump, or convexity. This is most often done in patients who are looking to have their nose reshaped while preserving more of their ethnic identity, which sometimes emanates from the nasal dorsum. In fact, I have now revised several rhinoplasty patients who had surgery elsewhere and desired at least partial replacement of the bump that was originally removed.

Surgery for A Dorsal Hump Deformity

Surgery to remove a dorsal hump deformity is often described as a ‘reductive’ rhinoplasty since it results in a reduction in the size of the nose. By definition, reductive rhinoplasty involves removal of a certain amount of cartilage and/or bone to achieve the desired appearance. Contrary to popular belief, this is actually one of the most challenging types of rhinoplasty to perform while achieving successful long-term results . This is largely due to the fact that changes involving the middle one-third of the nose (see section on Nasal Analysis), where most bumps exist, can significantly alter the three-dimensional appearance of the nose. It is relatively easy to reduce a hump deformity and achieve acceptable esthetic results as seen from the two-dimensional profile view. It is much more difficult, however, to achieve proper symmetry and balance of the bridge from all three views (profile, oblique and frontal) following hump reduction. This is precisely why many plastic surgeons will often publish only the profile view of their hump reduction patients.

The challenge in achieving excellent results in three dimensions is based on the underlying anatomy. The middle one-third of the nose is comprised of the dorsal septum with the upper lateral cartilage on each side (see adjacent diagrams). Together, these structures form the support for the middle one-third of the bridge and play a key role in the appearance of the mid-dorsum. This is a critical anatomic relationship that if compromised during hump reduction can eventually lead to unwanted collapse of the upper lateral cartilages. This is a complication that may not be noticed during the first 6-9 months following surgery because persistent swelling of the overlying tissue helps to camouflage the deformity. As time goes on, however, the middle one-third of nose begins to pinch inward, leaving a noticeable inverted V-shaped shadow across the bridge (also known as an inverted V deformity). Such a deformity significantly disrupts the brow-tip esthetic line (as discussed in the Nasal Analysis section) and brings unwanted attention to the area. Prevention of this complication relies on careful preoperative planning and meticulous surgical technique. Thus, Dr. Hilinski may recommend use of cartilage grafts (termed spreader grafts) as part of your dorsal hump reduction procedure. Placement of such grafts helps to stabilize the integrity of the mid-dorsum and increases chances of having a smooth bridge once complete healing has taken place.

In addition to these concerns, the nasal bones, or nasal vault, (see discussion in Nasal Analysis section) must be assessed during hump reduction. In most cases where at least a moderate reduction is being performed, the nasal bones also need to be narrowed. This requires what is termed an osteotomy, which means cutting the bone. In layman’s terms, this is breaking the bone. If this is not done when indicated following hump reduction, the nasal bridge may appear excessively wide from the frontal view. The adjacent diagrams are provided to illustrate this point. The diagram on the left demonstrates how high (red line) a dorsal hump deformity (blue arrow) might rise above the level of the nasal tip (black arrow). The diagram on the right demonstrates how much the nose may be effectively widened after reducing the bridge height by this amount (compare red and blue lines). Osteotomies are performed to compensate for this potential by narrowing the bridge to a more appropriate width.

In addition to the esthetic challenges, there are key functional considerations with dorsal hump reduction. The previously mentioned dorsal septum and upper lateral cartilage form an anatomic angle on the inside of each nasal passage, termed the internal nasal valve. This angle happens to be the area of the nasal passage that has the highest resistance to airflow. Consequently, even subtle narrowing of the internal nasal valve can result in subjective feelings of difficulty breathing through the nose. In cases where the upper lateral cartilage is excessively long (and the nasal vault is short) there is a higher likelihood of causing internal valve collapse by dorsal hump reduction. In these cases, it is often recommended that spreader grafts be placed to help restore and reinforce the integrity of the internal nasal valve. In this manner, there is less chance for compromised nasal breathing following surgery. In cases where the upper lateral cartilage is relatively short (and the nasal vault is long), it is usually not necessary to place spreader grafts, as there is less likelihood of causing narrowing of the internal nasal valve region.

In summary, dorsal hump reduction is one of the most challenging types of rhinoplasty given the fact that changes in the middle one-third can significantly impact the three-dimensional appearance of the nose. In addition to the esthetic considerations, one must also pay close attention to the functional implications of altering this region of the nose. This may include likely osteotomies and possible placement of spreader grafts once the hump has been reduced. With thorough preoperative planning and proper surgical technique, one can help maximize chances of achieving an esthetically pleasing result while maintaining optimal nasal function.

#### Droopy Nasal Tip Correction
Correcting a droopy nasal tip is one of the most common maneuvers I perform in terms of cosmetic rhinoplasty. We have previously touched on this topic in another of our rhinoplasty tutorial discussions. But additional case examples, like this one here, help to further highlight this type of cosmetic rhinoplasty surgery.

This patient from San Diego desired to have her nose reshaped to primarily address the droopy nasal tip. This is also referred to as a ptotic nasal tip – where the ‘p’ is silent and it pronounced ‘toe-sis’. If you look at her pre-rhinoplasty photo, you can see subjectively how her nasal tip region dominates the appearance of her nose – and mid face region to a great degree. If you measured her nasolabial angle (the angle created by the axis along the bottom of the nose crossing the axis of the upper lip), you would see that it is much less than the ideal female angle of 95-105 degrees.

In fact, the red lines here represent a 90 degree angulation and you can readily see how her nasal tip is even less than this angulation. So, by definition, she has a droopy, ptotic nasal tip that would likely benefit from cosmetic rhinoplasty surgery to help lift it up just a bit. If you look at her frontal view prior to rhinoplasty surgery, you can see her nasal tip is not only droopy, or heavy-looking, but also slightly boxy in appearance. In the process of lifting the ptotic nasal tip, we discussed making some minor changes to the actual shape of her tip to create a more feminine overall look.

Plunging Nasal Tip

It is worth mentioning that some people would refer to this type of nose as having a ‘plunging’ tip. A plunging nasal tip means that the tip of the nose appears to droop down even more when the patient smiles. This can be seen in the adjacent photo of this same patient when she smiles. Compared to her resting profile photo above, you can see how the tip of the nose appears to plunge even lower down upon smiling. Although it certainly looks like the tip of the nose drops down with smiling, research has actually shown that the tip of the nose plunges very little with animation. It is thought that this illusion is more likely to result from movement of surrounding facial muscles – like those in the upper lip region. Regardless of the explanation, the appearance of this plunging nasal tip is still bothersome to many patients and needs to be addressed at the time of rhinoplasty surgery.

Open Rhinoplasty Approach

In order to accomplish these type of planned changes, I recommended we perform an open rhinoplasty approach. As opposed to a closed rhinoplasty approach, the open allows for much better visualization of the actual cartilage framework that forms the tip shape. Although there are some great rhinoplasty surgeons who prefer the closed approach, a majority of cosmetic nose specialists would likely use an open approach in this particular case. The adjacent photo demonstrates the type of visualization that can be achieved with a standard open rhinoplasty approach – showing the paired lower lateral cartilages that comprise a majority of the nasal tip.

In this particular case, I ended up disassembling the entire tip first. I then repositioned the lower lateral cartilages and reattached them to the caudal septum in a better location. In the process of doing this, as noted earlier, I also narrowed her tip – but just slightly in order to preserve her overall look.

Droopy Nose Tip Repair – Side

The results of this patient’s surgery are shown here. As you can see, the angulation of her nose (and the drooping tip) have been improved significantly following rhinoplasty. In the photo below, you can readily see how the angle of her nasal tip (yellow line) was primarily in a downward direction prior to rhinoplasty. Following cosmetic reshaping of the nose, her nasal tip is now closer to a 95 degree angulation, which is within the range of being ideal.

Droopy Nose Tip Repair – Smiling

When you look at her smiling lateral view, the improvement is arguably more dramatic. That is because, as noted previously, when one smiles, there is an illusion that the nasal tip drops down more. Regardless whether or not this is real, the visual appearance is still there. Following her cosmetic rhinoplasty, including lifting of the nasal tip, there is a much more acceptable positioning seen. Even with a wide grin, her nasal tip does not appear droopy at all.

Droopy Nose Tip Repair – Front

From the frontal view, you can also appreciate how the droopy nasal tip has been now lifted so that it appears less heavy. If you look more closely at her columella, you can really appreciate how this plunges downward much less than it used to. The green line in the diagram photo represents where the bottom of her columella now rests following the rhinoplasty reshaping. The yellow line represents the bottom of her old columella. As you can see, there has been a change on the order of several millimeters. Now this may now sound like a lot – but keep in mind, when it comes to cosmetic nose reshaping, it is literally a game of millimeters!

In addition, her nasal tip now appears much more symmetrical, or even. Keep in mind that she still has some degree of mild swelling within the tip, which should settle down with more healing time. But also be mindful that the goal of cosmetic rhinoplasty is to achieve a natural looking result – which is precisely what she demonstrates in these photos. The goal, especially in someone who is more middle-aged like her, is to avoid creating a pinched or overly narrowed nasal tip. In the after photo, you can appreciate how her nasal tip is, in fact, still slightly rounded, or convex – which is close to the ideal ‘soft triangle’ that rhinoplasty surgeons should always strive to achieve.

Droopy Nose Tip Repair – Oblique

On this oblique, or three-quarter, view of her nose, you can also see how the nasal tip has been nicely lifted to approximate more of an ideal angulation. Much like the diagram photo seen above from the frontal view, you can readily appreciate how the new angulation of the nose is markedly better. The droopy tip has been lifted up just enough to create a more ideal nasolabial angulation.

Avoiding a Pig Nose Deformity

It is worth mentioning – because patients bring this topic up so frequently – that her results show a nice improvement without looking like a pig nose deformity. So many patients are concerned that rhinoplasty tip reshaping will result in a pig nose deformity, where the tip is overly rotated upward and there is excess nostril show (the ability to look into the nostrils). Fortunately, in experienced rhinoplasty surgeons’ hands, the chances of this occurring are quite low. In this particular case, her tip has been lifted an appropriate amount – safely avoiding any appearance of a pig nose.

Correction of a Droopy Nose Tip

If you have a droopy nasal tip and are considering cosmetic rhinoplasty to lift it up, please do not hesitate in contacting my office today to schedule a personalized consultation with me in our San Diego office.

#### Droopy Nasal Tip Rhinoplasty
This is a great case example of how rhinoplasty surgery can help to address a ptotic nasal tip. The term ‘ptosis’ means ‘drooping’ of the nasal tip region. These type of noses are also commonly referred to as drooping noses and hook noses. When you see a ptotic nasal tip, you really do notice it because one can easily appreciate how the tip of the nose appears to drop off from the end of the nose. On frontal view of the nose with a ptotic nasal tip, the nose appears to be quite rounded – in fact, in many cases the nasal tip appears to have a more ovoid shape to it as seen in the adjacent preoperative photo. The other finding that is commonly seen in the ptotic nasal tip is a relative lack of nostril show. This is completely opposite of what is typically seen in the over-rotated, or piggy, nose. What most patients don’t realize is that it is normal to see some degree of nostril show on the frontal view. But just as it is abnormal to see too much nostril show, it is also abnormal to see no nostril show – which is the case here. If you look at her nose from the frontal view, there is really no dark shadowing seen where the nostrils are located.

But there is no doubt the ptotic nasal tip is most easily appreciated on the side view of the nose. As you can see here in the attached diagrammed photo, the nasal tip appears to simply droop off of the end of the nose. When you measure this more objectively, you will see that the nasolabial angle (the angle formed by the intersection of the upper lip and the long axis of the nostrils) in the ptotic nose is much more acute than it should be. In females, the ideal nasolabial angle is between 100-105 degrees, which is indicated in the adjacent photo by the intersecting yellow lines. In the ptotic, or drooping, nasal tip the nasolabial angle is often times much sharper – and in some cases is even less than 90 degrees. In this particular case example of nasal tip ptosis, the nasolabial angle is, in fact, less than 90 degrees as shown by the intersecting red lines. The difference between these two angles visually demonstrates just how droopy her nasal tip really is on the side view.

When this patient smiles, you can see how the nasolabial angle becomes even more acute. Now this is something that happens with nearly everyone when they smile – the tip of the nose will appear to drop down a few degrees. This is largely a result of the depressor septi nasi muscle that, upon contraction, shortens the upper lip region. As one smiles, this muscle contracts and appears to pull the tip of the nose down a bit. In cases of a ptotic nasal tip that starts off well below where it should be positioned, this additional drooping becomes even more pronounced as seen here.

Cutting the Depressor Septi Nasi Muscle

In many rhinoplasty patients, surgeons will recommend transection, or cutting, of the depressor septi nasi muscle. The thought is that by eliminating this muscle activity, the upper lip will not shorten as much with smiling and the nasal tip will not droop down as far as it does – the end result being the nasal tip appears to have been lifted up. But is this procedure really necessary? And will cutting the depressor septi muscle change one’s smile after surgery? The answers to these questions are actually a bit controversial among rhinoplasty surgeons. In my opinion, I don’t really find it necessary to cut the muscle as part of a rhinoplasty procedure. If you were not having a full rhinoplasty, you could opt to cut this muscle as part of an isolated procedure. However, the results, in terms of elevating the nasal tip, may not be as dramatic as desired. If a formal rhinoplasty procedure is being performed, I usually recommend alternative techniques to lift the nasal tip without having to cut the depressor septi nasi muscle. This typically involves repositioning of the cartilage framework of the nose to place the nasal tip in a more ideal, aesthetically pleasing location. In terms of the effect on smiling, many rhinoplasty surgeons will tell you that there is very little effect on one’s smile after cutting the depressor septi nasi muscle. But I must say that, anecdotally, I have personally seen many cases over the years where patients note a marked difference in terms of their smile following resection of the depressor sept nasi muscle performed by other plastic surgeons. And these are changes that are way beyond the initial period of healing from rhinoplasty where one’s smile is frequently temporarily affected from early surgical swelling.

Rhinoplasty for the Drooping Nasal Tip

In this particular case, I recommended she undergo an open septorhinoplasty procedure to help in reshaping the entire nose – with specific emphasis on addressing the drooping nasal tip. A rhinoplasty worksheet of surgical changes is shown here. The hatched lines indicate where the bridge was conservatively rasped on each side to create a smoother contour. But this was considered a minor part of this rhinoplasty procedure compared to the desired changes involving the lower one-third of her nose.

The main emphasis was focused on her nasal tip. To help address the ptosis, or drooping, the lower lateral cartilages were taken apart – or deconstructed. The lower lateral cartilages are shown in the adjacent diagram as the shaded yellow structure. The lower lateral cartilages (which are paired) comprise a majority of the shape of the nasal tip region. If they are positioned too low, as is the case here, the nasal tip will appear ptotic, or droopy. So in order to address this cosmetic deformity, the lower lateral cartilages were taken apart and disconnected from the end of the septum, where they are normally attached. The pair of cartilages were then rotated upward and reattached in a more ideal position on the end of the septum, as indicated by the blue/white arrow. In addition to rotating the droopy nasal tip, conservative cephalic trimming was performed. This involved trimming off some of the excess cartilage along the upper margin of the lower lateral cartilages in the region indicated by the red asterisk. This was done simply to reduce the extra volume of cartilage in this area of her nasal tip. Finally, some permanent sutures were used to further refine the actual dome region of the tip – called dome-binding sutures – a very common technique in rhinoplasty that helps provide improved definition.

Could her nose have been reshaped using alternative techniques? Absolutely. A number of other rhinoplasty techniques could have been utilized in this case, such as a lateral crural overlay. But, in this particular instance, I felt that deconstructing her tip and repositioning the lower lateral cartilages was the best choice given her anatomical deformity.

As indicated by the rhinoplasty worksheet, a septoplasty was also performed – but more for functional improvement of her breathing.

Ptotic Tip Repair Before and After Photos

Below are the before and after photos showing typical results for correction of the ptotic, or droopy, nasal tip. You can readily see from the photos that she has quite a dramatic change in the appearance of her nose – yet she still looks very natural. Looking at her previously droopy nasal tip in particular, you can see how the angulation with her upper lip is much more favorable – but not excessively rotated. In fact, her nasolabial angle has now been improved to something closer to 100 degrees – over a 10 degree difference compared with her preoperative nose. Even when she smiles, you can see that the tip is quite stable and does not droop much at all – and this is without having to cut the depressor septi nasi muscle.

Computer Imaged Rhinoplasty Results

As part of the rhinoplasty consultation process, I will commonly perform computer imaging of the patient’s photos to help provide a realistic vision of what the surgery might produce. If you are wondering how close the actual results are to the imaged photos, you can see for yourself right here. On the left side is this patient’s before rhinoplasty lateral view. In the middle is the computer enhanced image I provided to her showing the surgical goal. On the right side is her actual post rhinoplasty lateral view. As you can easily see, the actual rhinoplasty result is quite close to the computer enhanced image discussed before her surgery. Obviously it is unrealistic to think the real life result is going to be an exact match of the imaged photo. But, in my opinion, it is pretty darn close – which was the real goal all along.

Rhinoplasty Consult for Nasal Tip Ptosis

If you happen to have a ptotic or drooping nasal tip, don’t hesitate in contacting my office today to schedule a personalized consultation to see what cosmetic nose surgery can possibly do for you.

#### Droopy Tip
Droopy Tip Nose Correction Surgery with Dr. John Hilinski: Expert Nasal Refinement in San Diego, CA

A droopy nasal tip, also known as a "ptotic" or downward-facing tip, can give the nose a long, heavy appearance and disrupt the overall balance of the face. This condition is often a result of genetics, aging, or prior trauma to the nasal structure. Droopy tip correction surgery aims to refine the nasal tip, lifting and reshaping it to create a more defined and harmonious appearance. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in droopy tip rhinoplasty, offering personalized care and precise surgical techniques to deliver natural-looking, aesthetically pleasing results.

What is Droopy Tip Nose Correction Surgery?

Droopy tip correction surgery is a type of rhinoplasty focused on elevating and reshaping the nasal tip to create a more proportional and balanced look. The procedure addresses the downward angle of the tip, which can make the nose appear longer or less defined.

There are several reasons why someone might choose this surgery:

Droopy tip correction surgery typically involves repositioning and reinforcing the nasal cartilage to provide support and lift to the tip. Depending on the patient's anatomy and goals, Dr. Hilinski may use cartilage grafting or suturing techniques to achieve a natural-looking lift.

Special Considerations for Droopy Tip Surgery

Subtle Changes with Significant Impact

Even small adjustments to the nasal tip can have a significant impact on the overall facial aesthetic. Dr. Hilinski’s expertise in facial harmony ensures that the correction complements the patient’s unique facial structure.

Tip Support and Longevity

Ensuring long-lasting results is crucial in droopy tip correction. Dr. Hilinski uses advanced techniques to reinforce the tip’s support structures, preventing the tip from drooping again over time.

Natural Results

A key goal of droopy tip rhinoplasty is to maintain or enhance the natural appearance of the nose. Dr. Hilinski’s personalized approach ensures that the results look subtle and balanced, enhancing the patient’s overall facial proportions.

Why Choose Dr. John Hilinski for Droopy Tip Correction?

Dr. John Hilinski is a double board-certified facial plastic surgeon with extensive experience in rhinoplasty, including droopy tip correction. His credentials include:

With his comprehensive training and expertise, Dr. Hilinski offers droopy tip correction surgery with precision and artistry. His personalized approach ensures that each patient receives the highest level of care, with results that are tailored to their specific goals and facial structure.

FAQ: Droopy Tip Correction Surgery

Schedule a Consultation with Dr. Hilinski

If you are interested in correcting a droopy nasal tip and enhancing your overall facial appearance, schedule a consultation with Dr. John Hilinski. As a leading expert in rhinoplasty in San Diego, Dr. Hilinski offers personalized care and advanced techniques to help you achieve your aesthetic goals. Contact us today to learn more about how droopy tip correction surgery can give you a more refined, balanced appearance.

#### Droopy Tip Raised Up
Here is a classic example of how a droopy, ptotic nasal tip can be lifted up to give a nice cosmetic improvement in the appearance of the nose.

This female patient from San Diego desired to have better tip definition and position. Her main issue anatomically with the nose was the fact her nasal tip was droopy. If you look at her frontal view here, you will notice that she barely has any nostril show. Meaning you don’t really see into her nostrils at all. Of course, the opposite situation is also not desirable where you can see into the nostrils too much. This is often referred to as a miss piggy nose where the tip of the nose is turned up too high. But just as this is considered undesirable and abnormal, so is the instance where the nostrils are barely visible from the front view. This latter situation is due to the tip of the nose hanging down too low – making it appear droopy. Plastic surgeons and rhinoplasty experts commonly refer to this as a ptotic nasal tip – with most of these patients having what is called under rotation of the nasal tip.

This patient consulted with Dr. Hilinski after doing thorough research online to try and find the best rhinoplasty surgeon in San Diego to fix her nose. After consulting with our office, she elected to proceed with the recommended open rhinoplasty surgery to help lift her tip and define the nose a bit more.

The nasal tip was mainly reshaped with reorientation of her cartilage framework. Very minimal cartilage grafting was needed to achieve this type of change. Keep in mind that she had very thick nasal skin, which detracts from the amount of definition and narrowing that a patient can ultimately realize from rhinoplasty surgery. But despite this anatomical challenge, she still has a very nice cosmetic improvement compared to before she underwent rhinoplasty by Dr. Hilinski.

Some before and after photos are provided here to show you just how much change can be seen with movement of the nasal tip several millimeters here and there.

Lifting the Nasal Tip

As you can see on these two telling views, her nasal tip has been lifted up nicely to put it into a much better position. You can now see some degree of her nostril opening. However, it is not excessive and looks quite natural for her face. You can also easily appreciate how much nicer her nasal tip shape now is following rhinoplasty. This is a direct result of cartilage reorientation, including narrowing, to make her nasal tip look more refined. Overall, her nose is vastly better – yet she still looks very natural – as if she could have been born with this nose.

#### Dysport
Dysport Injections at Hilinski Medspa: Smooth, Youthful Results with Expert Care

At Hilinski Medspa, we offer Dysport injections as a non-surgical solution to help smooth facial wrinkles and lines. Dysport is a popular neuromodulator similar to Botox, designed to relax specific muscles and reduce the appearance of dynamic wrinkles caused by facial expressions. With the guidance of board-certified facial plastic surgeon Dr. John Hilinski, our highly skilled team ensures that each patient receives customized care and natural-looking results that enhance their facial appearance without compromising movement.

Why Choose Dysport?

Dysport is ideal for treating dynamic wrinkles, which form due to repeated facial muscle movement over time. Common areas of treatment include frown lines between the eyebrows (also known as glabellar lines or "11s"), forehead lines, and crow's feet around the eyes. Dysport works by temporarily relaxing the targeted muscles, allowing the skin to smooth out and giving the face a refreshed and rejuvenated appearance.

Unlike Botox, which is more localized, Dysport spreads slightly farther from the injection site. This quality makes Dysport a preferred choice for treating larger areas, particularly in patients with moderate to severe facial wrinkles. At Hilinski Medspa, we customize each treatment to your unique facial anatomy, ensuring optimal results that enhance your natural beauty.

The Benefits of Dysport Injections

Dysport offers a range of benefits for patients seeking non-surgical facial rejuvenation:

Fast-Acting Results

Many patients notice results within 2-3 days after treatment, with the full effect visible after one week.

Natural-Looking Results

Dysport provides subtle, smooth improvements, making it ideal for those seeking wrinkle reduction without the “frozen” look.

Long-Lasting Effects

Results from Dysport typically last between 3-4 months, allowing patients to enjoy long-lasting rejuvenation with minimal maintenance.

Minimally Invasive

Dysport injections are quick, minimally invasive, and require no downtime, making them an excellent option for patients with busy schedules.

What to Expect During Your Dysport Treatment

Dysport injections are performed quickly in our office with little to no discomfort. The procedure typically takes 10-20 minutes, depending on the number of areas being treated. Dr. Hilinski or one of our expert injectors will strategically place small injections into the muscles responsible for your wrinkles, ensuring that the results are smooth and natural.

There is no significant downtime following Dysport injections. Patients can typically return to their regular activities immediately after the procedure, although we recommend avoiding strenuous exercise and lying down for a few hours post-treatment to allow the product to settle. Mild redness or swelling may occur at the injection site but should subside within a few hours.

Dysport vs. Botox: Which is Right for You?

While both Dysport and Botox are neuromodulators used to treat facial wrinkles, they have slight differences that may make one more suitable for certain patients:

During your consultation, Dr. Hilinski will assess your facial anatomy, discuss your aesthetic goals, and determine which treatment--Dysport or Botox--will provide the best results for your unique needs.

FAQs About Dysport Injections

Schedule Your Dysport Consultation at Hilinski Medspa

If you're interested in smoothing fine lines and wrinkles with Dysport, contact Hilinski Medspa today to schedule a consultation. With Dr. John Hilinski's expert guidance and our highly skilled team, you can achieve rejuvenated, natural-looking results that leave you feeling confident and refreshed.

#### Ear
Ear Plastic Surgery Procedures with Dr. John Hilinski: Expert Ear Surgery in San Diego, CA

Dr. John Hilinski, a double board-certified facial plastic surgeon, is a leading expert in ear plastic surgery procedures. Whether you're seeking to improve the appearance of prominent ears, repair damaged earlobes, or address congenital ear deformities, Dr. Hilinski offers advanced techniques that deliver natural-looking results. With years of specialized training and a personalized approach to each patient, Dr. Hilinski ensures that every ear procedure is tailored to enhance your appearance and boost your confidence.

Ear Plastic Surgery Procedures Offered by Dr. John Hilinski

Dr. Hilinski provides a range of ear plastic surgery procedures to address both cosmetic and reconstructive needs. The following subpages fall under the comprehensive ear plastic surgery services offered:

Each of these ear plastic surgery procedures is customized to meet the specific needs and goals of the patient, ensuring optimal results and minimal downtime.

Schedule Your Consultation with Dr. Hilinski

If you're considering ear plastic surgery to enhance the appearance of your ears or repair ear deformities, schedule a consultation with Dr. John Hilinski today. As San Diego's leading expert in ear surgery, Dr. Hilinski offers advanced techniques and personalized care to help you achieve the look you desire. Contact us to learn more about how these procedures can restore your confidence and improve your overall appearance.

#### Ear Reduction (Macrotia)
Ear Reduction Surgery (Macrotia) with Dr. John Hilinski: San Diego's Specialist in Reducing Large Ears

If you feel that your ears are too large or out of proportion with the rest of your facial features, macrotia surgery, or reduction otoplasty, may be the ideal solution. This specialized cosmetic procedure is designed to reduce the size of excessively large ears, creating a more balanced and harmonious appearance. Dr. John Hilinski, a board-certified facial plastic surgeon, is a renowned expert in macrotia surgery in San Diego. He offers personalized treatment plans to help patients achieve natural-looking results that enhance their confidence.

Hilinski Macrotia Surgery

What is Macrotia?

Macrotia is a medical condition where the ears are significantly larger than average, making them appear disproportionate to the face. While macrotia does not cause any physical harm, it can greatly impact a person's self-esteem and confidence. People with macrotia often feel self-conscious about the size of their ears, which can draw unwanted attention or comments.

Macrotia surgery specifically addresses the vertical and horizontal dimensions of the ear, reducing its overall size without affecting the ear's functionality. This procedure is ideal for individuals whose ears are abnormally large but do not have significant ear protrusion.

Do I Have Macrotia?

If you are concerned about the size of your ears, Dr. Hilinski can perform a thorough assessment to determine if you have macrotia. In some cases, the front view of the ears may not reveal their excessive size, but from a side or 45-degree angle, the ears may appear disproportionately large from top to bottom.

Using specialized assessment techniques, Dr. Hilinski evaluates the long axis (vertical length) and short axis (width) of the ear. If either of these dimensions is excessive, the patient is diagnosed with macrotia.

Benefits of Macrotia Surgery

Macrotia surgery offers several benefits for patients who feel that their ears are too large:

How is Macrotia Surgery Performed?

Macrotia surgery typically involves making incisions along the natural creases of the ear to remove excess cartilage and skin. Dr. Hilinski uses advanced techniques to reduce both the vertical and horizontal dimensions of the ear, ensuring a natural and balanced outcome.

The surgery is performed as an outpatient procedure under local or general anesthesia, depending on the patient's needs and preferences. Recovery time is relatively short, with most patients returning to their normal routines within a week.

FAQ: Macrotia Surgery

Schedule a Consultation with Dr. Hilinski

If you're considering ear reduction surgery to correct the size of your ears, schedule a consultation with Dr. John Hilinski, San Diego's leading expert in macrotia surgery. With his extensive experience and personalized approach, Dr. Hilinski can help you achieve natural-looking, balanced ear aesthetics that enhance your overall appearance. Contact our office today to learn more about your options for ear reduction surgery.

#### Ear Reduction Case Study
This is a great example of macrotia ear reduction surgery that highlights how patients will look within several weeks of their surgical procedure.

I happen to be one of the few plastic surgeons in the United States who offers macrotia ear reduction surgery. This stems from my exclusive experience in performing cosmetic ear reshaping (otoplasty) on a very regular basis. As a result of my expertise in other types of cosmetic ear surgery, I developed my own techniques to help patients seeking actual reduction in the size of their ears – termed macrotia, or scapha reduction, surgery.

Hilinski Macrotia Surgery

What is the Scapha?

So what is the scapha of the ear? The adjacent photo diagram will help to illustrate what I am referring to in terms of the scapha. The scapha of the ear is the flattened area that is situated between the helical rim (the outer border of the ear) and the antihelix (a natural ridge or elevation indicated by the blue line).

In some patients, the scapha is simply too large, or overdeveloped. This type of scapha enlargement results in an ear that looks too big in terms of vertical height as well as width. Believe it or not, this type of problem is more common than you would think. In fact, many patients consult with me thinking they need to have their ears pinned back (more traditional otoplasty surgery). But after examining them, it is more obvious the scapha is enlarged, which needs an entirely different type of surgery.

Ear Reduction Surgery

Macrotia is ear reduction surgery – taking an excessively larger ear and making it smaller. It is the essentially the opposite of microtia surgery where a new ear is being created or built. The reality is that many doctors still frequently mistake macrotia surgery for microtia surgery, which tells you that very few board certified plastic surgeons know how to correct this problem. In fact, I am one of the very surgeons in the entire nation who has established expertise in macrotia scapha reduction ear surgery. Today, I see patients flying in to San Diego from all over the country to have macrotia ear reduction surgery by me.

Macrotia Ear Reduction

This case example shows – more visually – why and how the ear reduction surgery is performed. It is essentially done for patients who have a large scapha – the region indicated above. The adjacent photo shows how the scapha was reduced in this particular case. These represent the preoperative markings showing how much of the ear cartilage and skin was going to be removed. There are actually several different techniques that can be used to accomplish a similar goal. This includes a number of variations in terms of incision placement. I happen to utilize all of the different methods for ear reduction surgery and make an individualized decision for each and every patient. Once the excess skin and cartilage have been excised (removed), the perimeter of the ear (the helical rim) is then reattached to help restore proper shape and form.

Ear Reduction Early Healing

These photos here show what early healing looks like following macrotia ear reduction surgery. In fact, these photos are taken within 14 days of the operation. I provide them here so that prospective patients can get a real sense of how the healing process unfolds following macrotia surgery. Yes – you can see how the ear still looks quite red and inflamed. However, this discoloration and swelling will settle down significantly over the following weeks to ultimately assume a natural color with normal surface contour. If you look along the upper portion of the ear you can see a short, raised area of skin. This corresponds to the area where a cut was made across the helical rim of the ear in order to help remove the excess tissue. This is intentionally raised up using deeper sutures – a technique called wound eversion. This, too, will settle down with time and eventually assume a more natural, smooth contour.

Overall, what can really appreciate in these early healing photos is how her ear now looks smaller. That is because, indeed, it is a smaller ear after undergoing macrotia surgery. The distance across the scapha region has now been nicely reduced and it assumes a more normal size and shape. In many cases, we can reduce an ear like this upwards of one (1) centimeter, if not more in rare circumstances. To some of you that may not sound like a lot – but when it comes to the ear that can translate into a reduction of 10-15% of the size. Plus, keep in mind that macrotia ear reduction surgery like this will also help create a more favorable shape.

Longer-Term Healing

These photos here show what the ear looks like several months out from macrotia ear reduction surgery. As you can see – compared with the early healing process – the ear now looks less inflammed (less red) with more definition starting to emerge in terms of the natural surface contour. With additional time, the ear will heal some more to the point where there is even less signs of having had macrotia surgery.

#### Ear Trauma
Ear Trauma Repair with Dr. John Hilinski: Restoring Function and Aesthetics to Damaged Ears in San Diego

Ear trauma can result from a variety of causes, including accidents, injuries, or even complications from piercings. Whether the trauma is minor or severe, it can lead to significant cosmetic deformities and functional issues. Dr. John Hilinski, a leading facial plastic surgeon in San Diego, offers expert ear trauma repair to restore the appearance and functionality of damaged ears. With his specialized training and experience in ear reconstruction, Dr. Hilinski can address a wide range of ear injuries, providing personalized treatment plans to achieve natural, long-lasting results.

What is Ear Trauma Repair?

Ear trauma repair is a specialized surgical procedure that aims to correct physical damage to the ear caused by injury, trauma, or other complications. This type of surgery can involve repairing torn earlobes, reconstructing parts of the ear, or addressing other trauma-related deformities. Dr. Hilinski’s approach to ear reconstruction focuses on restoring both the form and function of the ear while minimizing visible scarring.

Benefits of Ear Trauma Repair Surgery

Types of Ear Trauma Repair

Dr. Hilinski offers a range of treatments for ear trauma, including:

The Ear Trauma Repair Procedure

The exact procedure for ear trauma repair varies depending on the nature and extent of the injury. For minor injuries, such as a torn earlobe or small cuts, the repair can typically be completed in under an hour using local anesthesia. In cases of more severe trauma, such as cartilage damage or major deformities, the surgery may involve more advanced reconstructive techniques, including cartilage grafts and tissue rearrangement.

During your consultation, Dr. Hilinski will evaluate the injury and recommend the best approach for your specific case. His goal is to restore the ear's natural appearance while ensuring the most minimal scarring possible.

Recovery from Ear Trauma Repair

After ear trauma surgery, most patients experience minimal discomfort and can return to normal activities within a few days. Stitches are typically removed within 5-7 days, and any swelling or bruising will subside within a week or two. Dr. Hilinski will provide detailed aftercare instructions to ensure optimal healing and results.

Ear Trauma Repair FAQ

Schedule a Consultation with Dr. Hilinski

If you've experienced ear trauma and are seeking expert repair, schedule a consultation with Dr. John Hilinski, San Diego's leading ear trauma specialist. With his extensive experience and commitment to patient care, Dr. Hilinski can help restore the natural shape and function of your ear. Contact our office today to learn more about your options for ear trauma repair.

#### Earlobe Reshaping
Earlobe Reshaping Procedures with Dr. John Hilinski: Expert Ear Surgery in San Diego

Earlobes play a significant role in the overall appearance of the ears and face. Whether due to trauma, aging, or congenital issues, abnormally shaped or oversized earlobes can affect your confidence and aesthetics. Earlobe reshaping, also referred to as earlobe repair, is a specialized procedure designed to correct the appearance of the earlobes, offering patients a more balanced, symmetrical look. Dr. John Hilinski, a board-certified facial plastic surgeon, is a leading expert in earlobe reshaping and repair in San Diego, offering personalized solutions to meet each patient's unique needs.

Why Consider Earlobe Reshaping Surgery?

Earlobe reshaping surgery can address a variety of cosmetic and functional concerns, including:

Dr. Hilinski specializes in all forms of earlobe reshaping, ensuring each patient receives natural-looking results that are proportionate to their facial features.

Benefits of Earlobe Reshaping Surgery

Restores Symmetry

Corrects elongated, torn, or misshapen earlobes for a more symmetrical appearance.

Minimal Scarring

Dr. Hilinski’s advanced techniques minimize visible scarring, ensuring natural-looking results.

Quick Recovery

Most earlobe reshaping procedures are minimally invasive, with a recovery time of only a few days.

Personalized Results

Each surgery is tailored to the individual’s specific concerns, ensuring the outcome aligns with the patient’s aesthetic goals.

Long-Lasting Outcome

Earlobe reshaping provides permanent correction, improving both appearance and self-confidence.

Types of Earlobe Reshaping Procedures

Earlobe Reshaping Surgery Procedure

Earlobe reshaping is typically performed under local anesthesia in Dr. Hilinski's San Diego office. The procedure takes about 15-30 minutes per earlobe, depending on the complexity of the case. For more extensive repairs, such as those following gauging, the surgery may take slightly longer. The recovery process is generally quick, with most patients experiencing minimal pain and downtime. Sutures are typically removed within 4-5 days, and full healing is expected in a few weeks.

FAQ: Earlobe Reshaping

Schedule a Consultation with Dr. Hilinski

If you're considering earlobe reshaping to correct torn, stretched, or enlarged earlobes, schedule a consultation with Dr. John Hilinski, San Diego's leading expert in ear surgery. With his extensive experience and commitment to patient satisfaction, Dr. Hilinski can help you achieve natural-looking, balanced results. Contact our office today to learn more about your options for earlobe reshaping.

#### Erbium Laser
Erbium Laser Skin Rejuvenation at Hilinski Medspa

Looking for an effective, minimally invasive way to improve skin texture, reduce wrinkles, and address pigmentation issues? At Hilinski Medspa in San Diego, we offer Erbium Laser treatments to help you achieve smoother, younger-looking skin with minimal downtime. Supervised by board-certified facial plastic surgeon Dr. John Hilinski, our erbium laser treatments are tailored to your unique needs, providing dramatic results for skin rejuvenation, wrinkle reduction, and scar treatment.

Benefits of an Erbium Laser Peel

Erbium laser peels offer several key benefits:

How Does the Erbium Laser Work?

The Erbium YAG laser uses a 2940 nm wavelength of light to target specific areas of the skin, removing the top layers while stimulating deeper layers to regenerate collagen. The laser’s precision makes it ideal for patients seeking skin resurfacing with minimal risk to surrounding tissues.

Erbium Laser Treatment Process

The procedure involves a warm sensation during treatment, with some patients choosing a topical anesthetic for enhanced comfort. Post-treatment, the skin will appear slightly red, resembling a sunburn. We apply a cooling gel to soothe the skin, and patients are encouraged to use emollients like Aquaphor to aid healing during the first week. Noticeable improvements typically begin within 3-5 days, with optimal results appearing within 6-8 weeks.

Combining Erbium Laser with RF Microneedling

For more dramatic results, we offer a combination of Erbium laser resurfacing and RF microneedling with the Pixel8 RF system. This approach allows us to target both the surface and deeper layers of the skin, promoting enhanced collagen production and superior cosmetic outcomes.

Candidates for Erbium Laser

Erbium laser is suitable for patients seeking non-surgical skin rejuvenation. However, those who have used isotretinoin (Accutane) within the last 9-12 months should avoid resurfacing treatments, including Erbium lasers, as it can negatively affect the body's ability to heal.

FAQs About Erbium Laser

Schedule Your Consultation

For smoother, more radiant skin with minimal downtime, contact Hilinski Medspa today to schedule a consultation with Dr. John Hilinski, San Diego's trusted expert in laser skin treatments.

#### Ethnic Rhinoplasty
Ethnic Rhinoplasty with Dr. John Hilinski: Expert Nose Reshaping in San Diego, CA

Ethnic rhinoplasty is a specialized form of nose reshaping surgery designed to enhance the appearance of the nose while preserving the unique characteristics of a patient's ethnic background. Patients of diverse ethnicities often seek rhinoplasty to address cosmetic or functional concerns without compromising their cultural identity. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, offers personalized ethnic rhinoplasty to help patients achieve their aesthetic goals while maintaining the natural beauty that reflects their heritage.

What is Ethnic Rhinoplasty?

Ethnic rhinoplasty is a type of nose surgery tailored to the specific anatomical features and aesthetic goals of patients from various ethnic backgrounds, including African American, Asian, Hispanic, and Middle Eastern individuals. Unlike traditional rhinoplasty, which may follow a more standardized approach, ethnic rhinoplasty considers the distinct nasal structures, skin thickness, and overall facial harmony of each patient's ethnicity. The goal is to refine and enhance the nose while preserving the patient's natural features, ensuring the results look both subtle and authentic.

Common reasons for seeking ethnic rhinoplasty include refining a bulbous tip, adjusting the size or shape of the nostrils, narrowing or augmenting the nasal bridge, and correcting functional issues such as difficulty breathing. Whether the patient is seeking cosmetic improvement or enhanced nasal function, ethnic rhinoplasty is designed to deliver balanced, natural-looking results that respect the patient's cultural identity.

Why Choose Ethnic Rhinoplasty?

Patients choose ethnic rhinoplasty for several reasons, including:

Dr. Hilinski's expertise in ethnic rhinoplasty allows him to deliver personalized results that align with each patient's aesthetic goals while maintaining their ethnic features. His patient-centered approach ensures that every treatment plan is carefully tailored to meet individual needs, producing results that are subtle, natural, and reflective of the patient's unique background.

FAQ: Ethnic Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering ethnic rhinoplasty and want to learn how this specialized procedure can enhance your nasal appearance while maintaining your ethnic identity, schedule a consultation with Dr. John Hilinski. As San Diego's expert in ethnic rhinoplasty, Dr. Hilinski combines his extensive credentials, personalized approach, and commitment to excellence to provide exceptional care. Contact us today to begin your journey toward achieving your ideal nose.

#### Evolus Rewards
Earn Savings with Evolus Rewards

We encourage all of our San Diego patients who receive Jeuveau® treatments to join Evolus Rewards. This free loyalty program lets you earn points every time you choose Jeuveau, which you can redeem toward future treatments. It’s an easy way to save while maintaining your smooth, refreshed look.

Evolus Rewards is designed specifically for patients who love the results of Jeuveau and want to keep their treatments consistent and cost-effective.

How Evolus Rewards Works

Every qualifying Jeuveau treatment earns points in your Evolus Rewards account. As you accumulate points, you can redeem them for discounts on future treatments. The program also offers occasional bonuses and special promotions, giving you even more opportunities to save.

New to Evolus Rewards?

Signing up is quick and free. Create your Evolus Rewards account here to start earning points at your next Jeuveau appointment.

Already a Member?

As an Evolus Rewards member, you don’t need a password — just use your mobile phone number when you check in with us. We’ll send you a “magic phrase” via text or phone call, and that lets you redeem your $40 savings on the spot.

#### Excess Eyelid Skin
Excess Eyelid Skin Surgery with Dr. John Hilinski: Restore Your Youthful Appearance

As we age, the skin around our eyes loses elasticity, resulting in excess eyelid skin that can cause a tired, aged appearance. For many, this excess skin can also impact vision, especially when it droops over the upper eyelids. Excess eyelid skin surgery, also known as blepharoplasty or eyelid lift surgery, is an effective solution to rejuvenate the appearance of your eyes and restore your youthful look. Dr. John Hilinski, a renowned board-certified facial plastic surgeon in San Diego, specializes in this transformative procedure, helping patients achieve refreshed and natural results.

Why Choose Excess Eyelid Skin Surgery?

Excess skin on the eyelids is a common concern for both men and women, typically resulting from natural aging, sun exposure, and even genetics. This drooping skin not only makes you look older but can also lead to functional issues such as obstructed vision or difficulty applying makeup. Excess eyelid skin surgery can address these concerns, offering both cosmetic and functional benefits, including:

Smoother, more youthful eyelids

Improved vision by removing sagging skin

A refreshed, alert appearance

Enhanced confidence and facial harmony

The Excess Eyelid Skin Surgery Procedure

Dr. Hilinski’s approach to excess eyelid skin surgery focuses on achieving natural, balanced results. The procedure involves the removal of sagging skin, tightening of the underlying muscles, and, in some cases, the removal of fat deposits that contribute to puffiness around the eyes.

Upper Eyelid Surgery:

For the upper eyelids, the incision is carefully placed within the natural crease of the eyelid, making it virtually invisible after healing. Dr. Hilinski removes the excess skin and, if necessary, trims the underlying muscles and fat to enhance the contour of the eyelid. The result is a more defined upper eyelid with a youthful, refreshed appearance.

Lower Eyelid Surgery:

For patients with excess skin or puffiness under the eyes, Dr. Hilinski performs lower eyelid surgery. The incision for this procedure is either placed just beneath the lash line or inside the lower eyelid to remove or reposition excess fat and skin. The goal is to smooth out the area and eliminate bags or wrinkles, resulting in a rejuvenated look.

Recovery After Excess Eyelid Skin Surgery

Recovery from excess eyelid skin surgery is typically smooth and quick, with most patients returning to normal activities within 7 to 10 days. Swelling and bruising are common in the first few days and can be minimized with cold compresses and keeping the head elevated while resting. Any discomfort is generally mild and can be managed with over-the-counter pain medication.

Dr. Hilinski will provide detailed aftercare instructions to ensure optimal healing and results. Stitches are usually removed after 4 to 7 days, and most patients find that any remaining swelling subsides within 2 to 4 weeks.

FAQ: Excess Eyelid Skin Surgery

Schedule Your Consultation with Dr. Hilinski

If you're considering excess eyelid skin surgery to rejuvenate your appearance and improve your vision, schedule a consultation with Dr. John Hilinski in San Diego. As an expert in facial plastic surgery, Dr. Hilinski will evaluate your unique concerns and create a personalized treatment plan to help you achieve your aesthetic goals. Contact our office today to take the first step toward a refreshed, youthful appearance.

#### Eyelid Surgery
Blepharoplasty (Eyelid Surgery) with Dr. John Hilinski

Eyelid surgery, or blepharoplasty, is a popular procedure designed to rejuvenate the eye area by removing excess skin, fat, and muscle from the upper and/or lower eyelids. Many patients who seek blepharoplasty are concerned with bagginess along the upper eyelid or puffiness under the lower eyelid, which can create a tired, prematurely aged appearance. As a San Diego Blepharoplasty Specialist, Dr. John Hilinski offers a range of eyelid surgery options to help you look refreshed and rejuvenated, while also correcting functional issues caused by sagging or drooping eyelids.

Upper and Lower Blepharoplasty

Eyelid Surgery Candidates

Ideal candidates for blepharoplasty include healthy men and women who want to improve the appearance of aging around the eyes. Common concerns include:

Dark circles or shadows under the eyes

Heavy or drooping upper eyelids

Excess skin that interferes with vision

Bags or puffiness under the eyes

The Eyelid Surgery Procedure

Blepharoplasty is typically performed under local anesthesia with sedation in an outpatient surgery setting. The procedure time varies depending on whether the surgery is for the upper or lower eyelids, or both, but generally takes between one and two hours.

Dr. Hilinski tailors each eyelid surgery to the patient's specific needs, ensuring natural, youthful results. He will evaluate the position of your brow to ensure that a brow lift is not needed in conjunction with your blepharoplasty, as a sagging brow can contribute to eyelid issues.

Recovery from Eyelid Surgery

After your procedure, you will be able to return home the same day. Swelling and bruising are common in the first week but can be minimized with cold compresses and keeping your head elevated while resting. Most patients can resume normal activities within 7 to 10 days and find that swelling subsides fully within a few weeks. Sutures are typically removed 4 to 7 days post-surgery.

Blepharoplasty FAQ

Schedule Your Consultation

If you're considering blepharoplasty to enhance your eye area, schedule a consultation with Dr. John Hilinski. He will evaluate your specific needs and provide a customized treatment plan to help you achieve the youthful, refreshed appearance you desire.

#### Eyes & Brows
Eyes and Brows Plastic Surgery with Dr. John Hilinski

The eyes and brows are one of the most prominent features of the face, contributing significantly to your overall appearance and expression. As we age, the skin around the eyes and brows can begin to droop or sag, leading to a tired or aged appearance. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in advanced cosmetic and reconstructive procedures for the eyes and brows. With his expert skill set and extensive credentials, Dr. Hilinski provides natural-looking results that enhance the beauty and functionality of the eyes, offering a refreshed and youthful appearance.

Comprehensive Eyes and Brows Procedures

At his San Diego practice, Dr. Hilinski offers a range of eyes and brows plastic surgery procedures to address a variety of concerns. Whether you are looking to elevate sagging brows, remove excess skin from your eyelids, or improve vision affected by eyelid drooping, Dr. Hilinski will provide a tailored treatment plan to meet your specific needs.

Some of the most common reasons patients seek out eye and brow surgery include:

Asian eyelid concerns

Sagging or drooping eyelids

Excess skin around the eyes

Puffiness or bags under the eyes

Tired or aged appearance

Obstructed vision due to eyelid drooping

Lack of definition or shape in the brows

Dr. Hilinski offers both surgical and non-surgical solutions to achieve your desired results. Visit the following pages to learn more about procedures offered at our San Diego practice:

About Us
Accessibility Policy
Blog
Contact
Hilinski Foundation for Surgery
Home
Links
Lop Ear Surgery with Dr. John Hilinski
Macrotia Ear Reduction Surgery with Dr. John Hilinski
Medspa
Newsletter
Notice of Open Payments Database
Patient Info
Privacy Policy
Revision Skincare Products
Rhinoplasty Tutorial
Sitemap
Stahl’s Ear Correction
Surgical
Terms of Use
Thank You

Each procedure is carefully designed to achieve natural-looking results that help you look younger, more refreshed, and vibrant. Dr. Hilinski uses advanced techniques to ensure minimal scarring and a comfortable recovery.

Schedule a Consultation with Dr. Hilinski

If you're interested in enhancing the appearance of your eyes or brows, or if you have functional concerns related to your eyelids, schedule a consultation with Dr. Hilinski today. During your consultation, he will assess your individual needs and discuss the best options to achieve your aesthetic or functional goals.

#### EZ Gel
At Hilinski MedSpa in San Diego, we are dedicated to providing our clients with the most advanced and natural aesthetic treatments available. One of our standout offerings is the EZ Gel procedure, a revolutionary non-surgical approach to facial rejuvenation that utilizes your body’s own resources to restore volume and vitality to your skin. This treatment incorporates Platelet-Rich Fibrin (PRF) to help further stimulate collagen production and enhance skin quality.

Discover the Science Behind EZ Gel: A Natural Path to Rejuvenation

The Advantages of Choosing EZ Gel for Your Aesthetic Goals

A Step-by-Step Guide to the EZ Gel Procedure at Hilinski MedSpa

EZ Gel Recovery & Results

Targeted Treatment Areas: Where Can EZ Gel Make a Difference?

Why San Diego Residents Trust Hilinski MedSpa for Their Aesthetic Needs

EZ Gel FAQs

Discover the Science Behind EZ Gel: A Natural Path to Rejuvenation

EZ Gel is an innovative autologous filler derived from your own blood, specifically utilizing Platelet-Rich Fibrin (PRF) and Human Serum Albumin (HSA). This cutting-edge treatment involves drawing a small amount of blood, processing it to concentrate these natural components, and then injecting the finished gel into targeted areas to promote tissue regeneration and subtle volume enhancement.1,2

Unlike traditional dermal fillers that use synthetic materials, EZ Gel offers a biocompatible solution with minimal risk of allergic reactions. The presence of PRF within the gel adds regenerative growth factors that help improve overall skin texture, elasticity, and tone.

The Advantages of Choosing EZ Gel for Your Aesthetic Goals

A Step-by-Step Guide to the EZ Gel Procedure at Hilinski MedSpa

EZ Gel Recovery & Results

One of the advantages of EZ Gel is that it requires little to no downtime. You may experience mild redness, swelling, or tenderness at the injection sites for a day or two, but these effects are temporary and typically resolve quickly. Most patients return to normal activities right away.Results develop gradually as collagen production increases, with optimal improvement usually visible after several weeks. Skin appears smoother, firmer, and more radiant, with a soft, natural look that can last longer than traditional fillers. Maintenance treatments may be recommended to sustain your rejuvenated appearance.

Targeted Treatment Areas: Where Can EZ Gel Make a Difference?

EZ Gel’s versatility allows it to address a range of aesthetic concerns, including:

Hollows beneath the eyes

Periorbital wrinkles3

Nasolabial folds

Marionette lines

Loss of jawline definition

Thinning lips

Sunken cheeks

Volume loss in the hands

Comparing EZ Gel to Traditional Dermal Fillers: Making an Informed Choice

While traditional dermal fillers, often composed of hyaluronic acid, provide immediate volume restoration, they rely on synthetic substances. EZ Gel, in contrast, uses components from your own blood to achieve similar volumizing effects while promoting long-term collagen formation and healthier skin. This natural approach minimizes risk and supports a more holistic path to facial rejuvenation.

Why San Diego Residents Trust Hilinski MedSpa for Their Aesthetic Needs

Dr. John Hilinski and his team at Hilinski MedSpa are dedicated to providing personalized care and exceptional results. With a focus on utilizing the most advanced and natural treatments available, we ensure that each patient receives a customized approach tailored to their unique needs. Our commitment to excellence and patient satisfaction makes us a leading choice for aesthetic treatments in the San Diego area.

Embark on Your Journey to Natural Rejuvenation: Schedule Your Consultation Today

If you're interested in exploring the benefits of EZ Gel and how it can help you achieve a refreshed and natural appearance, contact Hilinski MedSpa in San Diego to schedule your consultation. Our team is here to guide you through every step of the process, ensuring a comfortable and rewarding experience.

Sources

1 Dermatologic Therapy. Platelet-Rich Fibrin as an Effective Method of Skin Revitalization. https://onlinelibrary.wiley.com/doi/10.1155/2023/9040608. Accessed November 12, 2025.

2 Majewska L. Autologous plasma gel as an effective method of facial volume restoration and skin rejuvenation. Dermatol Ther. 2023;2023:9989544. doi:10.1155/2023/9989544. Available: https://onlinelibrary.wiley.com/doi/10.1155/2023/9989544. Accessed November 12, 2025.

3 Mahmoodabadi RA, Golafshan HA, Pezeshkian F, Shahriarirad R, Namazi MR. Evaluation of the Effect of Platelet-Rich Fibrin Matrix in the Correction of Periorbital Wrinkles: An Experimental Clinical Trial. Dermatol Pract Concept. 2023 Jan 1;13(1):e2023050. doi: 10.5826/dpc.1301a50. PMID: 36892335; PMCID: PMC9946120. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC9946120/. Accessed November 12, 2025.

#### Face & Neck
At Dr. John Hilinski Facial Plastic Surgery, we offer a comprehensive range of face and neck plastic surgery procedures designed to help you achieve natural, youthful results. Whether you're looking to reduce signs of aging, enhance facial contours, or address specific concerns such as sagging skin or excess fat, Dr. Hilinski provides personalized treatment plans that cater to your unique aesthetic goals. As a double board-certified facial plastic surgeon in San Diego, Dr. Hilinski combines advanced surgical techniques with an eye for detail to deliver exceptional results with minimal downtime.

Comprehensive Face and Neck Procedures

Facial rejuvenation and contouring can have a transformative effect on your appearance, boosting your confidence and helping you feel your best. Dr. Hilinski offers a variety of procedures aimed at tightening loose skin, improving facial contours, and enhancing the overall balance of your facial features. From full facelifts to neck liposuction, every treatment is tailored to your needs. Visit the following pages to learn more about specific procedures:

Facial Plastic Surgery Procedures Offered by Dr. Hilinski

Schedule a Consultation with Dr. Hilinski

If you're interested in learning more about facial and neck surgery, contact Dr. John Hilinski today. As one of San Diego's leading experts in facial plastic surgery, he will provide a thorough consultation to determine the best procedure for your unique needs. Achieve a youthful, refreshed appearance with the help of a board-certified specialist who prioritizes natural results and patient satisfaction.

#### Facelift & Mini Face Lift
Facelift & Mini Facelift in San Diego with Dr. John Hilinski: Restore a Youthful, Refreshed Appearance

A facelift, also known as rhytidectomy or cervicofacial rhytidectomy, is one of the most popular procedures for reversing the visible signs of aging. In 2018, more than 120,000 people in the U.S. underwent facelift surgery to restore a youthful appearance. San Diego Facelift Specialist Dr. John Hilinski, a Board Certified Facial Plastic Surgeon, offers advanced facelift and mini facelift procedures designed to address sagging skin, jowls, and other age-related changes, delivering natural-looking results that leave patients feeling rejuvenated.

San Diego Facelift Surgery

As we age, facial wrinkles and sagging skin become more pronounced, especially around the jawline and neck. Facelift surgery effectively addresses these concerns, creating dramatic improvements in the lower face and upper neck. Dr. Hilinski uses advanced techniques to remove excess skin and tighten facial tissues, restoring a more youthful contour to the face.

Benefits of Facelift Surgery

Look refreshed and rejuvenated

Restore a youthful appearance

Reduce sagging and jowling

Enjoy long-lasting, natural-looking results

Facelift surgery can enhance your overall appearance, giving you a more rested and youthful look that better reflects how you feel.

Facelift Candidates

Ideal candidates for facelift surgery are healthy men and women who are concerned about sagging skin along the lower face and upper neck, as well as the appearance of jowls. If you are unhappy with facial aging, especially along the jawline and chin, a facelift can provide significant improvement. However, deep smile lines, known as nasolabial folds, are often better treated with a midface lift or volume enhancement using dermal fillers.

The Facelift Procedure

During a facelift, incisions are typically made along the hairline and the border of the ear to keep them well hidden. The surgery focuses on the lower third of the face and the upper neck. Excess skin is removed, and underlying tissues are repositioned for a more youthful appearance. Facelift surgery usually takes between four to six hours to complete, and it can be performed under general anesthesia or twilight sedation. Some patients may choose to combine a facelift with procedures such as brow lift or eyelid surgery for full facial rejuvenation.

Recovery from Facelift Surgery

Most patients experience mild swelling and bruising for the first few days after surgery, which typically subsides after the first week. Stitches are removed within five to six days, and most patients are able to return to work after seven to ten days. Although bandages are required, patients who are comfortable wearing them may return to work sooner. Full recovery may take several weeks as the skin continues to heal and refine.

About the Mini Facelift

A mini facelift, or S-lift, is a minimally invasive alternative to a traditional facelift that targets sagging in the lower face and upper neck. It is ideal for patients with early signs of aging who do not require a full facelift. Mini facelifts are performed under local anesthesia in Dr. Hilinski's office, with patients typically recovering more quickly compared to traditional facelift surgery. This procedure provides significant improvement with minimal downtime, making it a popular choice for patients seeking subtle but effective rejuvenation.

Facelift FAQs

Mini Facelift FAQs

Schedule Your Consultation Today

If you're interested in learning more about facelift or mini facelift surgery with Dr. John Hilinski, schedule a consultation today. As a double board-certified facial plastic surgeon, he has the expertise to deliver natural, long-lasting results.

#### Facelift/Necklift Case Study
This is a great case example focusing on some of the nuances of performing facelift and neck lift surgery. This patient, who was in her early 70s when she consulted with me, desired to simply look younger and more rejuvenated. She was already considered an attractive female – she just wanted to look her best for her age.

As you can see from her preoperative photo, she demonstrated the classic signs of aging that commonly prompt patients to seek out a facial plastic surgeon. This included lower face skin sagging and jowling (A), upper neck skin laxity (B) and submental/submandibular banding (C). This classic triad accounts for a great majority of patients her age seeking to undergo cosmetic face and neck enhancement surgery.

Her and I discussed the options available to her – which really distilled down to face and neck lift surgery. Although there are a good number of non-surgical devices and treatments currently available (such as Ultherapy®, ThermiTight®, etc), none of them can realistically substitute for face and neck lift surgery. These devices, which are aggressively marketed by many plastic surgeons, will provide for a modest (and sometimes very temporary) improvement in the jaw and neck line. But they are really no comparison to true rhytidectomy surgery.

This patient ended up undergoing what is considered a fairly standard facelift operation. When we, as plastic surgeons, mention the term ‘facelift’ surgery, what we really mean is ‘lower face and upper neck’ surgery. Meaning, this type of cosmetic facial enhancement surgery truly only targets the lower one-third of the face and the upper one-third of the neck. This is diagrammed above and represented by the area between the two yellow lines. This type of facelift surgery will not provide improvement to the brow, midface and lower neck regions. If you are seeking improvements to these other areas, this would necessitate other cosmetic procedures intended to specifically target these regions.

Ear Malpositioning After Facelift

The results of her lower face and upper neck lift procedure are shown below. But I wanted to take this opportunity to point out one particular concern that many patients have regarding outcomes from this type of facial plastic surgery – abnormal positioning of the ear. So many patients are worried about looking overly done after a facelift with that dreaded windblown look that still somehow appears in this day and age following excessively aggressive pulling of the face and neck. As I tell patients all the time, you almost have to go out of your way to create this scenario as a facial plastic surgeon. Fortunately, with good technique, this type of outcome can almost always be avoided following facelift surgery. But another thing that we, as surgeons, look to avoid is abnormal positioning of the ear. What I am referring to here is how the ear position and shape may change as a result of the facelift surgery. When plastic surgeons lift the lower face and upper neck, they do so by suturing the deeper soft tissues. These sutures are anchored high up in front of the ear as well as behind the ear (as shown by the yellow arrows). In doing so, surgeons should be careful so as to avoid ‘pulling’ the ear down and forward in this process. If this occurs, the ear will look as if it was repositioned lower down on the face – closer to the angle of the jaw (the red asterisk). The ear will appear as if it was rotated down and forward (clockwise on the left side and counter clockwise on the right side). The ear will also appear elongated – and sometimes even bigger in overall size. The adjacent photo is a morphed image of the current case study patient showing what this type of ear can look like when it the shape and position has been altered as a result of the lift procedure. Ideally, the ear will look as if it has changed very little after facelift surgery. It should be the same relative size in its same relative location on the side of the head. In this particular case, you will see below how her ear looks to be essentially unchanged in terms of shape, size and position. Compare that image to the one above and you will be better able to appreciate this point.

Facelift Neck Lift Before and After Photos

#### Facial Reconstruction
Facial Reconstruction Surgery with Dr. John Hilinski

Facial reconstruction surgery addresses functional and cosmetic concerns caused by trauma, illness, or congenital defects, helping patients regain normal facial functions and improve appearance. Whether the issue stems from a skin cancer removal, an accident, or a congenital deformity, reconstructive surgery offers solutions that can dramatically enhance both quality of life and self-confidence. Dr. John Hilinski, a renowned board-certified facial plastic and reconstructive surgeon in San Diego, specializes in providing highly personalized care for patients undergoing facial reconstruction. His dual board certifications in Facial Plastic and Reconstructive Surgery, as well as Head and Neck Surgery, enable him to deliver expert care for even the most complex facial reconstruction cases.

What is Facial Reconstruction?

Facial reconstruction refers to surgical procedures designed to repair and restore facial features impacted by trauma, cancer, or congenital issues. Unlike elective cosmetic surgeries, facial reconstruction prioritizes the restoration of function while also improving the appearance of facial structures. Dr. Hilinski employs a wide range of advanced reconstructive techniques tailored to each patient's unique needs. From soft tissue repair to bone reconstruction, Dr. Hilinski's experience ensures optimal outcomes for patients.

Why Might You Need Facial Reconstruction?

Facial reconstruction may be necessary for individuals who have experienced:

Benefits of Facial Reconstruction Surgery

Facial reconstruction offers numerous benefits, including:

Improved facial appearance and symmetry.

Restored functionality in vital facial areas (such as the ability to speak, eat, or smile).

Enhanced quality of life and self-confidence.

Psychological benefits by addressing disfigurement or traumatic injuries.

Potential medical benefits, such as improved vision or breathing.

Types of Facial Reconstruction Procedures

Depending on the extent of damage or injury, Dr. Hilinski may recommend one or more of the following procedures:

Why Choose Dr. John Hilinski?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Preparing for Facial Reconstruction

Preparing for facial reconstruction may involve undergoing medical tests and assessments, avoiding certain medications, and arranging transportation and post-surgery care. Dr. Hilinski will provide clear, personalized instructions to ensure you are ready for surgery and recovery.

Recovery from Facial Reconstruction

The recovery process varies based on the extent of the procedure. Swelling, bruising, and discomfort are common in the first few days. Dr. Hilinski will offer specific aftercare instructions to ensure proper healing. Full recovery can take several weeks to months, depending on the complexity of the surgery.

FAQ: Facial Reconstruction Surgery

Schedule a Consultation for Facial Reconstruction

If you are considering facial reconstruction to address functional issues, correct disfigurement, or enhance the appearance of facial features affected by trauma, cancer, or congenital defects, it is essential to choose an experienced and highly skilled surgeon. Dr. John Hilinski is a leading expert in facial plastic and reconstructive surgery in San Diego. With years of specialized training and a deep commitment to patient care, Dr. Hilinski offers a comprehensive and personalized approach to every procedure.

During your consultation, Dr. Hilinski will take the time to understand your specific concerns, thoroughly evaluate your condition, and recommend the most effective treatment options tailored to your needs. Whether you require minor revisions or more extensive reconstruction, his expertise ensures that you are in the best hands. By scheduling a consultation with Dr. Hilinski, you are taking the first important step toward achieving improved functionality, aesthetics, and overall well-being.

Contact our office today to schedule your consultation and learn more about how facial reconstruction surgery with Dr. Hilinski can help you regain confidence and enhance your quality of life.

#### Facial Rejuvenation Case Study
This patient is a great teaching case to educate potential facelift patients on some of the thought that goes into evaluation and treatment of female patients considering cosmetic facial rejuvenation.

This particular female from San Diego, CA presented to our clinic requesting possible surgery to help her appear more rested and youthful. She was like many 50-60 year old females in San Diego who desire to look their best at that particular age. She showed signs of aging that were consistent with many candidates considering facial rejuvenation surgery at her age. These included excess upper eyelid skin, crepe lower eyelid skin changes, lower face jowling, poor jaw line definition and a heavy neck. This is visually highlighted in the following photos.

As you can see, her upper eyelids demonstrate moderately excessive skin that bunches up to the point it hangs over the eyelashes. This results in a prematurely tired, aged look. Although not readily seen in these photos, her lower eyelids have a more crepe appearance due to loss of skin elasticity in this region related to the aging process. Her lower face shows fairly typical jowling along the jawline, which contributes to the appearance the lower one-third of the face is falling. In this particular case example, there is also noted atrophy (shrinkage) of the jawbone in combination with a congenitally smaller chin. This results in the lower face looking even less defined in the setting of the aging process. Furthermore, her upper neck is heavy due to skin sagging in this area along with excess, unwanted fat and poor tone of the underlying muscle (called the platysma muscle).

Plan for Facial Rejuvenation

Having reviewed these issues with the patient, it was recommended that she undergo a variety of procedures to help rejuvenate her facial appearance. As with many patients seeking this type of cosmetic face surgery in San Diego, she was quite realistic in terms of what she wanted to achieve. She simply wanted to look more youthful and rested following surgery – without appearing surgically altered or ‘done’ as many people say. This is actually a very important prerequisite for having cosmetic facial surgery. Patients need to be realistic in terms of their expectations of what this type of intervention will provide them. For instance, as in this case, a 50-60 year old female should realistically anticipate that she would appear more rested and rejuvenated as a result of surgery. She should not expect to look like a 40 year old once again. We call this ‘age appropriate’ in the field of facial plastic surgery. In addition, it is unrealistic to expect that all of her wrinkles and creases would be gone following surgery. She is still going to have some residual lines and shadows around the face that simply cannot be erased by undergoing plastic surgery. The realistic goal of this type of facial plastic surgery procedure is improvement and enhancement.

In this particular patient, we recommended she undergo a combination of procedures to provide the desired outcome. This included an upper eyelid lift (called an upper blepharoplasty), a lower eyelid tuck (a lower blepharoplasty), augmentation of the chin with an implant, and a lower face/upper neck lift (referred to as a rhytidectomy). These proposed changes are visually indicated below in the diagrammed photo series.

As you can see, the excess upper eyelid skin was to be removed. This was planned so that the incision would be placed into her natural upper eyelid skin crease so that postoperative scarring would be minimized. In addition, the lower eyelid skin needed tightening, which was going to be done through an incision hidden underneath her lower eyelid lash line (called a subciliary incision). Her lower face was to be lifted back and up at the same time a chin implant was used to bring her jawline forward. This was going to involve making incisions around her ear to do the facelift portion and a short incision under the chin for placement of the implant. The neck lift was to be done in conjunction with the lower facelift using the same incisions around the ear extended into the hairline. These procedures were to work in harmony to create an overall more rested, rejuvenated facial appearance.

San Diego Facial Rejuvenation Results

As you can see in the following before and after photos, she clearly has a cosmetic improvement in her face and neck. More specifically, her upper eyelids are no longer as heavy and tired looking. Coincident with this is the fact her eyes now look more open. Her lower eyelids are also smoother in contour with less crepe skin change now noted. When looking at her lower face and upper neck you can now see an improved jawline with less obvious jowling. Looking from the oblique and side views, you can also get a good appreciation for what the chin implant did to further improve her jawline by bringing it forward. On side view, you can see that she now has a more angulated and defined neck. If you try and look more closely at her side view, you will notice that her incision lines around the ear are barely visible. Moreover, her ears are in essentially the same position they were prior to surgery without obvious signs of distortion.

Does she have some residual wrinkles and creases? Yes, she does. But, as pointed out above, this is to be expected in surgery of this nature in this particular age group. More importantly she does not look surgically ‘done’ – a concern that is much more of a priority. Overall, this patient has what would be considered a great surgical result from combined facelift, neck lift, eyelid lift and chin augmentation with an implant.

Facelift Consultation in San Diego

If you are interested in having a facelift procedure to enhance your facial appearance, feel free to contact our San Diego facial plastic surgery office today to schedule a complimentary consultation with one of the best facial cosmetic surgery specialists in the region – Dr. John Hilinski.

#### Fat Transfer
Fat Transfer with Dr. John Hilinski

Fat transfer, also known as autologous fat grafting, is a highly effective cosmetic procedure designed to restore facial volume, smooth wrinkles, and enhance facial contours by using a patient's own fat cells. Dr. John Hilinski, a double board-certified facial plastic surgeon, offers this advanced procedure to patients seeking a more natural and long-lasting solution to signs of aging. Fat transfer provides a safe and minimally invasive way to rejuvenate the face without the need for synthetic fillers or implants, making it an increasingly popular option for those looking to improve facial volume and definition.

As we age, the natural fat in our face diminishes, leading to hollow or sunken areas, deeper lines, and a loss of youthful fullness. Fat transfer is an ideal solution to replace this lost volume, particularly in areas such as the cheeks, lower eyelids, nasolabial folds, and jawline. Dr. Hilinski utilizes a refined technique to ensure the transferred fat integrates smoothly into the surrounding tissue, resulting in soft, natural-looking contours.

Benefits of Fat Transfer

Fat transfer offers numerous benefits, especially when compared to other cosmetic treatments, such as dermal fillers. Here are some of the key advantages:

The procedure's natural results and versatility make it an excellent option for those looking to restore facial balance and enhance overall appearance.

Fat Transfer Candidates

Fat transfer is ideal for individuals seeking to enhance their facial contours, smooth deep wrinkles, and restore volume lost due to aging. Candidates for fat transfer typically have areas of the face that look sunken, hollow, or overly wrinkled, such as:

Lower Eyelids

Fat transfer can help reduce the appearance of hollow or tired-looking eyes, providing a smoother transition between the lower eyelid and the cheek.

Cheeks

This procedure can restore volume to the cheeks, enhancing the overall facial contour and providing a youthful lift.

Nasolabial Folds

Fat can be injected into the deep creases that run from the sides of the nose to the corners of the mouth, softening the appearance of smile lines.

Jawline

Fat transfer can define the jawline, reduce jowling, and improve overall facial symmetry.

Ideal candidates should be in good overall health and have realistic expectations about the results. They should also have enough excess fat in donor areas, such as the abdomen or thighs, to provide the necessary volume for transfer.

The Fat Transfer Procedure

The fat transfer procedure is relatively simple and minimally invasive, making it an appealing option for facial rejuvenation. Here's a step-by-step outline of how the process works:

The entire procedure usually takes less than an hour and can be performed in Dr. Hilinski's office under local anesthesia. For patients undergoing fat transfer in combination with other facial procedures, such as a facelift or eyelid surgery, general anesthesia or deep sedation may be used.

Recovery from Fat Transfer

Recovery from fat transfer is typically quick and uncomplicated, with most patients returning to normal activities within a few days. Here's what to expect during the recovery process:

For patients undergoing fat transfer in combination with other facial surgeries, the recovery time may be longer, depending on the scope of the procedures.

Fat Transfer FAQs

Scheduling a Fat Transfer Consultation with Dr. John Hilinski

If you're interested in learning more about how fat transfer can enhance your facial contours and restore lost volume, scheduling a consultation with Dr. John Hilinski is the first step toward achieving your aesthetic goals. During your personalized consultation, Dr. Hilinski will evaluate your facial structure, discuss your concerns, and determine if fat transfer is the right procedure for you. He will also assess potential donor areas for fat harvesting and explain the entire procedure in detail, ensuring that you have a clear understanding of what to expect.

#### Female Hump and Tip Refinement
This particular patient is a great example of how cosmetic rhinoplasty can be used to address a nasal bridge hump deformity in a female. This young lady from San Diego, CA consulted with our office complaining of a bump on the bridge of her nose as well as asymmetry when looking at her nose from the front. In addition, her nasal tip was more rounded than she desired. Overall, she was looking to make her nose smaller and more in balance with her surrounding facial features.

During her rhinoplasty consultation in our San Diego office, we reviewed what was recommended in terms of the nose reshaping process. These issues are highlighted in the below pre-rhinoplasty photo diagrams.

Frontal Before Rhinoplasty View

On her frontal view, you can see that her bridge is asymmetric, or crooked from left to right. This is indicated by the red curved line that demonstrates how her bridge appears collapsed inward on this side. If you take a step back and look at the width of her nose as seen from the front, you will also appreciate that it looks too narrow for her face. When this is seen in context of her nasal tip being too rounded (as indicated by the blue parentheses), her excessively narrow bridge appears even more exaggerated. The appearance of an overly thin nasal bridge is a direct function of her nose having a hump deformity. As in many patients with a nasal hump deformity, the frontal view of the nose will often times appear excessively thin due to the high nasal bridge causing more abrupt shadowing when light hits it.

Oblique Before Rhinoplasty View

When looking at her nose from the oblique, or 45 degree, angle, you begin to get a better appreciation of the nasal hump deformity in this case. This is shown in the adjacent photo diagram as a blue arrow – highlighting where the nose looks too high. The red arrow corresponds to the side of the nose that is collapsed inward – correlating to the red curved line noted above. When looking at the patient’s right oblique angle, we are actually looking at the left side of her nasal bridge. This is why the left collapsed side wall of the nose is best seen when looking from this angle. The excessively high bridge in combination with collapse of the left side of the nose makes this oblique angle view particularly telling in terms of cosmetic issues with her nose.

Lateral Before Rhinoplasty View

On the lateral, or side, view of her nose you can easily appreciate the hump deformity issue alluded to above. This is highlighted by the red curved line, although it is quite obvious when simply glancing at her profile view. If you look really closely at her nasal tip, you can also get a sense that her tip is projected out from the face slightly more than it should be. This is termed ‘overprojection’ of the nasal tip since the nose appears to stick out too far from the plane of the face. In order to effectively reshape this patient’s nose, consideration must be given to not only reducing the nasal hump deformity, but also repositioning her nasal tip.

One issue that is not necessarily visible in these photos relates to the thickness of her nasal skin. This is an important consideration when it comes to rhinoplasty surgery as the skin thickness often times dictates how much change will actually be visible following surgery. In her case, the nose skin was considered ‘medium thickness’ – not too thick and not too thin. This meant her nasal skin was likely going to conform to whatever changes were being made to the underlying cartilage and bone – but without shrink wrapping down too much, which would risk showing even minor contour irregularities under the skin.

Avoiding the Inverted V Deformity

One of the central concerns in this particular patient was properly managing the hump deformity in the context of making her nose appear better overall in terms of balance with her face. Many unexperienced rhinoplasty surgeons would look at her nose and think to themselves – easy. Just sand down or reduce the nasal bridge hump with removal of some cartilage from her nasal tip and – voila – that is all that is needed. Unfortunately, this approach is much too simplistic for a nose like this and in a good majority of rhinoplasty cases will result in all sorts of problems. For instance, if you just sand (rasp) down her nasal hump and narrow the nasal bones to manage the bump – without doing anything else – she will likely end up with what is called an inverted V deformity in the world of rhinoplasty.

An inverted V deformity is visually demonstrated in the adjacent photograph of a patient who had prior rhinoplasty by a different plastic surgery clinic. She originally had a dorsal hump deformity that was removed by simply rasping, or sanding, the nasal bridge down. Unfortunately, the rhinoplasty surgeon did not do anything else to reinforce the middle portion of her bridge, called the middle nasal vault, after bringing the bridge height down. As the healing process unfolded, the middle nasal vault, which is composed of the upper lateral cartilage on each side, began to collapse inward. This is indicated by the blue outlined arrows showing where the upper lateral cartilage is situated. Since much of the support of the upper lateral cartilage was removed during the hump reduction without stabilizing the remaining cartilage structure, this area began to collapse. This is particularly true in patients, like this case example, who have thinner skin than average. This type of inverted V deformity does not occur within the first few months of rhinoplasty healing. It is a phenomenon that begins to manifest 6-12 months after surgery – as the swelling of the nose begins to subside. The end result of this collapse is an abnormal pinching that can be seen through the middle nasal vault region. This causes an undesirable shadowing effect in the shape of an inverted V through the middle of the nose as seen from the front view – thus the inverted V deformity.

Successful Cosmetic Rhinoplasty Surgery in San Diego

In rhinoplasty patients where there is the concern for an inverted V deformity following hump reduction, as in this case, the rhinoplasty surgeon should consider placement of spreader grafts. Spreader grafting in rhinoplasty surgery is discussed in detail in another section in our online rhinoplasty tutorial, which is worth reviewing in context of this case example. In short, spreader grafts are used in this type of rhinoplasty patient to stabilize the structural support of the middle of the nose after the hump has been removed. In doing so, the middle of the nasal bridge is reinforced to compensate for having a portion of it removed during hump reduction. Thus, the chances of the upper lateral cartilage collapsing and creating an inverted V deformity are markedly reduced. So why do some rhinoplasty surgeons not place spreader grafts? The answer is because spreader graft placement can be more technically challenging than your average rhinoplasty procedure. It demands an experienced rhinoplasty surgeon to place the spreader grafts with meticulous technique to minimize chances that the grafts can be seen post-operatively. Because they can be somewhat of a challenge for some rhinoplasty surgeons, many will simply forego their placement. Unfortunately, in many cosmetic nose reshaping patients, spreader grafts are a must with the extra time and effort to place them being well worth it.

In this particular rhinoplasty patient from San Diego, CA, the hump deformity was reduced as expected. Once this was accomplished, the nasal bones were narrowed using careful osteotomy technique – where the bones were cut (broken intentionally) and brought in closer to one another. After this was done, the spreader grafts were placed to stabilize the middle vault as previously discussed. The spreader grafting was done more on her left side to address the preoperative asymmetry that was noted in the photos above. After this was done, her nasal tip was then refined by narrowing the cartilage and creating a more feminine nasal tip.

Before and After San Diego Rhinoplasty Photos

The following photos demonstrate her rhinoplasty results from Dr. John Hilinski. These photos represent her cosmetic changes before surgery, one week out from rhinoplasty, several months into her healing process, and nearly one year following rhinoplasty surgery. It is actually quite informative to see this type of progressive change during the healing process from rhinoplasty. In fact, it is rare for rhinoplasty surgeons to show this type of evolution through a series of before and after rhinoplasty photos.

Frontal Rhinoplasty Changes

The general trend that you can see in the series of rhinoplasty photos is how swollen many rhinoplasty patients appear at one week out from surgery. Just look at her tip, for instance, on this frontal view. You can appreciate that her tip is moderately bulbous at one week, which simply represents the fact that a considerable amount of work was performed during rhinoplasty to reshape the tip cartilage. As the months of rhinoplasty healing begin to unfold, though, you can see how the tip begins to shrink down progressively while starting to take shape and definition. At one year out from rhinoplasty, her tip has now become even more refined with a more feminine overall look. You will also appreciate in these frontal photos that her nasal bridge width is now more fitting for her face. Prior to cosmetic rhinoplasty, she had an overly thin bridge as seen from the front with more pinching noted on her left side. Following cosmetic nose reshaping surgery, her bridge is now more symmetric and has a more appropriate width overall as seen from the front.

Before

One Week Out

Months Out

One Year Out

Oblique Rhinoplasty Changes

On the oblique view of her nose, you can begin to get an appreciation of how the bridge height has been adjusted through rhinoplasty. Even very early on in the rhinoplasty healing period at one week out, you can see how her nasal hump is now gone. Is she swollen? Absolutely. But as the months begin to pass by, her nose begins to take a better shape as a result of the rhinoplasty. By one year out, you can see that her nasal bridge has come down quite a bit to leave her with a very feminine contour. Looking at her nasal tip on the oblique view, you can also see how it begins to take on a more refined appearance as the swelling subsides.

Before

One Week Out

Months Out

One Year Out

Lateral Rhinoplasty Changes

On the lateral view of her nose, you get the best perspective of how her bridge has been refined through rhinoplasty surgery. At one week out, you can see that her overall bridge height is somewhat pronounced, even compared to before having rhinoplasty surgery. You can also see her healing incision line under the nasal tip region on this lateral view. As the months go on, the nasal bridge height begins to shrink down, creating a more feminine profile view. At one year out from rhinoplasty reshaping of the nose, her bridge has reached a fairly stable height transitioning very nicely into her tip region. If you look closely, her nasal tip is now actually closer to her face after being deprojected during the rhinoplasty procedure. This effectively makes her nose appear actually smaller than it did before nose reshaping. Overall, she now has a nose that is much more fitting and in balance with her face with a very natural appearance. Looking at her today, you would never think that she has undergone a surgical transformation of her nose. That is the essence of doing great rhinoplasty.

Before

One Week Out

Months Out

One Year Out

Natural Cosmetic Rhinoplasty Surgeon Consult in San Diego, CA

To consult with one of San Diego’s best cosmetic nose surgeons who specializes in creating natural looking rhinoplasty results, contact us today.

#### Financing Options
Plastic Surgery Financing Options at John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are committed to making your aesthetic transformation as accessible and affordable as possible. Led by Dr. John Hilinski, a Harvard-trained, double board-certified facial plastic surgeon, our practice offers a variety of plastic surgery financing options to ensure that you can achieve your desired results without financial barriers. Whether you are undergoing cosmetic facial surgery or a non-surgical procedure, we work with several payment methods and financing plans to accommodate your needs.

Why Choose Dr. John Hilinski?

Dr. John Hilinski has extensive training in both cosmetic and reconstructive facial surgery, making him one of the leading facial plastic surgeons in San Diego. His education at Harvard Medical School and board certifications in both Facial Plastic and Reconstructive Surgery and Head and Neck Surgery ensure that every patient receives the highest level of care, safety, and precision. With over 20 years of experience, Dr. Hilinski has helped countless patients achieve natural, beautiful results.

Whether you are considering a rhinoplasty, facelift, or non-surgical rejuvenation, Dr. Hilinski and his team are dedicated to providing you with personalized care, along with flexible payment options to make your procedure more affordable.

Payment Options for Plastic Surgery

We offer multiple payment methods to make your procedure as convenient as possible. The final out-of-pocket cost of your procedure can be paid using the following:

Cash

Personal check

Visa®

MasterCard®

American Express®

Discover®

Financing with PatientFi

We offer PatientFi so you can pay over time with a convenient monthly plan that works for you. Apply and use your plan risk-free–with no impact to your credit score! Start a monthly plan that works for you!

Apply and get approved in seconds

Get instant access to your funds

Spend freely, pay an easy monthly amount

PatientFi offers instant funding up to $50k and zero-interest* plan options for all approved patients. And there are no gotchas or hidden fees in the fine print!

Financing with CareCredit®

We proudly offer CareCredit® financing, a popular healthcare credit card that allows you to break down your total cost into smaller, manageable payments. CareCredit® can be used for both surgical procedures and non-surgical treatments, such as Botox and fillers. This financing option provides flexibility with no-interest and extended payment plans, making it easier for you to undergo a procedure that may otherwise be out of reach.

CareCredit® Benefits:

No-interest payment plans (if paid within the promotional period)

Extended payment options for larger procedures

Quick and easy application process

Use for both surgical and non-surgical treatments

Get Started Today

If you're ready to take the next step toward achieving your aesthetic goals, we invite you to explore our plastic surgery financing options. At John Hilinski MD Facial Plastic Surgery, we are here to help you through every step of the process, from consultation to payment. Contact us today to schedule a consultation and learn more about how we can make your desired procedure affordable and accessible.

Let us help you achieve beautiful, natural results with flexible financing options at  John Hilinski MD Facial Plastic Surgery!

#### Finesse Female Ethnic Rhinoplasty
One of my favorite operations to perform is ethnic rhinoplasty. I love this procedure because it requires so much preoperative consideration as well as technical execution in the operating room.

I thought this was a particularly notable case example of a young, ethnic female rhinoplasty patient who desired reshaping of her nose. Specifically, she desired to have a more narrow bridge contour in addition to lifting and refining the nasal tip region. All the while, she wanted to preserve her baseline ethnic appearance.

Clinical Assessment

On her frontal view, you can see that she clearly has an ethnic face with moderately strong ethnic facial features. If you look closer at her nose, you can appreciate that her nasal tip does appear somewhat flat across (red line) and the bridge looks moderately wide (blue lines).

On her oblique, or 45 degree angle, view, one can see that her nasal bridge does appear slightly long for her face (red line). Overall, I would agree that her length issue is not real dramatic. But the nose is slightly elongated.

On her side, or lateral, view, this length issue becomes even more visually evident. As you can see, her nasolabial angle (yellow lines) is just under 90 degrees. If you remember from our Rhinoplasty Tutorial Nasal Analysis chapter, the nasolabial angle is ideally more open than this – in the range of 95-105 degrees in a female patient. In this particular case, the patient desired to have this angle opened slightly in the process of creating a shorter looking nose from the oblique and side views.

Finesse Ethnic Rhinoplasty

So why do I describe this case as being a finesse type of ethnic rhinoplasty? This is because, generally speaking, her nose is really not all that bad in terms of appearance. She did not desire nor seek out a major transformation of her nose. She simply wanted to narrow a little here and refine a little there – while trying to keep the nose looking consistent with her background ethnic facial features. This does not mean that only finesse maneuvers were performed during her rhinoplasty surgery. The surgery still required all the work that normally goes into cosmetic nose surgery – incisions, lifting the skin, reshaping the cartilage, etc. The goal, however, was to perform all the usual surgical maneuvers while reshaping the nose in a way to achieve finesse changes.

Finesse Rhinoplasty Procedure

I ended up performing an open cosmetic rhinoplasty procedure on this patient. As part of the nose reshaping process, I cut her lower lateral cartilages and moved them to a more desirable position. I used a technique called lateral crural overlay, which happens to be a common maneuver used to shorten a nose. In doing so, I was able to bring her nasal tip upward slightly while also creating more tip definition. At the same time, I performed medial and lateral osteotomies to narrow the upper bridge. Finally, I used a small piece of her own cartilage as a graft to further refine the nasal tip region.

As noted above, this type of finesse rhinoplasty surgery still required a full effort in terms of general anesthesia, surgical exposure of the nasal framework, and reshaping of the individual components of the nose. I also still required a full year of recovery as does almost all types of cosmetic rhinoplasty surgery. But the end result visually was intended to be more of a finesse type of change.

Finesse Rhinoplasty Results

The actual surgical results are shown below. As you can see, there have finesse changes in terms of the appearance of her nose. She still looks like herself, just with a more refined version of her old nose. She now has improved tip position with a more defined looking nasal tip. In addition, the nasal bridge has been narrowed slightly as a result of the osteotomies. Her nose is also now slightly shorter when measured from the nasal tip to the area between the eyes. Yet, overall she still looks natural.

Finesse Rhinoplasty Consult

If you are considering a finesse rhinoplasty procedure, contact my office staff today to schedule a personalized appointment to see what might be possible with your nose.

#### Finesse Female Rhinoplasty
This is one of my favorite rhinoplasty patient examples because it truly reflects the essence of performing cosmetic nose surgery. This is a female patient from outside of San Diego who consulted with me to address some issues about her nose that were bothering her. As I discussed with her during our initial rhinoplasty consultation, she happens to have a very attractive face – largely due to beautiful, overall facial symmetry that is not commonly seen in the general population. What was bothering her primarily was the fact that her nasal bridge was somewhat irregular in contour. More specifically, she had a bump on the bridge that included irregular ‘bony horns’ (as they are often referred to) that stuck out on each side. This is diagrammed in the adjacent photo where the bony horn on her right is highlighted by the white arrow. What this translates into is a disrupted, or broken, brow tip esthetic line (as shown in the diagram) when looking at her nose from the frontal view. As we discussed in the Nasal Analysis chapter, the brow tip esthetic line is a key finding that is often associated with a more ideal bridge contour. When it is disrupted, as in this particular case, unwanted attention can be drawn toward this area detracting from an otherwise esthetically pleasing nose and face.

On her oblique and profile views, you can see much of the same in terms of her nasal bridge. The white arrows indicate the same bump along the nasal bridge that was seen on her frontal view. From both the oblique and the profile view you can appreciate how this feature could be interpreted as a distraction to her facial appearance.

But looking at the rest of her nose, there is really not much more to focus on in terms of potential changes through cosmetic rhinoplasty surgery.

In fact, during her rhinoplasty consultation we performed computer enhanced digital imaging of her preoperative photos. The frontal imaging is shown here in the adjacent photo diagram.On the left side is her original frontal photo before any surgery. On the right is the digitally enhanced version of the same photo showing what might be possible from rhinoplasty surgery. As you can see, the computer imaged photo focused primarily on providing her a smoother looking nasal bridge without disruption of her brow tip esthetic line. Beyond this, not much more was recommended in terms of cosmetic nose reshaping. With the nasal bridge made smoother by removal of the bump and bony horns, her nose hardly needed any more work.

With that plan in mind, she decided to proceed with the recommended rhinoplasty surgery. We ultimately agreed to perform a closed cosmetic rhinoplasty procedure that would allow me to focus on reshaping her nasal bridge. This was a great option for her because she did not need any real tip reshaping performed. The closed rhinoplasty procedure was done as usual through the nostrils without having to make an external cuts in her skin. The approach is shown diagrammatically in the adjacent photo showing how we approached her nasal bridge by going into the nostril opening to access the dorsum of the nose.

Once the skin was lifted up off of the nasal bridge, the cartilage and bone that were contributing to the bump were then reshaped. This involved very meticulous carving of the cartilage segment and sanding of the nasal bone. The bony horns on each side required additional sanding along the side of the nasal bridge to allow a smoother transition out to the sides.

One thing that might be surprising to some patients who have researched this topic online is that I did not perform any osteotomies on this nose. Meaning – I did not break her bones. Instead, I relied on very careful sanding technique (referred to as rasping the nasal bridge) to reshape the nose. Because I was able to avoid breaking her bones, she had a quicker recovery without any significant bruising noted after surgery.

The end result of her rhinoplasty surgery is shown below in the before and after photos.

Frontal Before & After Finesse Closed Rhinoplasty

As you can see in her frontal photos, there is a definite change in the appearance of her nose, but not so much so that she looks entirely different. What you will notice is that her nasal bridge now looks much smoother without any significant disruption of the brow tip esthetic lines on each side. The bony horns have been removed and her nose simply looks more refined. If you compare the imaged photo above to her after photo below, you will see that we are very close to achieving the type of change that was envisioned during her consultation.

Oblique Before & After Finesse Closed Rhinoplasty

Her oblique before and after photos show a much more refined looking bridge that is straighter and smoother. Notice in particular how the bump along the dorsum has been removed.

Lateral Before & After Finesse Closed Rhinoplasty

Her lateral before and after photos show how the bump has been removed and the bridge has been made straighter. Now, again, some people would question whether or not she should have had the bridge taken down even more. However, the aim of this rhinoplasty procedure was to address the features of her nose (like the bump) that she disliked while leaving the remainder of her nose alone to preserve a much more natural look.

Finesse Rhinoplasty Consultation in San Diego, CA

If you are seeking finesse type results from rhinoplasty surgery, contact our San Diego office today to learn more about what cosmetic nose surgery can do for you.

#### Flaring Or Wide Nostrils
Flaring or Wide Nostrils Surgery with Dr. John Hilinski: Expert Nasal Refinement in San Diego, CA

Flaring or wide nostrils can create an unbalanced appearance, making the nose appear broader and drawing attention away from other facial features. For individuals seeking a more refined, proportional look, nostril reduction surgery--also known as alar base reduction--can be the solution. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in correcting flaring and wide nostrils, offering personalized surgical techniques to create a more balanced, aesthetically pleasing nose. With his extensive expertise, Dr. Hilinski delivers natural-looking results that enhance overall facial harmony.

What is Flaring or Wide Nostrils Surgery?

Flaring or wide nostrils surgery, also known as alar base reduction, is a rhinoplasty technique that focuses on reducing the size and width of the nostrils. Some individuals have naturally wide or flared nostrils due to genetics, while others may develop this appearance as part of the aging process or as a result of previous nasal surgery.

This procedure typically involves removing a small wedge of tissue from the nostrils to narrow the base, creating a more refined and proportional nose. Dr. Hilinski ensures that the reduction is subtle and natural-looking, blending seamlessly with the rest of the nose and face.

Why Choose Flaring or Wide Nostrils Surgery?

Patients choose nostril reduction surgery for several reasons:

Special Considerations for Flaring or Wide Nostrils Surgery

FAQ: Flaring or Wide Nostrils Surgery

Schedule a Consultation with Dr. Hilinski

If you are considering nostril reduction surgery to correct wide or flaring nostrils, schedule a consultation with Dr. John Hilinski. As a leading facial plastic surgeon in San Diego, Dr. Hilinski combines advanced surgical techniques with personalized care to help you achieve a more refined, balanced nasal appearance. Contact us today to learn more about how this procedure can enhance your facial harmony.

#### Flat Or Depressed Bridge
Flat or Depressed Bridge Surgery with Dr. John Hilinski: Expert Nasal Augmentation in San Diego, CA

A flat or depressed nasal bridge can affect the overall symmetry and proportion of the face, creating a less defined profile and making the nose appear wider. This condition can be due to genetics, injury, or previous surgery. Flat or depressed bridge surgery, also known as dorsal augmentation rhinoplasty, is a specialized procedure designed to build up the nasal bridge, creating a more refined, balanced appearance. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, is highly experienced in nasal augmentation, using advanced techniques to create natural-looking results that enhance the overall facial structure.

What is Flat or Depressed Bridge Surgery?

Flat or depressed bridge surgery, also called dorsal augmentation, is a type of rhinoplasty designed to elevate and reshape a flat or sunken nasal bridge. Many individuals with a flat or depressed nasal bridge seek this procedure to improve the profile of their nose, create a stronger, more defined look, and balance the overall appearance of their face.

The surgery typically involves the use of grafts made from the patient's own cartilage (often from the septum, ear, or rib) or a biocompatible implant to elevate the bridge and create the desired contour. Dr. Hilinski carefully tailors each procedure to suit the individual's facial anatomy and aesthetic goals, ensuring natural and harmonious results.

Why Choose This Surgery?

Patients choose flat or depressed bridge surgery for several reasons:

Special Considerations for Flat or Depressed Bridge Surgery

FAQ: Flat or Depressed Bridge Surgery

Schedule a Consultation with Dr. Hilinski

If you are considering flat or depressed bridge surgery to enhance your nasal profile and improve facial harmony, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in nasal augmentation and rhinoplasty, Dr. Hilinski offers personalized care and advanced surgical techniques to help you achieve natural, long-lasting results. Contact us today to learn more about how this procedure can enhance your appearance.

#### Functional Septorhinoplasty Surgery
Functional septorhinoplasty, or functional rhinoplasty, is a term often used to reference several different types of reconstructive nose surgery intended to improve the function of the nose. In essence, it is surgery being performed to help a patient breathe better through their nose. There is a wide variety of techniques that may need to be employed when trying to make the nose function better. This example is presented here because it highlights a number of the most commonly used septorhinoplasty techniques in functional reconstruction of the nose.

Initial Presentation

This particular male patient from San Diego was referred to the office with a chief complaint of difficulty breathing through the nose. Like many patients, he had obstructed breathing on both sides of his nose. This turned out to be the result of a number of anatomical problems with the framework of his nose – meaning, the cartilage structure underlying the nasal skin.

The manifestation of this in terms of appearance can be seen in his preoperative photos shown here. As you can see, his nose is quite asymmetrical, or crooked. In fact, looking at his frontal view, you can see that his nasal bridge deviates off to his right side (left when looking at the photo). On both his oblique and lateral view, the nasal tip appears quite droopy, or ptotic (pronounced ‘tot-ik’).

Assessment of Nasal Obstruction

Examining his nose in more detail, there are a number of anatomical problems that needed to be assessed and understood before proceeding with any type of reconstructive surgery. This is where experience in reconstructive nose surgery becomes so critical in terms of achieving a successful outcome.

One thing that is not visible in photos is the presence of a deviated nasal septum. This was initially diagnosed by his primary care doctor before he was referred to my office. My examination confirmed the septal deviation and the need for septoplasty surgery. However, as it turns out, the deviated septum was only one factor when explaining why he had such severe nasal obstruction.

The diagrammed photo provided here helps explain the other issues with the cartilage framework of his nose.

For example, let us go back to his frontal view. The white vertical line in the diagram indicates where the bridge of the nose really should be aligned in terms of the middle of his face. Instead, you can appreciate how a majority of his nose appears displaced to his right side as noted previously. This visual illusion is primarily due to the fact his nose is collapsed through the middle one-third as indicated by the curved blue line. This actually corresponds to a critical area of the nose often times referred to as the ‘middle vault’ or ‘internal nasal valve area’ by rhinoplasty experts. The middle vault and internal nasal valve are discussed in more detail in our rhinoplasty tutorial chapter on spreader grafting. But suffice it to say that a collapsed middle vault or internal nasal valve, as in this case, can be a significant factor when it comes to difficulty breathing through the nose. In addition, a collapsed middle vault can contribute to visual asymmetry when it comes to the appearance of the bridge as is shown here.

On the oblique view of his nose, you can see how the collapsed middle vault gives the illusion that this side of the nose is relatively flat (as shown by the blue rectangular outline). This is because the upper lateral cartilage, which is a key component of the middle vault anatomy, is depressed toward the opposite side of his nose. Thus, when looking at the nose from this angle, indeed, it does appear somewhat flat.

When looking at his nose from the profile view, you can also sense how the tip of the nose is mild to moderately ptotic, or droopy. This can be confirmed by looking more closely at the nasolabial angle (the angle created by the junction of the upper lip and the bottom of the nose). Normally the nasolabial angle should be around 90-95 degrees in a male. In this particular case, the nasolabial angle is less than 90 degrees. So what does this mean in terms of nasal function and breathing? In many cases, a ptotic nasal tip can contribute to some degree of nasal obstruction. In severe cases of nasal tip ptosis, this can be one of the major factors in terms of obstruction. But it does not have to be severe to negatively impact one’s breathing. Even in cases such as this one, mild to moderate nasal tip ptosis can be a relevant factor that needs to be addressed in order to help improve nasal function. By simply lifting the nasal tip up several degrees (increasing the rotation of the nasal tip), some patients will note moderate to significant improvement in their nasal breathing. Go ahead and try this with your nose – you will note that by lifting the tip slightly (especially if you have nasal tip ptosis) you can breathe easier. It just so happens that lifting the nasal tip up can also improve the aesthetic appearance of the nose in many cases.

Nasal Shape and Functional Improvement

This is a great example of a patient where the nasal shape is going to passively change in concert with functional improvement of the nose. There are a good number of patients who require functional improvement of then nose, but the shape of their nose will change very little. This is because some types of anatomical obstruction of the nose can be corrected without having to reshape the nose. For instance, traditional septoplasty surgery does not have any significant impact on the external appearance of the nose. But in this particular case, because he has significant collapse of the middle vault and ptosis of the nasal tip (with both contributing to obstruction), the corrective nose surgery cannot be done without changing the shape of the nose. In fact, this is an issue that should be openly discussed with patients undergoing this type of reconstructive surgery since they should be fully aware there are passive changes that will occur in the process of improving the nasal function.

Insurance Coverage for Septorhinoplasty

Because of the implications in terms of improving nasal function, this type of nose surgery (internal nasal valve repair) can often times be covered by the patient’s insurance plan. This is largely due to the fact the thrust of the surgery is to improve nasal function. Although there will be a change in the appearance of the nose, it is not being reshaped for purely cosmetic indications. In my practice, only certain PPO health care plans will provide this type of coverage for nasal reconstruction surgery. The most common PPO health plans that I see for reconstructive nose surgery include United Healthcare, Cigna Health Insurance, Health Net, Aetna and others. The surgical plan (in terms of specific procedures needed to be performed) is submitted to the insurance company for preauthorization well in advance of the procedure date. Once this process has been completed and there is relative assurance of health care coverage, the nasal reconstruction can be scheduled and performed accordingly.

Functional Septorhinoplasty

In this particular case, an open septorhinoplasty procedure was performed. This means that an incision was made between the nostrils extending into the nose on both sides. This allowed for the skin of the nose to be lifted up, thus exposing the cartilage framework of his nose.

Upon opening the nose, it was readily appreciated that his middle vault was displaced to his right side. This is represented here in the adjacent photo diagram where you can see that his nasal bones were actually quite symmetrical. The issue with his crooked bridge alignment was not a result of displacement of the nasal bones, which is a very common issue that I encounter in my rhinoplasty practice. The crooked alignment was, instead, largely a direct result of the cartilage being pushed off to his right side. Because the middle portion of the bridge was displaced, the nasal tip cartilage followed suit also going off to his right side. What this told me during the surgery was that I did not have to break his nasal bones in order to improve the alignment of his bridge. In order to help correct the anatomical problem, I had to focus on the middle vault of the nose, which was comprised of the paired upper lateral cartilages and the dorsal septum.

Ultimately, as was planned, I ended up placing a layered spreader graft on his left side to correct the problem. Spreader grafting is a very valuable technique that I happen to use quite frequently in my rhinoplasty and revision rhinoplasty practice. You can read more in detail about spreader grafting using this link here to our rhinoplasty tutorial chapter focusing on reconstruction of the middle nasal vault. For the sake of brevity, spreader grafting is an advanced rhinoplasty technique that involves placing a segment of cartilage in a strategically located position, which helps to open up the internal nasal valve. In the process of doing so, spreader grafts can also help to augment (build up) one side (or both if desired) of the nasal bridge to add width. If a spreader graft is created so that it extends further toward the nasal tip (called an extended spreader graft), it can be used to straighten the nasal bridge and tip. That is precisely what was done in this case example.

In the adjacent photo diagram the spreader grafts are represented by the yellow shaded rectangles. In fact, in this case, I ended up using three spreader grafts made from harvested septal cartilage sewn together as one, thick layered graft. In doing so, I was able to create a very stiff, moderately thick splinting graft that was resilient enough to help straighten a fairly crooked bridge. The blue ovals represent the sutures used to fixate the graft in position. If you look closely, the upper end of the spreader graft actually extends just underneath the inferior edge of the nasal bone. It then extends along the left side of the nasal bridge into the tip region. As the sutures were sequentially placed from top to bottom, I was able to draw or pull the cartilage framework of his nose toward his left side (as indicated by the arrow). The end result as you can see in the diagram, is restoration of a straighter cartilage alignment – thus providing him an improved and more symmetrical bridge. In terms of the internal valve itself, this type of triple layered spreader graft helped to open up the cross sectional area of the internal valve inside of his nose, contributing to a marked improvement in nasal function.

In terms of his nasal tip region, I mentioned earlier how his tip was quite ptotic and contributed to some of his nasal obstruction. Looking at the underlying cartilage framework of his tip (as diagrammed here), you can see how the lower lateral cartilage is the primary problem. The lower lateral cartilage refers to the pair of wings that essentially make up much of the nasal tip shape and support. When the lower lateral cartilages are not positioned correctly, as is the case here, they can give the appearance the nasal tip is drooping down. Functionally, this can be a key factor in patients who cannot breathe optimally through their nose. Once I opened this patient’s nose in surgery, it was confirmed that the lower lateral cartilages needed to be reshaped in order to improve his breathing. In situations like this, the entire nasal tip is deconstructed by separating the lower lateral cartilages – basically detaching them from the rest of the nose. They are then moved to a more ideal position and anchored in their new location using long-term sutures.

This technique is commonly referred to as a tongue-in-groove maneuver where the medial crura on both sides (forming a groove) are repositioned on the caudal septum (the tongue). In fact, this is a powerful rhinoplasty technique that is used quite frequently in my practice. The overall effect is shown visually in the adjacent diagram where you can now see the nasolabial angle has been opened up to nearly 90 degrees. Comparing the two side views of the cartilage framework, you can appreciate in the after photo the difference in shape and position of the lower lateral cartilage. You can also get the sense that the lower lateral cartilage volume (width) has been decreased in this process. By lifting the nasal tip up using this type of surgical technique, this patient was provided the opportunity to breathe much better. Passively, the nasal tip also appears more esthetically pleasing because there is now less of a droop.

Results of Functional Septorhinoplasty

In the end, this patient benefitted greatly from the reconstructive septorhinoplasty in terms of nasal function. He was able to breathe better out of both sides of his nose largely due to the septoplasty (septal reconstruction), spreader graft placement and correction of the nasal tip ptosis.

In addition, he had passive changes to the appearance of his nose that are shown here. Overall, you can see that his nose is now much straighter on his face with marked improvement in terms of symmetry. And keep in mind that the nasal bones were not broken during his surgery. The improvements noted in his alignment are a direct result of the middle vault reconstruction using the layered spreader grafting techniques explained above.

On his oblique (45 degree angle) views, you can also see how much change there has been in the nasal tip region. His nose is now shorter in terms of overall length because the nasal tip has been lifted up to a more ideal position. By doing this in combination with placement of the spreader grafts, his left oblique view shown here has been improved significantly. These same changes carry through to his profile view as well where you can now see his tip is more optimally shaped and positioned. He still maintains a very nice, masculine profile. But this new nose of his now looks and functions much better.

Functional Septorhinoplasty Consult

If you have significant trouble breathing through your nose and feel as if functional septorhinoplasty may benefit you, do not hesitate in contacting my San Diego office today. I am considered one of the regions foremost experts in functional, reconstructive nose surgery.

#### Functional Upper Eyelid Surgery
Functional Upper Eyelid Surgery with Dr. John Hilinski

Functional upper blepharoplasty is an eyelid reshaping procedure designed to improve poor vision caused by excess upper eyelid skin. This surgery, often medically necessary, can enhance your field of vision by removing the heavy skin that blocks peripheral vision, providing both functional and cosmetic benefits. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in advanced techniques to achieve excellent results for patients in need of functional eyelid surgery.

How Upper Eyelid Surgery Can Improve Vision

Excess skin on the upper eyelids can impair peripheral vision, causing difficulty in daily activities. As shown in the accompanying images, excess upper eyelid skin can create a heavy, drooping effect that obstructs the visual field. By undergoing functional upper eyelid surgery, patients can see significant improvements in their vision as the excess skin is removed, allowing for a wider and clearer field of view.

Understanding Ptosis and Its Impact on Vision

In addition to excess skin, some patients suffer from upper eyelid ptosis, where the eyelid itself droops below its normal position, further contributing to vision problems. Ptosis is caused by a weakening of the levator muscle, which lifts the eyelid. Dr. Hilinski performs ptosis repair surgery to correct this condition by tightening the levator muscle, restoring the eyelid to its proper position and improving vision.

Cosmetic Benefits of Functional Upper Eyelid Surgery

While the primary goal of functional upper eyelid surgery is to improve vision, patients often experience cosmetic benefits as well. By removing excess skin and lifting the eyelid, this procedure can create a more youthful, refreshed appearance. Many patients find that their eyes look less tired, and their overall facial appearance is enhanced.

The Functional Upper Eyelid Surgery Procedure

Dr. Hilinski performs functional upper eyelid surgery using local anesthesia or light sedation. The procedure is completed on an outpatient basis, allowing patients to return home the same day. During surgery, Dr. Hilinski makes an incision along the natural crease of the upper eyelid to remove excess skin and, if necessary, tighten the levator muscle to correct ptosis. The incision is carefully closed with sutures, leaving minimal scarring that fades over time.

Recovery from Functional Eyelid Surgery

Recovery from functional upper eyelid surgery is generally quick and involves minimal discomfort. Patients may experience mild swelling and bruising for the first few days, but most are able to resume normal activities within a week. Sutures are typically removed after 5-6 days, and the majority of patients feel comfortable returning to work and social activities within 7-10 days.

Insurance Coverage for Functional Upper Eyelid Surgery

Many insurance companies will cover functional upper blepharoplasty if it is deemed medically necessary to improve vision. Dr. Hilinski's office works with most major PPO insurance plans, including Blue Cross, Blue Shield, United Healthcare, Aetna Healthcare, and Tricare. A visual field test is often required to provide objective evidence that the excess skin is impairing your vision. This test compares your vision with and without the eyelid taped, helping to confirm the need for surgery.

Functional Upper Eyelid Surgery: FAQ

Schedule Your Consultation

If you are experiencing impaired vision due to excess upper eyelid skin or drooping eyelids, contact Dr. John Hilinski's San Diego office today. We can help you determine if functional upper eyelid surgery is right for you and guide you through the insurance process.

#### Gauge Earlobe Repair
Gauge Earlobe Repair with Dr. John Hilinski: Restoring Natural Earlobe Appearance in San Diego

Gauged earrings have gained popularity in recent years, but many people eventually decide to reverse the process and repair the stretched earlobe holes. If you're ready to close your gauged earlobes and restore a natural look to your ears, gauge earlobe repair may be the solution for you. Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, offers expert earlobe repair surgery to help patients regain confidence in their appearance.

What is Gauge Earlobe Repair?

Gauge earlobe repair is a surgical procedure designed to close and reshape earlobes that have been stretched or altered due to gauging. Over time, gauged earlobes may not return to their natural shape on their own, and surgical intervention is often necessary to correct the appearance of the earlobe. This procedure involves reconstructing the earlobe by closing the stretched holes and restoring its natural contours.

Various Gauge Earring Defects

Gauge earring holes vary in size, and the complexity of the repair depends on the degree of stretching. Some patients have small holes that require minimal reshaping, while others have large holes due to years of wearing increasingly larger gauges. The approach to repair is customized to each patient's specific needs.

The Problem with Gauge Earring Defects

When gauged earlobes are stretched, they create a soft tissue void, meaning there's a lack of skin and tissue where the hole once existed. Simply stitching the hole closed won't provide a natural-looking result, as it can lead to a distorted or overly narrow earlobe. To ensure a smooth, rounded earlobe shape, the repair requires careful planning and advanced techniques.

Repairing a Gauge Earring Defect

Dr. Hilinski uses advanced techniques to reconstruct the earlobe and close the gauge defect. The goal is to replace the missing tissue by borrowing from surrounding areas of the earlobe and ear. This method, known as local flap reconstruction, involves mobilizing nearby tissue to fill the hole and recreate the natural earlobe shape. Dr. Hilinski’s approach ensures that the earlobe maintains its original structure and symmetry.

The procedure typically begins by de-epithelializing the skin around the hole, which means removing the lining of the stretched hole. Once the skin is prepared, a local flap is used to cover and close the hole, restoring the appearance of the earlobe. The surgery is usually completed under local anesthesia and takes about 1-2 hours, depending on the extent of the repair.

Benefits of Gauge Earlobe Repair Surgery

FAQ: Gauge Earlobe Repair

Schedule a Consultation with Dr. Hilinski

If you're considering gauge earlobe repair to close stretched or gauged earlobes, schedule a consultation with Dr. John Hilinski, San Diego's expert in ear surgery. With years of experience and a personalized approach, Dr. Hilinski can help you restore the natural shape of your earlobes and achieve the aesthetic results you desire. Contact our office today to learn more about your options for gauge earlobe repair.

#### Hair Transplant
Hair Transplant Procedures with Dr. John Hilinski

Hair transplant surgery is a life-changing procedure for men and women dealing with hair loss or thinning hair. Hair restoration offers a permanent solution for hair loss, providing natural-looking results and helping patients regain confidence. Board-certified facial plastic surgeon, Dr. John Hilinski, specializes in hair transplant procedures, delivering exceptional outcomes for his patients in San Diego.

Why Hair Transplant Surgery May Be Needed

Hair loss can be caused by a variety of factors, including genetics, aging, hormonal changes, and stress. For many individuals, hair loss can result in reduced self-esteem and confidence. Hair transplant surgery is an effective way to restore a natural hairline, fill in thinning areas, and reverse the effects of balding. Whether hair loss is due to male-pattern baldness, trauma, or thinning, hair transplant procedures offer a long-lasting, effective solution.

Recovery After Hair Transplant Surgery

After the hair transplant procedure, patients may experience mild swelling and discomfort, which typically subsides within a few days. Any post-surgical scabs will fall off within 7-10 days. Most patients can resume their normal activities within a week. New hair growth begins within a few months, with full results typically visible within 9-12 months.

Hair Transplant Techniques

Dr. John Hilinski offers advanced hair restoration techniques, utilizing state-of-the-art methods to ensure optimal outcomes. He performs both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE), two of the most effective and popular methods for hair transplantation.

FUE (Follicular Unit Extraction)

This minimally invasive method involves extracting individual hair follicles from a donor area (typically the back of the head) and transplanting them to the recipient area. FUE leaves no linear scar and requires minimal downtime, making it an excellent option for patients who want discreet, natural results.

FUT (Follicular Unit Transplantation)

Also known as the strip method, FUT involves removing a small strip of scalp from the donor area. The follicles are then meticulously dissected and transplanted into the thinning or balding areas. This method is ideal for patients who require a larger number of grafts for their desired results.

FAQ: Hair Transplant Surgery

Schedule Your Hair Transplant Consultation

If you're ready to restore your hairline and regain confidence, schedule a consultation with Dr. John Hilinski today. As one of San Diego's top hair transplant specialists, Dr. Hilinski is committed to providing exceptional results and personalized care. Contact us now to learn more about your options for hair restoration.

#### Hilinski Foundation for Surgery
The Hilinski Foundation for Surgery is a non-profit entity established by Dr. John Hilinski and his wife to provide complimentary surgery to boys and girls in the greater San Diego region. Both Dr. Hilinski and his wife are native San Diegans and feel blessed to grow up in America’s Finest city. In an effort to give something back to the San Diego community, they established the Hilinski Foundation for Surgery as a means to provide charity facial plastic surgery to those who could not otherwise afford these types of services.

Impact of Facial Plastic Surgery

So why did Dr. Hilinski and his wife establish their foundation? Research studies over the past decade have documented that the effect of a visible disfigurement can be devastating for a child’s development particularly when the disfigurement is on the face. As one of our patients with a sizable birthmark on her face said, “……other students tease and bully me and say things that hurt my feelings and make me cry”.

A child’s development, self-confidence, and self-esteem can be greatly impacted when they experience constant ridicule, teasing and embarrassment and the impact can be life-long. There are few solutions for kids that are socially or economically disadvantaged if they have deformities from birth defects, abuse or accidents. Many children are not insured, underinsured or not covered by their insurance because the deformities are considered cosmetic in nature. Often insurance companies do not take into consideration the mental and emotional impact a disfigurement can have on a child.

This is the very reason why Dr. Hilinski and his wife founded The Hilinski Foundation For Surgery.

They had a vision of providing charitable plastic surgery services to disadvantaged boys and girls and bringing more happiness and joy to those less fortunate. The Hilinski Foundation for Surgery hopes to provide these youth an improved sense of spirit and confidence enabling them to live life to the fullest.

Charitable Plastic Surgery Provided

The Hilinski Foundation for Surgery provides a wide range of cosmetic and reconstructive facial procedures that includes but is not limited to the following:

Otoplasty or ear pinning

Ear reduction

Reconstructive nose surgery including rhinoplasty

Traumatic facial injury repair including facial reconstruction and scar revision

For each surgery, the foundation will provide cost coverage for the surgeon, anesthesia staff, nursing staff, surgical technicians and ambulatory surgery center supplies. Routine post-operative care is also provided by the foundation.

Unfortunately, the foundation is not able to provide coverage for medical services delivered at an outside facility (such as a hospital).

Case Example of Otoplasty

Here is a classic example of how otoplasty, or ear pinning, surgery can have such an incredibly positive impact on a young child’s life. This young lady and her family were concerned how her congenital ear deformity was starting to affect her outlook. When younger kids get to the age where they begin socializing with more of their peers, such as around the first grade, their prominent ears can be a focus of unwanted attention. This then triggers brutally honest questions from their classmates that make them feel even more insecure. As we all know, younger kids can simply be rude – especially when it comes to making unsolicited comments. In situations like this where a young child’s ears are excessively prominent because they stick out too far, otoplasty surgery can have a monumental positive impact on their life.

As you can see below, this young patient’s ears were quite prominent and stuck out asymmetrically – meaning, one ear (her left) stuck out further than the right one.

Eligibility for Facial Plastic Surgery

To be eligible for surgery, patients must be between 5-18 years of age and demonstrate some type of facial abnormality that is amenable to surgery. In addition, candidates will be screened thoroughly to confirm they are financially unable to afford such corrective surgeries on their own.

#### Hispanic Rhinoplasty Case
This is a great example of cosmetic nose surgery in an ethnic Hispanic rhinoplasty patient. This young lady came to my office desiring reshaping of her nose. Having a practice based relatively near the border of Mexico, I happen to see a large number of ethnic rhinoplasty patients who have Hispanic roots. Consequently, Hispanic cosmetic nose surgery has become a significant part of my ethnic rhinoplasty practice over the years. In this particular Hispanic rhinoplasty case example, the patient specifically desired to make her nose look smaller and more refined overall. In the process, she did not wish to have her Hispanic ethnicity erased – she simply wanted to address certain ethnic features of her nose that were bothering her. As you can see from her preoperative photos shown here, the nose was, indeed, disproportionally large for her surrounding facial features. This is a visual finding that is noted immediately on initial glance. When examined, her nose was found to have many of the other common features found in Hispanic rhinoplasty patients. For example, her nasal skin was assessed as being moderately thick and her nasal bridge showed a bump that was best seen on the side. In fact, she had what is termed a dorsal hump deformity – where the nasal bridge contour rises up to create somewhat of a convex shape when looking at the profile view. As in other Hispanic rhinoplasty patients, her nasal tip was considered poorly defined – almost appearing too wide on the frontal view. When looking at her nasal tip from the side view, it was found to be quite ptotic (pronounced tot-ii), or droopy. This is another common characteristic of Hispanic noses and often times a major compelling reason for seeking cosmetic ethnic nose reshaping surgery.

Hispanic Rhinoplasty Computer Imaging

During our rhinoplasty consultation, the patient and I reviewed her photos while performing computer imaging. This is a routine practice that I frequently employ to help the patient (and myself) better understand what type of cosmetic changes might be possible with the nasal reshaping process. Computer imaging involves morphing of the patient’s actual photographs to reshape the nose in demonstrating what type of surgical change might be accomplished. However, all patients must keep in mind that computer imaging like this is not an exact science – nor is it a guarantee/warranty of actual changes that might result from rhinoplasty. Rather, computer imaging should be viewed as just another tool to help the patient and surgeon understand what direction and degree of change is desired.

In this Hispanic rhinoplasty patient, the computer imaging is shown here. As you can see from the frontal images (shown to the left), I tried to show her how ethnic rhinoplasty surgery can help make the bridge look more narrow. At the same time, her nasal tip could be made to look more defined and narrowed. As part of this process, the nasal tip would need to be lifted up slightly to help address the ptotic tip issue.

Computer imaging of her lateral photo is shown here as well. As you can see, I tried to show her what it might look like if the nasal bridge height was reduced. In particular, I wanted to demonstrate how the bridge might look if it were straighter – not scooped – just straighter without the hump. With regard to the nasal tip, I morphed the photo to show how it might look with elevation and rotation of the nasal tip to try and create a more feminine tip position. Based partially on these morphed computer images (along with a thorough discussion of her case), the patient decided to proceed with the rhinoplasty surgery.

Hispanic Rhinoplasty Surgery

I ended up performing an open cosmetic rhinoplasty procedure to try and accomplish the type of changes seen in the computer morphed images above. The open rhinoplasty approach was necessary, in my opinion, so that optimal exposure of the nasal tip could be achieved. In cosmetic nose surgery cases like this, it is really important to have full visualization of the nasal tip region when trying to make more dramatic changes as was desired. During the rhinoplasty surgery, the excess cartilage along the bridge was first trimmed down. This is shown in the adjacent diagram as indicated by the red line. The bony portion of the nasal bridge was then shaved down using a rasping technique (yellow line). Once this was accomplished the sides of the nasal bones were then cut so that they could be narrowed as seen from the frontal view. Her nasal tip was then completely taken apart as it was detached from the remainder of her nose. This allowed me to literally move her tip into a new position. The green shaded structure in the diagram is her lower lateral cartilage, which forms a majority of the nasal tip shape. Originally, her lower lateral cartilage was positioned much lower down toward her upper lip. This is indicated by the nasolabial angle formed between the pink and white lines (where the white line runs along the lower border of her old nasal tip). This old angle was less than 90 degrees. The ideal nasolabial angle in a female is closer to 95-105 degrees. Once her nasal tip was moved, the new nasolabial (formed by the pink and light blue lines) was considered much closer to ideal. Finally, the nasal tip was narrowed from the frontal view and given more definition with use of a cartilage graft (as indicated by the blue rectangle sitting atop the lower lateral cartilage).

Hispanic Rhinoplasty Results

The actual results of this Hispanic patient’s rhinoplasty are shown here. Overall, you can tell at initial glance that her nose is now much more proportional in terms of size. It is also much more defined as seen from the frontal view. Just look at the comparison of her nasal tip width before and after rhinoplasty. Through this type of Hispanic rhinoplasty surgery, the entire nasal tip region has been made to be more triangular in shape, which produces the appearance of a more narrow, refined nasal tip. The bridge has also been narrowed as seen from the front. The improvements made to the nasal tip position are best seen from the oblique and side views as shown below. As you compare her before and after photos, see for yourself how changes to the lower lateral cartilage translate into a more elegant looking nasal tip. Combine this with reduction of the bridge height and removal of the dorsal hump deformity and you can really see a dramatic difference in the overall shape of her nose. But her nose still looks like it fits her face. There are no obvious signs of her having had a ‘nose job’ as they say. Her nose now appears as if she could have been born with it.

Computer Imaged Comparison

Looking back at her computer enhanced photos and comparing these to her actual surgical results reveals a fairly close approximation.

Hispanic Rhinoplasty Consultation

If you or someone you know is interested in undergoing Hispanic cosmetic rhinoplasty surgery, do not hesitate in contacting my office today to schedule a complimentary consultation to review your options. As one of the most well-trained rhinoplasty experts in this region, I can offer you unparalleled experience with ethnic cosmetic rhinoplasty surgery.

#### Home
URL: https://www.drhilinski.com/

#### Hump Reduction Without Breaking Bones
Every once in a while we get an online rhinoplasty inquiry regarding a dorsal hump and whether or not the bones have to be broken in the process of taking the bump down. So we decided to post a case example of exactly this.

Here is a male rhinoplasty patient who consulted with Dr. Hilinski regarding a few cosmetic issues. One of the main issues he had was a dorsal hump, which can be readily seen on his profile view. When you look at his frontal view and you focus more on his bridge, you will see that his nose actually looks too thin from this angle. This is because he has a very ‘tall’ bridge and when light hits it (or anything that is tall) there is a sharp shadowing effect that occurs – making this nasal bridge appear very narrow.

This is precisely the set up, or anatomical combination, that warrants doing cosmetic rhinoplasty to reduce the bridge height without breaking the nasal bones at the same time. So why is this? It is because whenever you take down the nasal bridge height and stop there – without breaking the bones to move them inward – the appearance of the bridge becomes wider. This is due to the fact that you now have a structure that is not so tall and does not shadow light as readily. Therefore, it appears wider from the frontal view. In this particular case, our goal was to make his nasal bridge appear less narrow – or wider in other words. So taking the bridge height down without moving the nasal bones inward was precisely what was indicated to achieve the desired cosmetic changes to his nose.

Hump Reduction No Bone Breaking

So what does this look like? Here are his photos showing a stable one (1) year recovery result. As you can tell on the front view of his nose, rhinoplasty surgery has resulted in a bridge that now has a more appropriate width from left to right. No longer does his nose look too thin or narrow. In fact, the nose looks wider from this frontal perspective, which is precisely what the goal was going into the rhinoplasty surgery. But when you look at his side view, the bump is now reduced and he maintains a nice, strong, masculine profile. Overall, he still looks very natural in that he now has a nose that appears as if he could have been born with it. And all of this was accomplished without actually breaking his nasal bones!

Of note, his nasal tip was also narrowed nicely during the rhinoplasty and now gives his nose a much stronger, more defined look.

#### Indian Rhinoplasty
Indian rhinoplasty is a specific type of ethnic rhinoplasty that demands expert knowledge and technique. Surgical alteration of the Indian nose requires a rhinoplasty surgeon to make improvements in the shape of the nose while maintaining ethnic consistency with the surrounding facial features. As in other types of ethnic rhinoplasty, it is so important to create a final result in Indian rhinoplasty that appears natural.

Thick Skin in the Indian Nose

One of the most common features that rhinoplasty surgeons encounter in the Indian nose is a relatively thick skin layer. Because Indian noses possess thicker skin, the underlying bone and cartilage need to be altered in a more deliberate manner compared with other rhinoplasty patients. The underlying framework of the nose requires more definitive changes so the final result will show through the thicker overlying skin layer. If surgical changes to the bone and cartilage are too conservative in the Indian nose, the desired new shape will not be readily visible.

Drooping Tip in the Indian Nose

Another common feature found in the Indian nose is a drooping tip. This is also frequently referred to as a ptotic nasal tip. This is usually best seen from the side, or profile, view where the tip of the nose can be seen to droop downward. If you look more specifically at the angle made between the bottom of the nose and the upper lip, it is commonly less than 90 degrees in the ptotic nose. This can make the Indian nose appear longer than desired and in some cases more aged in appearance.

Dorsal Hump in the Indian Nose

The Indian nose is also frequently noted to have a dorsal hump deformity. This refers to a bump on the bridge of the nose that creates a convex contour best appreciated when looking from the side view. A dorsal hump can also contribute to the nose looking longer than desired. When this is present in the setting of a droopy nasal tip, the overall appearance can be even further exaggerated.

Rhinoplasty for the Indian Nose

Indian rhinoplasty is intended to target those features of the nose that are bothersome while leaving alone the remainder of the nose to preserve ethnic consistency. In a majority of cases of Indian rhinoplasty, an open approach is my preferred technique. Using an open rhinoplasty approach in the Indian nose allows me more exposure of the nasal tip region, which often times requires moderate change as noted above. This includes use of cartilage grafting technique that is much more accurate when the nose is fully exposed via the open approach. In cases of Indian rhinoplasty where minimal tip work is being performed, a closed approach is certainly reasonable for reshaping primarily the nasal bridge.

Indian Rhinoplasty Example

This example of Indian rhinoplasty shows a male patient who had concerns with the bridge, tip and base regions of his nose. More specifically, he desired to have the dorsal convexity – meaning, curvature along the bridge – reduced. In addition, he desired some tip refinement for more definition and slight narrowing of the nostril base.

These changes were accomplished in this case with a closed rhinoplasty approach. As noted above, in cases where limited nasal tip work is being done, a closed rhinoplasty approach is reasonable. In this case of Indian rhinoplasty, the nasal bridge was reduced to create a straighter profile. The nasal tip was refined with use of cephalic trimming technique – meaning, the cartilage that comprises the nasal tip was trimmed along the upper edge to make the tip appear more narrow. As the nose healed, the scarring effect from the cephalic trim then rotated the tip upward to slight degree. In addition, the base of the nose was made more narrow by removing some of the skin from inside of the nostril on both sides. The overall effect was to provide him with a more refined look. As you can see from his before and after photos, his nose appears more defined. Yet, we have preserved his ethnic identity in that his nose does not look incongruent with his surrounding facial features. His nose still looks Indian – just a more defined and refined version of his old nose.

Indian Cosmetic Nose Surgery

If you are Indian and considering cosmetic nose surgery, contact my San Diego office today to schedule a personalized consultation with me, Dr. John Hilinski. Over the years I have performed Indian rhinoplasty on a very regular basis to provide my patients with beautiful yet natural looking cosmetic results.

#### Injectable Fillers
Injectable Fillers at Hilinski Medspa: Achieve Youthful, Natural Results

At Hilinski Medspa, we offer a comprehensive range of injectable fillers to help you achieve a youthful and vibrant appearance without the need for surgery. Injectable fillers are a popular non-surgical method for addressing wrinkles, restoring volume, and enhancing facial contours. Whether you're looking to smooth out deep creases, plump your lips, or improve skin hydration and smoothness, our advanced filler treatments are designed to meet your individual needs.

Board-certified facial plastic surgeon Dr. John Hilinski is renowned for his expertise in facial aesthetics. With years of experience and a deep understanding of facial anatomy, Dr. Hilinski and his team provide personalized injectable filler treatments that deliver natural-looking results with minimal downtime.

Injectable Fillers Offered at Hilinski Medspa

Why Choose Injectable Fillers?

Injectable fillers are a versatile, minimally invasive solution to a wide range of cosmetic concerns. These treatments involve using soft tissue filler materials, such as Restylane®, Perlane®, JUVÉDERM®, and Radiesse®, to smooth out facial lines, plump hollow areas, and contour facial features. Common areas treated with injectable fillers include the nasolabial folds (smile lines), lips, cheeks, under-eye hollows, and jowls.

Injectable fillers offer several benefits:

Immediate results

Minimal recovery time

Long-lasting effects (6-12 months or longer)

Non-surgical enhancement

Benefits of Injectable Fillers

What to Expect from Injectable Filler Treatment

Injectable filler treatments at Hilinski Medspa are quick and easy, usually taking less than 15 minutes. Our skilled providers may administer topical anesthesia or a nerve block to ensure your comfort during the procedure. Most fillers now come pre-mixed with a numbing agent, which further enhances patient comfort.

Results are visible immediately, and while there may be some minor swelling or bruising, these side effects typically resolve within 24-48 hours. Most patients can return to their regular activities right away, making injectable fillers a convenient option for those with busy lifestyles.

Why Choose Dr. John Hilinski for Injectable Fillers?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Schedule Your Injectable Filler Consultation at Hilinski Medspa

If you're considering injectable fillers to enhance your appearance, contact Hilinski Medspa today to schedule a personalized consultation. With Dr. Hilinski's expert guidance and tailored treatments, you can achieve your aesthetic goals and enjoy a refreshed, youthful appearance.

#### Insurance & Nose Surgery
Many patients considering nose surgery often wonder whether or not their health insurance covers this type of surgery. And if their health insurance does cover nose surgery, the question is whether or not it will cover the type of surgery that they are interested in having done. Unfortunately, this can be a very confusing topic for patients and plastic surgeons alike. Hopefully in this online tutorial chapter I can help shed some much needed light on the topic of health insurance as it relates to nose surgery including rhinoplasty and revision rhinoplasty.

What Type Of Health Insurance Do You Have?

The first thing you have to clarify is what type of health insurance do you have? There are basically two different types of health insurance.

The first is called an HMO, which stands for health maintenance organization. This is the type of health plan where you pay a monthly ‘premium’ (your monthly payment) to see doctors that belong to the HMO group. These doctors have an agreement with the HMO to see patients having this type of HMO coverage. You, in turn, agree to only see doctors that have this agreement with the HMO. A major issue with HMO health care plans is that you have to have your health care orchestrated through a primary care provider, or PCP. So if you have a deviated septum or fracture your nose, you must see your PCP before being ‘referred’ to a specialist. And the specialist you would see, for instance, the rhinoplasty specialist, would be a surgeon within the HMO plan. If you happen to like a different rhinoplasty specialist who does not belong to the HMO (also phrased as being ‘outside’ of the HMO), you are, unfortunately, out of luck. In very rare cases, your HMO may grant permission to be treated by a surgeon outside of the HMO plan, but this is definitely the exception rather than the rule. So in a sense, you are stuck with seeking treatment by the surgeons that are listed in your HMO.

The second major type of health insurance is a PPO plan, or preferred provider plan. In a PPO health care plan, you pay a monthly premium to have your health care covered like in an HMO. The difference is that in a PPO health care plan, you do not have to go through a PCP in order to seek care with a specialist. So you do not need the PCP ‘referral’ that is so often a source of frustration in an HMO plan. You are free to seek out any physician that takes your PPO insurance to have care and treatment administered. Nowadays most surgeons take most PPO health care plans. Meaning, these surgeons have an agreement, or contract, with the PPO to treat their patients. These surgeons are labeled as being ‘in network’ since they belong to the network of doctors that have the agreement with the PPO. There are, however, some surgeons who are not contracted with these particular PPO plans. These surgeons are considered ‘out of network’ since they do not have any formal agreements with the PPO. When it comes to health care coverage, you will be covered more (meaning pay less) by having your care with a network PPO physician. If you go out of network, you will still have some degree of health care coverage. But you will pay more out of pocket to see the out of network versus the in network surgeon. So make sure you clarify in advance of your visit whether or not your chosen surgeon is in network with the PPO plan. This could translate into a significant cost savings for you and your family when it comes to nasal surgery.

Now there are a variety of other health insurance plans that fall somewhere in between an HMO and PPO plan, but I could not do it justice to try and explain all of the nuances here. The major differences are really between HMOs and PPOs. Keep in mind that it is ultimately the patient’s responsibility to understand their own health insurance coverage. So read your policy very carefully and if you have any questions, make sure you contact your health plan representative directly.

Of note, I personally do not belong to any HMOs. But I am in network with a number of PPOs when it comes to treating patients who require nasal reconstructive surgery.

Deductibles, Co-Insurance, Out of Pocket Max & Copays

Most of the information below relates to PPO insurance plans.

A deductible is a term that refers to a threshold amount of money that a patient has to pay out of pocket before their health insurance policy kicks in. For instance, if you have a deductible of $1500 for a planned septoplasty surgery, you will be responsible for paying the $1500 before your insurance plan actually kicks in. Most deductibles are considered annual deductibles and reset each calendar year. This is often times why many patients seek to have additional surgery towards the end of the year if their deductible has already been met for that year. If they wait until January of the following year, the deductible resets and they must meet this amount once again before insurance kicks in again. Usually the higher the deductible, the lower your monthly premiums are in a similar fashion as automobile insurance. Now keep in mind that some insurance plans have different deductibles for different types of service being provided. For example, they might have a $2000 deductible for surgical services like septoplasty, but a $500 deductible for pharmacy prescription coverage.

A second term commonly used in the industry is co-insurance. Co-insurance refers to the amount of money, based on a percentage (not a fixed amount), that you are responsible for paying for each medical bill submitted by your surgeon. For example, a common co-insurance is what they call ’80/20′ where the insurance company pays 80% of the medical bill and the patient pays 20% of the amount. Co-insurance applies to medical bills that are above and beyond your deductible amount and simply outlines how the patient and insurance company will share the bills up to the out of pocket maximum.

The out of pocket maximum, or cap, is a certain dollar amount that you have to pay before your insurance plan begins to pay 100% of your medical bills. Expenses that can be applied to your out of pocket max each year include your deductible and co-insurance that may have been paid. Usually, copays (see below) and monthly premiums do not apply to the out of pocket max.

Copay refers to a fixed amount of money that is paid by the patient every time they seek care or services. For example, if your PPO plan has a $30 copay, you are responsible for paying this amount of money every visit to the doctor irregardless of whether or not you have met your deductible and/or co-insurance.

Types of Nose Surgery Covered By Health Insurance

Now that we have reviewed some of the financial terms used in the insurance industry, we can begin to focus on the types of nose surgery that are covered by health insurance.

In general, health insurance typically will provide coverage for medical conditions that adversely impact nasal function and cannot be readily treated with medication. The most common problems that fit this description include a deviated nasal septum, enlarged or overactive turbinates, nasal valve stenosis (or narrowing), and nasal fractures (broken nose). However, just because you are diagnosed with one or several of these conditions does not necessarily mean that you are automatically eligible to have surgery paid for by your insurance. You must first consult with a surgical specialist in this area – usually this is a board certified otolaryngologist (also known as an ENT or head and neck surgeon) or facial plastic surgeon. I happen to be board certified in both surgical subspecialties, which makes me uniquely qualified to evaluate and treat these type of conditions related to the nose. Once a qualified surgical specialist makes the diagnosis, they will then recommend a surgical treatment plan for your particular case.

Deviated Septum Surgery (Septoplasty or Septal Reconstruction)

Surgery for a deviated septum is called a septoplasty, or septal reconstruction. This surgery involves straightening the septum to address breathing problems that arise from a crooked septum. A deviated septum is something that many patients are born with and elect to have repaired as an adult because of breathing problems. Others develop a deviated septum as a result of some injury to the nose. Keep in mind that traditional septoplasty, or septum surgery, will not change the cosmetic appearance of the nose. Just because you have been diagnosed with a deviated septum and told that septoplasty surgery is needed, does not mean that your insurance will pay for you to also have a nose job done. Many patients do elect to have their nose reshaped at the same time as having septal surgery, but one can be done without the other.

To learn more about septoplasty surgery please reference our online rhinoplasty tutorial on septal reconstruction.

Enlarged Turbinate Reduction Surgery

The turbinates are normal structures inside the nose that run parallel to the nasal septum and help your nose humidify inspired air. There are actually three pairs of turbinates in the nose – the inferior, middle and superior. In most cases of nasal obstruction, it is the inferior turbinate that is the culprit. In many patients, the turbinates become enlarged, which can block the nasal airway in terms of breathing. When they do so, they can also become overactive and contribute to more nasal congestion. Topical medications, such as nasal steroid or antihistamine sprays, are the first line of treatment for this condition. If the medications do not work effectively or there are side effects from the sprays (such as nose bleeds and irritation), turbinate reduction surgery might be warranted. The turbinate reduction surgery is intended to make the turbinate structurally smaller while also reducing the activity of the turbinate so that there is less nasal congestion. This is done using one of several different techniques available out there. The most frequently used in my practice include partial resection, or removal, of the turbinate as well as cauterization of the turbinate. In a significant number of patients, enlarged turbinates can be found in conjunction with a deviated septum. When this situation occurs, these patients typically require combined turbinate reduction surgery along with septoplasty.

Nasal Valve Stenosis Surgery

Nasal valve stenosis implies a very specific condition where the nose is blocked on the inside due to narrowing of either the external or internal valve. These two critical areas inside of the nose refer to the nostril opening and the middle one-third of the nose on the inside, respectively. Surgery for external nasal valve narrowing usually involves placement of what is called a ‘batten graft,’ whereas surgery for internal valve narrowing is referred to as ‘spreader graft’ placement. Both types of nasal valve surgery are intended to help open the nose up internally to improve one’s nasal function (breathing). Your chosen rhinoplasty specialist should be able to determine whether or not you are a candidate to have this type of nasal reconstruction based on a detailed physical examination of your nose. Although nasal valve surgery is primarily intended to help improve your nasal function, in most cases there is some passive change in the appearance of the nose as a result of placement of these grafts.

Repair Of A Fractured (Broken) Nose

Repair of a fractured, or broken, nose is a very common procedure that is usually covered by your health insurance. In most cases, patients who have fractured their nose elect to have it repaired within the first two weeks of sustaining the injury. Others choose to wait months to years later before having the broken nose fixed. In a majority of patients who have a fractured or broken nose, there is some degree of visible change to the appearance of the nose. For instance, the nose can look crooked or shifted over in terms of alignment. Or the nose can appear collapsed as a result of the injury. In addition to a change in the appearance of the nose, a fracture can also cause difficulty breathing. This commonly results from a traumatic injury to the septum at the same time. The septum, which may be have been relatively straight before the injury, can be fractured and shifted over as well. This can cause a deviated septum that contributes to obstruction of the nasal passage. In this type of injury to the nose, the septum should be addressed at the same time as the fractured nose is being repaired.

Getting Insurance To Cover Your Nose Surgery

Once your nose specialist has properly diagnosed you with a certain condition that warrants surgery, they typically need to communicate this information to your health insurance carrier. Most nose specialists will write up a letter summarizing their findings and recommendations.

Every diagnosis (for example, deviated nasal septum) has what is called an ICD code. In the medical insurance industry, these ICD codes correspond to a specific diagnosis. For a deviated septum, for instance, this is 802.0. If you have more than one diagnosis, an ICD code has to be submitted for each one.

Every procedure (for example, septoplasty) has what is called a CPT code. In medical industry jargon, a CPT code corresponds to a specific procedure that is being performed. For instance, the CPT code for a septoplasty, or septal reconstruction, is 30520. Like the diagnoses codes, each proposed procedure requires a specific CPT code. The CPT codes are of more interest to the health insurance company since these codes determine what is being paid out to the surgeon, anesthesiologist and surgery center.

The ICD and CPT codes are sent to your insurance company for what is called preauthorization. The preauthorization process is a requirement of your insurance company before you have surgery. It is sort of like them giving permission to your surgeon to perform the procedures that are being recommended. I say sort of because, unfortunately, the preauthorization process is not a guarantee that all the procedures will indeed be covered by your insurance carrier. Now not all surgical procedures require preauthorization, but it is always a good idea to submit all the codes being performed so your insurance company is well informed of what is going on with your care. A denial of coverage means that your insurance company is denying you coverage to have that particular procedure or combination of procedures performed. Fortunately, you have an option to appeal this decision if there is a denial.

Explanation of Benefits (EOB)

Once your surgery has been completed, your surgeon, anesthesiologist and surgery center (also known as the facility fee) will submit bills to your insurance company for payment. After processing these, your insurance company will make payment individually to the surgeon, anesthesiologist and facility. A copy of this payment will be sent to you as well in what is called an explanation of benefits, or EOB. This usually outlines what was billed to your insurance company, what your insurance is going to pay out, and your financial responsibility.

In most cases, patients are quite surprised at how high the fees are for the surgeon, anesthesiologist and facility. But before you get too excited, these dollar amounts are hardly ever paid out to the respective parties involved. In fact, the surgeon, anesthesiologist and facility are typically paid only a fraction of the fees that were requested. Rarely are payments anywhere near what was billed to your insurance company.

What About Cosmetic Nose Reshaping Done At The Same Time?

There are quite a number of patients who choose to have cosmetic reshaping of the nose, or cosmetic rhinoplasty, at the same time as functional nose surgery. There is an advantage in doing so since you will already be under an anesthetic and you can combine the healing process into one recovery period. But it is real important to understand that any reshaping of the nose done for strictly cosmetic reasons will not be covered by your health insurance. And despite paying for the cosmetic rhinoplasty portion, you will still be financially responsible for any and all deductibles, co-insurance, and copays that arise from the functional nose surgery. Meaning, any out of pocket money you pay for the cosmetic rhinoplasty cannot be applied to any of the fees that are due from your insurance company.

#### Jeuveau Injections
Jeuveau Injections at Hilinski Medspa: A Modern Alternative for Smooth, Youthful Skin

Looking for an advanced non-surgical solution to treat frown lines and other wrinkles in San Diego or La Jolla? Dr. John Hilinski is proud to offer Jeuveau – a next-generation neuromodulator injection – to help you achieve smoother, younger-looking skin. Jeuveau (often nicknamed “Newtox”) is one of the newest FDA-approved options for wrinkle reduction and works similarly to Botox®. When administered by expert injectors like Dr. Hilinski and his RN, Jeuveau can deliver natural-looking, refreshed results without surgery or downtime. At Hilinski Medspa in San Diego, Dr. Hilinski and his skilled team provide personalized Jeuveau treatments, ensuring the highest quality care and outcomes for patients from San Diego, La Jolla, and surrounding areas.

Why Choose Jeuveau at Hilinski Medspa?

Jeuveau is a simple, office-based procedure that can smooth fine lines and wrinkles, providing fast results with little to no downtime. Dr. Hilinski, a double board-certified facial plastic surgeon, leverages his expertise in facial anatomy to perform precise Jeuveau injections that avoid the unwanted “frozen” look. This meticulous approach ensures you achieve a natural-looking rejuvenation, so you’ll appear refreshed but never overdone.

How Does Jeuveau Work?

As we age, repetitive facial movements like frowning or squinting contribute to the formation of dynamic wrinkles. Jeuveau works by temporarily relaxing the underlying muscles, softening lines and creases. The injectable contains a purified form of botulinum toxin type A that blocks the nerve signals responsible for muscle contractions.

Jeuveau treatment takes only about 10 minutes and involves tiny injections with a fine needle. Most patients report minimal discomfort, and a topical numbing cream can be used if needed. Jeuveau was developed exclusively for aesthetic use and is manufactured using a modern purification process, which may contribute to its quick onset and reliable performance.

What to Expect After Jeuveau Injections

To maintain optimal results, we usually recommend follow-up treatments 3–4 times per year.

Jeuveau vs. Botox: What's the Difference?

While Jeuveau and Botox are both neuromodulators using botulinum toxin type A, there are a few distinctions:

During your consultation, Dr. Hilinski will help determine which injectable is best suited to your individual goals.

Common Treatment Areas for Jeuveau

Jeuveau is ideal for treating dynamic wrinkles caused by facial expressions, including:

Frown Lines (Between the Eyebrows)

Forehead Lines

Crow’s Feet (Outer Corners of the Eyes)

Bunny Lines (Sides of the Nose)

Lip Lines and Chin Dimples (Off-label)

Benefits of Jeuveau

Smooths fine lines and wrinkles

Non-surgical, no incisions or scars

Minimal discomfort and no downtime

Natural-looking results with preserved facial expressions

Fast treatment and quick results

High patient satisfaction and repeat use

Who Is a Candidate for Jeuveau?

Jeuveau is a great option for adults in good general health who want to reduce visible signs of aging without surgery. Ideal candidates are:

Realistic about temporary results (3–4 months on average)

Bothered by moderate facial wrinkles

Seeking a quick, minimally invasive solution

Hoping to avoid downtime or surgical procedures

Not currently pregnant or breastfeeding

FAQs About Jeuveau

Schedule a Jeuveau Consultation in San Diego or La Jolla

If you're ready to smooth away wrinkles and refresh your appearance without surgery, Jeuveau may be the perfect solution. Contact Hilinski Medspa today to schedule your consultation with Dr. Hilinski and discover how this advanced treatment can help you look naturally youthful and confident.

We proudly serve patients throughout San Diego, La Jolla, and the surrounding Southern California communities. Call our office or request your appointment online – and take the next step toward smoother skin and a rejuvenated you.

#### Keloid Removal
Keloid Removal with Dr. John Hilinski: Expert Treatment for Keloid Scars in San Diego

Keloids are raised, thickened scars that form as a result of abnormal healing after an injury, surgery, or piercing. These scars can grow larger than the original wound and can be itchy, painful, or cosmetically unappealing. Dr. John Hilinski, a leading facial plastic surgeon in San Diego, offers expert keloid removal procedures to help patients achieve smoother, more natural-looking skin. With advanced techniques in scar management and reconstruction, Dr. Hilinski can effectively treat keloids and minimize their recurrence.

What Are Keloids?

Keloids are a type of excessive scar tissue that forms at the site of a skin injury. Unlike normal scars, keloids extend beyond the boundaries of the original wound and can continue to grow over time. They appear as raised, thick, and often darker-colored areas on the skin. Keloids can occur anywhere on the body but are most common on the earlobes, neck, chest, shoulders, and back.

Common Causes of Keloids:

Surgical incisions

Traumatic injuries

Acne scars

Piercings, particularly on the ears

Vaccination sites

Burns

Keloids are more common in individuals with darker skin tones, though anyone can develop them. They can also run in families, suggesting a genetic predisposition.

Benefits of Keloid Removal Surgery

Improved Appearance

Keloid removal can dramatically improve the cosmetic appearance of affected areas by reducing the size and thickness of the scar.

Relief from Discomfort

Many keloids cause itching, pain, or sensitivity, which can be alleviated through surgical removal.

Prevention of Further Growth

Removing keloids helps prevent them from growing larger or becoming more uncomfortable.

Minimized Recurrence

Dr. Hilinski uses advanced techniques to reduce the risk of keloid recurrence after removal.

Keloid Removal Procedure

Keloid removal involves carefully excising the keloid scar to restore a more natural skin contour. Depending on the size and location of the keloid, the procedure may involve several different techniques, including surgical excision, corticosteroid injections, laser therapy, or a combination of these treatments.

Keloid Removal: FAQ

Schedule a Consultation with Dr. Hilinski

If you are struggling with the appearance or discomfort of keloids, Dr. John Hilinski, San Diego's expert in keloid removal, can help. Schedule a consultation today to learn more about your treatment options and how keloid removal can help restore smooth, natural-looking skin. Contact us now to get started on your journey toward keloid-free skin.

#### Large Gauge Repair Case Study
This is another great example of what can be done to correct a large gauge earring defect. This case example focuses on a very pleasant young lady from San Diego, CA who desired to have her earlobes reshaped after having them dilated with gauge earrings. Like many other gauge earring patients, she simply got to the point where she wanted to restore the natural earlobe size and contour.

Gauge Earring Clinical Presentation

Looking at this patient’s left earlobe you can see that she has a rather sizable residual defect from the gauge earrings used. In fact, you can see very clearly that her earlobe has been stretched out quite a distance. Shown in the adjacent photo is an approximate size of the gauge that ultimately creates this size of earlobe defect. Once removed, you can see that the defect created by the gauge results in an earlobe that simply looks as if it is hanging off of the ear. In many cases, the hole in the earlobe will shrink down in size after the gauge has been removed for some time. Unfortunately, it will never close completely on its own and usually will leave a sizable enough defect that necessitates surgical repair of the earlobe.

This type of gauge earring defect is classified as being large in size. In my cosmetic ear surgery practice, I have seen many gauge earring defects that were smaller and others that were even larger in size. This particular patient’s gauge earring defect is shown below in this series that visually demonstrates the wide range of earlobe defects that I encounter regularly in my San Diego practice.

What gauge earring patients need to understand is that not all earlobe defects are repaired in the same manner. Smaller gauge earring defects require certain techniques while larger gauge defects necessitate different methods to be employed. For example, in cases like this large gauge earring defect, much of the stretched earlobe skin is removed in the surgical repair process. In cases of smaller gauge earring defects, the earlobe tissue is simply rearranged without removing much skin.

However, the goal is the same in every gauge earring defect procedure – to restore a more natural looking earlobe.

Large Gauge Earlobe Repair

In this particular case example, the gauge earlobe defect was repaired under local anesthesia. Meaning, the patient did not require anything more than a lidocaine injection in the ear while remaining awake throughout the procedure. Gauge earring patients have the option of undergoing a twilight anesthesia, but this is typically not necessary and is more expensive. Once the ear is numbed, there is really no discomfort with the operation. It is essentially like going to the dentist.

When dealing with a large amount of excess skin from gauge earring use it is necessary to remove the redundant, stretched tissue in the process of re-creating a new earlobe. The trick is to figure out what skin needs to be removed and what remaining skin is going to be used to shape the earlobe.

The adjacent photo diagram outlines one method I like to use to repair large gauge earring defects. I have also included the actual intraoperative photo to help you better understand how the skin was cut and rearranged.

On the left side of the photo you can see the gauge defect with colored markings showing the planned incisions. The red shaded area corresponds to the skin that was removed from the inner lining of the gauge defect. This is required in order to allow the hole to close up properly. The blue triangular shaped area represents a wedge of skin that is removed. The earlobe is then transected (cut across) along the yellow line.

In this process, the cut edges of the red shaded area are brought together as seen on the right side of the adjacent photo. At this point in the operation you can easily see how much excess skin there is from the tissue rearrangement. The green line indicates where additional transection is done to remove most of the excess skin. Additional incremental cuts are then made to remove the residual skin to the point where a natural earlobe contour is achieved. Fine sutures (stitches) are placed under the skin to provide added stability to the earlobe. Even finer sutures are used to bring the edges of the superficial skin layer together.

Gauge Earring Repair Results

This first photo series below actually includes the appearance of this patient’s ear one week out from gauge earring defect surgery. I included this photo because many gauge earring defect patients ask what their ears will look like in the early recovery period. If you look closely, the one week photo demonstrates residual swelling and fullness along the incision lines. But, overall, her earlobes already look much better in terms of size and shape. And she certainly appears publicly presentable even at one week out from gauge earring defect correction. Her one year photo on the right side below shows a well-healed earlobe that simply looks natural – as if she never had a gauge earring defect.

Final Gauge Earring Repair Results

This patient’s final results at one year out from gauge earring defect repair are shown below. As you can see from the various angles, her earlobes now appear quite natural with very little evidence of her ever having them previously stretched.

#### Laser Hair Removal
Laser Hair Removal at Hilinski Medspa

Are you tired of unwanted hair and seeking a long-term solution for smooth, hair-free skin? At Hilinski Medspa in San Diego, we offer advanced laser hair removal treatments designed to reduce hair growth and leave you with silky, smooth skin. Overseen by Dr. John Hilinski, a board-certified facial plastic surgeon, our medspa is dedicated to providing personalized care and superior results. Whether it's the face, neck, legs, or bikini line, laser hair removal is an effective and non-surgical solution to help you feel more confident.

What Is Laser Hair Removal?

Laser hair removal is a non-invasive treatment that uses a sophisticated laser to target and reduce unwanted hair. At Hilinski Medspa, we utilize an 810-nanometer diode laser, one of the most effective devices for this procedure. With its ability to deliver up to 10 pulses per second, this laser technology provides precise and efficient results, helping patients achieve long-term hair reduction.

Laser hair removal is among the top five most requested cosmetic procedures due to its ability to reduce the time and hassle of constantly shaving or waxing.

How Does Laser Hair Removal Work?

To understand how laser hair removal works, it’s essential to know the basics of hair growth. Hair grows in cycles: anagen (active growing), catagen (transitional), and telogen (resting). Laser hair removal targets the melanin (pigment) in the hair follicle during the active growth phase. The laser’s light energy is absorbed by the melanin, heating the follicle and ultimately destroying it to inhibit future hair growth.

However, since hair grows in cycles, not all hair follicles are affected in a single session. This is why multiple laser treatments are necessary to achieve optimal results.

Benefits of Laser Hair Removal

Laser hair removal offers numerous benefits, including:

Is Laser Hair Removal Permanent?

While some patients experience permanent hair loss after laser hair removal, others may see partial regrowth. However, regrowth is usually finer, lighter, and less noticeable. With regular sessions, most patients enjoy long-term hair reduction lasting several years.

Laser Hair Removal Treatment: What to Expect

Before your treatment, you'll be advised to shave the treatment area either the night before or the morning of your appointment. This helps to ensure that the laser energy targets the hair follicle rather than surface hair. Additionally, it's recommended that you avoid sun exposure for two weeks prior to your treatment, as tanned skin can interfere with the laser's precision.

During your treatment, you may feel slight discomfort, but our advanced technology makes the procedure well-tolerated by most patients. Sessions typically last anywhere from 15 to 60 minutes, depending on the size of the treatment area.

How Many Laser Hair Removal Treatments Will I Need?

Since hair grows in cycles, multiple treatment sessions are needed to achieve the best results. Most patients require 6 to 10 sessions, spaced several weeks apart, to ensure that all hair follicles are targeted during their active growth phase.

Laser Hair Removal Costs

When considering the costs of laser hair removal, it's essential to compare it to the long-term expense of shaving or waxing. For example, frequent bikini waxing over 10 years could cost thousands of dollars, while laser hair removal offers a more permanent solution for a fraction of that cost.

The cost of laser hair removal will vary depending on the treatment area. Smaller areas like the bikini line or face are generally more affordable, while larger areas like the back or legs may require more sessions and a higher investment.

FAQs: Laser Hair Removal

Contact Hilinski Medspa to Schedule an Appointment

At Hilinski Medspa, we are committed to helping you achieve smooth, hair-free skin with our advanced laser hair removal treatments. Contact our San Diego office today to schedule a consultation with Dr. John Hilinski and learn more about how laser hair removal can help you achieve your aesthetic goals.

#### Laser Tattoo Removal
Laser Tattoo Removal in San Diego at Hilinski Medspa

At Hilinski Medspa, we offer safe and effective laser tattoo removal for those looking to remove unwanted tattoos. Overseen by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, our San Diego medspa utilizes cutting-edge technology to help patients fade or completely erase tattoos. Whether you're experiencing tattoo regret or simply looking to clear your skin, our team can provide expert care using the latest laser technology.

Why Get Laser Tattoo Removal?

Tattoos have become increasingly popular, with over one-third of Americans between 18 and 40 having at least one tattoo. However, tattoo regret is also common, and many people seek ways to remove unwanted ink. The most effective method for tattoo removal is laser technology, which targets the pigment in the skin, breaking it down for your body to naturally eliminate.

At Hilinski Medspa, we understand that tattoos are highly personal, and so is the decision to remove them. Our team provides personalized care to ensure you achieve the best possible results with minimal discomfort.

Which Laser is Best for Tattoo Removal?

We utilize the Q-switched YAG/KTP laser, a gold standard in the tattoo removal industry. This advanced laser system uses dual wavelengths--1064 nanometers for darker inks and 532 nanometers for brighter colors--allowing us to treat a wide variety of tattoo colors and designs. Dr. Hilinski and his expert team ensure that each session is tailored to your specific tattoo to maximize results and minimize side effects.

How Does Laser Tattoo Removal Work?

The laser targets the ink pigments in your tattoo, delivering pulses of light that break the ink into tiny fragments. These fragments are then absorbed and eliminated by your body’s immune system over time. As the laser breaks down the tattoo, the ink gradually fades with each session. This method is highly effective for a wide range of tattoo styles, sizes, and colors.

What to Expect After Your Laser Tattoo Removal Session

Immediately following your laser tattoo removal session, your skin may appear frosted or white, a temporary effect that lasts several minutes. You may also experience redness, swelling, and mild tenderness for a few days. Blisters can form within 24 hours, which is normal. Avoid picking at any blisters or scabs, as this can hinder healing. Full healing usually occurs within 7-10 days.

To promote healing, we recommend keeping the treated area moisturized with Aquaphor or Vaseline and avoiding sun exposure.

How Many Tattoo Removal Treatments Will I Need?

The number of laser tattoo removal sessions required depends on several factors, including the tattoo's age, size, depth, and color. Simpler tattoos with darker ink may fade after 2-3 sessions, while more complex, professional tattoos may require 7-10 sessions for full removal. During your consultation, Dr. Hilinski will evaluate your tattoo and provide an estimated treatment plan.

Interval Between Laser Tattoo Removal Sessions

Since your body needs time to absorb and eliminate the fragmented ink, it’s essential to space your laser tattoo removal sessions 6-8 weeks apart. This interval allows the skin to heal and ensures the best results.

The Describe® Patch for Faster Laser Tattoo Removal

At Hilinski Medspa, we offer the Describe® PFD Patch to accelerate the tattoo removal process. This innovative patch allows for multiple laser passes during a single session, speeding up the removal process and helping the laser penetrate deeper into the skin. Additionally, the Describe® Patch helps reduce discomfort and inflammation, making the entire experience more comfortable for patients.

Costs of Laser Tattoo Removal

Tattoo removal can be more expensive than the initial tattooing process due to the number of sessions required. However, our team will provide a detailed cost breakdown based on your tattoo and the anticipated number of treatments.

FAQs: Laser Tattoo Removal in San Diego

Contact Hilinski Medspa to Schedule a Consultation

For expert laser tattoo removal in San Diego, schedule a consultation at Hilinski Medspa today. Led by Dr. John Hilinski, a highly experienced and board-certified facial plastic surgeon, we provide safe, effective tattoo removal to help you restore your skin. Contact us to learn more or to book your appointment!

#### Lasers
Laser Skin Treatments at Hilinski Medspa

At Hilinski Medspa in San Diego, we offer a range of advanced laser skin treatments designed to rejuvenate and enhance your skin. Led by renowned board-certified facial plastic surgeon Dr. John Hilinski, our medspa provides personalized care and cutting-edge technologies to help you achieve smoother, clearer, and more youthful skin. Whether you're looking to target wrinkles, remove unwanted hair, or improve skin texture, our laser treatments can deliver stunning results with minimal downtime.

Why Choose Hilinski Medspa for Laser Treatments?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Benefits of Laser Skin Treatments

Minimally Invasive

Laser treatments provide a non-surgical option to address skin concerns such as fine lines, pigmentation, acne scars, and unwanted hair.

Precision Targeting

Our lasers can precisely target specific areas of the skin for customized treatment plans.

Quick Recovery

Laser treatments typically involve minimal downtime, allowing patients to return to their regular activities quickly.

Versatile Solutions

We offer a variety of laser options to address a wide range of skin conditions, from hair removal to vein treatment.

Laser Skin Treatment Options at Hilinski Medspa

We offer a variety of laser procedures to meet your specific aesthetic needs. Our laser treatments include:

Personalized Laser Treatment Plans

At Hilinski Medspa, we understand that every patient has unique skin concerns. During your consultation, Dr. Hilinski and our skilled team will assess your skin and recommend the best laser treatment to achieve your desired results. Our focus is on delivering high-quality care in a relaxing, comfortable environment, ensuring that you leave our medspa looking and feeling your best.

Schedule a Consultation

If you're interested in achieving smoother, clearer skin with our laser treatments, schedule a consultation at Hilinski Medspa. Our expert team is here to guide you through the process, answer your questions, and customize a treatment plan that suits your individual goals.

Take the first step towards rejuvenated skin today--contact us to book your appointment

#### Lengthening a Short Nose
This young lady from outside of San Diego, CA desired to have a revision rhinoplasty following prior surgery by another plastic surgeon. Her main concern was in the region of the nasal tip where she thought her tip was too ‘piggy’ or turned up. Some people refer to this type of nose as also being too short since it is lacking proper length as measured from between the eyes down to the nasal tip. Others simply say they don’t like how much of the nostril opening they can see – also called excess nostril show by rhinoplasty surgeons. In addition, she was unhappy with the asymmetry between the two sides of her nasal tip. Furthermore, she felt as if her nasal tip stuck out too far from the plane of her face – a condition we call over-projection of the nasal tip.

Lengthening the Short Nose

She took the effort to drive to San Diego to consult with Dr. Hilinski given his nationwide reputation as being one of the best revision rhinoplasty experts around. Her skin was classified as being a bit thicker – consistent with her ethnic background and not too different from many of Dr. Hilinski’s ethnic rhinoplasty patients. Fortunately, her skin was considered amenable to making the desired changes to lengthen the overall shape of the nose – while also deprojecting the tip (bringing it back closer to the face).

An open rhinoplasty approach was chosen because it offered Dr. Hilinski maximum exposure to reshape the cartilage while doing very precise cartilage grafting. Fortunately for her, there was a sufficient amount of septal cartilage still in her nose that precluded having to look elsewhere for a source of cartilage grafting.

Her actual rhinoplasty diagram is shown here, which is a common way for rhinoplasty specialists to show more diagrammatically what specific maneuvers were performed during the surgery. In her case, this included:

Reduction of her bridge height

Breaking of the nasal bones (osteotomies)

Septal cartilage harvesting for grafting purposes

Complete tip reshaping including grafting

Placement of a caudal septal extension graft

The last maneuver on the list, placement of a caudal septal extension graft, is a powerful tool for some rhinoplasty experts that is key in helping to lengthen a nose. This is indicated in the diagram as CSE. In concept, a caudal extension graft is a piece of cartilage that is carefully sewn to the native septum so that it extends out toward the upper lip. In doing so, it allows the rhinoplasty surgeon to move the nasal tip down into a new position. Essentially, this adds desired and needed length to the nose and helps correct the short (pig) nose deformity.

Short Nose Correction

Here are her actual before and after photos showing an overall stable cosmetic improvement in the nose. As you can readily see, her nose has been lengthened very nicely thanks to the use of the caudal septal extension graft. The tip grafting gave her a beautiful new, more symmetrical nasal tip shape. This can even be appreciated on the oblique (45 degree angle) view where her tip no longer appears as irregular. You will also note how there is much less nostril show following the revision rhinoplasty. And on the side view, you can see how her tip has been lengthened as well as deprojected.

#### Links
URL: https://www.drhilinski.com/links

#### Lip Enhancement
Lip Enhancement in San Diego at Hilinski Medspa

As we age, our lips naturally lose volume, leading to thinner, less defined contours that can affect the overall balance of the face. This can result in an older appearance or even give the unintended impression of anger or displeasure. Fortunately, Hilinski Medspa offers lip enhancement treatments designed to restore the natural fullness and shape of your lips, giving you a rejuvenated, youthful look.

Under the care of Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, you can achieve natural-looking, fuller lips through advanced lip augmentation techniques. Dr. Hilinski's expertise in facial aesthetics ensures that your lip enhancement treatment is customized to meet your individual goals while maintaining balance and harmony with your facial features.

What is Lip Enhancement?

Lip enhancement, also known as lip augmentation, is a cosmetic procedure that adds volume, definition, and shape to the lips. At Hilinski Medspa, we offer temporary lip enhancement using dermal filler injectables like Restylane®. This procedure is quick, minimally invasive, and provides patients with immediate results, creating fuller, plumper lips that still look natural.

Temporary Lip Enhancement with Dermal Fillers

Temporary lip enhancement is a popular option for patients looking for a non-surgical solution to thin lips. Using Restylane®, a hyaluronic acid-based dermal filler, Dr. Hilinski carefully injects the filler into targeted areas of the lips to add volume and improve shape.

The procedure typically takes just a few minutes and can be done comfortably in an office visit. While some patients opt for a topical anesthetic to minimize any discomfort, most find the procedure very tolerable. Results are visible immediately and can last for six to nine months, after which you can return for follow-up treatments to maintain your desired look.

Why Choose Dr. Hilinski for Lip Enhancement?

When it comes to achieving natural and beautiful lip augmentation results, experience matters. Dr. John Hilinski is a board-certified facial plastic surgeon with extensive expertise in cosmetic facial treatments. With advanced training from Harvard Medical School and a specialized focus in facial plastic and reconstructive surgery, Dr. Hilinski has an unparalleled understanding of facial anatomy. This expertise ensures that your lip enhancement procedure will be performed with precision and care, resulting in subtle, yet impactful improvements that complement your unique facial features.

Dr. Hilinski’s approach to lip augmentation is rooted in creating balanced, harmonious results. His artistic eye, combined with years of experience in non-surgical facial rejuvenation, allows him to enhance your lips while ensuring they look proportional and natural.

Lip Enhancement FAQs

Call for a Consultation for Lip Enhancement at Hilinski Medspa

For fuller, more youthful lips, Hilinski Medspa in San Diego offers expert lip enhancement treatments. By choosing Hilinski Medspa, you'll benefit from the expertise of Dr. John Hilinski, a board-certified facial plastic surgeon with a track record of delivering stunning, natural results. His personalized approach ensures that each treatment plan is customized to meet your specific goals, ensuring that you receive the most effective care possible. To schedule a consultation, contact our office today!

#### Lip Injections
Lip Injections with Dr. John Hilinski: Enhance Your Natural Beauty

Lip injections are one of the most popular cosmetic treatments for individuals seeking to enhance the fullness and shape of their lips. Whether you're looking to add volume, improve lip symmetry, or achieve a more defined lip contour, Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, offers expert lip injection treatments tailored to your unique aesthetic goals. With years of experience in facial plastic surgery, Dr. Hilinski is renowned for providing natural-looking results that enhance your beauty without overdoing the volume.

Why Consider Lip Injections?

Lip injections can provide numerous cosmetic benefits, including:

Enhanced lip volume for a fuller, more youthful appearance.

Improved lip symmetry and definition.

Minimization of fine lines around the lips.

Natural-looking results that complement your facial features.

For patients who feel their lips have thinned with age or who naturally have smaller lips, lip injections offer a non-surgical solution to achieve a more balanced and attractive appearance.

Lip Injections with Dr. John Hilinski

Dr. John Hilinski is a highly respected, double board-certified facial plastic surgeon with extensive experience in facial rejuvenation and cosmetic procedures. Having trained at Harvard Medical School and completed advanced fellowship training in facial plastic surgery, Dr. Hilinski is a true expert in facial aesthetics. He is dedicated to providing individualized treatment plans and using the latest techniques to ensure optimal results for his patients. Whether you're seeking a subtle enhancement or a more dramatic change, Dr. Hilinski takes a personalized approach to help you achieve your desired outcome.

What Are Lip Injections?

Lip injections are performed using dermal fillers, typically hyaluronic acid-based fillers like JUVÉDERM®, Restylane®, and Belotero Balance®. These fillers are injected into the lips to provide added volume, shape, and definition. Hyaluronic acid is a naturally occurring substance in the body that helps to hydrate and plump the skin, making it an ideal choice for enhancing the lips.

During the procedure, Dr. Hilinski will carefully inject the filler into targeted areas of the lips, shaping and contouring them to meet your specific goals. The process is quick, minimally invasive, and requires little to no downtime.

Benefits of Lip Injections

What to Expect from the Procedure

Lip injections are performed in the comfort of Dr. Hilinski's San Diego office. The procedure typically begins with a consultation, where Dr. Hilinski will assess your lips and discuss your aesthetic goals. A numbing cream or local anesthesia may be applied to ensure your comfort during the injections.

Using fine needles, the dermal filler is then injected into specific areas of the lips to enhance volume, define the lip borders, and improve symmetry. The procedure is relatively quick, often taking 15 to 30 minutes.

After the treatment, you may experience mild swelling or bruising, which usually subsides within a few days. The final results will become visible as the swelling goes down, leaving you with beautifully enhanced lips.

Recovery and Results

After receiving lip injections, you may experience mild swelling, bruising, or tenderness around the injection sites. These side effects typically resolve within a few days. During this time, it's recommended to avoid strenuous activity and refrain from applying pressure to the lips.

Most patients notice immediate improvements in lip volume and shape, with the full results becoming apparent once the swelling subsides. Results from lip injections can last between six to twelve months, after which you may choose to schedule follow-up treatments to maintain your enhanced appearance.

Lip Injection FAQs

Schedule Your Lip Injection Consultation

If you're ready to enhance your lips with natural-looking results, schedule a consultation with Dr. John Hilinski. With years of experience in facial aesthetics, Dr. Hilinski can help you achieve the beautiful, full lips you've always desired. Contact our San Diego office today to get started.

#### Lip Reconstruction
Lip Reconstruction Surgery with Dr. John Hilinski

Lip reconstruction is a highly specialized procedure designed to restore both the function and aesthetics of the lips. As a critical feature of the face, the lips play an essential role in speech, eating, and overall facial harmony. Whether due to trauma, cancer removal, congenital deformities, or previous unsuccessful surgeries, lip reconstruction can provide patients with a natural, functional, and aesthetically pleasing outcome.

Dr. John Hilinski, a renowned board-certified facial plastic surgeon in San Diego, specializes in complex reconstructive surgeries. With advanced training and extensive experience in facial plastic and reconstructive surgery, Dr. Hilinski is dedicated to delivering the highest standard of care to patients seeking lip reconstruction.

Why Lip Reconstruction Surgery May Be Needed

Lip reconstruction surgery may be necessary for a variety of reasons:

Lip Reconstruction Surgery with Dr. John Hilinski

Dr. Hilinski employs a combination of surgical techniques to rebuild the lips, depending on the extent of damage and the patient's goals. Techniques may involve tissue flaps, grafts, and delicate suturing to ensure both function and aesthetics are restored. Dr. Hilinski's meticulous attention to detail allows him to achieve highly natural-looking results while maintaining the lips' essential roles in facial expression, speaking, and eating.

The Lip Reconstruction Process

Lip Reconstruction FAQs

Schedule Your Consultation

If you are considering lip reconstruction, contact Dr. John Hilinski's San Diego office to schedule a personalized consultation. Dr. Hilinski will thoroughly evaluate your condition and provide you with a treatment plan tailored to your specific needs, ensuring optimal functional and cosmetic results.

#### Lip Reduction
Lip Reduction Surgery with Dr. John Hilinski in San Diego

Are you concerned about overly large or protrusive lips? Lip reduction surgery can help balance your facial features, improve functionality, and boost your confidence. Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, offers expert lip reduction procedures to help patients achieve a more proportional and aesthetically pleasing lip size.

What is Lip Reduction Surgery?

Lip reduction surgery is a cosmetic procedure designed to decrease the size of the upper and/or lower lips. It's often performed for patients who feel their lips are disproportionately large or cause functional issues like difficulty speaking or eating. By removing excess tissue, the procedure improves both the appearance and function of the lips.

Benefits of Lip Reduction Surgery

Who is a Candidate for Lip Reduction Surgery?

Good candidates for lip reduction surgery include:

Individuals in good overall health.

Patients with realistic expectations about their surgical outcomes.

People who feel that their lips are overly large or asymmetrical and would like a more balanced facial appearance.

What to Expect During Lip Reduction Surgery

Preparing for the Procedure

Before surgery, you will attend a consultation with Dr. Hilinski. He will review your medical history, discuss your desired outcome, and provide guidance on how to prepare for the procedure.

The Lip Reduction Procedure

Most lip reduction surgeries are performed under local anesthesia and take about one to two hours to complete. The incisions are typically made inside the mouth, allowing any scarring to remain concealed. Dr. Hilinski will remove the necessary amount of tissue from the lips and reshape them to create the desired contour. The incisions are then closed with sutures.

Recovery Process

After surgery, you can expect some swelling and tightness in the lips, which will gradually decrease over time. Applying ice packs and following post-operative instructions will help minimize discomfort. Most patients return to work within two to three days, though full recovery may take a few weeks. The stitches are usually removed seven to ten days after surgery, revealing a more refined lip appearance.

FAQ: Lip Reduction Surgery

Schedule a Consultation

If you're interested in learning more about lip reduction surgery and how it can help you achieve the aesthetic results you desire, contact Dr. John Hilinski's office today to schedule a consultation.

#### Liposuction
Facial and Neck Liposuction with Dr. John Hilinski

Liposuction, also known as liposculpture or lipoplasty, is an outpatient cosmetic body contouring procedure that targets and removes unwanted fat deposits. At Dr. John Hilinski's practice in San Diego, facial liposuction focuses on contouring the face and neck to achieve a more youthful, angular appearance. Factors such as aging and genetics can cause fat to accumulate under the chin and along the jawline, leading to a less defined facial structure. Dr. Hilinski, a board-certified plastic surgeon, utilizes advanced techniques like VASER and tumescent liposuction to provide refined results for his patients.

Benefits of Facial and Neck Liposuction

Liposuction of the face and neck offers several key benefits:

Restores more refined angles around the neck

Enhances visibility of the jawline

Reduces roundness under the chin (often referred to as a "double chin")

Improves overall facial symmetry

Candidates for Liposuction

Ideal candidates for liposuction should be in good health, have a stable body weight, and possess good skin elasticity. Liposuction is not a weight loss solution and works best for individuals with stubborn fat deposits in the face and neck. Those with poor skin elasticity may not achieve optimal results, as the skin may not “snap back” into place. In such cases, a neck lift or facelift may be recommended in combination with liposuction.

The Liposuction Procedure

Facial and neck liposuction is typically performed under general anesthesia or local anesthesia with sedation. Small incisions are made near the treatment areas, and a cannula is used to carefully remove excess fat. Unlike other body areas, facial and neck liposuction requires the removal of small, strategic amounts of fat to ensure natural-looking results.

This procedure can be performed alone or in conjunction with other facial surgeries, such as a neck lift, facelift, or chin implants. Most patients can return home the same day and will need to wear a compression garment to help the face and neck conform to their new contours.

Recovery from Liposuction

Recovery typically takes about one week, during which mild bruising and soreness may occur. A compression garment is worn to ensure proper healing, and many patients feel well enough to resume light activities within two to three days. Final results become more apparent as swelling subsides over the following weeks.

Liposuction FAQs

Schedule Your Liposuction Consultation with Dr. John Hilinski

If you are considering facial or neck liposuction to achieve a more defined, youthful appearance, scheduling a consultation with Dr. John Hilinski is the first step. During your consultation, Dr. Hilinski will evaluate your facial structure, discuss your aesthetic goals, and recommend a personalized treatment plan tailored to your specific needs. You'll have the opportunity to ask questions about the procedure, recovery, and expected results to ensure you feel confident moving forward.

To schedule your consultation with Dr. Hilinski, contact our San Diego office today. Our experienced team is here to guide you through the process and help you achieve the refined, natural-looking results you desire.

#### Lips
Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, offers a range of advanced lip plastic surgery procedures designed to enhance and reshape the lips for aesthetic and functional purposes. With his double board certification in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery, Dr. Hilinski has established himself as a leader in lip enhancement and reconstruction. Whether you're looking to achieve a fuller pout, reduce lip size, or reconstruct damaged lips, Dr. Hilinski's expertise ensures natural, balanced, and beautiful results.

Lip Plastic Surgery: Enhancing Form and Function

Lip surgery can address a variety of cosmetic concerns, from creating fuller lips to correcting lip asymmetry or reducing overly large lips. Additionally, some procedures focus on restoring the lips' function and appearance after trauma or medical conditions. Dr. Hilinski's personalized approach allows patients to achieve their desired results while maintaining a natural look that complements their facial features.

Lip Procedures Offered by Dr. John Hilinski

Whether you're looking to enhance, reduce, or reconstruct your lips, Dr. Hilinski offers a variety of lip procedures, including:

Why Choose Dr. Hilinski for Lip Surgery?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Schedule Your Lip Surgery Consultation

If you are considering a lip procedure, schedule a personalized consultation with Dr. John Hilinski to discuss your aesthetic goals and explore the best treatment options for you. Dr. Hilinski's extensive experience in lip surgery ensures that you receive the highest level of care and the best possible outcome.

#### Liquid Rhinoplasty
Liquid Rhinoplasty at Hilinski Medspa:Transform Your Nose Without Surgery

Liquid rhinoplasty, also known as non-surgical rhinoplasty, injection rhinoplasty, or a non-surgical nose job, is a revolutionary cosmetic procedure that allows patients to reshape and enhance the appearance of their nose using dermal fillers--without the need for surgery. At Hilinski Medspa, board-certified facial plastic surgeon Dr. John Hilinski performs liquid rhinoplasty with skill and precision, delivering natural-looking results with little to no downtime. This minimally invasive procedure is perfect for those seeking subtle, yet impactful, improvements to their nose without committing to surgery.

Goals of Liquid Rhinoplasty

The primary goal of liquid rhinoplasty is to improve undesirable aesthetic features of the nose by using injectable fillers. Some common issues that can be addressed include:

Humps or bumps on the bridge of the nose

A low or depressed nasal bridge

Irregularities in the nasal profile

Poor nasal tip projection or definition

Abnormal tip angulation

Asymmetry in the nose's appearance

Liquid Rhinoplasty vs. Surgical Rhinoplasty

Many patients are hesitant to undergo surgical rhinoplasty for a variety of reasons, such as surgical risks, concerns about anesthesia, extended recovery time, and the higher cost of surgery. Liquid rhinoplasty offers a less invasive alternative with many advantages, making it an appealing option for patients who want to enhance their nose without surgery.

Benefits of Liquid Rhinoplasty

Liquid rhinoplasty offers several benefits, including:

Office-based treatment

Immediate results

Customizable to each patient’s facial structure

Minimal downtime

No incisions or general anesthesia required

Minimally invasive with fewer risks

Reversible when using certain fillers (such as hyaluronic acid)

Allows patients to “test drive” a new nose shape before opting for surgery

What to Expect During Liquid Rhinoplasty

Preparing for Liquid Rhinoplasty

Before your treatment, Dr. Hilinski will meet with you for a consultation to discuss your goals and create a personalized treatment plan. To minimize the risk of bruising, it's recommended to avoid alcohol and blood-thinning medications (such as ibuprofen) for a few days prior to your procedure.

The Liquid Rhinoplasty Procedure

During the procedure, Dr. Hilinski will inject dermal fillers--typically hyaluronic acid-based fillers like Restylane or Juvederm--into precise areas of the nose to achieve the desired shape and contour. The injections are administered with very fine needles, making the process quick and relatively painless. Most patients find the experience comfortable, as the fillers contain lidocaine to numb the area. For those who are more anxious, Hilinski Medspa also offers nitrous oxide (laughing gas) to enhance relaxation during the treatment.

Types of Fillers Used in Liquid Rhinoplasty

Hyaluronic acid (HA) fillers are the most commonly used products for liquid rhinoplasty. Restylane and Juvederm are two of the most popular options due to their ability to effectively reshape soft tissue and provide natural-looking results. These fillers are also reversible, offering patients the option to dissolve the filler if necessary. While longer-lasting fillers are available, they are not as commonly used due to their irreversible nature.

Results and Longevity of Liquid Rhinoplasty

The results of liquid rhinoplasty are temporary, as the fillers are gradually absorbed by the body. Most patients enjoy their enhanced appearance for about 10-12 months, though some individuals may experience results lasting up to 18 months. When the effects of the fillers start to diminish, patients can return for a quick follow-up session to maintain their new look.

FAQ: Liquid Rhinoplasty

Schedule Your Consultation at Hilinski Medspa

If you're considering liquid rhinoplasty, contact Hilinski Medspa today to schedule a consultation with Dr. John Hilinski. Discover how non-surgical rhinoplasty can help you achieve the nose you've always wanted--without surgery.

#### Lop Ear
Lop Ear Correction with Dr. John Hilinski: Expert Ear Reconstruction in San Diego

Lop ear, also known as a constricted ear or cup ear deformity, is a congenital condition that affects the appearance of the upper helix, or the top portion of the ear. This deformity can range from mild to severe, often giving the ear a folded or compressed appearance. While many plastic surgeons offer otoplasty (ear pinning) as a solution for prominent ears, true correction of lop ear requires advanced reconstructive techniques that few surgeons specialize in.

Dr. John Hilinski, a double board-certified facial plastic surgeon, is one of the few specialists in the San Diego area who is experienced in correcting lop ear deformities. Using advanced techniques, Dr. Hilinski reshapes the ear to restore a natural and balanced appearance. His extensive experience with congenital ear anomalies ensures that each patient receives personalized treatment tailored to their specific condition.

What is Lop Ear?

Lop ear deformity occurs due to the abnormal development of the helical rim, the upper edge of the ear. The top portion of the ear folds over, giving the ear a shorter, compressed appearance. Depending on the severity of the condition, the deformity may also involve the scapha--the segment just inside the helical rim--further compressing the upper third of the ear. This results in a visibly shorter ear height, which can affect overall facial symmetry.

In cases of constricted ear deformity, the ear appears vertically shortened or collapsed, and the upper ear does not maintain its natural projection. These deformities often require reconstructive surgery to restore the ear's natural shape and size.

Lop Ear Correction

Lop ear correction is a specialized procedure aimed at repositioning and reshaping the upper helical rim, restoring the ear’s natural height and projection. If diagnosed early, some cases of lop ear can be treated non-surgically with ear molding within the first few weeks of life. However, for older children or adults, surgical correction is typically required to achieve a successful outcome.

In severe cases, where there is a significant loss of cartilage structure, rib cartilage grafts may be needed to provide additional support and framework for the ear. This ensures the ear remains structurally sound while achieving the desired shape.

Lop Ear Surgery Procedure

The specific technique used for lop ear correction depends on the extent of the deformity. Dr. Hilinski tailors each procedure to the patient's unique condition, which may involve:

Through careful reshaping of the abnormal cartilage, Dr. Hilinski is able to restore the ear's height, projection, and natural appearance.

Lop Ear Surgery FAQ

Schedule a Consultation with Dr. Hilinski

If you or your child has a lop ear deformity and would like to learn more about surgical correction options, schedule a consultation with Dr. John Hilinski, San Diego's expert in ear reconstruction. With his advanced techniques and personalized approach, Dr. Hilinski can help you achieve natural, balanced ear aesthetics that enhance your overall appearance. Contact our office today to begin your journey toward a more confident look.

#### Lop Ear Surgery with Dr. John Hilinski
Lop ear, also commonly referred to as a constricted ear or cup ear deformity, is a condition where the upper part of the ear folds forward or outward, affecting the ear’s natural contour. It’s typically present from birth and may occur in one or both ears. While the condition doesn’t impact hearing, it can influence self-esteem, particularly in children.

Otoplasty surgery alone simply cannot resolve this issue, so over the years Dr. Hilinski has developed a much more creative and technical approach to reshape these ears. We have prepared a guide to provide you with as much knowledge as possible regarding lop ear and the corrective surgery to address it, including details about its origins, the consultation process, realistic expectations and actual surgical outcomes from several of Dr. Hilinski's own patients.

CLICK TO DOWNLOAD BROCHURE

#### Lower Lip Advancement
Lower Lip Advancement Surgery with Dr. John Hilinski

Lower lip advancement, also known as a lower lip mucosal advancement, is a specialized surgical procedure designed to enhance the fullness of the lower lip using your own tissue. This advanced technique provides a permanent solution to create a more volumized, aesthetically pleasing lip without the need for injectable fillers. San Diego plastic surgeon, Dr. John Hilinski, is a board-certified expert in facial plastic surgery who specializes in lip enhancement procedures, including lower lip advancements.

What Is Lower Lip Advancement?

Lower lip mucosal advancement is a surgical procedure that uses the natural tissue in the lip to create additional volume. While injectable fillers are a common way to enhance lip fullness, lower lip advancement offers a permanent alternative. This procedure is particularly ideal for patients who are seeking long-lasting results without needing regular maintenance with dermal fillers.

How Lower Lip Advancement Works

The procedure involves a technique called a V-Y advancement flap, where the tissue on the inside lining of the lower lip (the mucosal surface) is rearranged to create a fuller lip. Here's how it works:

The result is a fuller, more defined lower lip with natural-looking contours. Because the surgery uses the body's own tissue, the results are permanent, offering a one-time solution to enhance lip volume.

Benefits of Lower Lip Advancement

Patients choose lower lip advancement for several reasons:

Permanent Volume

Unlike fillers, this procedure offers long-term fullness.

Natural Results

The use of your own tissue creates a natural look and feel.

No Maintenance

There’s no need for regular filler injections.

Hidden Incisions

All incisions are made inside the lip, meaning no visible scarring.

Lower Lip Advancement FAQ

Schedule a Consultation With Dr. John Hilinski

If you're considering permanent lower lip enhancement through lower lip advancement surgery, schedule a consultation with Dr. John Hilinski today. Dr. Hilinski will evaluate your aesthetic goals and create a customized treatment plan to achieve the fuller, natural-looking lips you desire. His expertise in facial plastic surgery ensures that you'll receive the highest level of care and the best possible results.

#### Macrotia Ear Reduction Surgery with Dr. John Hilinski
Renowned globally as one of the foremost authorities in ear reduction surgery, Dr. John Hilinski has pioneered specialized techniques to address macrotia - a condition where the ears are disproportionately large. Unlike traditional ear pinning (otoplasty), Dr. Hilinski’s innovative approach focuses on reducing the actual size of the ear by reshaping key anatomical features, often creating more balanced, natural-looking proportions. Patients from across the U.S. and worldwide travel to his San Diego practice for this highly specialized procedure, confident in his unmatched expertise and extensive gallery of successful results. 

From the first consultation, whether in-person or virtual, patients receive a personalized evaluation and realistic expectations for outcomes. The comprehensive process covers preparation, the surgical experience, and recovery, with Dr. Hilinski guiding each step to ensure comfort, safety, and satisfaction. For those seeking smaller, well-proportioned ears, his artistry and skill have transformed not only appearances but also lives.

Download our Ear Reduction Surgery brochure below to learn more about the procedure, Dr. Hilinski's expertise and to find out if you could be a candidate for ear reduction surgery. 

CLICK TO DOWNLOAD BROCHURE

#### Male Eyelid Surgery
As men age, the eyes are one of the first areas to show signs of aging. Sagging, drooping eyelids and puffiness under the eyes can create a tired, older appearance even when you're well-rested. Male eyelid surgery, or male blepharoplasty, offers a way to restore a more youthful, refreshed look by addressing these concerns. Board-certified facial plastic surgeon Dr. John Hilinski is highly experienced in performing male eyelid surgery and understands the unique goals of male patients, delivering subtle, natural-looking results that maintain your masculine features.

Why Men Choose Eyelid Surgery

For many men, aging affects the delicate skin around the eyes, leading to the development of excess skin, puffiness, and drooping eyelids. These changes can make you look tired, stressed, or older than you feel. Some men also experience vision problems due to the sagging of the upper eyelids, making this surgery necessary for both aesthetic and functional reasons.

If you've noticed:

Puffiness or bags under the eyes

Drooping upper eyelids

Vision impairment from excess skin

A tired, worn-out appearance

Male eyelid surgery might be the right solution to restore a youthful, refreshed look while maintaining a natural, masculine appearance. Dr. Hilinski tailors each procedure to meet the specific needs and preferences of his male patients, using advanced techniques that ensure minimal scarring and downtime.

The Male Eyelid Surgery Procedure

Male eyelid surgery is typically performed on the upper eyelids, lower eyelids, or both. Depending on your unique concerns, Dr. Hilinski will recommend the best approach to achieve your desired results. The procedure generally involves:

The surgery is performed on an outpatient basis, and Dr. Hilinski utilizes techniques that promote a faster recovery and minimize scarring.

Recovery from Male Eyelid Surgery

After male eyelid surgery, you can expect some swelling and bruising, which typically subsides within 1 to 2 weeks. Most patients are able to return to work within 7 to 10 days. Dr. Hilinski will provide personalized post-operative care instructions to ensure optimal healing and results. As your recovery progresses, you'll notice a rejuvenated, refreshed appearance without looking like you've had surgery.

Male Eyelid Surgery FAQs

Schedule Your Consultation

To learn more about how male eyelid surgery with Dr. John Hilinski can help you achieve a refreshed, youthful appearance, schedule a consultation today. Dr. Hilinski will discuss your goals and create a personalized plan to ensure natural-looking, masculine results.

Dr. John Hilinski is a board-certified facial plastic surgeon in San Diego specializing in male blepharoplasty. With years of experience in male facial aesthetics, Dr. Hilinski delivers customized results that enhance your appearance while maintaining your masculine features.

#### Male Facelift Surgery
Male Facelift Surgery in San Diego with Dr. John Hilinski

A male facelift is a cosmetic procedure designed to restore a youthful appearance by addressing the signs of aging in the face and neck. As men age, they may experience sagging skin, deep wrinkles, jowls, and loose skin around the jawline and neck. These signs of aging can make a person look tired and older than they feel. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in male facelift surgery, offering men a natural, refreshed look while maintaining masculine facial features.

Why Male Facelift Surgery May Be Needed

Over time, factors like genetics, gravity, stress, and sun exposure can accelerate the aging process in men. A male facelift may be needed when signs of aging, such as sagging skin, deep wrinkles, and loss of jawline definition, become prominent. Some men choose facelift surgery because non-surgical treatments no longer provide the desired results. Others opt for a facelift to enhance their self-confidence, maintain a competitive edge in their professional lives, or simply feel better about their appearance.

Dr. Hilinski recognizes the unique anatomy of the male face, including thicker skin and different facial hair patterns, and tailors each procedure to deliver natural, masculine results. His expertise in facial plastic surgery allows him to address these concerns while preserving the strength and character of male facial features.

Benefits of Male Facelift Surgery

Creates a more contoured, masculine neck and face

Restores a more youthful, refreshed appearance

Tightens loose, sagging skin

Reduces the appearance of deep wrinkles and lines

Redefines the jawline and reduces jowls

The Male Facelift Procedure

Male facelift surgery typically focuses on tightening the underlying muscles and tissues of the face while removing excess skin. The procedure can be customized to address specific concerns, such as jowls, loose skin around the neck, and deep lines along the cheeks. Incisions are carefully placed along the hairline and natural contours of the face to ensure minimal scarring and a discreet result.

Dr. Hilinski uses advanced techniques to reposition and tighten the underlying facial structure while preserving the natural masculinity of the face. This ensures that the outcome is both youthful and masculine, without the overly pulled or tight appearance sometimes associated with facelift surgery.

Recovery from Male Facelift Surgery

Most men can expect to return to their regular routine within two to three weeks after surgery, although full recovery may take several months as swelling and bruising gradually subside. Dr. Hilinski provides detailed post-operative instructions to help minimize discomfort and ensure a smooth recovery process. Follow-up appointments will monitor healing progress and ensure that results align with your expectations.

Male Facelift Surgery FAQs

Schedule Your Male Facelift Consultation

If you're considering a male facelift, contact our San Diego office to schedule a personalized consultation with Dr. John Hilinski. During your consultation, Dr. Hilinski will assess your facial structure and discuss your goals to determine if a male facelift is the right procedure for you.

Dr. Hilinski is committed to providing customized care and delivering exceptional results tailored to each patient's unique needs. Trust your facial surgery to one of San Diego's leading facial plastic surgeons.

#### Male Plastic Surgery
Male Plastic Surgery with Dr. John Hilinski

In recent years, male plastic surgery has become increasingly popular as more men seek to enhance their appearance while maintaining a natural and masculine look. San Diego's leading facial plastic surgeon, Dr. John Hilinski, offers a variety of male-specific plastic surgery procedures tailored to the unique needs and goals of men. Dr. Hilinski is double board-certified in Facial Plastic and Reconstructive Surgery and Otolaryngology-Head and Neck Surgery, making him one of the most highly qualified surgeons for male facial aesthetics. His expertise in advanced techniques ensures natural-looking results that help men look and feel their best without compromising their masculinity. 

Why Choose Dr. John Hilinski for Male Plastic Surgery?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Popular Male Plastic Surgery Procedures

Dr. Hilinski offers a wide range of male plastic surgery options designed to meet the specific aesthetic goals of men, including procedures to enhance facial balance, reduce signs of aging, and improve overall appearance. Below are some of the most common male procedures offered:

Male Facelift Surgery

For men seeking a more youthful appearance, a male facelift addresses sagging skin, deep wrinkles, and jowls while preserving a natural and masculine look.

Male Eyelid Surgery

Male blepharoplasty (eyelid surgery) helps to eliminate sagging skin and puffiness around the eyes, rejuvenating a tired, aged appearance.

Male Rhinoplasty

Male rhinoplasty is designed to improve the appearance of the nose while maintaining harmony with other facial features and preserving a strong, masculine profile.

Schedule Your Consultation

If you're considering plastic surgery and want to achieve a more refreshed, balanced, and youthful look, schedule a consultation with Dr. John Hilinski. During your visit, he will thoroughly evaluate your aesthetic concerns, discuss your goals, and create a customized treatment plan to help you look and feel your best.

#### Male Rhinoplasty
Male Rhinoplasty Surgery with Dr. John Hilinski

Male rhinoplasty, commonly known as a "nose job," is a popular cosmetic and functional surgery aimed at enhancing the appearance or improving the function of the nose. Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, specializes in male rhinoplasty procedures designed specifically for men looking to refine their nasal contours while maintaining a strong, masculine appearance. As a board-certified facial plastic surgeon, Dr. Hilinski has extensive experience in rhinoplasty and is dedicated to delivering natural-looking results that complement each patient's unique facial features.

Why Might Male Rhinoplasty Be Needed?

Men seek rhinoplasty for various reasons, ranging from cosmetic concerns to functional issues. Some men are born with nasal shapes that they feel are disproportionate to their facial features, while others have sustained injuries or experienced breathing problems that impact their quality of life. Male rhinoplasty may be needed for:

Male Rhinoplasty Procedure with Dr. Hilinski

During a male rhinoplasty consultation with Dr. Hilinski, your facial features will be carefully analyzed, and your desired outcomes will be discussed. Dr. Hilinski tailors his surgical techniques to suit the unique structure and needs of each male patient, ensuring that the results enhance your natural masculinity. Rhinoplasty is typically performed under general anesthesia and takes approximately 2-3 hours, depending on the complexity of the surgery.

Dr. Hilinski focuses on creating balance and harmony between the nose and the rest of the facial features. For patients with breathing issues, the surgery may involve correcting the septum or other internal structures to improve airflow.

Benefits of Male Rhinoplasty

Achieve facial balance by enhancing the nose's shape and size

Create a more symmetrical and masculine appearance

Improve self-confidence and overall facial harmony

Address nasal deformities caused by injury or congenital factors

Improve breathing function by addressing obstructions or a deviated septum

Male Rhinoplasty FAQs

Schedule Your Male Rhinoplasty Consultation

If you're considering male rhinoplasty for cosmetic or functional reasons, schedule a consultation with Dr. John Hilinski, one of San Diego's leading facial plastic surgeons. With his expertise, you can achieve the natural-looking results you desire while improving both appearance and function.

#### Male Rhinoplasty San Diego
This is a great example of male, ethnic rhinoplasty performed by San Diego’s leading nose job surgeon, Dr. John Hilinski. This patient consulted with Dr. Hilinski with the hopes of making his nose more defined overall. He particularly disliked the fact his nasal tip was quite bulbous and ill-defined. He also did not like the curvature along the nasal bridge and the fact his nasal tip drooped down a bit.

Yet – like so many San Diego men seeking rhinoplasty surgeons – he did not want a nose that was going to look feminized or fake on his face. This may seem obvious to most patients. But – believe it or not – there are some rhinoplasty surgeons in San Diego who still perform the same type of nose job on all patients – whether or not you are a male or female!

Skin Thickness in Rhinoplasty

The other consideration in this patient was the thickness of his skin. Being here in San Diego (and well into Orange County and Los Angeles), there are quite a few male patients with mixed ethnic backgrounds seeking rhinoplasty and nose job surgery. This includes a lot of rhinoplasty candidates who are a mix of Hispanic, Middle-eastern, and Asian backgrounds. Why does this matter? Because thicker skin is sometimes harder to deal with when it comes to cosmetic nose job surgery where you want the nose to look smaller and more defined. Thicker skin simply doesn’t want to shrink down to a new, smaller size when it comes to rhinoplasty surgery. In males with mixed ethnic backgrounds, thick skin can be particularly challenging if you are wanting to make the nose look smaller and more refined. That is why Dr. Hilinski is constantly discussing this issue in male rhinoplasty patients like this who want to have their nose made smaller in size.

Male Ethnic Rhinoplasty

Dr. Hilinski ended up performing an open septorhinoplasty on this patient. This included complete reshaping of the nasal bones – reduction of the hump deformity as well as breaking the nasal bones to narrow the bridge. In addition, Dr. Hilinski refined his nasal tip by making the underlying cartilage smaller and more triangular in shape. Fortunately, in this case, the patient’s skin shrunk wrap quite nicely over the following 1-2 years. The end result can be seen in the photos below. Overall, you can easily appreciate how he had a nice, beautiful, dramatic improvement in terms of the shape and size of his nose. But the nose still appears very natural looking for his ethnic face – without any obvious signs that he underwent a nose job.

#### Medical Malpractice Expert
Dr. John Hilinski - Medical Malpractice Expert Witness in Facial Plastic Surgery

Dr. John Hilinski is a renowned facial plastic and reconstructive surgeon with extensive experience as a medical malpractice expert witness. With over two decades of practice and an outstanding reputation in the legal and medical communities, Dr. Hilinski provides expert opinions in both medical malpractice and product liability cases. His extensive education, specialized training, and deep knowledge of facial plastic surgery make him a highly qualified and sought-after expert in these complex cases.

Why Choose Dr. John Hilinski as a Medical Malpractice Expert?

Dr. Hilinski's qualifications as a medical malpractice expert witness are rooted in his advanced education, training, and experience. His background includes:

As a San Diego-based facial plastic surgeon, Dr. Hilinski has built a highly successful practice attracting patients from around the globe. His clinical experience extends beyond patient care, as he also serves as the medical director of his AAAASF-accredited ambulatory surgery center, further enhancing his understanding of regulatory and surgical standards.

Expertise in Medical Malpractice and Product Liability

Over the years, Dr. Hilinski has earned a strong reputation within the legal community for his expertise in medical malpractice cases. He has been retained by both defense and plaintiff attorneys to provide expert testimony, depositions, and trial work. His extensive surgical experience, combined with his in-depth knowledge of the standard of care in facial plastic surgery, makes him an invaluable resource for legal professionals.

In addition to medical malpractice, Dr. Hilinski has been hired as an expert witness in product liability cases. This includes complex multi-state cases involving plastic surgery equipment and products.

Medical Board of California Consultant

Since 2010, Dr. Hilinski has served as a designated reviewer for the Medical Board of California, where he is regularly called upon to evaluate cases involving facial plastic and reconstructive surgery. His role includes reviewing physician performance, evaluating standards of care, and rendering expert opinions on cases involving plastic surgery and medical spa and ambulatory surgery center practices. To date, he has been consulted on more than 30 cases.

Retain Dr. Hilinski as an Expert Witness

If you are seeking a highly qualified medical expert in facial plastic surgery, Dr. John Hilinski is available for consultation on medical malpractice and product liability cases. His proven track record as an expert witness, combined with his deep understanding of facial plastic surgery, makes him an ideal choice for legal professionals.

To retain Dr. Hilinski as a medical expert witness, please email him at info@drhilinski.com or contact his office directly.

FAQ: Dr. Hilinski as a Medical Malpractice Expert Witness

If you're in need of a qualified medical malpractice expert witness in facial plastic surgery, Dr. John Hilinski is here to provide reliable, professional insight. Contact us today to learn more or to retain Dr. Hilinski for your case.

#### Medspa
Non-Surgical Procedures at Hilinski Medspa

At Hilinski Medspa in San Diego, we offer a comprehensive range of non-surgical cosmetic procedures designed to enhance your natural beauty and restore a youthful appearance. Whether you're looking to smooth wrinkles, add volume, or improve your skin's texture, our expert team delivers advanced, minimally invasive treatments that provide stunning, natural results with little to no downtime. Each procedure is supervised by board-certified facial plastic surgeon Dr. John Hilinski, ensuring the highest standard of care and precision.

Why Choose Hilinski Medspa?

At Hilinski Medspa, we combine cutting-edge non-surgical treatments with the expertise of a board-certified facial plastic surgeon. Dr. John Hilinski, a renowned leader in facial aesthetics, and his dedicated team ensure that every patient receives a personalized treatment plan to meet their unique goals. With a focus on natural beauty and patient comfort, we aim to help you look and feel your best.

Our skilled team includes Aesthetic Nurse Jordan Olivera, RN, who brings extensive experience in dermatology and aesthetic procedures such as neurotoxins, fillers, laser treatments, and microneedling. Her expertise and passion for helping patients achieve their aesthetic goals make her a vital part of the Hilinski Medspa team.

Non-Surgical Procedures at Hilinski Medspa:

Experience Excellence: Skilled Care, Stunning Results

At Hilinski Medspa, we pride ourselves on offering exceptional care delivered by skilled professionals. Aesthetic Nurse Jordan Olivera, RN, brings years of experience in administering treatments such as Botox, fillers, laser therapies, and microneedling. Her personalized approach ensures that each patient receives top-tier care and achieves beautiful, natural-looking results.

Aesthetic RN Services

Our experienced nurses provide a variety of aesthetic services to enhance your beauty and rejuvenate your skin. These services include:

Schedule Your Consultation

Ready to take the next step in your aesthetic journey? Schedule a consultation at Hilinski Medspa to receive a personalized treatment plan tailored to your unique beauty goals. Our team is here to help you achieve radiant, youthful results with the utmost care and expertise.

#### Meet Dr. John Hilinski
Meet Dr. John Hilinski, MD - San Diego's Expert in Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, Dr. Hilinski offers unparalleled expertise in facial plastic and reconstructive surgery. A San Diego native, Dr. Hilinski returned to his hometown after completing his world-class medical training to establish his premier practice, which focuses on rhinoplasty, facial rejuvenation, and advanced cosmetic procedures for the face, head, and neck. With a patient-centered approach and a dedication to exceptional results, Dr. Hilinski has become one of the most trusted facial plastic surgeons in the region.

Why Choose Dr. John Hilinski?

Dr. John Hilinski's extensive credentials and specialized focus in facial plastic surgery distinguish him as a leader in his field. Harvard Medical School educated and double board-certified, Dr. Hilinski brings a wealth of knowledge and precision to each procedure he performs. His exclusive focus on facial surgery ensures that patients receive expert care tailored to their unique anatomy and aesthetic goals.

Dr. Hilinski's qualifications include:

Harvard Medical School graduate

Completed a General Surgery internship and Head and Neck Surgery residency at UCSD Medical Center

Fellowship-trained in Facial Plastic & Reconstructive Surgery under world-renowned surgeon Dr. Dean M. Toriumi at the University of Illinois, Chicago

Double board-certified in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery

Expertise in Facial Plastic Surgery

Dr. Hilinski's expertise extends to both cosmetic and reconstructive procedures, including:

Rhinoplasty and revision rhinoplasty

Facelift surgery

Eyelid surgery (blepharoplasty)

Non-surgical treatments such as Botox and dermal fillers

As a board-certified facial plastic surgeon, Dr. Hilinski dedicates his practice exclusively to the face and neck, unlike general plastic surgeons who may focus on multiple areas of the body. This allows him to master advanced techniques in facial surgery, ensuring natural-looking and long-lasting results.

Academic Contributions and Leadership

In addition to his clinical practice, Dr. Hilinski is an influential figure in academic medicine. He has served as a Clinical Instructor in the Division of Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Clinical Instructor in Plastic Surgery at UCSD School of Medicine.

Dr. Hilinski has published extensively on topics in facial plastic surgery, including contributions to instructional guides for surgical residents and chapters on rhinoplasty in the Emedicine World Medical Library. He is also an invited speaker at national surgical conferences, sharing his expertise with other professionals in the field.

Why Choose a Board-Certified Facial Plastic Surgeon?

Choosing a board-certified facial plastic surgeon like Dr. Hilinski ensures that you are receiving care from a specialist with advanced training, demonstrated skill, and a commitment to the highest standards of patient safety. Dr. Hilinski is certified by both the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) and the American Board of Otolaryngology (ABO), making him uniquely qualified to perform facial cosmetic enhancements with precision and artistry.

Publications, Presentations, and Professional Affiliations

Dr. Hilinski is a respected voice in the field of facial plastic surgery, having published numerous journal articles and book chapters on surgical techniques. His contributions include:

Publications on rhinoplasty, scar revision, and other advanced facial surgery techniques

Lectures and presentations at national surgical conferences

Membership in the American Academy of Facial Plastic and Reconstructive Surgery and the American Academy of Otolaryngology-Head and Neck Surgery

Personal and Professional Dedication

Beyond his professional achievements, Dr. Hilinski is dedicated to his family and enjoys spending his free time with his wife and children. His passion for facial plastic surgery and his commitment to patient care are reflected in the individualized attention he provides to every patient.

Contact Our Practice Today

At John Hilinski MD Facial Plastic Surgery, we are dedicated to helping you achieve your aesthetic goals with the highest level of care and expertise. Whether you are considering rhinoplasty, a facelift, or non-surgical facial treatments, Dr. Hilinski and his team are here to guide you through every step of your journey.

Contact us today to schedule a consultation with Dr. John Hilinski and begin your journey toward a more confident, beautiful you. Whether you're seeking facial rejuvenation or rhinoplasty, Dr. Hilinski's expertise and dedication ensure that you will receive the best possible care and results.

#### Mid Facelift
Midface Lift Surgery in San Diego with Dr. John Hilinski

The midface lift is a highly effective cosmetic procedure designed to restore youthful volume and contour to the cheek area, which is often overlooked in traditional facelift procedures. As we age, the cheeks tend to sag, resulting in a flattened appearance, tired eyes, deepening smile lines, and a generally aged look. Dr. John Hilinski, a board-certified facial plastic surgeon, specializes in midface lift surgery, helping patients rejuvenate their facial appearance with lasting, natural results.

Benefits of a Midface Lift

Midface Lift Candidates

The midface lift is ideal for individuals experiencing sagging or hollowing in the midface, often due to age-related volume loss. Typical candidates are those who:

Suffer from a tired, aged appearance in the cheek and lower eyelid area.

Have experienced volume loss or flattening in the cheeks.

Want to reduce puffiness under the eyes or soften deep smile lines.

Are considering cheek augmentation but want a more natural, surgical solution.

Have drooping midface tissue that affects facial harmony.

If you have any of these concerns, you may benefit from a midface lift consultation with Dr. Hilinski.

The Midface Lift Procedure

The midface lift is performed using small, hidden incisions, usually near the lower eyelid or along the hairline. During surgery:

The underlying cheek tissue is lifted and repositioned higher on the face.

Drooping skin is tightened, restoring cheek volume and improving facial contour.

The procedure helps create a smoother transition between the lower eyelid and cheek, reducing the appearance of deep smile lines.

The surgery typically takes a few hours and is often combined with other procedures like a facelift or brow lift.

The procedure is performed under general or deep sedation anesthesia, and recovery involves minimal discomfort. Most patients experience mild swelling and bruising that subsides within a week, with results that are both dramatic and long-lasting.

Midface Lift FAQs

Schedule a Consultation for a Midface Lift With Dr. John Hilinski

If you are considering a mid facelift to restore youthful volume and rejuvenate your appearance, the first step is scheduling a personalized consultation with Dr. John Hilinski. During your consultation, Dr. Hilinski will carefully evaluate your facial structure, discuss your aesthetic goals, and determine if a mid facelift is the best option for you. This one-on-one meeting allows you to ask questions, learn about the procedure, and understand the potential results. Dr. Hilinski will provide a customized treatment plan tailored to your unique needs, ensuring natural-looking, long-lasting results.

To schedule your midface lift consultation with San Diego's expert facial plastic surgeon, contact our office today. Our team will help you arrange a convenient appointment time and answer any initial questions you may have.

#### Mole Removal
Moles, also known as nevi, are clustered skin growths that commonly occur on the face and neck, although they can appear anywhere on the body. Moles can vary in color, ranging from brown and black to clear or matching the surrounding skin. While facial moles often develop in childhood, some may not appear until later in life.

Facial moles can be a cosmetic concern for many patients. Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, specializes in mole removal, offering various treatment options to remove moles with minimal scarring. His expertise allows him to effectively treat facial and neck moles, helping patients achieve smoother, mole-free skin.

Cosmetic Mole Removal Options

Dr. Hilinski provides cosmetic mole removal treatments for those seeking to eliminate unsightly moles. It's important to note that these treatments are not intended for skin cancer. If there is concern that a mole may be cancerous, patients should consult a dermatologist.

Mole Removal Techniques

Dr. Hilinski offers four primary options for mole removal:

Each procedure is performed under local anesthesia for patient comfort.

Laser Mole Removal

Laser mole removal is one of the most advanced methods available. The Lumenis CO2 laser can effectively vaporize the mole in layers until it is no longer visible. The heat from the laser helps destroy microscopic mole cells, reducing the chance of recurrence. This technique is especially beneficial for patients seeking minimal scarring.

Plasma Pen Mole Removal

Plasma pen mole removal is another minimally invasive option. Using plasma energy, the mole is vaporized without direct contact between the device and the skin. This technique is highly effective in reducing the mole's appearance without leaving a visible scar.

Mole Shaving

For raised moles, Dr. Hilinski may recommend a mole shave, which removes the mole at the surface. In some cases, additional dermabrasion or laser treatment is performed to prevent recurrence.

Mole Excision

Mole excision involves making an elliptical incision around the mole, removing it entirely along with a small margin of surrounding skin. This technique ensures that all mole cells are eliminated, minimizing the chance of regrowth.

Recovery After Mole Removal

Recovery time after mole removal varies depending on the method used. For laser and shave procedures, most patients experience minimal downtime, with complete healing occurring within a week. Mole excision may require a slightly longer recovery due to the deeper incision. While scarring is always a possibility, Dr. Hilinski's expertise helps to minimize its visibility.

Mole Removal FAQs

Schedule Your Mole Removal Consultation

If you're ready to remove unwanted moles with minimal scarring, contact Dr. Hilinski today. As a leading mole removal specialist in San Diego, Dr. Hilinski offers personalized consultations to help determine the best treatment option for you. Schedule your appointment today and take the first step toward smoother, blemish-free skin.

#### Nasal Analysis in Rhinoplasty
Nasal analysis in rhinoplasty is based on the premise there are ‘aesthetic standards’ used to determine how different a certain nose is compared to what facial plastic surgeons consider ideal. Complete nasal analysis takes into consideration not only the proportional balance of the individual subunits within the nose (for instance, tip and bridge), but also whether the nose is in harmony with the overall facial size and shape. These esthetic standards are reviewed below and help guide surgeons and patients alike when determining what areas of the nose should be altered and to what degree.

For many patients, these aesthetic ideals are the goal of having rhinoplasty performed. It must be pointed out, however, that beauty is a very subjective interpretation and cannot be simply reduced to measuring objective proportions and angles. For instance, many ethnic patients who are considering nose surgery will desire changes that are in many ways inconsistent with these aesthetic ideals. There are also many patients considering rhinoplasty that only desire reshaping of specific areas, while maintaining other features of their nose that a majority of people would otherwise want altered. This is precisely why it is nearly impossible to find agreement among a group of people who are assessing rhinoplasty outcomes. The ultimate goal of rhinoplasty is to make that particular individual happy with changes that are requested and made to their nose. Thus, the rhinoplasty surgeon should be ready and willing to deviate from aesthetic ideals if it means a non-surgical, natural appearance will be achieved.

Assessing Facial and Nasal Proportions

Facial Height

Analysis of the nose begins with overall assessment of facial and nasal proportions. One of the first assessments is analysis of what is termed the facial height. The overall height of the face should ideally be divided into equal thirds, referred to as horizontal thirds. The top one-third of the face is measured from the anterior hairline to the glabella. The glabella is usually the most prominent anterior projection along the lower forehead and approximates the level of the eyebrows. The middle one-third is between the glabella and the junction of the nose and upper lip, termed the subnasale. The lower one-third is between the subnasale and the chin prominence, termed the menton. Make note that the nose should ideally encompass nearly the entire middle one-third of the facial height. In patients who have a disproportionate balance of horizontal thirds, appropriate adjustments need to be made when determining how the nose surgery may favorably or unfavorably impact the overall shape of the face.

Facial Width

Facial width is assessed by dividing the face into five vertical columns, referred to as vertical fifths. Ideally, the vertical fifths should be equal across the face. The two outermost fifths are measured from the perimeter of the ear to the outside corner of the eye. The distance from the outer to the inner corner of each eye should account for one-fifth of the overall facial width. The central fifth is measured between the inner corner of one eye to the inner corner of the other eye, and should be equal to the remaining fifths.

In terms of rhinoplasty analysis, the central fifth is useful in determining the width of the nose in the context of overall facial width. Ideally, the shadow created by light reflecting to the side of the nose should fall within the central fifth. Noses that are excessively wide will appear washed out and typically shadow beyond the central fifth. The outer margin of the nostrils should also fall within the central fifth. Nostrils that flare beyond this margin contribute to an excessively wide appearance and should be appropriately addressed during rhinoplasty. An exception to this rule is the ethnic nose (including Asian, African-American, and Middle Eastern noses), which, in some cases, can tolerate a slightly wider look than normal to maintain ethnic consistency.

Specific Considerations in Nasal Analysis

Having learned the basics of analyzing facial height and width, it should now be quite obvious the size and shape of the nose (which essentially defines the middle one-third and central one-fifth) plays a critical role in one’s overall facial appearance. It is because of this relationship between the nose and face that rhinoplasty and revision rhinoplasty are considered among the most demanding plastic surgery procedures.

When considering potential candidates for rhinoplasty, assessment should also be made of key surface landmarks that contribute to the shape of the nose. In addition, certain nasal-facial (or naso-facial) relationships should be assessed that take into account various curves, angles, and shadows involving the nose and face. The following terms and diagrams are provided to help you better understand and visualize what changes may be appropriate for your nose.

Surface Landmarks of the Nose

A. The radix is also known as the root of the nose. This usually corresponds to where the nasal bones meet the forehead. The radix is just below the glabella, which corresponds to the most prominent point along the lower forehead ridge.

B. The nasal dorsum is also referred to as the bridge of the nose. The dorsum is comprised of rigid bone (upper segment) and flexible cartilage (lower segment) that contribute to the ridge of the nose. The rhinion is a specific point along the dorsum that corresponds to the junction of the bone and cartilage segments where the skin is the thinnest over the bridge.

C. The nasal vault usually corresponds to the upper one-third of the nose. It is comprised on the paired nasal bones and often plays a significant role in how wide the nose appears.

D. The middle vault is a critical area of the dorsum that usually comprises the middle one-third of the bridge. The middle vault is made up of the upper lateral cartilage on each and the cartilage portion of the mid-dorsum. It plays a key role in both function and appearance of the nose.

E. The nasal tip, or lobule, is the soft rounded area of the nose above the nostrils. The nasal tip usually corresponds to the point of the nose furthest from the plane of the face. Because of it’s leading position, the nasal tip plays a key role in defining the overall shape of the nose. The transition zone between the nasal tip and the middle vault is referred to as the supratip.

F. The alar rim, or nostril rim, is the gentle arch the extends off of the nasal tip toward the attachment to the face. The alar rim is naturally convex, or rounded, in shape and contributes to the appearance of the nasal tip. The alar rim also helps resist collapse of the nose and plays an important role in breathing.

G. The columella is the vertical soft tissue column in between the nostrils that helps provide support to the nasal tip. The columella also helps transition the nose into the upper lip.

H. The nasal base, or alar base, refers to the attachment of the nose to the face and upper lip.

Nasal-Facial (naso-facial) Relationships

The Brow Tip Aesthetic Line

The brow tip aesthetic line (see diagram of actual post-operative rhinoplasty patient of Dr. Hilinski) is an imaginary curvilinear line that begins at the inner eyebrow and extends along the shadow of the bridge, diverging slightly away from the midline as it transitions into the tip. Ideally, the brow tip aesthetic line should be a continuous curve that is not disrupted by unwanted shadows caused by abnormalities such as bony irregularities, middle vault contour deformities and asymmetric deviations. The brow tip aesthetic line is assessed on frontal view and should be symmetric between the left and right sides, similar to the shape of an hourglass. Achieving symmetry of the brow tip aesthetic lines is one of the most difficult challenges in rhinoplasty and revision rhinoplasty.

The Nasofrontal Angle

The nasofrontal angle (see diagram of actual post-operative rhinoplasty patient of Dr. Hilinski) is assessed on profile view and reflects the angle between the dorsum of the nose and the glabella. The radix is located just below the nasofrontal angle. Ideally, the nasofrontal angle should measure approximately 120-130 degrees in males and 115-125 degrees in females. The nasofrontal angle is commonly referred to as the nasal starting point, since it appears where the nose begins and the forehead ends. Ideally, the nasofrontal angle should be within several millimeters of where the upper eyelid skin crease is located. A nasofrontal angle that is below this level can contribute to the nose appearing excessively short, and vice versa.

The Nasolabial Angle and Tip Rotation

The nasolabial angle (see diagram) is assessed on profile view and reflects the angle between the upper lip and the columella. Although not entirely accurate, the nasolabial angle is often considered synonymous with nasal tip rotation. Rotation of the nose refers to nasal tip position relative to an imaginary arc (see dashed curve in diagram) on profile view of the face. A normal nasolabial angle in a male is 90-95 degrees, while normal in a female is 100-105 degrees. Patients with a hooked nose or drooping tip (termed ptosis of the nasal tip) have a nasolabial angle that is sharper than expected. These patients are classified as having an under-rotated tip. Patients with the opposite deformity (in layman’s terms, a ‘pig nose’ deformity) have a nasolabial angle that is greater than ideal. These patients are considered over-rotated and typically have a nose that appears excessively short for their face.

Frankfort Plane

An alternative and more accurate method of assessing the nasal tip rotation is based on use of what is termed the Frankfort horizontal plane (see diagram). The Frankfort plane is a line drawn from the lower rim of the bony eye socket toward the ear canal. A second line is drawn in parallel with the columella. The angle created by the intersection of these two lines is considered a reliable measure of the nasal tip rotation. A range of 0-15 degrees in males and 15-30 degrees in females is considered ideal.

Nasal Tip Projection

Nasal tip projection (see diagram) assesses how far out from the face the tip of the nose protrudes. There are several accepted methods of measuring nasal tip projection, but the most common one described is the Goode method. First the alar line is drawn, which is a line running perpendicular to the Frankfort plane. The alar line runs thru the alar-facial crease, which is where the nasal base attaches to the cheek (see dashed line). A measurement is then taken from the nasal tip to the alar line (“A” in the diagram) and compared to the distance from the nasal tip to the nasal starting point (“B” in the diagram). The ratio of “A” to “B” is a measure of tip projection and should ideally be 0.55-0.60 in most patients. When this ratio is higher than ideal (tip of the nose is positioned too far from the face), the nose is considered overprojected. When the opposite exists and the ratio is lower than ideal (tip of the nose too close to the face), the nose is considered underprojected.

Columellar Show

Columellar show (see diagram) is an assessment of how much of the inner nostril lining is visible when viewing the nose on a profile view. As is noted in the diagram of an actual post rhinoplasty patient of Dr. Hilinski, it is normal to see some nostril lining. In fact, the ideal amount of columellar show is 2-4 millimeters. In patients with insufficient columellar show, the nostrils appear “retracted” as seen on profile view (see photo example below left’). The opposite situation, termed excess columellar show, is present when greater than 4 mm of nostril lining is visible from the profile view (see photo example below right). This scenario could be the result of an alar rim that is retracted too high (excessively arched) and/or a columella that is too low (hanging columella). In either case, rhinoplasty should be planned to restore a more ideal configuration and shape.

Columella Retraction

Columella Excess Show

The Tip and Nasal Base

When viewing the nasal tip (or lobule) on frontal view (see diagram), the ideal shape is one that simply does not draw unwanted attention to the area. This typically translates into a tip that is slightly convex, or rounded, much like the top of a dome. The tip should transition smoothly and symmetrically on each side toward the alar rim. The tip should also smoothly transition superiorly (upward) into the supratip and dorsum. Inferiorly (downward), the nasal tip should blend into the columella as a soft curve in between the nostrils, which themselves should be slightly visible as shadows seen on the frontal view.

Analysis of the nasal base (see diagram) includes assessment of the alar rims, the columella and the undersurface of the tip. As was noted previously, the ideal width of the nasal base (measured from one outer nostril rim to the other side) should approximate the distance between both eyes. Noses that are excessively wide and demonstrate flaring of the nostril border usually require nasal base reduction that involves strategic removal of a wedge of tissue to narrow the base. The overall shape of the nasal base as viewed from below should fall within the general shape of an isosceles triangle. We term this a ‘soft triangle’ since the actual tip of the nose is more like a dome. This results in a nasal tip that appears well-defined yet maintains a slight convexity. When the alar rim and nostrils are excessively weak, they begin to bow inward, resulting in a tip that appears pinched and/or narrowed (see photo example below right). The opposite scenario, with alar rims that are excessively curved outward, contributes to a tip that is too wide and one that appears boxy or squared. This is often referred to as a ‘bulbous’ tip (see photo example below left). Rhinoplasty to recontour the tip or correct a deformity from prior surgery should aim to achieve this overall soft triangular shape.

Example of Bulbous Nasal Tip

Example of Pinched Nasal Tip

#### Nasal Base Reduction
Nasal base reduction refers to a rhinoplasty maneuver that is intended to narrow the base of the nose in cases where it is excessively wide for the face. Nasal base reduction of some form or another is fairly common in rhinoplasty and revision rhinoplasty. It is done even more frequently when performing ethnic rhinoplasty, including work on Asian noses, African American noses, and Middle Eastern noses. These particular patient populations tend to have a slightly wider nasal base making nasal base reduction more necessary to refine the nose.

Most rhinoplasty and revision rhinoplasty patients seeking out nasal base reduction present with a chief complaint that their nose looks too wide or too big at the bottom. The nasal base area is shown in the adjacent photo diagram outlined in red. This is typically measured from the outer margin of one nostril to the outer margin of the opposite nostril.

In general, the nasal base should not be wider than the distance between the two eyes. In other words, if you drop a vertical line down from the inner canthus (corner of the eye) on both sides, the nasal base should be contained within the two lines. This is shown in the adjacent photo and represented by the two white vertical lines. However, it should be noted that this measurement represents the esthetic ideal in a caucasian nose, but not necessarily the desired goal in ethnic noses. In fact, in many ethnic rhinoplasty patients, it is more natural looking to have the nasal base width be slightly wider than this measurement.

Anatomy Involved In Nasal Base Reduction

Knowledge of the anatomy in the region of the nasal base is essential to understanding what should be done surgically in certain rhinoplasty patients. The adjacent photo diagram is provided to help clarify some of the terminology commonly used in nasal base reduction. The columella is the column-like structure in the middle of the nasal base that separates the nostrils into right and left sides. The alar base insertion is the segment of the nostril side wall that inserts into the upper lip-cheek junction. The nasal sill region refers to the area in between the alar base insertion point and the columella.

A Wide Sill Region

Some rhinoplasty patients with a wide nasal base have an excessively wide sill region that contributes to the excess width. This is shown visually in the adjacent photo diagram of an African American female rhinoplasty patient with a wide nasal base. In her case, you can see that the sill region is abnormally wide as indicated by the yellow line. This translates into a more horizontally oriented nostril shape (red oval), which is quite commonly seen in patients with a wide nasal sill.

Wide, Flared Alar Base

Others have more of a wide and/or flared alar base that is responsible for the excess width.

Then there are those rhinoplasty patients who have both components that need to be addressed – a wide sill combined with a flared alar base.

Achieving Symmetry in Nasal Base Reduction

One of the most common questions we get asked as rhinoplasty specialists performing nasal base surgery is related to symmetry following nasal base narrowing.

#### Nasal Exercises
Nasal exercises, also known as ‘digital’ exercises, refer to a postoperative instruction that involves massaging the nasal bones after rhinoplasty or revision rhinoplasty surgery. Nasal exercises would only be recommended in rhinoplasty patients where the nasal bones were ‘broken’ during the nose reshaping process. This is also referred to as an osteotomy when the nasal bone is repositioned or narrowed or both. This is commonly performed after a large hump deformity has been corrected and in cases where the nose is crooked. An osteotomy is also frequently done simply to narrow a wide nose during cosmetic rhinoplasty.

Nasal Exercises Explained

Nasal exercises are done to help further contour the nose during the rhinoplasty recovery process. Whenever the nasal bone is reshaped as part of a rhinoplasty surgery, a nasal cast is placed to keep the bones in their new position. The nasal cast is usually removed in 5-6 days. In a majority of cases, the nasal bones are fairly well positioned in their new location. However, because the bones were completely cut and moved, they are also still mobile at 5-6 days out from surgery. Once the cast is removed, the nasal bones have the potential to move or drift out of the desired position. If they do so, they will typically trend toward moving back to their original position. And this movement or drifting can occur any time between cast removal and 6-8 weeks out from surgery. Why 6-8 weeks? Because this is the average amount of time it takes before the nasal bone fuses and heals in its new position.

Nasal Bone Diagram

The adjacent series of diagrams shows this concept visually. For demonstration purposes, we will consider the left photo as having a slightly wide configuration in terms of the nasal bones (light blue shaded area). In the middle you can see how the nasal bones are brought in after osteotomies to become more narrow. Once the cast has been removed, the nasal bones can drift slightly. This can occur on one side only or on both. If they displace, the bone may shift out to the side as indicated by the arrow. Why does the nasal bone do this? Because it is relatively free floating after the osteotomies. Since this area is also susceptible to swelling from the surgery, the bone may drift outward along the with adjacent swollen tissue. While the cast is in place the bone is relatively stable in its position. But once the cast comes off, the soft tissues are free to swell a little and can affect the desired position of the bone. This phenomenon is not the fault of the rhinoplasty surgeon. It is simply something that can and does occur following this type of nose surgery.

Nasal Exercise Technique

It is precisely because of this possibility that I see my rhinoplasty and revision rhinoplasty patients several times in the first few weeks of the recovery process. If I didn’t, the nasal bone might drift out on one or both sides and remain there for several weeks or months before it is discovered to be out of position. If this discovery is made after the bone has now healed (6-8 weeks), there is no recourse but to rebreak the nose. If, however, this is caught within the first 2-3 weeks of the rhinoplasty healing period, nasal exercises can be instituted to help reposition the bone. This window of opportunity (between taking the cast off and 6-8 weeks out) is critical when it comes to starting the nasal exercises.

Wide

Narrow

Displaced Bone

Nasal exercises, as noted above, imply placement of pressure by pushing on the bone to put it back into the desired position. These are also referred to as ‘digital nasal exercises’ since it is normally done with your thumb or finger. I prefer my patients to use the thumb since this has a larger ‘pad’ that can be used to press on the nasal bone. The adjacent diagram shows visually how this is typically done with the thumb. On the patient’s right side of the nose, they would use their right thumb to push on the side of the nose. It is real important that the pressure be applied only to the nasal bone, which is approximately the upper one-third of the nasal bridge. As you can see in the adjacent diagram, the pad of the thumb is used to apply the pressure inward toward the middle of the nose.

It is also important that you do not push on top of the bridge. In fact, I usually tell my rhinoplasty and revision rhinoplasty patients to make sure the thumb is always below the plane of the bridge. This can be appreciated in the adjacent diagram where the thumb is kept below the red line that indicates the horizontal plane of the nasal dorsum. If the thumb happens to push on top of the bridge it can actually inadvertently push the nasal bones out. Maintaining proper position of the thumb during nasal exercises is obviously critical to achieving the desired rhinoplasty outcome.

Normally when pressing on the nasal bones, patients should push down hard enough to elicit some degree of pain. If you don’t, you are not likely effecting any real change in the position of the bone. I normally recommend patients push down to the point of pain, then hold this position steady for approximately one minute. This exercise should be done on average 20-30 times throughout the day. These type of nasal exercises should always be done in conjunction with specific recommendations from your rhinoplasty surgeon.

In some rhinoplasty patients, equivalent pressure needs to be applied on both sides to help reposition the nasal bones (as seen in the adjacent photo of one of our San Diego rhinoplasty patients). In others, it might be recommended to do bilateral exercises, but push harder on the left versus right or vice versa. Still in others, the exercises are only necessary on one side to restore the desired symmetry of the nose.

I often times like to see my own San Diego rhinoplasty and revision rhinoplasty patients back every 2-3 weeks to make sure we don’t have to adjust the nasal exercises. Once we get up to 6-8 weeks out from surgery, the nasal exercises can usually be stopped. By this point, the bone has essentially become more fixed in position and is stable enough to resist further movement. This is precisely why it is increasingly difficult to elicit the pain response with nasal exercises as you approach the 6-8 week mark in healing.

Benefits Of Doing Nasal Exercises

The huge benefit of doing nasal exercises following rhinoplasty or revision rhinoplasty is that we can truly optimize the surgical results and achieve the best possible surgical outcome. As I tell my rhinoplasty patients from San Diego all the time – nasal reshaping is a collaborative effort between the facial plastic surgeon and patient. I can do the best possible rhinoplasty while in the operating room, but there are many variables that need to be accounted for following the surgery. Nasal bone drifting following rhinoplasty is a prime example of this. By instituting nasal exercises at the opportune time with proper technique, we can ensure that we are doing everything possible to achieve as much symmetry as possible. Plus, we can maximize chances of getting the nasal bones as narrow as desired following rhinoplasty.

To learn more about other rhinoplasty and revision rhinoplasty related topics, please visit our San Diego Rhinoplasty Tutorial.

#### Nasal MOHS Cancer Repair
Many patients in this area of the country are, unfortunately, diagnosed with various types of skin cancer involving the nose. The procedure done to remove the skin cancer is often times referred to as ‘MOHS surgery’ and is most commonly performed by specialized dermatologists. In many cases, the nose can be reconstructed shortly after the MOHS procedure to help restore a natural appearance. In some patients, however, this is not the case and they end up having to undergo secondary surgery. This is a great case example of the latter, which highlights how I go about reconstructing defects of this type.

This very pleasant lady from San Diego consulted with me regarding an abnormal contour and appearance that resulted from removal of a skin cancer performed by a local dermatologist. As you look at her from the front, you really don’t see an obvious problem with her nose. If you look closely, though, you can see a hint of the issue involving her right nostril rim.

When she begins to turn her head, the defect becomes much more obvious as shown here in the adjacent photo. What you appreciate is a ‘notched’ deformity along the nostril rim. It almost appears as if something was cut out of this area and nothing was done to try and reconstruct it. In fact, that is precisely what happened – the skin cancer was removed but no real effort was made to help restore a natural contour and shape.

Consequently, the patient presented to my office with the hope of possibly having reconstructive nose surgery to repair the skin cancer defect. I discussed with her the complexities and challenges of this type of nasal reconstruction. After all, this type of reconstructive rhinoplasty involves creating a new nostril rim where there is a complete absence of any tissue.

Reconstructive Rhinoplasty After MOHS

So how did I go about repair this specific deformity? After consulting with the patient, we decided the best approach would involve using what is called a composite ear graft to help restore a more natural nostril rim contour. A ‘composite’ refers to anything that is comprised of several different parts or elements. So a composite ear graft refers to a graft that is comprised of different layers of tissue. In this case, it refers to a graft that includes skin, cartilage and some soft tissue in between these layers.

In most cases when we use the term ‘composite ear graft’ we are referring to a graft that is taken from the concha cymba area of the ear. This is shown in the adjacent photo diagram as the small blue arrow. In this particular case example, though, the composite ear graft was being taken from a different area of the ear – near the root of ear where it attaches to the face. This is shown in the diagram as the red triangular shaped area. The reason for taking this alternative type of composite ear graft is because the shape of the graft was more suitable for the type of defect that I was dealing with along the nostril rim.

At the beginning of the operation, I had to first excise (cut out) a triangle-shaped area around the notched defect. This was done in order to ‘freshen’ the skin edges to allow the new composite graft to be placed properly. You might be thinking this makes the defect even larger. Yes, it did enlarge the defect to some degree – but in cases like this it is well worth it. The composite graft was modeled in size and shape based on the dimensions of the newly created defect along the nostril rim (also represented by the red triangular shaded area). This was then placed very carefully and sutured in position. A majority of the composite graft was used to restore the lost tissue on the outside of the nostril rim. But an equally important area to consider was the actual nostril rim where it transitioned to the inside of the nose. Fortunately, this type of composite ear graft accounted for this area and provided the necessary tissue to help reconstruct the nostril on the inside as well.

Before and After Reconstructive Rhinoplasty

Shown here are the actual surgical results following several months of healing. What you can readily appreciate in the before and after photos is that she now has restoration of a natural looking nose with a more appropriate nostril rim shape and contour. If you look closely at her oblique and lateral views in particular, you will really appreciate the type of improvement that has been made.

This was an incredibly gratifying procedure to perform since this patient truly appreciated the results. Needless to say, she was quite happy with the outcome of her surgery.

#### Nasal Tip Deprojection
One of the more uncommon maneuvers in cosmetic rhinoplasty involves what is called ‘deprojection’ of the nasal tip. Deprojection refers to reduction of the nasal tip projection. In short, projection of the nasal tip refers to how far out the tip protrudes from the face as seen from the profile, or side, view. Some rhinoplasty patients mistakenly refer to this type of change as making the nose shorter when, in fact, this actually refers more to the rotational position of the nasal tip. Nasal projection should be thought more of as a linear measurement as seen from the profile view. Please reference our online rhinoplasty tutorial section on nasal analysis for a more in depth discussion of nasal tip projection.

In the adjacent photo example of a rhinoplasty patient from San Diego, CA, the red line represents nasal tip projection. In this particular patient, the nose was thought to be excessively large overall in proportion to the remainder of her face. A significant factor in this assessment is how far out the nasal tip is projected since this often times determines the overall size of the remaining nasal structures. For example, the bridge height typically follows the nasal tip outward. In this case, her bridge height is also excessive since it transitions directly off of the nasal tip position (see green line). In some cases you will find a rhinoplasty patient who has an excessively over projected nasal tip with a normal bridge height, but this is quite rare.

As rhinoplasty surgeons we are trained to measure the nasal tip projection in relationship to other areas of the nose in order to determine whether or not there is over projection. One of the most common is the Goode method, named after Dr. Richard Goode from Stanford. In reality, though, most experienced rhinoplasty experts will simply look at the nose and determine by gestalt if the nasal tip is over projected. This is much the same way rhinoplasty patients look at themselves and subjectively note that their nose is just too big for their face. Sure you can measure it using the Goode method. However, if the nose looks too big on the face it probably is too big for the face.

What Causes An Over Projected Nasal Tip?

An overly projected nasal tip is most often the result of the underlying lower lateral cartilage, also known as the LLC. In the adjacent diagram, the LLC is indicated as the red shaded structure. There are actually a pair of lower lateral cartilages – one on each side – that primarily contribute to the shape and position of the nasal tip. When the LLC is positioned too far out on the nose it will then appear overly projected.

In revision rhinoplasty patients who have had prior cosmetic nose reshaping, their nasal tip might be overly projected because of different reasons. A common reason in the revision rhinoplasty population is that the bridge may have been over reduced, or brought down too much, while leaving the tip in proper position. In this situation the nasal tip may appear overly projected, but the true problem is the nasal bridge that needs to be brought back up to a more appropriate level.

Rhinoplasty For An Over Projected Tip

The goal in rhinoplasty for an overly projected nasal tip is to bring the tip of the nose closer to the face (deprojection of the nasal tip) while maintaining proportion with the remainder of the nose and face. As noted above, the bridge height is often times excessively high in patients with an overly projected nasal tip. Therefore, it is frequently necessary to reduce the bridge height while bringing the nasal tip in closer to the face.

In some rhinoplasty patients, deprojection of the nasal tip simply involves reducing the size of what is commonly referred to as the domal cartilage. The domal cartilage is the highest point of the lower lateral cartilage as it sticks out from the face. If this portion of the lower lateral cartilage is excessively prominent, very careful reduction of the dome can be undertaken to deproject the nasal tip. Some rhinoplasty terms that refer to this type of nasal tip deprojection maneuver include: domal truncation, crural overlay, and vertical dome division. In other rhinoplasty patients, the entire lower lateral cartilage has to detached, moved and reattached to accomplish the desired change in tip projection. Depending on the rhinoplasty surgeon’s expertise and experience, both methods can be done successfully using either an open or closed rhinoplasty approach.

In many cases where the nasal tip is being deprojected, the nose also has to be rotated slightly to maintain proper esthetic balance. To some degree this is directly proportional to the amount of tip deprojection being performed.

Rhinoplasty Example of Tip Deprojection

The following is a case example of how the nasal tip can be successfully reshaped to deproject the nose. As was noted above, this particular patient complained of a large nose that she wanted reshaped. We previously discussed how her nasal tip was over projected and bridge height was excessively high. We performed a closed rhinoplasty approach during her cosmetic nose reshaping procedure. This included use of what is referred to as a ‘full transfixion incision’ to drop her nasal tip back closer to the face to deproject the nose. Once this was done, we then reshaped her nasal bridge to bring it down to an appropriate height that matched the new position of her nasal tip.

As you can see in her before and after photos, her nasal tip has been successfully deprojected, or brought in closer to the face. The diagrammed photos demonstrate this more visually when you compare the preoperative nasal tip projection (red line) and bridge height (green line). In the after rhinoplasty photo, you can appreciate how much change has been made to the nose. Keep in mind that cosmetic nose reshaping is a game of millimeters. In this type of rhinoplasty, we have brought the tip in closer to the face by 2-3 millimeters and the nasal bridge by a similar amount, which is all that was needed to result in a beautiful looking nose. The nasal bridge was reduced to create a more feminine looking profile view and the nasal tip was rotated just slightly. Overall, she still looks very natural in terms of her appearance and now has a smaller nose that looks as if she could have been born with it.

Tip Deprojection Rhinoplasty Consultation

It should be emphasized here that deprojection of the nose should be done by plastic surgeons who are truly experts in rhinoplasty and revision rhinoplasty. As was noted in the beginning of this rhinoplasty tutorial chapter, deprojection of the nasal tip or deprojecting the nasal tip is a fairly uncommon maneuver in plastic surgery, unless you are a rhinoplasty specialist. A great majority of nose jobs do not require deprojection of the nasal tip. So if your chosen plastic surgeon performs rhinoplasty only on an occasional basis, it is unlikely they are going to be real familiar with deprojection of the nasal tip. Facial plastic surgeons who are experts in cosmetic nose reshaping and perform rhinoplasty surgery frequently will see this type of nose on a regular basis. They will be much more familiar with the nuances involved in this type of rhinoplasty and consequently will achieve successful results with nasal deprojection on a more consistent basis. Therefore, it is highly recommended that you consult with a plastic surgeon who has demonstrated experience in cosmetic nose surgery and is able to show you multiple examples of deprojected noses they have performed.

#### Nasal Tip Ptosis
Nasal tip ptosis (pronounced ‘toe-si s’) simply refers to a drooping or dropping nasal tip. Nasal tip ptosis can be a congenital deformity (that you were born with) or an acquired deformity arising from previous rhinoplasty where the tip was destabilized unintentionally.

Tip ptosis is a particular finding that is easily appreciated when looking at the nose even from several feet away or across the room. You do not necessarily need to be a board certified facial plastic surgeon to see this! Figure 1 is an example of tip ptosis in one of my rhinoplasty patients here in San Diego. Just looking at her nose from the side one can appreciate how it appears to point downward at the tip as the red arrow demonstrates. Granted this patient also has other issues with her nose like a dorsal hump (bump) and over projection of the tip. But, now that you know what we are looking for, you can easily appreciate what even mild to moderate tip ptosis looks like. One of the most well-known celebrity examples of nasal tip ptosis is Paris Hilton. Just look at the position of her nasal tip in photos and you can see what I mean!

Some rhinoplasty patients come into the office requesting reshaping of their nose for a ‘hook deformity’ – described as such because of how similar the nose looks to an actual hook on side view. Figure 2 demonstrates this analogy visually. Comparing the silhouette of this type of nose with the shape of an actual hook, you can see why the term ‘hook nose’ came to be. What makes a hook a hook is that it curves back upwards much like the tip of this patient’s nose does as it joins to the upper lip.

Many rhinoplasty patients present to our office noting their nose as being excessively long. In fact, sometimes rhinoplasty patients with tip ptosis come in simply requesting to have their nose shortened. They describe it in this manner because the nose actually appears to be too long for their face. Looking at this more objectively, we can measure the nasolabial angle to confirm these findings. Looking back to our tutorial on Nasal Analysis (see discussion in Nasal Analysis), the nasolabial angle is measured by crossing the lines made by the upper lip and the columella.

In Figure 3 you can see how the nasolabial angle (made by the two red lines) in this patient measures less than 90 degrees. This measurement is consistent with a ptotic (pronounced ‘taw-tic’), or drooping, nose. Normally this angle would be least 90 degrees (blue line) for a male rhinoplasty patient and more ideally 95-105 degrees (yellow) for a female rhinoplasty patient.

So what anatomical problems contribute to ptosis of the nasal tip? The primary anatomical problem involves the paired lower lateral cartilage (also known as the ‘lower laterals’)and the front part of the nasal septum (the middle wall on the inside of the nose).

Figure 4 A demonstrates the normal location and relationship of the lower lateral cartilage (colored in red) and the septum (colored in light yellow).The lower laterals refer to a pair of C-shaped structures that are normally attached to the front end of the septum. The position and contour of the lower lateralsdictate how the overlying skin, and thus the tip of the nose, will appear.

If the attachment of the lower laterals to the septum is loose, the tip will appear to hang down off of the nose like in our current example (See Figures 4B and 5).In addition, an excessively long nasal septum can contribute to the appearance of ptosis (See Figure 3C). When this occurs the attachment of the lower laterals is stable, however, it is being held ‘down’ by the septum causing the tip to look like it is hanging off the rest of the nose.

So how do we address ptosis of the nasal tip? In most rhinoplasty patients this requires repositioning of the lower laterals and possibly shortening of an elongated septum. Although this can be sometimes performed successfully with a closed rhinoplasty approach, I prefer to do this through an open rhinoplasty approach since this affords me greatest control of the cartilage shape and position.

Repositioning the lower lateral cartilage relies on an understanding of what is termed the ‘tripod theory’ in rhinoplasty. The tripod theory (Figure 6) draws a comparison between a photographer’s tripodand the two lower lateral cartilages of the nasal tip. In this analogy, the two lower laterals are assumed to be fused together in the middle. The lateral wings on each side (blue lines) and the fused central cartilage (red line) form the actual tripod. Each of the three legs is fixated (yellow circles) much like a real tripod would be stabilized flat on the ground.

One reliable way to lift a ptotic tip is to shorten both lateral legs as diagrammed in Figure 7. By cutting this segment of cartilage on each side and overlapping the pieces(without changing the fixation points) you can see how this changes the shape of the tripod. Effectively this helps to pull or raise the tip to a new position. The alternative method involves completely mobilizing the tripod (both lower lateral cartilages) from the fixation points and rotating the entire tripod unit as one.In addition to both of these techniques, it is sometimes necessary to shorten the anterior, or front, edge of the septum. Regardless of what method is chosen, the goal is accomplished in terms of lifting a ptotic nasal tip to a more appropriate position.

Figures 8-11 are before and after photos demonstrating correction of a ptotic nasal tip using an open rhinoplasty approach.These photos represent stable changes nearly one year out from rhinoplasty surgery. Notice in Figure 10 the change in her nasolabial angle from being less than 90 degrees before surgery to between 100-105 degrees following surgery. Also note how her nose no longer points downwards and she by no means has anything that resembles a hook deformity any longer. Although I also corrected a dorsal hump deformity and deprojected her tip (bringing it closer to the face), correction of her ptosis was one of the main efforts of her surgery.

#### Neck Lift
Neck Lift Surgery with Dr. John Hilinski: Achieve a Youthful, Sculpted Neck

Aging can take a toll on the neck area, causing the muscles to weaken, skin to lose elasticity, and fat to accumulate under the chin, along the jawline, and on the neck. These factors lead to sagging skin, jowls, and the dreaded "turkey wattle," making the neck appear droopy and aged. A neck lift is an effective surgical solution to rejuvenate the neck and jawline, offering long-lasting results and a more youthful appearance.

Benefits of Neck Lift Surgery

Tighter neck muscles

Smoother neck skin

Sculpted, defined jawline

Reduced neck folds, jowls, and excess fat

Improved appearance of a double chin

Enhanced self-confidence with a younger, fresher look

What is a Neck Lift?

A neck lift combines platysmaplasty, which tightens the muscles in the neck, and cervicoplasty, which removes excess skin and fat. Together, these techniques sculpt the neck and improve jawline definition while eliminating sagging skin and fatty deposits.

Neck Lift Specialist in San Diego

Dr. John Hilinski, a double board-certified facial plastic surgeon, is a renowned expert in neck and face lifting techniques. With advanced training in cosmetic surgery, Dr. Hilinski has become one of San Diego's leading plastic surgeons, specializing in procedures that restore a youthful, natural appearance to the face and neck.

Who is a Candidate for Neck Lift Surgery?

Neck lift surgery is ideal for patients experiencing:

Excess fat and loose skin under the chin

Sagging muscles and skin along the neck and jawline

Jowls and deep neck creases

Candidates should be in good health, non-smokers, and seeking to achieve a more youthful neck contour. During a consultation, Dr. Hilinski will review your medical history, assess your neck's skin elasticity, and create a personalized treatment plan.

The Neck Lift Procedure

Performed on an outpatient basis, neck lift surgery typically takes 1 ½ to 3 hours under general anesthesia or sedation. Dr. Hilinski will make a small incision under the chin to tighten the platysma muscle and remove excess fat. For patients with additional skin laxity, a second hidden incision may be made near the ear. The results include a tighter, more contoured neck and jawline.

Recovery from Neck Lift Surgery

Post-surgery, patients wear a compressive bandage for 24 hours to help reduce swelling and support the healing process. Dr. Hilinski will prescribe medication to manage any discomfort, and sutures are typically removed after one week. Bruising and swelling may last up to 10 days, and most patients can return to work within 7 to 10 days.

FAQ: Neck Lift Surgery

Schedule Your Consultation

To determine if a neck lift is right for you, contact Dr. John Hilinski for a personalized consultation. Discover how neck lift surgery can redefine your jawline, tighten sagging skin, and leave you with a more youthful, rejuvenated appearance.

#### Neck Liposuction
Neck Liposuction Surgery with Dr. John Hilinski

Achieve a more defined and youthful neck contour with neck liposuction surgery by Dr. John Hilinski, a renowned double board-certified facial plastic surgeon in San Diego. This procedure is an excellent solution for individuals looking to eliminate excess fat from the neck and chin areas, often referred to as a "double chin." Neck liposuction can enhance your jawline, create a more sculpted appearance, and improve your overall facial harmony.

What is Neck Liposuction?

Neck liposuction, also known as submental liposuction, is a minimally invasive procedure designed to remove unwanted fat deposits from the neck area. It is particularly effective for patients who experience fullness under the chin and along the jawline but still have good skin elasticity. The procedure involves using a small cannula to suction out excess fat, providing patients with a slimmer and more contoured neck and jawline.

Why Choose Neck Liposuction?

Many individuals opt for neck liposuction to enhance their overall facial appearance and boost self-confidence. This procedure can deliver significant improvements, such as:

Reduction of a double chin or excess fat in the neck

Improved jawline definition and contour

A more youthful and rejuvenated appearance

Increased facial harmony without the need for a full facelift

For patients who are not ready for a more extensive surgical procedure like a neck lift, neck liposuction offers a quicker recovery and excellent results with minimal downtime.

Benefits of Neck Liposuction

Who is a Good Candidate for Neck Liposuction?

Good candidates for neck liposuction are individuals who are in good health, have realistic expectations, and have localized fat deposits in the neck area that are resistant to diet and exercise. Ideal candidates will also have good skin elasticity, which allows the skin to conform to the newly sculpted contours of the neck after fat removal.

The Neck Liposuction Procedure

Dr. John Hilinski performs neck liposuction as an outpatient procedure in his state-of-the-art San Diego surgical center. The surgery typically takes 1 to 2 hours and can be performed under local anesthesia with sedation or general anesthesia, depending on the patient's preference and the complexity of the procedure.

During the procedure, Dr. Hilinski makes small, discreet incisions under the chin or behind the ears. Through these tiny incisions, a thin cannula is inserted to suction out excess fat. Dr. Hilinski uses advanced liposuction techniques to ensure smooth, even fat removal and achieve natural-looking results.

Recovery After Neck Liposuction

After neck liposuction, most patients experience mild swelling and bruising that subsides within a week. A compression garment may be worn to help reduce swelling and promote optimal healing. Most patients are able to return to work and normal activities within a few days, though more strenuous activities should be avoided for at least two weeks.

Final results typically begin to appear as the swelling subsides, revealing a slimmer, more defined neck and jawline. Dr. Hilinski will provide personalized aftercare instructions to ensure a smooth recovery process.

Neck Liposuction: FAQs

Schedule a Consultation for Neck Liposuction

If you're interested in neck liposuction and want to learn more about how it can enhance your appearance, schedule a consultation with Dr. John Hilinski in San Diego today. During your personalized consultation, Dr. Hilinski will discuss your goals, evaluate your anatomy, and develop a customized treatment plan to help you achieve the defined, youthful look you desire.

#### Neck Liposuction Case Study 1
This is a case example of a San Diego patient who underwent neck liposuction combined with platysma muscle tailoring (called a platysmaplasty). Many patients and plastic surgeons consider this surgery one form of a necklift procedure. For any patients considering this type of plastic surgery, we hope this particular patient example proves useful in helping to make a more educated decision.

The Patient

The patient is a middle-aged female who desired more definition along her lower face and upper neck region. However, she was not enthusiastic about having to consider an actual ‘facelift’ procedure. She was hoping to have a enhancement procedure that was less invasive than a facelift, but would provide her a nice cosmetic improvement in terms of the jawline and neck. After consulting with her in our office, it became more evident that what she was really bothered by was the unwanted fullness under her chin region.

Looking at her preoperative photographs, she does have some loss of definition along her jawline and upper neck. This can be better appreciated when you look at her oblique (angle) and profile (side) views as indicated in the diagrams by the red arrow. In the world of plastic surgery and cosmetic enhancement, this area is called the cervico-mental angle, and is a common target for necklift surgery. This is the angle that is created by the junction of the horizontal jaw and vertical neck. In terms of esthetic ideals, most patients desire to have cervico-mental angle as close to 90 degrees as possible. This is the type of angulation that translates into improved shadowing along the jawline and upper neck with a more cosmetically pleasing appearance overall.

In our case example, her physical examination showed this extra fullness to be partially from excess fat in the region. This is indicated by the yellow shaded area in the adjacent diagram and referred to as submental (‘below the chin’) liposis, or excess fat. However, some of the fullness in this particular patient was also due to the platysma muscle hanging down from the jawline (red arrow). The platysma is a sheet of muscle that spans the neck on each side from the lower border of the jawline all the way down to the clavicle (collarbone). If the muscle is hanging down too low under the chin, it can detract from an, otherwise, more defined neck. Ideally, there is no excess fat in front of the platysma and the muscle is positioned tighter up underneath the chin to help create more of a 90 degree cervico-mental angle (right side of diagram as indicated by the white arrow). As in this particular patient, many people seeking to contour their neckline have a combination of unwanted fat (submental liposis) and platysma muscle drooping – both of which have to be addressed at the same time to provide a nice cosmetic enhancement in the neck.

Recommended Neck Plastic Surgery

In this case example, it was recommended that the patient undergo liposuction of the neck along with platysmaplasty. In some cases, neck liposuction is also referred to as ‘lipocontouring’ since removal of the neck fat is done with the intention of contouring the neck. Other plastic surgeons refer to this as ‘neck liposculpture’ because they feel like they are sculpting the neck. The platysmaplasty refers to reshaping of the platysma muscle – essentially tightening the muscle up underneath the chin. Some plastic surgeons will refer to this as ‘platysma muscle tailoring’ instead of platysmaplasty since the procedure involves careful stitching of the muscle.

This patient elected to undergo this exact combination of procedures – neck liposuction and platysmaplasty. The surgery was performed under a general anesthetic, which kept her quite comfortable while allowing us to accomplish all of the surgical goals with no distractions (like her moving or feeling pain). Some patients would rather have a deep intravenous sedation, which would work as well for this type of plastic surgery.

The liposuction portion of the surgery is done through a small incision made just underneath the chin. In her case, we also made a small incision behind the earlobe on each side (hidden incisions) so that we could perform microliposuction of the area along the jawline. Microliposuction, also referred to as ‘micro-liposuction,’ simply means that we use even small caliber liposuction instruments to perform finer contouring in certain regions of the face and neck. Liposuction involves use of a vacuum device connected to a specially designed plastic surgery instrument that allows removal of unwanted fat. This fatty layer is typically located just under the skin but above the muscle as is shown above in the diagram. Lipocontouring of this fatty layer is performed in a very careful fashion to reshape the neck and lower face. The key is to remove a sufficient amount of fat while leaving behind a thin layer to maintain a nice natural look following liposuction. It is also real important for the plastic surgeon to liposuction both sides of the neck to achieve as much symmetry as possible.

The platysmaplasty portion of her surgery was done through a slightly wider incision made in the same place as the liposuction incision under the chin. This is usually done after the excess fatty layer has been liposuctioned. The muscle can then be more easily visualized. There is a platysma muscle on each side of the neck as shown below left in the diagram. As mentioned above, the aging process and even congenital predisposition can account for the edges of the muscle (closer to the midline) hanging down under the chin. This is what contributes to an unwanted bulge in this area of the neck along with any excess fat that might be present in front of the plastysma. The platysmaplasty is performed by bringing the two muscle edges closer together as shown below right in the diagram. In some cases, a horizontal incision (cut) is made in the muscle on each side to help create a better angulation of the neck. The platysma muscle is sutured, or sewn, together as indicated by the blue threads and white arrows below right. Because this technique resembles the ties in a corset, some plastic surgeons refer to this as a corset platysmaplasty. By placing these sutures into the muscle, the platysma is tightened in an upward direction bringing it closer to the chin. This translates into a sharper angulation in terms of the cervico-mental angle with better definition of the lower jaw and upper neck. There is usually no skin removed during this maneuver, although in some cases a small amount of skin might be removed during the closure of the incision line. Altogether, combined liposuction and platysmaplasty surgery takes about 60-90 minutes from beginning to end.

Recovery From Liposuction & Platysmaplasty

Following completion of the liposuction and platysmaplasty necklift surgery, a tight bandage is placed around the face and neck. This compressive bandage is intended to keep the skin and soft tissue in place while also preventing swelling. Keep in mind that this head dressing can be a source of pain and discomfort early on in the healing process. This initial dressing is typically left in place for 24-48 hours then changed to something that is much more comfortable. For instance, a foam wrap is commonly used after the first dressing comes off. The adjacent photo shows our case example patient in her foam dressing wrap 24 hours following the liposuction and platysmaplasty surgery. As you can see, the foam wrap is intended to place pressure under the chin and along the new cervico-mental angle. As mentioned above we typically do not cut out skin with this type of necklift surgery. Therefore, we rely on dressings like this to help encourage the neck skin to shrink wrap up to its new, more rejuvenated position.

Most patients are fairly comfortable on low dose narcotic medications, such as Vicodin or Tylenol with codeine, that are frequently stopped by day 3 after surgery. The sutures in the skin are removed in 4-5 days. Most neck liposuction and platysmaplasty patients feel fairly presentable in the public within 10-14 days of the surgery.

Before & After Necklift Photos

The following photos show our case example patient before and after liposuction and platysmaplasty surgery. As you can see on her frontal view, she now has a more defined jawline and chin. This is evidenced by a sharper demarcation along the lower border of her chin with more of an actual shadow now that the neckline has been lifted up. This same change can be also appreciated on her oblique angle. On the profile, or lateral, view of her neck there is also a nice cosmetic improvement noted. There is less fullness under the chin now that the submental fat has been liposuctioned and the platysma muscle pulled tighter. You can also see that her cervico-mental angle is now closer to 90 degrees further contributing to the improved definition along her lower face and upper neck. All this, without any obvious scarring and no skin removal. Overall, this patient was quite pleased with her surgical results, especially since she did not have to undergo a more formal facelift procedure to achieve cosmetic enhancement in her facial appearance. In fact, she now proudly displays her new profile image as her Facebook photo – something she was very reluctant to do in the past.

#### Neck Liposuction Case Study 2
This is another case example of neck lift surgery using a combined technique that involves cervical liposuction and platysmaplasty surgery. We have discussed elsewhere on out site the virtues of performing neck enhancement with these combined procedures, but case examples are a great way for potential patients to see real life results in other patients.

Case Example Neck Lift Surgery

This female patient from San Diego desired to have enhancement of her neckline for unwanted fullness under the jaw region. She felt as if this was giving her a prematurely aged look – despite feeling quite young on the inside. However, she did not wish to undergo a more extensive, formal facelift/necklift procedure. Part of this decision was based on the fact that facelift surgery would necessitate longer incisions around the ear with a more involved healing process. This is actually a very common concern amongst patients considering neck lift surgery. They just don’t wish to have a more extensive surgical procedure that includes making the usual incisions all around the ears.

As an alternative to performing a formal facelift/necklift operation, we discussed the option of doing combined neck (also referred to as cervical) liposuction and platysmaplasty surgery. The neck liposuction procedure would involve suctioning out the excess fat under her chin while the platysmaplasty surgery would involve tightening the neck muscle just underneath the fatty tissue layer. The goal was to create a more defined neckline that appeared more youthful. In addition, her desire was to achieve a more refined looking jawline in the process.

Skin Elasticity & Neck Liposuction

One of the most important considerations in this type of case is skin elasticity. This refers to the rubber band-like quality of skin where it ‘snaps’ back after pinching or pulling it. As patients age, they lose more and more of this skin elasticity. This particular patient had skin that still had some reasonable degree of elasticity – meaning, it still had a good rubber band-like quality that would allow it to snap back. This is a critical element in the decision making process to undergo neck lift surgery using this technique because it relies on the skin shrinking upward to the newly created neck contour. This is shown in the adjacent photo diagram. When the fat is suctioned out under the chin, what happens to the overlying skin? Since neck liposuction does not involve cutting skin out, it relies on the skin moving upward to create a new defined neck contour. This is indicated by the red arrows showing the direction the skin is required to go in for an optimal surgical outcome. This process is like a deflating balloon as the air is taken out. If the skin does not have this elastic quality remaining, the neck would simply hang or drape down after the fat was removed.

After examining this patient in the office, we determined that her skin, indeed, had sufficient elasticity making her a candidate for neck liposuction and platysmaplasty. In patients who are much younger – 20s and 30s – having sufficient skin elasticity is not much of a concern. As patients age into their 40s and 50s, skin elasticity becomes an increasing concern when considering this particular surgical technique. In patients who have only marginal skin elasticity left, this technique of neck liposuction and platysmaplasty may not be in their best interest as the skin may just hang down more after surgery. In these cases, a formal lower facelift/upper neck lift with incisions around the ears is likely necessary in order to pull the excess skin back and up.

Liposuction & Platysmaplasty Surgery

This patient elected to have the combined liposuction and platysmaplasty surgery performed from underneath the chin region.

Her surgery was done under an anesthetic in our own accredited ambulatory surgery center. She was put comfortably to sleep and underwent removal of the excess fat under her chin along with tightening of the platysma muscle through the same small incision beneath the chin. The operation took about one and a half hours to complete. She was then awoken and sent home a relatively short time later.

She knew going into the operation that this approach relied on her skin elasticity bringing the neck skin back up during the healing process. If the skin elasticity turned out to be insufficient, which would not be fully known until the healing process occurred, her skin would, unfortunately, just hang there. It would then necessitate a second operation to go around the ears and lift the skin as is done in a formal lower facelift/necklift procedure. Fortunately for this patient, her skin ‘read the rulebook’ as they say and shrunk to accommodate the areas where the fat was removed.

As you can see from the photos provided here, there has been a somewhat dramatic change in her submentum (area below the chin) and jawline.

Before And After Photos

As you can see from the front view, her neckline and jawline now have much better definition. This can be appreciated by looking at the shadows under her chin that were not as defined prior to surgery because of the excess fat and skin wrinkling. Now her neck appears much smoother with an overall more youthful look. On her oblique view, you can also appreciate how much improvement was made with the liposuction and platysmaplasty surgery. On this angle one can see how the skin has, indeed, pulled itself upward under the jawline to create more definition. On her profile view, the new angulation that was created along her neck is quite obvious. Whereas before her neck was much fuller, it is now more angulated and youthful. Keep in mind that no skin was actually cut out from under the chin. Once the fat was suctioned out and the muscle was tightened up under the chin, the skin (that was once bulging forward) shrunk upward and back. This only occurred because she had sufficient elasticity that allowed this process to take place. These results also did not just appear within weeks of having surgery. This type of stable result took many months to evolve after the neck liposuction and platysmaplasty were performed. In the meantime, patients are asked to wear a compression bandage at nighttime while sleeping to encourage the skin to shrink faster. In addition, some patients are told to massage the skin to further help optimize the surgical results. In the end, these type of surgical results are possible without having to undergo a more extensive lower facelift/necklift procedure with certainly more scarring and the potential to have an even longer recovery.

#### Newsletter
URL: https://www.drhilinski.com/newsletter/

#### Non Surgical Hair Growth in San Diego
Hair thinning and loss can affect confidence and self-image for both men and women. While surgical hair restoration is a powerful solution, many patients prefer to explore effective non-surgical options first. At the office of San Diego plastic surgeon Dr. John Hilinski, we offer the innovative NAMF Protocol — a comprehensive, evidence-based approach designed to preserve existing hair and stimulate new growth without surgery.

What is the NAMF Protocol?

The NAMF Protocol — short for Nourish And Maintain Follicles — is a multi-therapy treatment plan that combines four proven methods to target the different causes of hair loss. By addressing hormonal, nutritional, vascular, and follicular health, the protocol creates a strong foundation for long-term results.

N.A.M.F. Explained

Benefits of the NAMF Protocol

Delivers both short-term improvement and long-term maintenance

Targets multiple pathways of hair loss for maximum effectiveness

Preserves existing hair and stimulates new growth

100% non-surgical, with customizable options

Who is a Candidate?

The NAMF Protocol may be ideal for:

Individuals seeking non-surgical options before considering surgery

Men and women experiencing early to moderate thinning

Patients who want to maintain the results of a prior hair transplant

What to Expect: The Process

Preparation

No extensive preparation is required. During your consultation, Dr. Hilinski will review your medical history, current medications, and previous hair loss treatments to design a tailored NAMF plan.

Treatment Process

Nutrafol supplements are taken daily to improve internal support for hair growth.

Ariessence biologic treatment is performed in-office, targeting areas of thinning to activate follicle repair.

Minoxidil is prescribed as either topical or oral therapy depending on your needs.

Finasteride is prescribed when appropriate, typically for male patients, to reduce DHT and protect follicles.

Aftercare & Maintenance

Most patients resume daily activities immediately after treatment. Supplements and medications are continued at home. Biologic treatment may be repeated periodically for ongoing results. Regular follow-up visits help Dr. Hilinski monitor progress and make adjustments as needed.

FAQ: Non Surgical Hair Growth

Schedule a Consultation

If you’re noticing hair thinning or loss and want a non-surgical, science-driven solution, the NAMF Protocol may be right for you. Contact the practice of Dr. John Hilinski in San Diego today to schedule your consultation and learn how you can preserve and restore your hair with a personalized treatment plan.

Schedule Now

#### Non-Surgical Eye Lift
Non-Surgical Eye Lift in San Diego with Dr. John Hilinski

As we age, the delicate skin around the eyes often begins to sag, wrinkle, or develop under-eye bags, resulting in a tired or aged appearance. For those who desire a more youthful look but wish to avoid surgery, a non-surgical eye lift offers a minimally invasive option. Dr. John Hilinski, a renowned board-certified facial plastic surgeon in San Diego, specializes in non-surgical procedures that can rejuvenate the eye area without the need for extensive recovery or invasive techniques.

What Is a Non-Surgical Eye Lift?

A non-surgical eye lift refers to a series of cosmetic treatments designed to lift and rejuvenate the area around the eyes without the need for traditional surgical incisions. These treatments help tighten skin, reduce puffiness, smooth wrinkles, and refresh the eye area. Dr. Hilinski utilizes advanced non-invasive techniques that can yield natural-looking results with minimal downtime.

Benefits of a Non-Surgical Eye Lift

Minimally Invasive

No surgical incisions or sutures required.

Quick Recovery

Minimal to no downtime, allowing you to return to your daily activities faster.

Immediate Results

Some treatments provide visible results after just one session.

No Anesthesia Required

Most non-surgical eye lift procedures are performed with topical numbing or light sedation.

Customized Approach

Treatments are tailored to address your unique concerns.

Non-Surgical Eye Lift Techniques Offered by Dr. Hilinski

Dr. Hilinski offers several cutting-edge non-surgical techniques to address common signs of aging around the eyes:

What to Expect During a Non-Surgical Eye Lift

During your consultation with Dr. Hilinski, he will assess your concerns and develop a customized treatment plan based on your unique needs. The non-surgical procedures are typically performed in-office and can take anywhere from 30 minutes to an hour, depending on the techniques used.

You can expect minimal discomfort during the treatment, with most procedures requiring only topical anesthesia or light sedation. Following the procedure, you may experience mild redness or swelling, which typically subsides within a few hours to a few days.

Recovery and Results

One of the primary benefits of a non-surgical eye lift is the quick recovery time. Most patients are able to return to their normal activities the same day or shortly thereafter. Results can be seen immediately in some cases, and improvements continue over the following weeks as collagen production increases.

The results of a non-surgical eye lift can last anywhere from several months to a couple of years, depending on the treatment. Regular maintenance treatments may be recommended to prolong the effects.

FAQ: Non-surgical Eye Lift

Schedule Your Non-Surgical Eye Lift Consultation Today

If you're interested in refreshing your appearance with a non-surgical eye lift, contact Dr. John Hilinski's San Diego office to schedule your consultation. Dr. Hilinski is dedicated to providing personalized care and expert results that help you look and feel your best.

#### Nose
Nose Procedures by Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

Dr. John Hilinski is a leading expert in rhinoplasty and other nose procedures, offering advanced surgical solutions to enhance your nose's form and function. As a double board-certified facial plastic surgeon in San Diego, CA, Dr. Hilinski has extensive experience in performing a wide range of nose surgeries tailored to each patient's unique needs. Whether you are looking to refine your nasal appearance, correct breathing issues, or repair damage from trauma, Dr. Hilinski combines precision, artistry, and advanced techniques to deliver natural and harmonious results.

Personalized Rhinoplasty for Every Patient

Dr. Hilinski understands that each patient's nose is unique and requires a personalized approach. During your consultation, he takes the time to listen to your concerns, assess your facial structure, and discuss your aesthetic goals. This thorough understanding allows him to create a customized treatment plan that addresses your specific needs, ensuring outcomes that improve your nose and enhance your overall facial balance.

From primary rhinoplasty to complex revision cases, Dr. Hilinski's expertise in nose surgery spans a variety of specialized procedures. Using the latest advancements in rhinoplasty techniques, including preservation and piezo rhinoplasty, he strives to achieve the most natural-looking results while maintaining the functionality of your nose.

Explore Our Nose Procedures:

Schedule a Consultation with Dr. Hilinski

If you are considering rhinoplasty or any other nose procedure, schedule a consultation with Dr. John Hilinski, San Diego's leading rhinoplasty expert. With a commitment to excellence and a personalized approach, Dr. Hilinski is dedicated to helping you achieve the results you desire. Contact us today to learn more about how our advanced nose procedures can enhance your appearance and boost your confidence.

#### Nose Hump
Nose Hump Correction Surgery with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A dorsal hump, commonly referred to as a nose hump, is a prominent bump on the bridge of the nose that can affect the profile and overall facial balance. Many individuals with a nose hump feel self-conscious about the appearance of their nose and seek correction to achieve a smoother, more refined contour. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in nose hump correction surgery, offering advanced techniques to help patients achieve natural-looking results that enhance their facial harmony.

What is Nose Hump Correction Surgery?

Nose hump correction surgery, also known as dorsal hump reduction, is a type of rhinoplasty procedure designed to smooth and reshape the nasal bridge by removing or reducing the hump. This surgery is often chosen by patients who feel that the bump on their nose creates an unbalanced profile or draws unwanted attention to their nose.

The procedure typically involves removing excess bone or cartilage from the bridge of the nose to create a straighter, more proportional appearance. Dr. Hilinski uses precise techniques to ensure that the nose is refined without compromising its structural integrity or natural look.

Why Choose Nose Hump Correction Surgery?

Patients seek nose hump correction surgery for a variety of reasons:

Special Considerations for Nose Hump Correction Surgery

Why Choose Dr. John Hilinski for Nose Hump Correction in San Diego?

Dr. John Hilinski is a double board-certified facial plastic surgeon with extensive experience in rhinoplasty, including nose hump correction surgery. His credentials include:

With this extensive training and experience, Dr. Hilinski offers nose hump correction surgery with a focus on natural results that enhance the patient's overall facial harmony. His personalized approach ensures that each patient receives a treatment plan tailored to their individual needs and aesthetic goals.

FAQ: Nose Hump Correction Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you are considering nose hump correction surgery and want to learn how Dr. John Hilinski can help you achieve a smoother, more refined nasal profile, schedule a consultation today. As San Diego's expert in rhinoplasty and nasal reshaping, Dr. Hilinski offers personalized care and advanced surgical techniques to deliver natural-looking results. Contact us to start your journey toward a balanced and confident appearance.

#### Not Your Usual Septoplasty
This is a case that involves the repair of a deviated septum – called a septoplasty – but not your usual septoplasty.

Septoplasty Terminology

Some patients actually call the procedure ‘a deviated septum’ – as in they “underwent ‘a deviated septum’ last week” – but this is not a correct use of the term. Septoplasty is the more accurate term for someone undergoing surgical repair of a deviated septum. Septal reconstruction is another term used to describe this type of nose repair to improve nasal breathing.

Septoplasty Evaluation

This particular patient consulted with Dr. Hilinski because of his known reputation in San Diego as one of the best septoplasty and rhinoplasty surgeons around. In fact, this patient happened to know quite a few plastic surgeons in San Diego – but chose and trusted Dr. Hilinski as her surgeon.

When evaluating her nose prior to surgery, you can see quite readily why she was having trouble breathing through her nose. When seen from below, her nostrils are clearly two different sizes. Now everyone has asymmetry of the nostrils – even after great plastic surgery. But hers are way off! Her right nostril is significantly smaller than her left nostril, which translated into much more difficulty breathing through this side of her nose. When seen from the front, her nose was also quite displaced. This is commonly called a crooked nose. You can see how the tip of her nose was pushed off to her right side (left in the photo). This was also a contributing factor in terms of her not being able to breathe properly through her nose.

San Diego Septoplasty Repair

In this particular case of a deviated septum, Dr. Hilinski recommended she undergo an open technique. This means he wanted to make a cut under the nose to lift the skin up in order to repair her septoplasty. The reason behind this had to do with the location of her deviated septum.

In most cases of septoplasty done in San Diego, the surgeon will make cuts on the inside of the nose in order to access the deviated septum. That is because most septums that are deviated are crooked further back inside the nasal cavity. The adjacent septoplasty diagram shows where most deviations are located – as indicated by the red area. Believe it or not, all of this cartilage and some bone can be removed in the red area to help improve nasal function and breathing – and the nose will stay nicely supported. That is because the yellow shaded area – called the L-strut – is still left intact, or preserved during routine septoplasty. If this yellow area is violated – or cut out during a septoplasty procedure – the patient will risk having collapse of the nose bridge and/or the nasal tip. Unfortunately, even here in San Diego there are ENT doctors who perform deviated septum surgery who accidentally cut into this L-strut of cartilage and leave patients with significant problems after routine septoplasty. But if the L-strut is minded and left intact, there should not be much of a concern of collapse following septoplasty.

In cases where the deviated septum involves any part of the yellow L-strut region (for example, where the red arrow is pointed in the adjacent diagram), a routine septoplasty will not be the appropriate surgical answer. In these types of septoplasty, the deviated septal cartilage is often times best addressed using the open rhinoplasty approach alluded to above. That is because the deviated septal cartilage has to cut out – but then replaced to help maintain an adequate L-strut. In other cases, the cartilage has to be mobilized and literally moved over and re-secured in a new location. This is best done by the open rhinoplasty approach where grafting can be done much more readily given the optimal exposure of the anatomy. This is frequently referred to as an ‘open septoplasty’ surgery. But this type of septal reconstruction is usually not performed by ENTs and otolaryngologists – largely because it requires training and experience in doing nose jobs and rhinoplasties. So more commonly this type of septoplasty is done by facial plastic surgeons who have dedicated knowledge and training in reshaping noses.

In this particular case example, her deviated septum involved the front part of the L-strut. This can be easily seen in her operative photo taken during the septal surgery performed here in San Diego by Dr. Hilinski. The outline of this L-strut area – technically called the caudal septum – can be see in between the forcep tongs in the photo. Compare the location of the septal L-strut versus where the middle of her face is – which can be roughly estimated by looking at the center of her beautiful, white teeth. You can readily see how far off of the middle this is – likely on the order of 6-7 millimeters. This is actually a good distance off in the world of septoplasty and nose reconstruction. No wonder her nostrils were so different in size and shape! And no wonder she was having trouble breathing through her nose due to the deviated septum issue.

Ultimately, Dr. Hilinski ended up having to rebuild this entire area of her septum – including use of cartilage grafts taken from further back in her nose. But in taking the extra effort to do this type of septoplasty surgery, Dr. Hilinski was confident in being able to make her septum straighter – while also putting her nasal tip in a better esthetic position.

Open Septoplasty Results

Fast forward to her new nose created by Dr. Hilinski. The first thing you can appreciate is just how straight her nose is now – after the open septoplasty/rhinoplasty procedure. Her nose tip is now more centered on her face and her nostrils are also much more symmetrical in size and shape. On the oblique and side views, you can also see how her columella and angle of the nasal tip are improved as a result of Dr. Hilinski’s surgery. And the base view speaks for itself! Overall, this patient was quite happy with Dr. Hilinski’s septoplasty-rhinoplasty procedure – and can now breathe like a champion!

#### Notice of Open Payments Database
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

#### Nutrafol
Say Goodbye to Thinning Hair — Discover the Power of Nutrafol at Dr. Hilinski Facial Plastic Surgery

If you're struggling with hair thinning or early-stage hair loss in the San Diego or La Jollaarea, Nutrafol offers a scientifically-backed, natural solution trusted by dermatologists andnow offered by double board-certified facial plastic surgeon Dr. John Hilinski. Withpersonalized care, clinical insight, and a commitment to natural aesthetics, our clinic is proudto be a top destination for hair restoration support in Southern California. Our officeisn't just a distributor of Nutrafol — it's a place where hair restoration is approached withmedical precision, patient-centered care, and a commitment to achieving lasting, naturalresults.

Why Choose Nutrafol?

Nutrafol is not just another supplement — it's a physician-formulated, clinically tested hairwellness solution that targets the root causes of thinning hair from within. Unlike harshtreatments or invasive procedures, Nutrafol promotes hair growth through a natural, multi-targeted approach.

Key Benefits of Nutrafol:

Supports visibly thicker, stronger hair growth

Balances stress hormones and improves scalp health

Clinically effective for men and women

100% drug-free and backed by clinical studies

Includes ingredients like saw palmetto, marine collagen, ashwagandha, and biotin

Studies show that 84% of users experienced improved hair growth and 81% noticed thickerhair after six months of use.

Local Relevance: Hair Loss in Southern California

Hair loss is more common in our region than you might think. According to the American Hair Loss Association, over 35 million men and 21 million women in the U.S. experience some form of hair thinning — and warm, sunny climates like San Diego’s can increase scalp inflammation and accelerate follicular stress.

Residents of coastal neighborhoods such as La Jolla, with their exposure to salt air, sun, and hard water, often face environmental challenges that contribute to brittle hair, breakage, and scalp irritation. Our practice understands how these local factors interact with personal biology and lifestyle — and why a holistic approach like Nutrafol, guided by medical expertise, is more effective than one-size-fits-all supplements.

Who Can Benefit from Nutrafol?

Adults with early signs of thinning hair or shedding

Postpartum women or those experiencing hormonal imbalances

Men and women seeking natural alternatives to medications like minoxidil or finasteride

Patients recovering from cosmetic procedures involving the scalp, face, or neck

How We Help You Navigate Hair Loss Treatment in San Diego and La Jolla

One of the most common frustrations our patients express is confusion over which treatment paths are effective, safe, and right for their specific needs. At Dr. Hilinski Facial Plastic Surgery, we’ve helped guide countless local patients through:

Understanding the underlying causes of hair loss

Deciding between supplement-based, procedural, or combination therapy

Creating an ongoing regimen that supports whole-body wellness

Monitoring results and fine-tuning care for better outcomes

Our clinic combines clinical rigor with a deep understanding of local patient needs. Whether you’re a student at UC San Diego, a professional based in downtown San Diego, or a retiree living in La Jolla, we take the time to craft a plan that aligns with your lifestyle and goals.

Nutrafol FAQ

Book Your Consultation Today

If you're ready to take control of your hair health, schedule a consultation at Dr. Hilinski Facial Plastic Surgery in San Diego. Conveniently located near La Jolla, our clinic welcomes patients from throughout Southern California who are looking for medically sound, natural hair restoration support. Call us or use our online scheduler to request your appointment.

#### Open Rhinoplasty Incision Cleaning
The following video is provided to our patients as a guideline for cleaning the open rhinoplasty incision. This incision is typically made across the center of the columella (the column of tissue that separates the nostrils) and is shaped like an inverted V. It is normal to see a slight bump or prominence under the incision line, which is done on purpose. If you have any additional questions or concerns with regard to cleaning your open rhinoplasty incision, do not hesitate in contacting our office for further direction and guidance.

How to Clean Open Rhinoplasty Incision

#### Osteotomies – Narrowing a Wide Nasal Bridge
Osteotomies are a specific maneuver performed during rhinoplasty surgery to help narrow a wide nasal bridge and/or to straighten a crooked bridge. This rhinoplasty tutorial here focuses on the former – using osteotomies to narrow what is seen as a wide nasal bone.

This young lady consulted with me for a variety of reasons related to the cosmetic appearance of her nose. One of her main issues was that her nasal bones (and nasal bridge) appeared too wide. In looking at her preoperative frontal photograph provided here, you can readily appreciate that her nasal bridge, indeed, looked a bit wide. The vertical yellow lines approximate the actual width of her nasal bones, also referred to as the bony nasal pyramid. Ideally, these lines would be closer together in the midline position – creating a more favorable shadowing effect along the sides of the bridge.

As part of her cosmetic rhinoplasty procedure, I ended up performing nasal osteotomies. This is commonly referred to as breaking the nose because this technique actually involves cutting the bones that comprise the upper one-third of the nasal bridge. The adjacent photo diagram shows this concept more visually. There are two different types of osteotomies that were performed in this particular case. The first one is referred to as a ‘medial’ osteotomy and is indicated by the shorter, hashed red lines near the middle of the upper bridge. The second is referred to a a ‘lateral’ osteotomy and is indicated by the longer, hashed red lines running along the sides of the bridge. Medial and lateral osteotomies were performed on both sides, which is why there is a pair of similar hashed red lines. The nasal bone is shown as the purple shaded area below the hashed lines. By cutting the nasal bones in this manner, the bones are no longer fused together as a single pyramid structure. Instead, the upper one-third of the bridge is now effectively divided into two main segments of bone that are mobile – which means they can be reshaped by moving them around. In this case, the upper bridge was narrowed by bringing the nasal bones closer together (as shown by the arrows).

The end result of these osteotomies is shown here in the adjacent before and after photos. As you can now see, the upper one-third of her nasal bridge is now much more narrow than it used to be. By bringing the nasal bones closer together, more favorable shadowing is created along the sides of the bridge. This translates into a more shapely, feminine looking bridge.

#### Otoplasty
Otoplasty/Ear Pinning Surgery with Dr. John Hilinski: San Diego's Expert in Ear Shaping

Prominent or protruding ears can significantly affect self-esteem in both children and adults. Children with noticeable ear protrusion may face teasing or feel different from their peers, while adults may try to hide their ears or feel self-conscious in social situations. Otoplasty, also known as ear pinning or ear shaping surgery, is a procedure that repositions and reshapes prominent ears to create a more natural and balanced appearance.

San Diego Otoplasty specialist, Dr. John Hilinski, is a double board-certified facial plastic surgeon who specializes in ear surgery. He has extensive experience with both pediatric and adult otoplasty, providing personalized care and natural-looking results for every patient. Dr. Hilinski also performs a variety of other ear procedures, including ear reduction (macrotia surgery), gauge earlobe repair, and earlobe reshaping. His focus on achieving excellent outcomes helps patients feel more confident and comfortable with their appearance.

What is Otoplasty?

Otoplasty is a cosmetic surgery used to reposition the ears closer to the head and improve the appearance of congenital ear deformities, such as lop ear or cup ear. The surgery typically makes the ears appear smaller or less prominent. Otoplasty can be performed on both children (around the age of five) and adults, making it a versatile procedure for anyone dissatisfied with the shape or position of their ears.

For children, early intervention can help prevent teasing and psychological distress related to prominent ears, while for adults, otoplasty can provide long-term relief from self-consciousness.

Key Terms and Anatomy in Otoplasty

To understand otoplasty, it's essential to recognize the key anatomical landmarks of the ear:

By addressing these anatomical areas, Dr. Hilinski can reshape and reposition the ear for a more balanced and natural look.

The Otoplasty Procedure

Dr. Hilinski typically performs otoplasty as an outpatient procedure at his AAAASF-certified surgery center. The surgery is usually done under general anesthesia for children and IV sedation or local anesthesia for adults. During the surgery, Dr. Hilinski makes small incisions behind the ears to access the cartilage and reshape it. Permanent sutures are used to hold the ear in its new position, and in some cases, excess cartilage may be removed to achieve the desired shape. The incisions are closed with absorbable sutures, leaving no visible scars.

Recovery and Results

Most patients experience minimal discomfort following otoplasty. Children typically need 1-2 weeks off from school, while adults can return to work in a few days. A compression wrap is applied after surgery to help maintain the new ear shape and prevent complications. Full recovery, including wearing the wrap at night, may take several weeks. The ears will appear slightly overcorrected immediately after surgery but will settle into their natural position over the following weeks and months.

Dr. Hilinski prioritizes patient safety and satisfaction, ensuring that otoplasty results are long-lasting and natural-looking.

Otoplasty FAQ

Schedule Your Otoplasty Consultation with Dr. Hilinski

If you're considering otoplasty or ear pinning surgery to improve the appearance of prominent ears, schedule a consultation with Dr. John Hilinski, San Diego's leading ear surgery specialist. With his extensive experience and personalized approach, Dr. Hilinski helps patients achieve natural-looking, long-lasting results that boost confidence and self-esteem. Contact our office today to begin your journey toward a more balanced appearance.

#### Otoplasty Case Study 1
This is a classic example of cosmetic ear reshaping, or otoplasty surgery, in a male patient from San Diego, CA. This patient desired ear surgery to address overly prominent auricles that simply stuck out too far from his head.

Before Ear Reshaping

His before ear reshaping photos show some of the classic findings in patients who seek out cosmetic otoplasty surgery. For instance, you can see how one ear sticks out more than the other. In this case, his left ear was more angulated outward as can best be appreciated when looking from below (middle photo). In addition, you can see that most of the problem with his ears related to an overly prominent conchal bowl, which is the center of the external ear that forms a cup-like shape. To remind yourself of these various terms related to cosmetic ear reshaping, please visit our online otoplasty patient primer page. His antihelix was slightly under-developed and is a very common finding in cosmetic ear reshaping patients.

After Ear Reshaping

Here are his before and after ear reshaping photos for comparison. He underwent a standard cosmetic otoplasty procedure to bring his ears closer to the head while creating the type of contour that is found in a normally developed auricle. As you compare these before and after otoplasty photos, you can see that, despite cosmetic ear surgery, he still looks quite normal and natural. His ears simply have less attention now drawn to them. This is precisely the goal of well performed cosmetic ear reshaping surgery – to make it look like the patient could have been born looking just like this. The ears have been brought in closer to the head (which is why it is also called ear pinning surgery) by reducing the prominence of the conchal bowl and suturing the ear backward using permanent stitches. The antihelix was then better defined by creating a new, natural appearing ridge along the upper portion of the ear. The ear lobe was passively repositioned as the remainder of the ear was reshaped resulting in more optimal positioning of the ears. You can also see that the differences between the ears has been greatly improved with better symmetry having been achieved following otoplasty.

San Diego Ear Pinning Consultation

If you are interested in having your ears pinned back through cosmetic ear reshaping surgery, feel free to contact our office today. We are one of the most experienced plastic surgery offices in San Diego, CA when it comes to performing cosmetic ear reshaping or ear pinning surgery.

#### Otoplasty Case Study 2
This is a great example of a fairly niche type of otoplasty surgery – cosmetic reshaping of the ear lobe. This particular male patient from San Diego, CA presented to the office complaining that he disliked the size and shape of his ear lobes. The ear lobes refer to the fleshy portion of the external ear that joints with the side of the face. This particular patient simply thought the ear lobes looked too rounded as seen from the side view and he desired to have the ear lobes reshaped. He sought out the services of our office because of our well-known expertise in and around San Diego when it comes to cosmetic otoplasty surgery, or plastic surgery of the ear.

Otoplasty Case Presentation

If you look at his pre-operative photos, you can see that his earlobes are within the normal range for size and shape. However, he was bothered by them because the ear lobules looked too rounded for his desires. This is pointed out in the adjacent photos as indicated by the curved lines. You can see how the earlobes are more rounded in shape and loop downward slightly before joining into the side of the face.

Could this particular otoplasty patient leave his ears as is and simply live with them. Sure. But this is the beauty of plastic surgery – there is usually a procedure out there for everyone -regardless of how rare the motivation is to seek out change.

Cosmetic Ear Lobe Surgery

After consulting with this patient, it became quite clear that all he wanted was to have the ear lobes reshaped to appear less rounded and full. In fact, he would pull the ear lobe backward to demonstrate what he really desired in terms of an ear lobe that was straighter across as seen from the side.

We formulated a recommendation to perform the cosmetic ear lobe surgery using a specialized technique that involved making an incision (cut in the skin) only on the back side of the ear. Many plastic surgeons who are not specialists in otoplasty surgery would likely place their incisions on the front side of the ear lobe in an attempt to reduce the size. This is visually demonstrated in the adjacent photo as indicated by the red dotted line. This is the area where many plastic surgeons would cut into the skin with removal of the yellow shaded zone to create a smaller ear lobe. Unfortunately, this type of surgical technique would result in an unnecessary scar on the front side of the ear lobe. In addition, this approach risks creating a very unnatural looking border to the bottom of the ear. As an alternative, I recommended to the patient that we use an incision that is entirely hidden on the back side of the ear lobe. In this manner, would could hide the scar behind the actual ear and minimize chances of visibility. Furthermore, we would preserve a more natural contour to the bottom of the ear since we would not be cutting the skin in this particular area. The surgical technique I happen to use for this type of cosmetic ear lobe surgery utilizes an incision made on the back side of the ear lobe as indicated in the adjacent photo diagram. The curved arrow indicates that the incision is made on the back side of the ear lobe. Once the skin is incised, or cut, some of the soft tissue is removed from the back side of the ear lobe. The tissue is then sutured (or stitched) upward, which allows the bottom of the natural border of the ear lobe to be lifted without creating an unnatural appearance.

Before and After Ear Lobe Reshaping Photos

Here are this patient’s before and after photos showing results from his cosmetic ear lobe reshaping surgery. As you can see, he now has much straighter looking ear lobes with a less rounded appearance. These photos are taken just weeks after the procedure and demonstrate just how good patients look after this type of cosmetic ear enhancement procedure. The incisions are hidden behind the actual ear lobe so that there is no visible scarring. Using the otoplasty technique as described above, you can also appreciate how the natural curvature of the ear lobe has been preserved. The patient is quite happy with the cosmetic outcome from his otoplasty procedure and looks as if he could simply have been born looking like this.

#### Otoplasty Case Study 3
This is a somewhat unique case of cosmetic ear reshaping, or otoplasty surgery, that involves primarily use of anti-helix sutures to contour the ear.

This male patient from San Diego consulted with me for reshaping of his ears. Like many otoplasty candidates, he felt as if his ears were simply too prominent. In particular, he felt that his ears stuck out too far from the side of the head.

In looking at his preoperative photos, you can see that, indeed, the ear does stick out too far as seen from the frontal view.

From the side view you can sense how the ear almost comes out toward you. One way to think about this concept is to look at a closed and open door.This visual is provided here for demonstration purposes. Pretend the actual door is the patient’s ear and the doorway is the side of the patient’s head. When the door is closed (meaning flatter up against the doorway), it is analogous to an ear that is closer to the surface of the head. In this position (closed), you can see the entire outline and width (red line) of the door. When the door is open, it is more analogous to an ear that sticks out too far from the side of the head. When looking at the door (or ear) from this perspective, you cannot see the entire outline and the ear looks abnormally narrow (green line). An ear that is more ideally shaped and positioned up against the side of the head will show the entire outline when seen from this view. Going back to our current patient example, you can see from this perspective that his ear is sticking out at you, much like a door that is swung open. Otoplasty is intended to correct just this type of structural abnormality. In a sense, it is intended to help ‘close the door’ by bringing the ear closer to the head.

Mustarde Otoplasty Suture Reshaping

This case is somewhat unique in that the reshaping process was done essentially with Mustarde suture technique. Mustarde sutures are stitches that are placed behind the ear within the cartilage framework in order to create a more defined antihelix.Just to remind yourself, the antihelix is the natural ridge that runs in a vertical direction along the ear (‘2’ in the adjacent photo diagram). To a great degree, the antihelix ridge helps shape the normal ear by bending the top part inward so it is closer to the surface of the head. Since the antihelix helps flatten the ear against the head, the lack of an antihelix ridge results in the entire ear sticking out farther than it should.

Mustarde sutures can be used to create a new antihelix ridge, thereby drawing this portion of the ear closer to the head. This is done using the standard incision (cut in the skin) made behind the ear along the back surface. Once the cartilage is exposed, a series (several) of permanent sutures are placed that intentionally make a fold in the cartilage.When done properly, this fold mimics what would have been a natural antihelix ridge. This is demonstrated in the adjacent photo diagram of another otoplasty patient of mine. In this case I was trying to use Mustarde suture technique to bend the middle and top portion of her ear back closer to the surface of the head. This is indicated by the curved red arrow showing the desired direction of change. The white lines are indicative of the permanent Mustarde sutures that are placed within the ear cartilage from the back side. Usually a series of these Mustarde sutures are necessary to bend the ear cartilage into the desired shape. As you can see from this photo example, the entire ear been brought closer to the head. In addition, though, the antihelix ridge has now been formed with the Mustarde sutures.

No Conchal Bowl Reduction Needed

In most cases of otoplasty, Mustarde sutures are placed in conjunction with reduction of the conchal bowl (the cupped portion of the ear). The conchal bowl reduction is performed in order to reduce the volume of the cup. The cup, or conchal bowl, is then sutured closer to the head. This is simply another method of making the ear less prominent during otoplasty surgery.

In this particular case, though, the patient’s conchal bowl was not significantly enlarged. This is definitely more the exception than the rule when it comes to cosmetic ear reshaping surgery. In a majority of otoplasty patients, I perform a combination of conchal bowl reduction and placement of Mustarde sutures. But in this instance, his conchal bowl was considered normal in size. Therefore, all that was required was placement of Mustarde sutures to create an antihelix. In doing so, the mid to upper portion of the ear could be brought closer to the head – making the entire ear appear less prominent.

Mustarde Suture Otoplasty

I ended up performing this patient’s surgery using a standard post-auricular incision – meaning an incision that was made on the back side (posterior) of the ear (auricle).

The otoplasty procedure was performed with placement of several Mustarde sutures while creating a new antihelix for him on each side. The procedure took about 1.5 hours to complete and was done under local anesthesia (without going to sleep). A bandage was placed around his ears in the usual manner for otoplasty surgery. Although the bandages were changed the following day, they were left in place for about 5-6 days. Thereafter, he was able to wear a sweat band around the head to keep the ears in the desired position. This type of light compression wrap is recommended to be worn for upwards of 6-8 weeks after otoplasty surgery. This not only protects the ears from inadvertent damage, it also aids in maintaining proper healing.

Mustarde Suture Otoplasty Results

Here are the before and after pictures of this patient following Mustarde suture otoplasty surgery. As you can see in the photos, his ear has been brought closer to the plane of the head and does not stick out as far as it did. In addition, you can see from his side view that a new antihelix ridge has been created using the Mustarde suture technique. Referencing our analogy above, the door has now been closed thus allowing you to see the full (and normal) outline of his ear. As pointed out earlier, the conchal bowl was not touched as part of this particular cosmetic ear surgery, which is much different than your average otoplasty procedure. But when it comes to plastic surgery of the ear, one should only do what is absolutely necessary to achieve the desired goal. In this instance, Mustarde suture placement alone was sufficient to create the desired shape.

Mustarde Suture Cosmetic Ear Surgery

If you have overly prominent ears and feel that you might benefit from Mustarde suture placement, contact a cosmetic surgery specialist who has dedicated experience in plastic surgery of the ear – Dr. John Hilinski.

#### Out of Town Patients
Out of Town Patients at John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are honored to welcome patients from across the country and around the world who choose to travel to San Diego for expert facial plastic surgery. Led by Dr. John Hilinski, a Harvard-trained, double board-certified facial plastic surgeon, our practice provides world-class care, specializing in procedures such as rhinoplasty, facelifts, and facial rejuvenation.

We understand that traveling for surgery is a significant investment in both time and money, so we aim to make the process as smooth and convenient as possible. The following information will help guide you through the steps of consultation, travel, and recovery during your stay in Southern California.

The Consultation Process for Out of Town Patients

While there is no substitute for an in-depth, one-on-one consultation with Dr. Hilinski, we recognize that traveling for a consultation may not be immediately feasible. To assist with your decision, we offer a complimentary online screening consultation for out-of-town patients. This allows Dr. Hilinski to review your goals, medical history, and photographs prior to your visit.

Online Screening Consultation

The online consultation typically involves:

Email correspondence between Dr. Hilinski and the patient

Review of submitted photos (see below for details)

Discussion of your surgical goals and medical history

In some cases, Dr. Hilinski may recommend a preliminary surgical plan based on this screening consultation. If so, you can schedule a surgical date and plan to meet with Dr. Hilinski 1-3 days before the surgery for an in-person consultation and final evaluation.

In other cases, Dr. Hilinski may advise an in-person consultation prior to scheduling surgery to ensure a more comprehensive assessment of your candidacy for the procedure.

Sending Photos for Review

For the online consultation, please send photos to help Dr. Hilinski assess your needs. Photos can be mailed in standard print format or uploaded directly via our Virtual Consultation page. Digital photos may also be emailed to info@drhilinski.com. We recommend submitting at least three views to provide a comprehensive perspective of the treatment area.

Accommodations in San Diego

San Diego is a beautiful and popular destination with plenty of accommodation options. To help make your stay more comfortable, we recommend several nearby hotels based on their proximity to our office and price range:

Courtyard San Diego Sorrento Valley

Homewood Suites by Hilton San Diego-Del Mar

Holiday Inn Express & Suites San Diego-Sorrento Valley

Hilton Garden Inn San Diego Del Mar

Sheraton La Jolla

Embassy Suites by Hilton San Diego La Jolla

San Diego Marriott La Jolla

Hilton La Jolla Torrey Pines

Hyatt Regency La Jolla At Aventine

Our team can assist with your hotel selection and any other travel arrangements you may need to ensure a seamless experience.

Postoperative Stay and Care

After surgery, Dr. Hilinski typically recommends that you stay in San Diego for 10-14 days before traveling back home, depending on the procedure. During this time, you will attend an early postoperative visit within 1-3 days of surgery to monitor your recovery.

It is important to have a responsible family member or friend accompany you during the first few days of recovery. If this is not possible, we can help arrange for a private nurse to provide care for the first 24 hours following your surgery.

Convenient Travel to San Diego

The closest airport is San Diego International Airport, located approximately 22 minutes from our office. Another nearby option is McClellan-Palomar Airport, which is about 24 minutes away.

FAQs for Out of Town Patients

If you're ready to take the next step, contact us today to schedule your online screening consultation with Dr. John Hilinski. Let us help you plan a successful and comfortable experience during your stay in San Diego for facial plastic surgery.

#### Pain Free Nitrous Oxide
At Hilinski Medspa, we are committed to providing the highest level of comfort during your cosmetic treatments. One of the ways we ensure a relaxing experience is by offering pain-free nitrous oxide sedation. Overseen by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, our goal is to make every procedure as comfortable and anxiety-free as possible, especially for those who may have concerns about discomfort or needles.

What is Nitrous Oxide?

Nitrous oxide, commonly known as "laughing gas," is a safe and effective sedative used to ease pain and anxiety during cosmetic procedures. It is a 50-50 mixture of nitrous oxide and oxygen, which, when inhaled, creates a calming effect. Laughing gas has been widely used for decades in dental and medical procedures, known for its quick onset and safety.

At Hilinski Medspa, we use nitrous oxide to help patients relax during minimally invasive treatments such as Botox, injectable fillers, and laser procedures. Whether you're concerned about discomfort or simply wish to have a more relaxed experience, nitrous oxide can be an excellent solution.

The Nitronox™ System

We utilize the Nitronox™ system for precise control of nitrous oxide doses, ensuring a safe and effective experience. This system delivers a 50-50 blend of nitrous oxide and oxygen, allowing patients to self-administer the gas for a more controlled and personalized experience. The Nitronox™ system is nearly identical to its competitor Pro-Noxâ„¢, and both systems have an excellent track record for patient safety and comfort.

How Nitrous Oxide Works

With the Nitronox™ system, the process is simple and straightforward. Patients self-administer the nitrous oxide through a handheld tube, inhaling the gas just before and during their procedure. As the gas takes effect, patients quickly feel relaxed and calm, helping reduce pain and anxiety associated with cosmetic treatments. The effects are short-lived, so once you stop inhaling the gas, it leaves your system within minutes. You will be alert and ready to drive home almost immediately after your treatment.

What Treatments Can I Get With Nitrous Oxide?

At Hilinski Medspa, nitrous oxide can be used to enhance comfort during a variety of cosmetic procedures, including:

If concerns about pain or anxiety have kept you from pursuing cosmetic treatments in the past, nitrous oxide may be the perfect solution to make your experience more enjoyable and stress-free.

Nitrous Oxide FAQs

Contact Our Medspa Today to Schedule Your Consultation

At Hilinski Medspa, we believe in creating a comfortable and anxiety-free experience for every patient. If you're interested in pain-free cosmetic treatments with nitrous oxide sedation, contact us today to schedule your consultation. With Dr. John Hilinski's expert care and our advanced nitrous oxide technology, we can help you feel relaxed and confident while achieving your cosmetic goals.

#### Patient Forms & Instructions
The following forms and instructions are provided as general information and guidelines for future and current patients of Dr. Hilinski.

Instructional information is provided to make your chosen procedure and recovery period as comfortable as possible while ensuring proper healing. If you have are any remaining questions, please do not hesitate in contacting our office.

Click on the links below to download information and forms in printable PDF format. If you do not have Adobe Acrobat Reader, click here to download a free version.

General Guidelines

Restricted Medication List

General Wound Care

Medspa Guidelines

Peri-Operative Laser Medical Guidelines

Surgical Guidelines

Peri-Operative General Guidelines

Peri-Operative Laser Surgery Guidelines

Peri-Operative Nose Surgery Guidelines

Peri-Operative Eyelid Surgery Guidelines

Peri-Operative Ear Surgery Guidelines

#### Patient Info
Patient Information at John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are dedicated to providing high-quality care through a comprehensive selection of cosmetic and reconstructive facial procedures. Led by Dr. John M. Hilinski, a Harvard-trained, double board-certified facial plastic surgeon, our practice focuses on delivering personalized, patient-centered treatments that help you achieve your aesthetic goals. Our team strives to make every patient's experience a positive one, offering the most effective and conservative treatment options in a safe and comfortable environment.

All procedures are performed in our state-of-the-art, AAAASF-accredited surgical facility, where patient safety and comfort are our top priorities. Whether you are undergoing rhinoplasty, facelift surgery, or any other facial rejuvenation procedure, you can trust that you are in the hands of an experienced team committed to excellence.

What to Expect at John Hilinski MD Facial Plastic Surgery

Our practice is designed to provide you with detailed information and resources to ensure you have a seamless experience from consultation through recovery. The links below offer valuable insights into the various aspects of your journey with us, from rewards programs to patient forms, virtual consultations, and testimonials.

Comprehensive Care at John Hilinski MD Facial Plastic Surgery

At John Hilinski MD Facial Plastic Surgery, we are committed to guiding our patients through every stage of their aesthetic journey, ensuring that they feel informed, comfortable, and confident throughout the process. From your first consultation, Dr. Hilinski and his dedicated team will take the time to understand your unique goals and develop a treatment plan tailored to your individual needs. We believe in a collaborative approach, where patients play an active role in their care and decision-making.

In addition to our in-office care, we offer resources for out of town patients, including travel assistance and virtual consultations to make the process as seamless as possible. Our goal is to provide comprehensive support and outstanding care at every step of the journey, so you can achieve your aesthetic goals with confidence.

If you are ready to take the next step toward enhancing your natural beauty, contact us today to schedule your consultation with Dr. John Hilinski. We look forward to helping you achieve the results you desire in a safe, professional, and personalized environment.

#### Persian Female Rhinoplasty
Persian Female Rhinoplasty Surgery

Persian rhinoplasty is a very specialized subset within the world of rhinoplasty that should only be performed by expert plastic surgeons who have dedicated experience in ethnic cosmetic nose reshaping surgery.

Persian Rhinoplasty Evaluation

This female patient highlighted here is an example of Persian nose surgery that involved extensive reshaping of the nasal framework.

In this particular case, the patient noted several issues with her nose that she desired to have reshaped. First and foremost was trouble breathing through the nose. This was a consequence of a deviated septum as well as poor tip positioning. In addition, she was bothered by the fact she had a fairly rounded, broad nasal tip shape. But she was also unhappy with her broad, wide nasal bridge. These issues are readily seen in her preoperative photos shown here. Looking more closely at the photos, you can appreciate several other problems with her nose. For example, her nasal tip appears quite droopy where it meets with the upper lip. This area is called the nasolabial angle, which is ideally between 95-105 degrees in a female patient. In this case, her nasal tip is closer to 90 degrees. On the frontal view, such a closed nasolabial angle translates into very poor nostril shadowing. That is because her nasal tip is angled downward too much. No one desires to have excess nostril visibility as seen from the front (the so-called dreaded pig nose). But it is quite normal to have at least some nostril show (visibility) when looking straight on at the face. In this case example, you can see she has essentially no nostril visibility – which is fairly abnormal and should be corrected.

Overall, these various anatomical issues contribute to her nose simply looking too large for her face.

Persian Rhinoplasty Surgery

After discussing with her the various options, this patient ultimately decided to proceed with a reconstructive septorhinoplasty surgery to hopefully make her nose function better while also creating a more desirable appearance.

It should be emphasized that it is very important when performing Persian rhinoplasty surgery that one does not attempt to erase all ethnic features of the nose. Yes, Persian patients are looking to address certain prominent features of their nose that they dislike. However, the goal in Persian rhinoplasty, as is the case in other forms of ethnic rhinoplasty, is to create a nose that still appears Persian – not one that suddenly now appears more Caucasian.

In this case example, an open rhinoplasty approach was utilized in order to provide optimal exposure of the cartilage and bone framework. The areas of bulging along the sides of the bone were rasped conservatively – meaning, they were sanded down to create a smoother contour. This is shown visually in the adjacent diagram where the red hatched lines indicate the area of rasping on both sides. Next, the nasal bones were then reshaped to bring them in closer to one another. This is indicated by the yellow broken lines corresponding to the medial and lateral osteotomies used to cut the nasal bones. In doing so, this helped to address the excess width seen along the upper one half of her nose. Her nasal tip was then reshaped and repositioned. This included trimming off some of the excess volume as shown by the red strips in the adjacent diagram. At the same time, her nasal tip cartilage was sutured on both sides (indicated by green markings) to create a more narrow shape and contour. Finally, the entire nasal tip was rotated upward and repositioned along the caudal septum as shown by the white arrows. Inside of her nose, a full septoplasty was performed to help improve her obstructed nasal breathing. Combined, these maneuvers allowed for complete transformation of her nose – inside and out.

Persian Female Rhinoplasty Results

The results of this Persian female’s septorhinoplasty can be seen here and represent very stable results close to one year out from her nose surgery. As you can see, nearly all of the preoperative issues have been successfully addressed as a result of the surgery. For example, her nasal bridge is much smoother in contour now that the excess bony prominences have been removed. Narrowing the nasal bones has helped further in this process. Reshaping and repositioning the nasal tip has allowed for her to have much better definition and refinement despite her very thick Persian skin. If you once again look at her nasolabial angle, it is now more appropriately around 95 degrees – creating just enough nostril visibility, or show. Lifting and rotating the nasal tip in this manner can have a huge impact on one’s nose as seen here.

Overall, you can readily see that her nose now appears smaller and more proportional for her face. Yet, she still looks Persian with a nose that is ethnically consistent with her surrounding facial features.

Case 1 Lateral Photos

Case 1 Oblique Photos

Case 1 Frontal Photos

Persian Rhinoplasty Consult

If you are Persian and looking to have functional and/or cosmetic nose reshaping surgery, do not hesitate in contacting our San Diego office today for a personalized consultation.

#### Persian Middle Eastern Rhinoplasty
Persian (Iranian) rhinoplasty is a very common type of Middle Eastern cosmetic nose surgery performed in my practice. In fact, I would say that Persian (Iranian) patients make up a significant portion of my ethnic rhinoplasty patient population. This should not really be surprising, however, since Iran is widely considered by many insiders to be the rhinoplasty capital of the world – making nose job surgery quite acceptable within the Persian culture. Presented here is an excellent example of cosmetic rhinoplasty in a very pleasant Persian lady who was looking to address certain features of her nose she simply did not like.

Persian (Iranian) Rhinoplasty Presentation

This patient’s main desire, like many Persian (Iranian) rhinoplasty patients, was to have a nose that looked ‘smaller’ and more defined. On her frontal view, you can see that her nose was really not too bad in terms of overall balance and harmony with her surrounding facial features – especially for an ethnic nose. Perhaps it was a bit wide along the bridge. But, overall, not bad. As you begin to see her oblique and side views, the bridge of the nose now becomes a little more obvious in terms of having excess height. This is seen in combination with the fact her nasal tip is droopy. This drooping is even more noted when she smiles as can be readily seen in her preoperative rhinoplasty photo series.

Persian (Iranian) Rhinoplasty Skin Thickness

One major factor in this case that is not readily appreciate in the photos is her skin thickness. In most Persian (Iranian) rhinoplasty patients, the skin thickness is a very important consideration, particularly when dealing with planned tip reshaping. This is because thick skin does not readily shrink down in size compared to thinner skin. In many Persian (Iranian) rhinoplasty patients, the desire is to make the nose look smaller – especially in the region of the tip. If the cartilage framework of the tip is reduced considerably in size in an attempt to make the nose look smaller, the thick skin will often times not shrink down to match the new smaller framework. If this occurs, the skin will actually appear amorphous, or without shape – making the nasal tip look even less defined than it was to start.

Larger to Look Smaller?

So what do you do in Persian (Iranian) patients to make the nasal tip look smaller? In many cases of Persian (Iranian) rhinoplasty you actually have to make the nose physically larger to appear smaller. Whenever I broach this topic with potential rhinoplasty patients, they invariably give me the same response – ‘… but Dr. Hilinski I don’t want my nose to be any bigger’ – which is completely understandable if you do not grasp this concept. But the reality is that in many cases of Persian rhinoplasty, the cartilage framework of the nasal tip has to be made larger in order to provide a more defined, smaller looking nose. By adding cartilage to the nasal tip in the form of grafts, the thicker than average skin can be ‘pushed’ out to make the tip appear more narrow – or visually smaller. That is precisely what was done in this particular case as cartilage was taken from inside of her nose (from the septum) and used to graft the nasal tip region to provide her with a more defined nasal tip.

Persian Rhinoplasty Reshaping

In addition to reshaping her nasal tip to provide a more defined look, I ended up lifting her nasal tip (also referred to as rotating the tip) to address the drooping effect. For her excess upper bridge height, I performed a reduction of this area using rasping techniques, or sanding.

These type of changes to her nasal tip and bridge can be seen diagrammatically in the adjacent rhinoplasty diagram.

Persian (Iranian) Rhinoplasty Columella Scar

The entire surgery was done using what is called an open rhinoplasty approach where an incision is made across the columella (the column of tissue that separates the right and left nostrils). In my humble opinion, this type of rhinoplasty technique provides a huge benefit in terms of visualization versus doing a closed rhinoplasty approach – especially when dealing with such tip reshaping surgery. Many rhinoplasty patients concern themselves about this incision because, after all, no one really wants to have visible scarring. Fortunately, in most cases this open rhinoplasty scar is barely visible from several feet away. The actual healed scar from this current case example of Persian rhinoplasty is shown here. On the left side is the actual incision made during the surgery as is shown by the red marking. On the right is the well-healed post-rhinoplasty scar. As you can see for yourself, the scarring is quite acceptable and should not be considered a huge deterrent to undergoing an open cosmetic rhinoplasty procedure.

Persian (Iranian) Nosejob Results

Shown here are the before and after rhinoplasty photos of this particular patient. As you can see from her frontal view, there is a noted improvement in terms of her nasal tip with a more refined look that can be seen following rhinoplasty. As you begin to look at her oblique and side views, you can also appreciate how the nasal tip has been brought up a bit to get rid of the appearance of a drooping nasal tip. Now when she smiles (as shown), her nasal tip remains quite stable in its position. On the side view you can also see how the upper portion of her nasal bridge has now been reduced in height to give a more feminine overall look with a smoother contour. But the most important thing is that her nose still looks quite natural on her face and does not appear as if it was surgically altered.

Persian (Iranian) Rhinoplasty Consult

If you are considering cosmetic nose job surgery and have a Persian (Iranian) background, feel free to contact my office today to schedule a personalized consultation to determine if you are a good candidate to undergo Persian (Iranian) rhinoplasty surgery.

#### Piezo Rhinoplasty
Piezo Rhinoplasty by Dr. John Hilinski: Advanced Ultrasonic Nose Reshaping in San Diego, CA

Piezo rhinoplasty represents a cutting-edge approach to nasal reshaping that utilizes ultrasonic technology to precisely sculpt nasal bones and cartilage. Unlike traditional rhinoplasty techniques that rely on rasps and chisels, piezo rhinoplasty employs an ultrasonic device to reshape the bone with high-frequency sound waves, minimizing trauma to surrounding tissues. Dr. John Hilinski, a leading facial plastic surgeon in San Diego, is at the forefront of this innovative technique, offering his patients enhanced precision, reduced recovery times, and more natural-looking results.

What is Piezo Rhinoplasty?

Piezo rhinoplasty, also known as piezoelectric rhinoplasty, uses an ultrasonic device that generates high-speed sound waves to safely and accurately reshape the nasal bones. This technology selectively targets bone and denser cartilage without damaging the overlying skin, mucosal tissues, or surrounding soft tissue structures. By focusing only on the bone and dense cartilage, piezo rhinoplasty reduces bleeding, minimizes bruising, lowers inflammation, and shortens the overall healing time for patients.

Traditionally, rhinoplasty surgeons have used rasps (metal files) and chisels (osteotomes) to reshape the nasal bones. While these tools can be effective, they often cause additional trauma to nearby tissues, leading to increased bleeding, swelling, and the potential for scarring. The use of piezo technology eliminates the need for these traditional tools, offering a gentler approach that enhances both the surgical experience and the results for patients.

Benefits of Piezo Rhinoplasty: Precision and Reduced Trauma

One of the significant advantages of piezo rhinoplasty is its ability to provide highly accurate and precise sculpting of nasal structures. The ultrasonic device is equipped with specialized tips designed for the various angles and shapes encountered during rhinoplasty, allowing Dr. Hilinski to achieve detailed reshaping with minimal risk of complications like splinter fractures or unwanted bone breaks. This level of precision is especially beneficial when narrowing the nasal bones or addressing complex nasal contours, as it ensures smoother, more predictable results.

Piezo rhinoplasty also offers benefits in both open and closed rhinoplasty techniques. While initially adopted for open rhinoplasty, piezo technology is now effectively used in closed rhinoplasty as well, thanks to advancements in surgical understanding and access points. This versatility allows Dr. Hilinski to choose the best approach for each patient, maximizing the aesthetic and functional outcomes.

Who Is a Candidate for Piezo Rhinoplasty?

Piezo rhinoplasty is ideal for patients who:

Are looking for precise and natural-looking changes to their nose

Desire a reduction in nasal hump or refinement of the nasal bridge

Prefer a less invasive approach with minimized trauma to surrounding tissues

Seek faster recovery and reduced postoperative discomfort

Are in good overall health and have realistic expectations

During your consultation, Dr. Hilinski will assess your nasal structure and discuss your goals to determine if piezo rhinoplasty is the best approach for you.

FAQ: Piezo Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering piezo rhinoplasty and want to explore how this advanced ultrasonic technique can help you achieve precise, natural-looking results, schedule a consultation with Dr. John Hilinski. As San Diego's expert in piezo rhinoplasty, Dr. Hilinski combines his extensive credentials, personalized approach, and dedication to excellence to provide exceptional care. Contact us today to begin your journey toward your ideal nose.

#### Pinched Nasal Tip
A pinched nasal tip refers to a nose that is excessively narrowed in the region of the tip. This type of nasal abnormality can arise as a congenital problem – meaning the patient was born with this – or as a result of having had prior unsuccessful rhinoplasty surgery. In most cases, rhinoplasty patients presenting with a pinched nasal tip have had prior surgery that contributed to the problem. It is much less common to see patients who have a congenitally pinched nasal tip.

Why Does The Nose Pinch?

To understand why the nose pinches inward at the nasal tip, you must first have a good understanding of the nasal anatomy. Please refer to our online rhinoplasty tutorial chapter on nasal analysis to familiarize yourself with the pertinent anatomy and surface landmarks of the nose.

The tip of the nose is normally comprised of the paired lower lateral cartilages along with the lower portion of the septum. In reality, the lower lateral cartilages are the structures that more directly contribute to the shape of the nasal tip. This anatomy is depicted below and shaded red to show the pair of lower lateral cartilages in their normal position and shape. As you can see from the diagrams, particularly the base view from below the nose, normal lower lateral cartilages create what is called a ‘soft triangle’ shape to the nasal tip. This means that the tip is overall a triangular shape but does not have any sharp angulations. This is precisely what gives the ideal nasal tip a soft, yet defined appearance.

When the lower lateral cartilages deviate from this ideal position and shape, the appearance of the nasal tip will follow suit. In the case of a pinched nasal tip, the lower lateral cartilages are somehow weakened or compromised, resulting in collapse of the nasal tip support on one side or another. As noted above, this type of abnormality can be either congenital or a result of prior rhinoplasty surgery.

So what happens to the lower lateral cartilage when the nasal tip is pinched? In most cases, the nose pinches inward because the lower lateral cartilage is too narrow to support the sides of the nasal tip. This concept is shown below in a series of rhinoplasty diagrams.

In many cases of rhinoplasty, the plastic surgeon attempts to narrow the appearance of the tip in the hopes of providing more definition to the nose. One technique that is still commonly used in rhinoplasty and revision rhinoplasty today is removal of some of the cartilage around the tip region. This includes a technique called cephalic trimming, where the cartilage along the cephalic border (the side of the lower lateral cartilage closer to the eyes) of the nasal tip is removed. In the adjacent rhinoplasty diagrams, this cartilage removal is represented by the blue shaded area where there used to be red (cartilage). The idea is that this cartilage is contributing to a rounded or bulbous look to the nasal tip. By removing this strip of cartilage during a rhinoplasty procedure, the tip can be made more narrow and, thus, more defined.

Unfortunately, when a rhinoplasty surgeon is too aggressive and removes excessive cartilage in this area, they are diminishing the structural support of the natural nasal tip. In some rhinoplasty patients, this can amount to as much as one-third of the native cartilage support of the nasal tip that is being removed. If you look at the diagrams above, you can easily appreciate that removing this amount of cartilage (the blue shaded segment) is going to compromise the tip support to some degree. Yes, you may produce a ‘more defined nasal tip,’ but at what cost? In cases where there is insufficient lower lateral cartilage left behind, the nasal tip may not have enough structural support to maintain proper shape. It is these cases where a pinched nasal tip can result following a nose reshaping procedure. 

This is the type of complication from rhinoplasty that is not going to be appreciated on the operating room table at the time of the surgery. Instead, this type of rhinoplasty deformity will appear months down the road of recovery once the swelling resolves and the skin shrink wraps down. The adjacent rhinoplasty diagram shows what happens to the lower lateral cartilage following removal of excessive amounts of cartilage. The side wall of the nasal tip begins to pinch inward since the remaining cartilage is not strong enough to support the sides of the tip and the nostril rims. This pinching effect occurs to the side of the actual tip where the nose transitions out to the side of the nostrils. The depression that results can be an obvious stigma of having had a prior unsuccessful rhinoplasty surgery.

Breathing Problems From A Pinched Nasal Tip

There are also functional implications from having a pinched nasal tip above and beyond the cosmetic concerns. Normally the lower lateral cartilage helps to maintain an patent airway, or breathing passage, in terms of the nostril opening. Think of the normal lower lateral cartilage as the arched roof of the nostril opening. If this support is compromised to a significant degree, the roof will eventually collapse. This is seen more graphically in the adjacent photo showing what happens in nature when an arched contour looses its integrity to the point of collapse. In terms of the nostril opening, the remaining, weakened lower lateral cartilage also collapses inward. As shown in the adjacent diagram, the cartilage is no longer positioned out to the side providing support to the roof of nostril rim. Instead, it begins to drop into the nasal airway on both sides (yellow arrows showing cartilage dropping into the black nasal airway), blocking the breathing passage. So, in addition to cosmetic issues with the nose, these rhinoplasty patients, unfortunately, also present with trouble breathing through the nose.

Appearance Of The Pinched Nasal Tip

The following real life rhinoplasty patient photos visually demonstrate what the nose looks like when the tip begins to pinch inward. These are patients who had previously undergone rhinoplasty surgery to reshape their nose. The rhinoplasty, performed by a different facial plastic surgeon, was unsuccessful in that the nasal tip became pinched following surgery. They had each consulted with our San Diego facial plastic surgery office to consider a revision rhinoplasty, or secondary rhinoplasty, surgery.

On the frontal view of the nose, the red arrow points to the zone of maximal collapse, or pinching. You can appreciate the fact that there is a drop in contour when going from the nasal tip out to the side of the nostril. Usually this results in an abnormal shadow that is cast in these rhinoplasty patients. And in most cases, this pinching is asymmetric, or in other words, different from side to side. On the base view of the nose (from underneath), the red arrow also points to the zone of maximal collapse, or pinching. In fact, compare these real life rhinoplasty patients’ base view with the diagram above, showing the pinched nasal tip. You can see precisely where the nose pinches inward as was demonstrated in the diagram. Instead of having a gentle, convex contour from the nasal tip out to the side of the nostril, there is a notable depression due to the pinching and collapse of the cartilage.

Rhinoplasty To Correct The Pinched Nasal Tip

Rhinoplasty surgery to correct a pinched nasal tip is intended to target the lower lateral cartilage where there is maximal collapse. This usually requires cartilage grafting to rebuild the support mechanism around the nostril. Cartilage grafting is typically needed since the root of the problem is that too much cartilage was removed or was never present (in congenital cases). In patients where the septal cartilage is present in sufficient quantity, this can be used to create the cartilage grafts. In rhinoplasty patients who do not have enough septal cartilage for grafting purposes, ear cartilage (also known as auricular cartilage) is a fairly good alternative in most instances.

The goal is to create a graft that is relatively straight and rigid that can span the distance from the nasal tip out to the side of the nostril. In the adjacent rhinoplasty diagram, this is shown visually. The blue rectangles represent the actual cartilage grafts that are placed. As you can see, they need to be fairly linear in shape with sufficient rigidity to resist collapse – much like a steel beam. In addition, the cartilage grafts need to have a adequate length to span the entire zone of maximal collapse plus an overlap onto natively stable structures. As is depicted in the diagram, the cartilage grafts are usually sutured (sewn) into place (white suture loop with knot). With precise placement and positioning of the cartilage graft, a rhinoplasty surgeon can carefully ‘pull’ the collapsed, lower lateral cartilage outward. Think of a bird spreading their wings. This type of meticulous cartilage grafting can restore a more esthetically ideal contour to the nasal tip and mitigate unwanted shadowing. As you can see in the diagram, the nasal passageway is also improved as a byproduct of this type of rhinoplasty repair.

Revision Rhinoplasty For Pinched Nasal Tip Before And After Photos

The following clinical examples are revision rhinoplasty patients of ours from San Diego. In these particular patients, auricular cartilage grafting was required to rebuild the pinched nasal tip since there was insufficient septal cartilage available for this purpose. The most dramatic change can be seen in the base view of their nose. It is from this angle that one can easily see how rebuilding the lower lateral cartilage support can impact the overall shape of the nasal tip. Whereas these patients had pinching of the nasal tip prior to revision rhinoplasty, they now have restoration of a soft triangular shape to the nose. You can also easily imagine how much better their nasal breathing is following the revision rhinoplasty with cartilage grafting. The real trick is trying to restore enough structure support to the nasal tip while maintaining a nice natural look to the nose. This is the type of revision rhinoplasty surgery that should only be tackled by plastic surgeons with advanced training in revision rhinoplasty technique. When performed by an experienced, knowledgeable revision rhinoplasty expert, this type of challenging, complicated nose reshaping procedure can be done with excellent results.

#### Pinched Nasal Tip Repair
Pinched Nose Following Rhinoplasty

This is a great case example that demonstrates repair of a pinched nasal tip. This gentleman had previously undergone rhinoplasty surgery performed by a different plastic surgeon a few decades ago. Unfortunately, as time went on, his nasal tip began to collapse on both sides – resulting in pinching of the nostril side walls. This is readily seen in his preoperative frontal photograph shown here. Not only did this type of problem result in an abnormal cosmetic appearance – the pinched nasal tip also created problems in terms of breathing. After researching revision rhinoplasty surgeons online, he decided to drive down to San Diego to consult with me in person. Although there was a good number of board certified plastic surgeons in his local area, he felt that my experience and qualifications in revision rhinoplasty were better suited for his particular case.

Pinched Nose Evaluation

During his consultation I was able to confirm for him the precise reason why his nasal tip collapsed following his original rhinoplasty surgery. The way I explained this to him is shown visually below.

In the normal, structurally sound nose, the nasal tip gets it’s shape from the underlying cartilage framework. These two segments of cartilage are referred to as the lower lateral cartilages, or LLCs. The pair is typically fairly symmetrical in size and shape. As you can see, the lower lateral cartilages normally extend out away from the midline – sort of mimicking a pair wings when seen from the front. These wings are what helps to provide support to the side walls of the nostrils.In this particular case, the patient’s past rhinoplasty surgeon ended up resecting, or removing, a good portion of the lower lateral cartilages. This is shown graphically in the above photo where you can see a good portion of the lower lateral cartilage has been erased away. This was likely done in an attempt to create a more defined nasal tip. Unfortunately, this particular technique, called cephalic trimming, can be dangerous if too much of the lower lateral cartilage is removed without providing reinforcement in some other manner. In the beginning of the healing process, the problem is not real evident. But as time goes on (6-12 months after surgery), the nose begins to pinch in on both sides of the tip because there is now a relative lack of cartilage support. This evolution is represented by the red arrows in the above photo – showing how the nasal tip slowly pinches inward on both sides.

The end result is a nasal tip that has harsh shadowing on both sides – often times a telltale sign of prior rhinoplasty surgery. In addition, the nostril support is compromised – leading to trouble breathing through the nose because of the structural collapse.

Rhinoplasty Repair for Pinched Nose

Based on the underlying problem, I recommended this patient undergo an open revision rhinoplasty procedure to help repair his pinched nasal tip. An open approach was necessary in order to have an optimal view of the collapsed cartilage and to allow precise placement of the grafts needed to restore proper support.

In concept, I planned on using cartilage grafts to help rebuild his pinched nasal tip. In the end, we chose to use cadaveric costal cartilage – also known as rib cartilage taken from a tissue bank. I would have used septal cartilage from inside of his nose, however, there was none left following his prior surgery. What about using ear cartilage? This was an option in his case, but I felt the rib cartilage graft would provide a more stable repair and more sturdy long-term result.

The above photo shows essentially how the rib cartilage grafting was performed to help repair the pinched nasal tip. I ended up creating cartilage grafts that extended from the midline out toward the side of the nostrils. Out toward the side, the cartilage grafts were very carefully positioned inside of what we call a ‘precise pocket’ so that they would stay put during the healing process. More toward the center of the nose, the cartilage grafts were secured to the remaining segments of the lower lateral cartilage. What this allowed me to do was reverse the pinching effect that was seen preoperatively (see green arrows). His surgery went quite well without any complication. At the same time, this patient also required a spreader, splinting graft that was placed on his right side to help provide further reinforcement to his cartilage framework.

Pinched Nose Repair Results

Here are his results following my revision rhinoplasty. As you can see from this front view, his nasal tip is no longer pinched with abnormal shadowing along each side. The tip of his nose now has more of a convex overall shape, which is normal.

On this base view of his nose, you can really see how the nostril support has been improved with revision rhinoplasty. He now has more of what we call a ‘soft triangle’ outlined appearance to his nose – instead of the pinched, collapsed nostril walls that can be seen before surgery.

On this oblique view, you can also appreciate the improvements made to the nose. More specifically, you can see how the pinched nostrils are now more rounded – precisely the goal of the revision rhinoplasty.

His other oblique view, you can see how symmetry was relatively preserved with the cartilage grafting technique.

Revision Rhinoplasty Consult

If you feel that revision rhinoplasty surgery may benefit your nose, do not hesitate in contacting my office today. In the meantime, take a closer look at our online rhinoplasty tutorial, which helps provide patients like you a more in-depth understanding of this very complex, yet satisfying, plastic surgery procedure.

#### Pinched Nose
Pinched Nose Correction Surgery with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A pinched nose occurs when the nasal tip or bridge appears narrowed or constricted, creating an unnatural or aesthetically unbalanced appearance. This condition can result from trauma, previous rhinoplasty, or congenital factors. Pinched nose correction surgery aims to restore proper nasal structure, improving both the appearance and function of the nose. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, is a recognized expert in rhinoplasty, specializing in advanced techniques to correct a pinched nose and deliver natural, long-lasting results.

What is Pinched Nose Correction Surgery?

Pinched nose correction surgery involves rebuilding and widening the nasal structure, particularly in the area of the tip or middle third of the nose. This can involve cartilage grafting to restore the natural contours of the nose, improving both aesthetics and function. Patients with a pinched nose often experience nasal obstruction, which can lead to breathing difficulties. This surgery addresses both the cosmetic and functional issues associated with a pinched nose, ensuring a balanced, well-functioning nose.

Why Choose Pinched Nose Correction Surgery in San Diego?

Patients opt for pinched nose correction surgery for several reasons:

Special Considerations for Pinched Nose Correction Surgery

FAQs: Pinched Nose Correction Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you're considering pinched nose correction surgery and want to learn more about how Dr. John Hilinski can help restore the appearance and function of your nose, schedule a consultation today. As San Diego's expert in advanced rhinoplasty techniques, Dr. Hilinski offers personalized care and natural-looking results. Contact us to start your journey toward a more confident, balanced appearance.

#### Pix:E
Pix:E Microneedling and Skin Resurfacing at Hilinski Medspa

At Hilinski Medspa in San Diego, we are proud to offer Pix:E Microneedling and Skin Resurfacing, a groundbreaking non-surgical treatment that combines RF microneedling and Erbium YAG laser resurfacing. This powerful dual-action technology is designed to tighten crepey skin, reduce fine lines, wrinkles, acne scars, sun damage, and improve overall skin texture--all with minimal discomfort and downtime.

Under the expert guidance of Dr. John Hilinski, a board-certified facial plastic surgeon and renowned expert in skin rejuvenation, our medspa delivers safe and effective treatments that are fully customized to meet your unique aesthetic goals.

What is Pix:E Microneedling and Skin Resurfacing?

Pix:E is an FDA-cleared device that combines two advanced skin treatments for comprehensive rejuvenation:

With its customizable settings, Pix:E allows our providers to tailor each treatment specifically to your skin type, ensuring a personalized experience with optimal results.

What Can Pix:E Treat?

Pix:E is designed to address a wide range of skin concerns, making it a versatile and effective solution for many patients. Some of the skin issues that Pix:E can treat include:

Fine lines and wrinkles

Acne scars and sun damage

Stretch marks and hyperpigmentation

Crepey skin and uneven skin tone

Loose skin and large pores

Benefits of Pix:E Microneedling and Skin Resurfacing

At Hilinski Medspa, Pix:E offers several advantages, including:

Preparing for Pix:E Microneedling and Skin Resurfacing

Your treatment journey begins with a consultation, during which our skilled providers will assess your skin and discuss your aesthetic goals. You'll learn more about how Pix:E can benefit your specific skin concerns and receive a personalized treatment plan.

The Pix:E Treatment Experience

Approximately 30-40 minutes before your Pix:E treatment, an anesthetic cream will be applied to ensure maximum comfort. Depending on the area being treated, the session may last up to 60 minutes. The treatment is relatively comfortable, and you'll be able to resume most of your daily activities shortly after.

Pix:E Recovery and Results

After your treatment, you may experience redness and a sensation similar to sunburn, which typically resolves within 24-48 hours. Your provider will recommend using an emollient, such as Aquaphor, to moisturize and protect the skin.

Results are noticeable immediately, with continued improvements in skin texture, tone, and firmness as your skin heals and regenerates over the following weeks. Pix:E’s anti-aging effects continue to enhance your appearance long after your session.

FAQs: Pix:E Microneedling and Skin Resurfacing

Schedule Your Consultation

Ready to experience the transformative power of Pix:E Microneedling and Skin Resurfacing? Contact Hilinski Medspa in San Diego today to schedule your consultation with Dr. John Hilinski and discover how this advanced treatment can rejuvenate your skin.

#### Pixel 8 RF Microneedling
Pixel8 RF Microneedling in San Diego at Hilinski Medspa

At Hilinski Medspa, we offer the advanced Pixel8 RF Microneedling treatment to help you achieve smoother, younger-looking skin. This non-surgical skin rejuvenation procedure combines the benefits of microneedling with radiofrequency (RF) energy to treat wrinkles, fine lines, acne scarring, stretch marks, and more. Led by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, this innovative treatment can deliver dramatic improvements with minimal downtime.

What is RF Microneedling?

RF microneedling is a non-surgical cosmetic procedure designed to tighten and rejuvenate the skin on the face, neck, and body. By creating tiny microchannels in the skin with fine needles, RF energy is delivered below the surface, stimulating collagen production and triggering skin tightening. This process results in smoother, firmer, and more youthful-looking skin. In some cases, the results are so significant that RF microneedling is often referred to as a non-surgical facelift.

Benefits of RF Microneedling

Pixel8 RF Microneedling offers a wide range of benefits, including:

Skin tightening and firming

Reduction of wrinkles and fine lines

Minimized acne scars and stretch marks

Improved skin texture and tone

Reduction of large pores

Blending of stretch marks

Reduction of excessive sweating (hyperhidrosis)

The ability to tighten skin and improve overall skin quality makes Pixel8 RF Microneedling an excellent choice for patients looking to achieve a youthful, revitalized complexion without surgery.

What Areas Can Be Treated with RF Microneedling?

Pixel8 RF Microneedling is most commonly used on the face and neck to reduce wrinkles and tighten the skin, but it can also be used on the arms, abdomen, and legs. It's an ideal solution for areas where the skin has become loose due to aging or weight loss.

Pixel8 RF vs. Morpheus8

Both Pixel8 RF and Morpheus8 are popular RF microneedling devices, but Pixel8 RF stands out due to its ability to deliver 2 megahertz of energy--double that of Morpheus8. This translates into a more comfortable experience with less discomfort during the treatment. Many patients who have tried Morpheus8 report difficulty tolerating the procedure due to pain, while Pixel8 RF is much better tolerated, ensuring patients can complete the treatment and achieve optimal results.

Pixel8 RF Microneedling Treatment Process

Each Pixel8 RF Microneedling treatment takes approximately 30-60 minutes, depending on the area being treated. Before the treatment, a numbing cream is applied to ensure comfort. The Pixel8 RF device creates microchannels in the skin while delivering radiofrequency energy to stimulate collagen and tighten the skin.

Recovery After Pixel8 RF Microneedling

One of the major benefits of Pixel8 RF Microneedling is the minimal recovery time. Patients may experience mild redness or swelling for 24-48 hours following the treatment, but this typically subsides quickly. Most patients can resume their normal activities, including applying makeup, within 1-2 days.

Enhancing Results with PRP

To boost the effects of Pixel8 RF Microneedling, we offer the option to combine it with Platelet-Rich Plasma (PRP) therapy. PRP is derived from your own blood and contains powerful regenerative properties. When applied after microneedling, PRP accelerates healing and enhances the results by stimulating deeper tissue repair. This combination leads to even more youthful, radiant skin.

Combining Pixel8 RF Microneedling with Erbium Laser

For patients seeking a non-surgical facelift, combining Pixel8 RF Microneedling with Erbium Laser Resurfacing can deliver remarkable results. While the Pixel8 RF focuses on rejuvenating the deeper layers of the skin, the Erbium Laser resurfaces the top layers, creating a synergistic effect that leaves the skin smoother, tighter, and more radiant.

How Many RF Microneedling Treatments Will I Need?

While some patients notice improvements after just one treatment, most will benefit from a series of Pixel8 RF Microneedling sessions. We typically recommend a series of three treatments spaced about four weeks apart to achieve optimal results. During your consultation, Dr. Hilinski will develop a personalized treatment plan based on your specific goals.

FAQ: Pixel8 RF Microneedling

Schedule Your Pixel8 RF Microneedling Consultation

If you're ready to rejuvenate your skin with Pixel8 RF Microneedling, the first step is scheduling a consultation at Hilinski Medspa. During your personalized consultation, Dr. John Hilinski, a board-certified facial plastic surgeon, will evaluate your skin concerns and design a customized treatment plan to help you achieve your aesthetic goals. Whether you're looking to reduce wrinkles, tighten loose skin, or improve acne scars, Pixel8 RF Microneedling offers a non-surgical solution with impressive results.

Contact us today to schedule your consultation and take the first step toward smoother, tighter, and more youthful-looking skin. Our expert team is here to guide you through every step of the process, ensuring a comfortable experience and exceptional results. Don't wait--start your journey to a radiant complexion at Hilinski Medspa in San Diego now!

#### Placing Spreader Grafts
Spreader grafting, or placement of spreader grafts, is a specific surgical maneuver commonly used in the world of rhinoplasty and revision rhinoplasty. The technique itself was originally introduced by famed rhinoplasty surgeon Dr. Jack Sheen sometime in the mid 1980s. At that time, Dr. Sheen proposed using spreader grafts as part of a nose reshaping procedure to reconstruct the mid-dorsum, or middle portion of the nasal bridge. Since then, the indications for use of spreader grafts in rhinoplasty and revision has expanded considerably.

Spreader Graft Placement For Nasal Function

Spreader grafts are placed in the midst of a rhinoplasty or nasal reconstructive procedure for several different reasons.

The most common indication for a spreader graft is for functional problems related to the middle vault of the nose. To better understand why this is, you first have to know precisely what the middle vault refers to in rhinoplasty. The middle vault of the nose refers to the middle 1/3 of the nasal bridge. As shown in the adjacent diagram shaded in blue, the middle vault is the section of the nose above the nasal tip cartilages and below the nasal bones. The middle vault is comprised of the paired upper lateral cartilages on each side and a portion of the septum running in between these two cartilage segments (called the dorsal septum). You can see this as the shaded blue area in the adjacent photo diagram. On each side of the nose, this junction of the upper lateral cartilage and dorsal septum forms an angle. We call this the internal nasal valve (or just internal valve) in the world of rhinoplasty and nasal reconstruction.

As you can see in the adjacent diagram, the internal nasal valve is that specific portion of the nose at the lower end of the middle vault. The internal nasal valve is normally between 10-15 degrees in a Caucasian nose. In ethnic noses, this angulation can be more varied. The internal nasal valve happens to be the area inside of the nose that has the highest resistance to airflow compared with any other region. Therefore, the internal nasal valve plays a vital role when it comes to nasal breathing. If this angle is less than ideal, it can dramatically increase the resistance to airflow, which translates into a higher degree of nasal obstruction. This can occur when the upper lateral cartilages are inherently weak, or more floppy than normal. It can also be seen in patients who have undergone prior rhinoplasty where the middle vault anatomy was unknowingly compromised. In the latter case, this is often not appreciated for many months to years following the original nose surgery. Patients later present with collapse of the upper lateral cartilage and feelings of difficulty breathing through their nose.

Your chosen nose expert or rhinoplasty specialist should be familiar with evaluation of the internal nasal valve. One of the most classic physical examination methods to assess the internal valve is called the Cottle maneuver. The Cottle maneuver is done while the patient breathes in gently through the nose. At the same time, the cheek is pulled out to the side, thus manually opening the internal nasal valve. A positive Cottle sign occurs when the patient subjectively senses an improvement in breathing during this maneuver. In many cases, a positive Cottle sign indicates that the patient may benefit from spreader graft placement to improve the nasal breathing.

Spreader Graft Placement For Cosmetic Appearance

The middle vault also plays a major role in terms of the cosmetic appearance of the nose. As you might imagine, in most patients the middle vault makes up the entire 1/3 of the bridge as seen on frontal view. If you remember from our rhinoplasty tutorial on nasal analysis, the front view of the nose should demonstrate two fairly equal brow-tip esthetic lines – imaginary curvilinear shadows seen when looking directly at the nose. As shown in the adjacent photo diagram of one of my own San Diego post-rhinoplasty patients, the brow-tip esthetic line starts at the eyebrow. Ideally, this gentle curve then runs along the side of the bridge, through the middle vault, before gently diverging away from the tip. If there is an abnormal contour involving the middle vault of the nose, the brow-tip esthetic line can be easily disrupted since the middle vault comprises the entire mid section of this imaginary curve. This usually involves some degree of excess narrowing, pinching, or collapse of the middle vault upper lateral cartilage. This disruption in the brow-tip esthetic line translates into abnormal shadowing when looking at the front of the nose. In some cases, there is bilateral (both sides) narrowing, pinching, or collapse of the upper lateral cartilage, while in other rhinoplasty patients there is only one side of the middle vault that is involved.

The adjacent photo example is one of my own San Diego nose reshaping patients who exemplifies this issue of middle vault narrowing. As you can see, her middle vault was causing a disruption of the brow-tip esthetic line on both sides. On her left side she was pinched inward more so than the right side. This abnormality was a result of her upper lateral cartilage being asymmetrically collapsed following rhinoplasty performed by another plastic surgeon. As a result, an abnormal and unwanted shadow is cast through the middle of her nose, making it almost look somewhat washed out through this area. Such changes can also result in a less refined and defined look to the nose.

What Does A Spreader Graft Actually Do?

So what does a spreader graft actually do in terms of nasal function and cosmetic nose appearance?

When it comes to function, the spreader graft helps to open up the internal nasal valve region we discussed earlier. If this angulation is less than the desired 10-15 degrees, it can be increased by placing a segment of cartilage between the upper lateral cartilage and dorsal septum. The location of the graft is indicated by the blue rectangle in the adjacent diagram and demonstrates visually how the internal nasal valve angle is opened up wider. Essentially, it spreads the middle vault and internal nasal valve wider. When it comes to resistance to airflow through this critical angle, a change of 1-2 degrees in some cases can make a significant difference. So when a spreader graft is placed correctly, this can potentially make a dramatic improvement in terms of nasal breathing.

When it comes to cosmetic appearance, the spreader graft also helps to add volume through the middle nasal vault. As you can see in the adjacent diagram, the side with the spreader graft is now wider since placement of the graft pushes the side of the nose outward. So in rhinoplasty patients who have a depressed or collapsed upper lateral cartilage, or narrowed middle vault, a spreader graft can be used to create more width for esthetic purposes. In many cases, this helps to restore a more pleasing brow-tip esthetic line.

Like it or not, placement of a spreader graft is going to open up the internal nasal valve and technically widen the middle vault at the same time. So if your rhinoplasty specialist is recommending a spreader graft to help improve your nasal function, they should also explain that a possible byproduct of this maneuver is widening of the middle one-third of the nose when seen on frontal view. Fortunately, in many nose patients who have thicker than average skin, a relatively thin spreader graft will not add any significant width that is going to be readily visible to the naked eye. So you can improve the nasal function with a spreader graft without causing the nose to look excessively wide in patients with thick skin. In rhinoplasty patients with thin skin, they should be aware that a spreader graft will likely passively create a wider middle vault that may be noticeable following surgery.

What Is A Spreader Graft Made Of?

Spreader grafts are created by carving out a rectangular segment of cartilage. There are a variety of sources of cartilage including septum, ear, and rib. If the septum is intact, this is usually my first choice when it comes to harvesting cartilage to create a spreader graft. Ear cartilage is a reasonable alternative when there is insufficient septal cartilage remaining. It is quite rare, but some patients do need to have their rib harvesting in order to have an adequate amount of cartilage for grafting purposes.

In the adjacent diagram, you can see a large segment of septal cartilage that has been removed from the inside of the nose. The white arrows point to the outline of two relatively equivalent sized and shaped pieces of cartilage. These exact pieces were intended to be the spreader grafts. Once these are carved out, they can be placed between the upper lateral cartilage and dorsal septum to open the internal valve and widen the middle vault. As you can see, septal cartilage tends to be nice and straight while also having some degree of rigidity. This holds a distinct advantage over ear cartilage when it comes to making a spreader graft. After all, the ideal spreader graft is one that is uniformly straight so that it can span the entire distance of the middle vault. In addition, it needs to be stiff enough to push the overlying cartilage and skin outward while resisting bending forces.

In many cases, it is necessary to layer two or more pieces of cartilage together in order to create a sufficiently robust spreader graft. Layered spreader grafts such as this are more commonly used in ethnic rhinoplasty patients with thick skin. They are also utilized in nose reshaping patients who require a more significant degree of widening of the middle vault, for instance, in those with a marked collapse of the upper lateral cartilage following a previous, overly aggressive rhinoplasty.

Spreader Graft Placement

Spreader grafts can be placed using either a closed or open rhinoplasty approach. In fact, the original description by Dr. Sheen involved a closed approach to the nose. Although it is certainly possible to place a spreader graft using the closed approach, most nose specialists today prefer the open approach. The open approach means that we are making an incision under the nose in between the nostrils in order to lift the skin to expose the middle vault. As you can see in the adjacent intraoperative photo, this type of exposure is ideal when it comes to meticulous placement and suturing of the spreader grafts. In the photo, the blue arrows indicate the upper lateral cartilage on each side having been separated from the dorsal septum (green arrow). The yellow arrow is the actual spreader graft that is positioned between the upper lateral cartilage and the dorsal septum. The spreader graft is then sewn into position using fine suture threads. If bilateral spreader grafts are being placed, they are done in a very similar fashion. The upper lateral cartilage is then brought back into position and the middle vault is reconstructed with the spreader graft(s) in place. In nose reshaping patients who have thinner than average skin, your rhinoplasty specialist may recommend a temporalis fascia graft be blanketed over the middle vault after placement of the spreader graft(s). This is usually recommended to provide added cushioning of overlying skin and to prevent unwanted contour irregularities that might otherwise result.

Spreader Graft Risks

In some patients, there may be a visible contour irregularity seen in the middle vault region after placement of a spreader graft. This can result if the spreader graft becomes displaced and rises up over the dorsal septum. Or the spreader graft can get displaced and drop inward leaving a slight depression. In other cases, the spreader grafts may result in a slightly wider bridge than desired. When done for functional reasons, some patients may not enjoy as much improvement in their nasal breathing as anticipated. Fortunately, these risks associated with spreader graft placement are somewhat unusual and fairly limited.

Spreader Graft Case Example

This is the same patient noted above who presented to my office following a prior rhinoplasty by a different plastic surgeon in San Diego. She was noting difficulty breathing through her nose on both sides. In addition, her nose did not shadow the way she desired when seen on the frontal view. As we discussed previously, she had disruption of the normal brow-tip esthetic lines that contributed to a washed out look with less than ideal definition of her nose (see left photo below). On examination of her nose inside, she was found to have evidence of narrowing of the internal nasal valve that helped explain her difficulty breathing. The upper lateral cartilages were also collapsed, which explained her abnormal shadowing in the middle of her nose. I took her to surgery and performed an open revision septorhinoplasty with placement of bilateral spreader grafts. I placed a layered graft on her left side where there was more obvious pinching of the middle vault. Postoperatively, she noted a marked improvement in her nasal breathing with a more open internal nasal valve. From a cosmetic standpoint, she also had an obvious improvement. Her nose now has fairly symmetric brow-tip esthetic lines as noted below. This translates into a more refined, defined nasal appearance as seen from the front. To learn more about spreader grafts and rhinoplasty, feel free to visit my online Emedicine chapter – Plastic Surgery, Nose, Rhinoplasty, Spreader Grafts.

#### Plated™ Exosomes by Rion
The Future of Skin and Hair Rejuvenation Is Here – Exclusively at Hilinski Medspa

At Hilinski Medspa, we are proud to offer Plated™ Exosomes by Rion – a scientifically advanced, regenerative treatment that’s transforming how we approach skin rejuvenation, hair restoration, and post-procedure healing. Designed using the power of platelet-derived exosomes, Plated is a next-generation solution that accelerates cellular repair, reduces inflammation, and supports long-term aesthetic improvement from the inside out.

Whether you're looking to enhance your skin’s tone and texture, stimulate hair growth, or boost recovery after microneedling or laser resurfacing, Plated Exosomes offer a non-surgical, results-driven approach to regenerative aesthetics. And when administered under the expertise of Dr. John Hilinski – one of San Diego’s most trusted board-certified facial plastic surgeons – you can expect natural, high-impact results tailored to your unique needs.

What Are Plated™ Exosomes?

Exosomes are the body’s intercellular messengers. They are tiny extracellular vesicles naturally produced by cells, including platelets, that help regulate inflammation, tissue repair, and skin regeneration. Plated™ by Rion is the first exosome product of its kind to harness platelet-derived exosomes using a proprietary bioengineering process. These exosomes are purified, stable, and backed by clinical-grade science to deliver highly targeted skin and scalp rejuvenation.

In other words, Plated doesn’t just hydrate the surface or stimulate temporarily—it promotes biological change by signaling your body to heal, regenerate, and restore itself.

What Can Plated™ Be Used For?

Plated is incredibly versatile and is often combined with other aesthetic procedures to enhance outcomes. At Hilinski Medspa, we incorporate Plated into treatment plans for:

Plated can be applied topically (often immediately after resurfacing), injected directly into target areas, or used as a booster in customized skin or hair restoration protocols.

Why San Diego Patients Are Choosing Plated™ Over PRP

While PRP (Platelet-Rich Plasma) has long been the gold standard in regenerative aesthetics, Plated Exosomes take it a step further. Here's how they compare:

  
    
      
        Feature
        PRP
        Plated™ Exosomes
      
    
    
      
        Source
        Your own blood
        Purified human platelet-derived exosomes
      
      
        Consistency
        Varies patient-to-patient
        Pharmaceutical-grade consistency
      
      
        Processing
        On-site, manual
        Laboratory-purified, stable
      
      
        Growth Factors
        Present
        Present + targeted exosomal delivery
      
      
        Inflammation Control
        Mild
        Enhanced anti-inflammatory effect
      
      
        Recovery Boost
        Moderate
        High-level acceleration of healing
      
    
  

Plated offers a more consistent, potent, and biologically active formulation than traditional PRP. That means better results, faster recovery, and a higher level of predictability for both patients and practitioners.

What to Expect During a Plated™ Treatment

Your Plated experience begins with a consultation at Hilinski Medspa in San Diego or La Jolla, where we’ll evaluate your skin, scalp, or recovery needs and customize your treatment accordingly.

Depending on your goals, the exosomes may be:

Microneedled into the skin following treatments like Morpheus8, SecretRF, or laser resurfacing.

Injected directly into the scalp for hair restoration.

Applied topically post-procedure to calm skin and boost recovery.

Each treatment is quick, well-tolerated, and involves little to no downtime. Plated works behind the scenes at the cellular level, so visible results gradually appear in the days and weeks following treatment as your skin or scalp regenerates.

Benefits of Plated™ Exosomes

Patients across San Diego and La Jolla are choosing Plated for:

Faster Recovery from lasers, peels, and microneedling

Smoother, firmer, brighter skin

Improved skin barrier and reduced inflammation

Reduced appearance of fine lines and pores

Increased hair density and scalp health

Boosted collagen and elastin production

Non-surgical, needle-free applications (in some cases)

Plated is ideal for anyone looking to take a regenerative approach to aesthetics—whether for proactive aging prevention or to maximize results after in-office procedures.

Is Plated™ Safe?

Yes. Plated is manufactured in a cGMP-compliant facility using rigorous testing to ensure purity, potency, and stability. The exosomes are derived from screened human platelets and are cell-free, DNA-free, and protein-balanced to minimize risk of irritation or reaction. There are no live cells or risk of rejection. The result is a cosmetic-grade product that delivers therapeutic signals without the variability or downtime often associated with other regenerative treatments.

Frequently Asked Questions About Plated™ Exosomes

Ready to Experience the Power of Regenerative Aesthetics?

Whether you're looking to speed up recovery, improve skin health, or stimulate hair growth, Plated™ Exosomes offer a safe and science-backed solution for lasting rejuvenation. Discover why patients across San Diego and La Jolla are turning to Hilinski Medspa for the next wave of non-surgical transformation.

Schedule your consultation today with Dr. Hilinski and experience the benefits of biologically intelligent aesthetics—where science meets beauty.

#### Pollybeak Deformity
A pollybeak deformity refers to an excess prominence, or contour, in the region of the nose immediately above the tip of the nose. A pollybeak is typically classified as being a result of either cartilage or scar. Therefore, you will often see the terms cartilaginous pollybeak and soft tissue (scar) pollybeak used, respectively, when discussing this rhinoplasty topic. In most cases, a pollybeak deformity results from prior rhinoplasty surgery. It is much less common to see a pollybeak deformity that is congenital in nature.

Cartilaginous Pollybeak Deformity Following Prior Rhinoplasty

A cartilaginous pollybeak deformity usually arises in someone who had prior rhinoplasty to reduce the bridge height. Normally these are rhinoplasty patients who originally had a dorsal hump, or bump. In most cases of a dorsal hump, reduction of the bridge involves taking down both the cartilage and the bone to achieve a nice smooth, nasal profile. Unfortunately, some rhinoplasty surgeons fail to adequately remove the entire cartilage portion of the bump. This exact point is demonstrated visually in the adjacent rhinoplasty diagrams.

On the left is a nose with a dorsal hump or bump. When you remove a hump like this, you need to reduce the height of the cartilage (yellow) and bone (blue) in a fairly equivalent fashion to achieve a nice straight, smooth profile. The middle photo below shows what the ideal goal of hump reduction is in rhinoplasty. In a pollybeak deformity resulting from prior rhinoplasty, some of the cartilage that should have been removed is still present. This area of residual cartilage is referred to as the supratip region. As is seen below right and indicated by the white arrows with red outline, the lower portion of the bridge cartilage is still intact while the remainder of the bridge (above the red arrow) has been taken down. In this particular situation, the middle and upper bridge is at the correct height and has been reduced properly. But the supratip portion immediately above the tip region is still excessively high. This remaining portion that should have been removed along with the rest of the bridge directly accounts for the cartilaginous pollybeak deformity.

#### Preservation Otoplasty
Preservation Otoplasty with Dr. John Hilinski: Expert Ear Pinning in San Diego

Over the past several years, Dr. John Hilinski has refined his otoplasty techniques to offer what he calls preservation otoplasty. Unlike traditional ear pinning surgeries that often involve removing cartilage, Dr. Hilinski's preservation otoplasty focuses on reshaping and repositioning the ear while preserving the cartilage. This innovative approach maintains the ear's structural integrity, ensuring long-lasting, natural results without compromising strength or stability.

Dr. Hilinski, a board-certified facial plastic surgeon, is highly regarded for his expertise in ear surgery. His preservation otoplasty technique is ideal for patients who want to reduce ear prominence while maintaining the natural support of the ear cartilage.

What is Preservation Otoplasty?

Preservation otoplasty is a specialized ear pinning technique where the ear cartilage is preserved rather than removed. Instead of cutting out cartilage from areas like the conchal bowl (the cup-shaped part of the ear that often contributes to a prominent appearance), Dr. Hilinski strategically uses sutures to reshape and reposition the ear, effectively reducing its prominence.

While incisions are still made during the procedure, cartilage is not removed. Dr. Hilinski makes precise cuts in the cartilage, known as relaxing incisions, which allow the ear to be repositioned closer to the head. By preserving the ear's natural structure, the long-term stability of the ear is maintained, preventing the potential weakening that can occur with cartilage removal.

Why Choose Preservation Otoplasty?

Patients choose preservation otoplasty for several reasons:

Conchal Bowl Reshaping

The conchal bowl, the bowl-shaped part of the ear, often contributes to the ear's prominence. In traditional otoplasty, cartilage from the conchal bowl is often removed to reduce the ear's size and pin it closer to the head. However, with preservation otoplasty, Dr. Hilinski makes an incision in the conchal bowl but preserves the cartilage. Instead of removing it, he uses sutures to reposition the cartilage and effectively bring the ear closer to the head without excising any tissue.

Relaxing Incisions

A key element of preservation otoplasty is the use of relaxing incisions, which are precise cuts made in the cartilage in specific areas. These incisions help overcome the natural "memory" of the cartilage, allowing it to settle more naturally in its new position. Dr. Hilinski uses these relaxing incisions to bend and reshape the ear more predictably and effectively, ensuring the ear stays in its new position during the healing process.

One of the primary locations for a relaxing incision is in the upper half of the ear, where it connects with the face. This allows the upper ear to be reshaped with minimal risk of the cartilage returning to its original position.

FAQ: Preservation Otoplasty

Schedule a Consultation with Dr. Hilinski

If you're considering preservation otoplasty to reduce ear prominence and achieve natural, long-lasting results, schedule a consultation with Dr. John Hilinski today. As a leading otoplasty expert in San Diego, Dr. Hilinski offers personalized care and innovative surgical techniques to help you achieve the look you desire. Contact us today to begin your journey toward a more confident appearance.

#### Preservation Rhinoplasty
Preservation Rhinoplasty by Dr. John Hilinski: Natural Nose Reshaping in San Diego, CA

Preservation rhinoplasty is one of the most significant advancements in cosmetic nose surgery, focusing on refining the nose while maintaining its natural structure. This modern approach minimizes the excision and reconstruction typically involved in traditional rhinoplasty, leading to more natural-looking results and quicker recovery times. Dr. John Hilinski, a leading preservation rhinoplasty specialist in San Diego, is among the few plastic surgeons in the U.S. with extensive hands-on training and experience in these advanced techniques. With his commitment to excellence and patient-centered care, Dr. Hilinski utilizes preservation rhinoplasty to deliver beautiful, balanced outcomes that align with each patient's aesthetic goals.

What is Preservation Rhinoplasty?

Preservation rhinoplasty is a specialized approach to nose reshaping that emphasizes maintaining the natural cartilage and bone structure of the nose. Unlike traditional rhinoplasty, which often involves removing and reshaping significant portions of the nasal framework, preservation rhinoplasty conserves these elements, allowing for more refined and natural-looking changes. This technique is particularly effective for patients seeking subtle enhancements, such as reducing a dorsal hump or refining the nasal tip, while preserving the nose's overall integrity and function.

Patients who undergo preservation rhinoplasty often experience quicker recovery times and fewer complications compared to traditional rhinoplasty, as there is less disruption to the nose's natural anatomy. By focusing on preserving the nasal structure, Dr. Hilinski can achieve results that look more harmonious and less surgical, enhancing the nose's appearance while maintaining its unique characteristics.

Preservation Rhinoplasty vs. Traditional Rhinoplasty

There are several key differences between preservation rhinoplasty and traditional rhinoplasty techniques. While preservation rhinoplasty may not be suitable for every patient, it offers significant benefits for those who are good candidates, including the preservation of the nasal bridge, soft tissue, and alar cartilages.

Preservation of the Bridge

In traditional rhinoplasty, a nasal hump is often removed by rasping or sanding down the bone and cutting away excess cartilage. While effective, this approach can destabilize the nose's natural structure, increasing the risk of postoperative complications and irregular healing. In contrast, preservation rhinoplasty allows Dr. Hilinski to lower the nasal bridge without removing the underlying bone and cartilage. By making strategic incisions within the nose, Dr. Hilinski can adjust the position of the nasal bridge without compromising its natural support, resulting in a smoother, more natural contour with fewer variables in the healing process.

Preservation of Nasal Soft Tissue

Preservation rhinoplasty also emphasizes the conservation of the nasal soft tissue envelope and nasal ligaments--dense, fibrous bands that connect various tissues within the nose. Traditional rhinoplasty may involve cutting or disrupting these structures, which can lead to unpredictable changes in the shape of the nose and increase the likelihood of revision surgery. Dr. Hilinski's meticulous approach to preserving the soft tissue envelope and nasal ligaments helps maintain the nose's natural appearance and supports more predictable healing outcomes.

Preservation of the Alar Cartilages

The alar cartilages play a crucial role in defining the nasal tip. In traditional rhinoplasty, these cartilages are often partially removed or reshaped to achieve a desired nasal tip appearance, which can result in unpredictable contour changes and scarring. Preservation rhinoplasty, however, seeks to maintain the integrity of the alar cartilages, adjusting their position without removing them. This approach minimizes the risk of unwanted changes during the healing process and reduces the likelihood of requiring revision surgery.

Preservation of the Alar Cartilages

The alar cartilages play a crucial role in defining the nasal tip. In traditional rhinoplasty, these cartilages are often partially removed or reshaped to achieve a desired nasal tip appearance, which can result in unpredictable contour changes and scarring. Preservation rhinoplasty, however, seeks to maintain the integrity of the alar cartilages, adjusting their position without removing them. This approach minimizes the risk of unwanted changes during the healing process and reduces the likelihood of requiring revision surgery.

Am I a Candidate for Preservation Rhinoplasty?

Preservation rhinoplasty is ideal for patients who:

Have not had prior nose surgeries

Desire natural-looking results with minimal changes to the nasal structure

Wish to reduce the appearance of a nasal hump or refine the nasal tip

Are in good overall health and have realistic expectations

During your consultation, Dr. Hilinski will assess your nasal structure and discuss your goals to determine if preservation rhinoplasty is the best approach for you.

FAQ: Preservation Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering preservation rhinoplasty and want to explore how this innovative technique can help you achieve natural-looking results, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in preservation rhinoplasty, Dr. Hilinski combines his extensive credentials, personalized approach, and dedication to excellence to provide exceptional care. Contact us today to begin your journey toward your ideal nose.

#### Preservation Rhinoplasty
Want to see what a preservation rhinoplasty outcome looks like? Well, here is a great example of how Dr. Hilinski uses preservation rhinoplasty technique to reshape a relatively prominent nasal hump deformity in this female patient.

#### Preservation Rhinoplasty Bridge Reduction
People have been inquiring about preservation rhinoplasty results so we wanted to put up a quick post.

This is a young lady who desired lowering of her nasal bridge as well as deprojection of her nasal tip (bringing the tip closer to the face). When you looked at her nose, you could see that it was just a bit oversized for her face. The hump on the nasal bridge certainly contributed to this issue of her nose looking too big. In combination with this, her nasal tip also stuck out too far. This is indicated in the adjacent photo diagram by the red line, which corresponds to what we call the nasal tip projection. Some patients often times erroneously refer to this as nasal length – commonly saying that their nose is too long. But in plastic surgery jargon, this is more accurately referred to as projection. Length of the nose is actually reserved for describing something entirely different.

For the two main cosmetic issues – the dorsal hump and overly projected nasal tip – Dr. Hilinski recommended cosmetic septorhinoplasty surgery to help make her nose look smaller overall. Although taking the nasal hump down is something that rhinoplasty experts do all the time, bringing the tip closer to the face, or deprojection of the nasal tip, is not nearly as common.

Preservation Rhinoplasty

In planning out her cosmetic rhinoplasty procedure, Dr. Hilinski ultimately decided to use a preservation rhinoplasty technique. This highly specialized type of rhinoplasty surgery is rooted in the fact that much, if not all, of the nasal structures are more or less preserved rather than being resected, or cut out. For example, when it comes to her nasal hump, classic rhinoplasty surgery would dictate that the surgeon simply rasp or sand down the bump to the desired height. But bumps are made of both bone and cartilage. The bony portion of the hump is amenable to sanding it down. But the cartilage portion of the nasal hump requires resection or cutting. Whenever this is done in combination, you can imagine that the native anatomy and support structure of the nasal bridge is significantly compromised. After all, a good portion of the cartilage and bone are being sanded and cut away. To some extent, this disrupts the natural, smooth bridge contour and can, in some cases, lead to irregularities in the appearance of the nose.

This can take the form of unwanted bumps and shadows. In an attempt to minimize development of these postoperative cosmetic nose deformities, preservation rhinoplasty techniques are now being used more frequently. So what do we mean by preservation rhinoplasty when it comes to taking a hump down from the bridge? Instead of ‘sanding down’ the bridge and/or cutting the cartilage down, the bridge height is reduced from underneath. This is graphically demonstrated in the adjacent photo where you can see that the top of the bridge is moved back closer to the face to achieve a new, lower height.

Another way to explain how and why this is being done to the nose is to think of the bridge as the tip of an iceberg. In the accompanying graphic, you can see the starting point of the iceberg (or bridge of the nose). 

Remember our goal here is to reduce the height of the iceberg while maintaining its natural shape as much as possible.

One option (see ‘B’) is to sand down, or cut down, the iceberg to achieve the new, desired height. In doing so, the entire tip of the iceberg has to be reshaped. Although the new shape can closely mimic the old shape, it is still different to some degree. Take a close look at the tip of the iceberg in ‘A’ versus ‘B’ and you can see they are, indeed, different in terms of the shadows and highlights. This is not surprising given the fact that the iceberg was reshaped in a 360 degree manner. When it comes to the nasal bridge, the same concept applies – the new bridge can be made to look very similar to the old bridge, but it is technically still different. And when it comes to the nasal bridge, subsequent scarring and healing can lead to changes that may result in unwanted cosmetic irregularities.

An alternative method of achieving a lower height is to take away an inside layer of the iceberg (see ‘C’) and allow the remaining portion to drop down. This results in a lowering of the overall height by an amount equal to the amount of removal done below the surface level. As is shown here (see ‘D’), the tip of the iceberg drops down to achieve a new position and location – but is the same shape and contour with the same shadows and highlights as it was before. In fact, it IS the same as it was before. And since the intrinsic surface topography was not altered to any significant degree, it looks nearly identical. That is essentially what we are doing with preservation rhinoplasty when it comes to the nasal bridge. We are taking away a layer of cartilage and bone inside of the nose and below the bridge, thus allowing movement of the native bridge shape and contour to the desired, new, lower position. And since we haven’t altered the surface anatomy to any great extent, subsequent scar tissue during the healing process is unlikely to lead to unwanted cosmetic irregularities – leaving the bridge of the nose nice and smooth.

Preservation Rhinoplasty Case

Given the advantages with using preservation rhinoplasty technique, Dr. Hilinski elected to choose this method for this particular case. But in addition to needing the bridge height reduced, this patient needed to have the nasal tip brought closer to the face – called ‘deprojection’ of the nasal tip.

As you can see, her nasal bridge has been nicely reshaped – including a reduction in the height – and the tip is now less projected. And if you look very closely, you can see that the nasal bridge contour is very smooth and natural looking. The same could be said for her nasal tip as well. It has been deprojected and made to look just a bit more defined and refined.

Overall, though, she still looks quite natural, which is always the goal when it comes to cosmetic rhinoplasty.

#### Preserving One’s Overall Look
One of the more common concerns patients have regarding rhinoplasty surgery is whether or not their overall look is going to change following the procedure. This is because many patients seek out rhinoplasty or nose reconstruction to address specific features of their nose they do not like – but they would like to preserve their overall look if possible. To illustrate this point, I have provided this rhinoplasty tutorial chapter that utilizes a real patient example.

This particular patient from San Diego desired to have her nose reconstructed to include correction of her crooked bridge as well as the bump along the dorsum. As you can see from her frontal photo from before surgery, her nose was crooked to her right side (see arrow). Just look at the yellow vertical line drawn down the middle of her face. You can appreciate better how much of her nose is displaced off of the midline to her right side. In fact, the crooked nasal deformity causes her left side to appear almost concave as indicated by the blue curvature. This type of crooked nose deformity can actually contribute to patients having difficulty breathing through the nose since the nasal passageway is constricted from the displaced bridge. This was the case here where this patient had trouble breathing through the nose.

On her side or profile view, you can see that her nasal bridge had an obvious bump or hump deformity. As indicated by the arrow in the adjacent photo diagram, the bump involved primarily the upper one half of her nasal bridge and contributed to the nose looking excessively large for her face. Ideally her nasal bridge would be about the level indicated by the yellow line to make the nose better balanced with the face.

That being said, this patient desired to have these unwanted features reshaped as part of the nasal reconstructive process. However, she did not wish to change her overall look as a result of the nose surgery. She specifically wanted to preserve her natural overall facial appearance without looking too different. Therefore, we agreed on a surgical procedure that would effectively correct her main issues while preserving her overall look.

Ultimately, she ended up undergoing a closed rhinoplasty approach where we avoided using any external incisions (cuts in the skin). During the reconstructive surgery, the nasal bridge was reshaped. In the process of trying to straighten her nasal bridge, the upper dorsum was reduced in height by sanding it down to a more appropriate level. This helped in preparations for straightening the crooked nose deformity. This was accomplished by strategically moving the nasal bones over from her right side to a more midline position. This specific rhinoplasty maneuver is referred to as ‘osteotomies’ and implies the nasal bones are carefully cut and repositioned. That is precisely what was done in this case to help straighten out the crooked nose deformity. The good news for this particular patient was that her health insurance provided complete coverage for the reconstructive surgery since there were functional implications involved in her care. Meaning, since she had difficulty in using her nose, this was considered a medical condition. Therefore, her health insurance provided coverage for the surgery.

Before and After Reconstructive Rhinoplasty

As you can see in the following before and after closed rhinoplasty photos, the main concerns have been appropriately addressed as part of the reconstructive effort. More specifically, her nasal hump deformity has been taken down, but not so much so that she has a scooped or ski-sloped bridge appearance. In addition, her nasal bridge has been brought to a more midline position to repair the crooked nose deformity. Not to be discounted is the fact that she also still looks very much like her old self – just without the bothersome features of her nose. Could I have made more changes to her nose? Absolutely. But that is not what was desired in this specific case. To a certain degree, this is the essence of doing great rhinoplasty work – reshaping the nose to correct undesirable features while making it appear as if she was simply born with the new nose.

#### PRF (Platelet-Rich Fibrin)
At Hilinski MedSpa in San Diego, we take pride in offering cutting-edge, non-surgical treatments that rejuvenate your skin from within. Injectable Platelet-Rich Fibrin (PRF) is one of the most advanced options for restoring youthful vitality and improving skin texture, tone, and elasticity. Using your own blood, PRF naturally stimulates collagen production and tissue regeneration for long-term skin rejuvenation and natural-looking results.1While PRF can be performed on its own, it’s also commonly used to enhance the results of EZ Gel, another regenerative treatment derived from your own blood components that adds gentle volume for a more complete facial refresh.

Discover the Science Behind Injectable PRF

The Advantages of Choosing Injectable PRF for Your Aesthetic Goals

A Step-by-Step Guide to the PRF Procedure at Hilinski MedSpa

Targeted Treatment Areas: Where Injectable PRF Can Make a Difference

Comparing Injectable PRF to Other Rejuvenation Options

Injectable PRF Recovery & Results

Injectable PRF FAQs

Discover the Science Behind Injectable PRF

Natural Rejuvenation Redefined

Platelet-Rich Fibrin is a next-generation form of platelet-rich plasma (PRP), created by processing a small sample of your own blood through a specialized centrifuge. This technique separates the blood into a layer rich in platelets, white blood cells, and fibrin—components that naturally encourage the release of growth factors over time. These growth factors trigger new collagen production, enhance tissue regeneration, and improve skin health across multiple areas of the face.

Unlike dermal fillers made with hyaluronic acid, PRF contains no additives or synthetic substances, eliminating concerns about allergic reactions. The result is a biocompatible, cutting-edge treatment that revitalizes the skin from within while maintaining your body’s natural harmony.

The Advantages of Choosing Injectable PRF for Your Aesthetic Goals

Natural Regeneration

PRF uses your own blood to deliver concentrated growth factors that restore firmness, smooth fine lines, and improve overall skin texture for soft, radiant facial rejuvenation.2

Enhanced Skin Health

PRF improves elasticity and refines tone for patients with acne scars, uneven skin, or volume loss.3 It’s a natural way to support long-term skin rejuvenation and youthful vibrance.

Safe & Biocompatible

Because PRF is 100% autologous—derived entirely from your own blood—there is minimal risk of allergic reactions, making it a safe option for nearly any good candidate seeking natural enhancement.

Long-Lasting Results

PRF promotes continuous release of growth factors, encouraging new collagen and stronger skin structure. These gradual improvements deliver visible, long-lasting results that enhance your appearance over time.

A Step-by-Step Guide to the PRF Procedure at Hilinski MedSpa

Personalized Consultation

Your PRF journey begins with a personalized consultation, where a qualified provider will assess your skin and discuss your aesthetic goals—such as softening fine lines, brightening the under-eye area, or improving overall skin texture. During this visit, your provider will determine if you’re a good candidate for PRF therapy and develop a customized treatment plan to help you achieve smooth, natural-looking results.

Blood Draw & Processing

A small blood draw is performed, similar to a routine lab test. The sample is placed in a centrifuge, where it’s spun at a precise speed to separate the platelet-rich fibrin layer from the rest of the blood.

Preparation of PRF

The collected PRF contains high concentrations of white blood cells, platelets, and fibrin mesh that hold the growth factors responsible for collagen stimulation and tissue regeneration.

Precise Injection Technique

PRF is carefully injected into targeted areas of the face—such as the under-eye region, cheeks, nasolabial folds, or jawline—to naturally enhance firmness and smoothness.

Targeted Treatment Areas: Where Injectable PRF Can Make a Difference

Injectable PRF can address a variety of aesthetic concerns, including:

Under-eye hollows and discoloration

Fine lines and wrinkles, including the delicate areas around the eyes4

Smile lines and marionette folds

Dull or uneven skin texture

Volume loss in the cheeks or temples

Acne scars and sun damage

Early signs of aging on the neck and décolletage

Beyond facial rejuvenation, PRF can also be used for hair restoration, helping stimulate new hair growth and reduce hair loss by encouraging the same regenerative growth factors to repair follicles.

Comparing Injectable PRF to Other Rejuvenation Options

Traditional dermal fillers and hyaluronic acid products provide instant enhancement but rely on synthetic materials. Injectable PRF works differently—it gradually renews the skin through natural collagen production and sustained tissue regeneration, offering subtle, long-lasting improvement in tone and texture. This approach appeals to those seeking natural rejuvenation without synthetic substances or immediate filler effects.

Injectable PRF Recovery & Results

One of the best features of PRF is its minimal downtime. You might experience slight redness or swelling for 24–48 hours, but these effects fade quickly. Most patients return to daily routines right away.Improvements appear gradually as the skin’s collagen production increases and growth factors continue to rebuild healthy tissue. Expect firmer, smoother skin and a radiant glow that can last 9–12 months or longer. Many patients schedule routine PRF treatments to maintain their refreshed look and overall skin health.

Injectable PRF FAQs

Experience Natural Rejuvenation with Injectable PRF

If you’re ready to refresh your skin and restore youthful vitality with a natural, non-surgical solution, schedule your PRF treatment consultation at Hilinski MedSpa in San Diego today. Our expert team will design a plan tailored to your skin, lifestyle, and wellness goals for glowing, long-lasting results.

Sources

 1 Dermatologic Therapy. Platelet-Rich Fibrin as an Effective Method of Skin Revitalization. https://onlinelibrary.wiley.com/doi/10.1155/2023/9040608. Accessed November 12, 2025.

2 Indian Dermatology Online Journal. Platelet-Rich Fibrin, Preparation and Use in Dermatology. https://pmc.ncbi.nlm.nih.gov/articles/PMC8664174/. Accessed November 12, 2025.

3 Qin N, Kochheiser M, Akosman I, Dugue D, Raghunandan A, Pavuluri C, Gundlach C, Vaeth AM, Wei L, Wesorick BR, Otterburn DM. Systematic Review of Platelet-Rich Plasma and Platelet-Rich Fibrin in Facial Rejuvenation. Ann Plast Surg. 2025 Apr 1;94(4S Suppl 2):S376-S389. doi: 10.1097/SAP.0000000000004267. PMID: 40167104. Available: https://pubmed.ncbi.nlm.nih.gov/40167104/. Accessed November 12, 2025.

4 Mahmoodabadi RA, Golafshan HA, Pezeshkian F, Shahriarirad R, Namazi MR. Evaluation of the Effect of Platelet-Rich Fibrin Matrix in the Correction of Periorbital Wrinkles: An Experimental Clinical Trial. Dermatol Pract Concept. 2023 Jan 1;13(1):e2023050. doi: 10.5826/dpc.1301a50. PMID: 36892335; PMCID: PMC9946120. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC9946120/. Accessed November 12, 2025.

#### Privacy Policy
Introduction

This website is operated by Dr. John Hilinski, M.D. (collectively the “Company”, “We” or “Us”). We respect your privacy and the Company is committed to protecting it through our compliance with this policy.

This policy describes the types of information we may collect from you or that you may provide when you visit this website (our “Website”) and our practices for collecting, using, maintaining, protecting and disclosing that information.

This policy applies to information we collect:

On this Website

In email, text, phone and other electronic messages between you and this Website.

Through mobile and desktop applications you download from this Website, which provide dedicated non-browser-based interaction between you and this Website.

It does not apply to information collected by:

Us offline or through any other means, including on any other website operated by Company or any third party (including our affiliates and subsidiaries) that may link to or be accessible from or on the Website.

Please read this policy carefully to understand our policies and practices regarding your information and how we will treat it. If you do not agree with our policies and practices, your choice is not to use our Website. By accessing or using this Website, you agree to this privacy policy. This policy may change from time to time. All changes are effective immediately when we post them, and apply to all access to and use of the Website thereafter. Your continued use of this Website after we make changes is deemed to be acceptance of those changes, so please check the policy periodically for updates.

Children Under the Age of 13

Our Website is not intended for children under 13 years of age. No one under age 13 may provide any personal information to or on the Website. We do not knowingly collect personal information from children under 13. If you are under 13, do not use or provide any information on this Website or on or through any of its features/register on the Website, make any purchases through the Website, use any of the interactive or public comment features of this Website or provide any information about yourself to us, including your name, address, telephone number, email address or any screen name or username you may use.

Information We Collect About You and How We Collect It

We collect several types of information from and about users of our Website, including information:

By which you may be personally identified, such as name, postal address, email address, and telephone number (“personal information”);

That is about you but individually does not identify you; and/or

About your internet connection, the equipment you use to access our Website and usage details.

We collect this information:

Directly from you when you provide it to us.

Automatically as you navigate through the site. Information collected automatically may include usage details, IP addresses and information collected through cookies, web beacons and other tracking technologies.

Information You Provide to Us

The information we collect on or through our Website may include:

Information that you provide by filling in forms on our Website. This includes information provided at the time of registering to use our Website, subscribing to our service, posting material, or requesting further services. We may also ask you for information when you enter a contest or promotion sponsored by us, and when you report a problem with our Website.

Records and copies of your correspondence (including email addresses), if you contact us.

Your responses to surveys that we might ask you to complete for research purposes.

Details of transactions you carry out through our Website and of the fulfillment of your orders. You may be required to provide financial and personal information before placing an order through our Website.

Your search queries on the Website.

Mobile Numbers and Text Messaging

The user agrees any mobile phone number(s) provided by them to Dr. John Hilinski, M.D. shall be unique to that user. The user agrees mobile number(s) provided are not shared with, or common to, other users. If a user changes their mobile phone number(s), it is the user’s responsibility to contact us to update their mobile phone number in a timely manner.

Message/data rates may apply per phone plan. 


Message frequency varies.

Information We Collect Through Automatic Data Collection Technologies

As you navigate through and interact with our Website, we may use automatic data collection technologies to collect certain information about your equipment, browsing actions and patterns, including:

Details of your visits to our Website, including traffic data, location data, logs and other communication data and the resources that you access and use on the Website.

Information about your computer and internet connection, including your IP address, operating system and browser type.

The information we collect automatically may include personal information, or we may maintain it or associate it with personal information we collect in other ways or receive from third parties. It helps us to improve our Website and to deliver a better and more personalized service, including by enabling us to:

Estimate our audience size and usage patterns.

Store information about your preferences, allowing us to customize our Website according to your individual interests.

Speed up your searches.

Recognize you when you return to our Website.

The technologies we use for this automatic data collection may include:

Cookies (or browser cookies). A cookie is a small file placed on the hard drive of your computer. You may refuse to accept browser cookies by activating the appropriate setting on your browser. However, if you select this setting you may be unable to access certain parts of our Website. Unless you have adjusted your browser setting so that it will refuse cookies, our system will issue cookies when you direct your browser to our Website.

Flash Cookies. Certain features of our Website may use flash cookies to collect and store information about your preferences and navigation to, from and on our Website. Flash cookies are not managed by the same browser settings as are used for browser cookies.

Web Beacons. Pages of our Website and our emails may contain small electronic files known as web beacons (also referred to as clear gifs. pixel tags and single-pixel gifs) that permit the Company, for example, to count users who have visited those pages or opened an email and for other related website statistics (for example, recording the popularity of certain website content and verifying system and server integrity).

Javascript which uses third-party services to store data about activities and transactions.

Trackable telephone numbers which keep track of phone calls made to some phone numbers on this site.

Offline website data – including both local and remote storage of activities.

Geo-targeting information about your location at the time of use of the site.

We do not collect personal Information automatically, but we may tie this information to personal information about you that we collect from other sources or you provide to us.

How We Use Your Information

We use information that we collect about you or that you provide to us, including any personal information:

To present our Website and its contents to you.

To provide you with information, products or services that you request from us.

To fulfill any other purpose for which you provide it.

To provide you with notices about your account/subscription, including expiration and renewal notices.

To carry out our obligations and enforce our rights arising from any contracts entered into between you and us, including for billing and collection.

To notify you about changes to our Website or any products or services we offer or provide through it.

To allow you to participate in interactive features on our Website.

In any other way we may describe when you provide the information.

For any other purpose with your consent.

Your Access to and Control Over Information

You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website:

See what data we have about you, if any.

Change/correct any data we have about you.

Have us delete any data we have about you.

Express any concern you have about our use of your data.

Disclosure of Your Information

We may disclose aggregated information about our users, and information that does not identify any individual, without restriction.

We may disclose personal information that we collect or you provide as described in this privacy policy:

To fulfill the purpose for which you provide it.

For any other purpose disclosed by us when you provide the information.

With your consent.

To comply with any court order, law or legal process, including to respond to any government or regulatory request.

Privacy of Collected Data

We will never use the statistical analytics tool to track or to collect any Personally Identifiable Information (PII) of visitors to our site. Google will not associate your IP address with any other data held by Google. Neither we nor Google will link, or seek to link, an IP address with the identity of a computer user. We will not associate any data gathered from this site with any Personally Identifiable Information from any source, unless you explicitly submit that information via a fill-in form on our website.

Information to opt out of Google Analytics

Information About Remarketing

This website uses Google remarketing to advertise online using text or image ads on the Google Display Network. Remarketing is a feature that lets us reach people who have previously visited our site, and show them relevant ads when they visit other sites on the Google Display Network.

For websites using remarketing, a third-party DoubleClick cookie is used to enable remarketing for products like Google Ads on the Google Display Network. When someone visits our website, a few lines of code will drop an anonymous browser cookie. This cookie is a small file that stores information. The cookie will store the site visit, but does not store any sensitive information, such as visitor name, address or any other piece of information that might personally identify the visitor. The cookie will be enabled for a set period of time, such as 30 or 60 days, at which time, the cookie expires.

What is the Google Display Network?

A group of more than a million websites, videos, and apps where ads can appear. Sites in this network have partnered with Google to show relevant AdWords ads.

Opting out of Remarketing

Visitors may opt out of Google’s use of cookies by visiting the Ads Preferences Manager.

Visitors may opt out of a third-party vendor’s use of cookies by visiting the Network Advertising Initiative opt-out page.

Changes to Our Privacy Policy

Our Privacy Policy may change from time to time and all updates will be posted on this page. If you feel that we are not abiding by this privacy policy, you should contact us immediately via the email address or phone number given on our website.

Contact Information

To ask questions or comment about this privacy policy and our privacy practices, please write to us or call us based on the contact information and address found in our Website.

#### Profound RF
Profound RF Skin Tightening by Dr. John Hilinski

Profound RF by Syneron Candela is a cutting-edge, FDA-approved, non-surgical method for tightening skin. It combines microneedling with radiofrequency (RF) energy to achieve a remarkable improvement in skin texture, firmness, and overall appearance. Dr. John Hilinski, a highly skilled and board-certified facial plastic surgeon, offers Profound RF to his San Diego patients as a minimally invasive solution to reverse the signs of aging without surgery. With its unique ability to target collagen, elastin, and hyaluronic acid, Profound RF stands out as one of the most effective non-surgical skin rejuvenation treatments available.

Benefits of Profound RF Skin Tightening

Stimulates natural collagen, elastin, and hyaluronic acid production

Tightens skin on the face, neck, and body

Reduces the appearance of wrinkles and fine lines

Minimizes skin laxity around the jowls and neck

Improves the appearance of cellulite

Provides natural-looking, long-lasting results

Minimal downtime compared to surgical procedures

How Does Profound RF Work?

Profound RF combines microneedling and RF energy to create controlled micro-injuries in the skin, stimulating the body's natural healing response. As collagen, elastin, and hyaluronic acid production increase, the skin becomes firmer, smoother, and more youthful. This non-surgical approach can produce significant cosmetic improvements, with results typically visible within 2-4 weeks and continuing to improve over several months.

Ideal Candidates for Profound RF

Profound RF is an ideal solution for patients who want to address:

Facial wrinkles and fine lines

Sagging skin on the cheeks, jawline, and neck

Skin laxity on the abdomen or thighs

The appearance of cellulite

Loss of skin elasticity due to aging or weight loss

Profound RF Procedure and Recovery

The procedure takes about 60-90 minutes and can be done using topical and injectable anesthesia. Most patients experience mild swelling, bruising, and redness for 5-7 days following the treatment. Full results can be seen within 6-9 months as the skin continues to heal and regenerate.

Profound RF FAQ

Dr. John Hilinski's Credentials

Dr. John Hilinski is a board-certified facial plastic surgeon with advanced training in both cosmetic and reconstructive procedures. He earned his medical degree from Harvard Medical School and completed his residency in Head and Neck Surgery at the University of California, San Diego (UCSD) Medical Center. Dr. Hilinski is recognized for his expertise in facial aesthetics and skin rejuvenation, offering personalized treatment plans that prioritize patient satisfaction and natural-looking results.

Schedule Your Consultation for Profound RF with Dr. John Hilinski

If you're seeking a non-surgical solution to tighten and rejuvenate your skin, Profound RF may be the ideal treatment for you. Dr. John Hilinski, a board-certified facial plastic surgeon, has extensive expertise in helping patients achieve natural, youthful results through advanced aesthetic procedures. During your personalized consultation, Dr. Hilinski will evaluate your skin, discuss your cosmetic goals, and determine if Profound RF is the right option for you. Contact Dr. Hilinski's office today to schedule your personalized consultation.

#### Radiesse
Radiesse Injections at Hilinski Medspa

At Hilinski Medspa, we offer Radiesse injections to help restore lost volume, smooth fine lines, and enhance facial and hand contours. Radiesse is a versatile dermal filler known for its ability to provide immediate results while stimulating your body's natural collagen production for long-lasting rejuvenation. Whether you're looking to enhance your hands, chin, or other areas, board-certified facial plastic surgeon Dr. John Hilinski and his team are here to deliver exceptional care with personalized, natural-looking results.

What is Radiesse?

Radiesse is a unique dermal filler made from calcium hydroxylapatite (CaHA) microspheres. Unlike other fillers that primarily add volume, Radiesse also stimulates collagen production, which enhances the skin's structure and firmness over time. Radiesse is used for facial contouring and hand rejuvenation, making it a versatile choice for patients seeking non-surgical solutions to combat the signs of aging.

Benefits of Radiesse Injections:

Why Choose Dr. John Hilinski for Radiesse Injections?

Dr. Hilinski brings an exceptional level of expertise and training to every procedure, making him one of the foremost authorities in facial plastic surgery. He graduated from the prestigious Harvard Medical School, followed by an intensive General Surgery internship at the University of California, San Diego (UCSD) Medical Center. He then completed a highly specialized Head and Neck Surgery residency at UCSD, where his focus was exclusively on surgeries involving the face and neck.

Dr. Hilinski further honed his skills with a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago, under the mentorship of world-renowned surgeon Dr. Dean M. Toriumi.

Board Certifications:

Facial Plastic and Reconstructive Surgery (American Board of Facial Plastic and Reconstructive Surgery)

Head and Neck Surgery (American Board of Otolaryngology)

Professional Affiliations:

Member, American Academy of Facial Plastic and Reconstructive Surgery

Member, American Academy of Otolaryngology-Head and Neck Surgery

In addition to his clinical practice, Dr. Hilinski has contributed significantly to the academic field. He has served as a Clinical Instructor in Facial Plastic and Reconstructive Surgery at the University of Illinois, Chicago College of Medicine and as a Grand Rounds Instructor in Plastic Surgery at UCSD School of Medicine.

His extensive research has led to numerous publications, including journal articles and book chapters on facial plastic surgery techniques. He has also co-authored surgical guides, including chapters on rhinoplasty for the Plastic Surgery textbook in the Emedicine World Medical Library.

Dr. Hilinski is a sought-after speaker, frequently invited to present at national surgical conferences. He is proud to serve the San Diego community, where he has established a successful facial plastic surgery practice and holds a prominent role as a staff surgeon at Scripps Clinic.

Radiesse Treatment Areas

Radiesse is a versatile filler used to address volume loss and enhance definition in various areas of the face and body:

Chin

Radiesse is a popular choice for non-surgical chin augmentation, helping to create a more defined and balanced profile.

Hands

Radiesse is FDA-approved for hand rejuvenation, restoring volume and reducing the appearance of wrinkles and veins.

The Radiesse Injection Process

The Radiesse injection process is quick, taking approximately 15 to 30 minutes depending on the treatment area. A topical anesthetic is typically applied to ensure patient comfort. Dr. Hilinski or his team of skilled injectors will carefully administer the filler to the targeted areas, achieving immediate volume enhancement. The collagen-boosting effects will continue to improve the skin's firmness and texture over the following months.

Recovery and Results

After Radiesse injections, you may experience mild swelling or bruising, which should resolve within a few days. Results are visible immediately, with continued improvement as the body's natural collagen production is stimulated. Most patients can return to their daily activities right after treatment, with full results typically seen within a few weeks. Radiesse results can last up to 18 months.

Visit the Following Radiesse Subpages:

FAQs About Radiesse Injections

Schedule Your Consultation

If you are looking to rejuvenate your appearance with Radiesse injections, contact Hilinski Medspa in San Diego to schedule your personalized consultation with Dr. John Hilinski and his expert team. Discover how Radiesse can help you achieve a more youthful, refreshed look.

#### Radiesse Chin Injection
Radiesse® Chin Injections at Hilinski Medspa

Enhance your chin contour with Radiesse® chin injections at Hilinski Medspa, offering a non-surgical solution to improve chin projection and facial balance. Led by Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, Radiesse® injections deliver long-lasting, natural-looking results that rival surgical chin implants without incisions or downtime.

Why Choose Radiesse® for Chin Augmentation?

Radiesse® is a calcium-based dermal filler designed to add volume and enhance facial contours. It's especially effective for chin augmentation, offering an immediate improvement in chin projection and definition. Radiesse® stimulates the body's natural collagen production, leading to long-term results that last longer than traditional hyaluronic acid fillers.

Radiesse® Chin Injection Procedure

The Radiesse® chin injection procedure is quick, comfortable, and performed in-office. Dr. Hilinski uses a blunt-tipped cannula to carefully place Radiesse® along the chin and jawline to mimic the effect of a chin implant. The filler includes lidocaine for added comfort during the treatment, which takes only about 15 minutes.

Results from Radiesse® Chin Injections

Radiesse® provides immediate improvements in chin projection, creating a more defined, balanced facial profile. The filler helps to smooth and sculpt the lower face, improving jawline contours for a more structured, youthful appearance. Radiesse® can also create the illusion of a slimmer neckline by enhancing chin projection and redefining the facial contours.

Benefits of Radiesse® Chin Augmentation

Non-surgical alternative to chin implants

Long-lasting results

Minimal discomfort and downtime

Immediate improvement in facial contour

Natural collagen stimulation for prolonged effect

Radiesse® Chin Injection FAQs

Schedule Your Consultation at Hilinski Medspa

If you're considering enhancing your facial contours or rejuvenating your appearance with Radiesse® chin injections, the first step is to schedule a personalized consultation at Hilinski Medspa. During your consultation, Dr. John Hilinski, a board-certified facial plastic surgeon with extensive experience in non-surgical facial enhancement, will carefully evaluate your unique facial structure and discuss your aesthetic goals in detail. He will explain how Radiesse® works, what results you can expect, and answer any questions you may have about the procedure.

At Hilinski Medspa, we believe in providing a comprehensive and customized approach to every treatment. Dr. Hilinski's deep understanding of facial anatomy, combined with his expertise in the latest non-surgical techniques, ensures that you receive the highest standard of care. Whether you're looking to improve chin projection, restore youthful volume, or achieve a more balanced profile, Dr. Hilinski will develop a treatment plan tailored to your individual needs.

Contact Hilinski Medspa in San Diego to learn more about how Radiesse® chin injections can help you achieve the facial harmony and enhancement you're looking for. We look forward to helping you look and feel your best!

#### Radiesse Hand Injection
Radiesse® Hand Injections at Hilinski Medspa

At Hilinski Medspa, we offer Radiesse® Hand Injections, an advanced non-surgical treatment designed to rejuvenate aging hands. Over time, the natural aging process can cause volume loss on the back of the hands, resulting in visible veins, tendons, and an overall aged appearance. Radiesse® hand injections provide a solution by restoring lost volume and revitalizing the hands for a smoother, more youthful look. Under the expertise of board-certified facial plastic surgeon Dr. John Hilinski, Radiesse® hand rejuvenation treatments offer stunning, natural-looking results with minimal downtime.

Why Choose Radiesse® for Hand Rejuvenation?

Radiesse® is a dermal filler composed of biocompatible calcium-based microspheres that stimulate your body's natural collagen production. This makes it an excellent choice for rejuvenating hands and smoothing deep lines. Radiesse® is particularly effective for reducing the appearance of veins and tendons, giving hands a more youthful, fuller appearance.

Key Benefits of Radiesse® Hand Rejuvenation

Radiesse® Hand Treatment Procedure

Radiesse® hand treatment is a straightforward office-based procedure. Dr. John Hilinski carefully injects Radiesse® filler under the skin along the back of the hands. The treatment is comfortable for most patients because Radiesse® contains lidocaine, which provides an immediate numbing effect during the injection process.

After injecting the Radiesse®, Dr. Hilinski expertly sculpts the filler to ensure a smooth, natural appearance. You will see immediate improvements as the filler plumps the soft tissue, creating a fuller and more youthful look.

Most patients require at least one syringe of Radiesse® per hand to achieve optimal results. Depending on the level of aging, additional syringes may be necessary for more dramatic improvement.

How Long Do Radiesse® Hand Injections Last?

Radiesse® hand rejuvenation typically offers results that last up to one year. However, individual results may vary depending on skin condition and aging factors.

Radiesse® Hand Rejuvenation FAQs

Restore Youthful Hands with Radiesse® at Hilinski Medspa

If you're looking to restore the youthful appearance of your hands, Radiesse® injections offer a highly effective solution. Contact Hilinski Medspa today to schedule your personalized consultation with Dr. John Hilinski and explore how Radiesse® can rejuvenate your hands for long-lasting, natural results.

#### Rebuilding One Side of the Nose
This particular case example highlights what is possible when rebuilding one side of the nose to create more symmetry. This particular patient from San Diego, CA sought out the services of Dr. John Hilinski because of his known expertise in the field of cosmetic and functional nose reshaping surgery. She consulted with Dr. Hilinski following an injury to the side of her nose that resulted in significant collapse of the right side of her nose. Unfortunately, she had previously undergone nose surgery prior to suffering this most recent injury. The fact she had prior reconstructive rhinoplasty surgery made this particular case even more challenging given the scarring that she had from previous surgery as well as distortion of the normal anatomy inside of the nose.

In terms of the type and degree of nasal collapse that was noted, it can be readily seen in the adjacent photo as seen from the frontal view. The red outlined arrows indicate how her right nasal wall was crushed inward as a result of the trauma. With such a marked degree of collapse, the normal shadowing of the nose becomes significantly disrupted as seen from the front view. Keep in mind that the ideal nose has relatively symmetrical brow-tip esthetic lines that are discussed in more detail in our online rhinoplasty tutorial section on nasal analysis. In this particular case, the brow-tip esthetic line on her right side is notably disrupted when compared to her left side. In addition to the obvious cosmetic concerns with a nose such as this one, consideration must also be given to the negative impact this type of change has on the function of the nose. In this patient, she also presented with a complaint of moderate difficulty in breathing through the right side of her nose, which is not surprising when looking at her her nose. In cases like this, there is really no type or amount of nasal medication that can be prescribed to help counter the effect of such a structural collapse.

When looking at her oblique (45 degree angle) view of the nose, you can get more of an impression of just how much collapse is present along her right side. When looking at oblique photos of rhinoplasty patients, you are actually assessing the opposite side of the nose. Meaning, in this case we are looking at her nose from the left side of her face. But what we are truly assessing in terms of her nose is the right side of her bridge. In this particular rhinoplasty patient, it almost appears as if someone scooped out the right side of the nose leaving her with an obvious concavity in terms of the nasal bridge contour. This red curved line does not represent a scooped appearance from the side view of the nose. In fact, her side view was relatively normal as can be seen in her before and after photos below. What this red scooped contour represented was a significant collapse involving the bone and cartilage along her right bridge.

Revision Rhinoplasty Reconstruction in San Diego, CA

In this type of nasal collapse following trauma to the nose, the bridge needs to be reconstructed by adding cartilage to the nose to restore structural support. This is called cartilage grafting in the world of rhinoplasty. In this particular rhinoplasty patient who had prior nose surgery, the septal cartilage was previously harvested (partially taken out) by another plastic surgeon. Therefore, septal cartilage grafting was not an option. We discussed the secondary options of trying to use rib grafting versus ear grafting to rebuild her collapsed nose. After reviewing the advantages and disadvantages of each option, the patient elected to go forward with reconstructing her nose using ear cartilage grafting.

The cartilage was harvested by making a hidden incision behind the ear so that there was no visible scarring once healed. Like in all cases of ear cartilage grafting in rhinoplasty, a sufficient amount of cartilage was left behind to maintain proper support and shape for the ear. The ear cartilage that was removed for grafting was then used to reconstruct this patient’s right nasal bridge.

A closed rhinoplasty approach was utilized in this particular case because there was minimal work being done to her nasal tip. A closed rhinoplasty approach simply means that no external incisions are being made on the nose. All of the nasal reshaping is being performed by making incisions only inside of the nose. This is a classic tenet in rhinoplasty surgery – if minimal or no work is being planned for the nasal tip region, a closed rhinoplasty approach is feasible to allow proper exposure to reshape the nasal bridge. In this case, the grafting was able to be performed successfully using a closed rhinoplasty approach to reshape her right nasal bridge. Using very careful rhinoplasty technique, the cartilage taken from behind her ear was meticulously placed to restore proper support of her bridge as well as symmetry. In addition, an effort was made to ensure that her nose was functioning better following surgery.

Before and After Revision Rhinoplasty with Ear Grafting

The following photos show her revision rhinoplasty results with use of ear cartilage grafts to reshape the nasal bridge. As you can see, she now has an overall improvement in symmetry of the nasal bridge, especially when looking from the frontal view. When looking from her left oblique angle (shown above), you can see how her right nasal bridge has been lifted up and out to restore a more normal contour. As alluded to above, her side view was not significantly affected by the injury and remained fairly stable before and after rhinoplasty surgery. In the end, this San Diego revision rhinoplasty patient was provided with a marked improvement in her nasal bridge contour with restoration of a fairly normal looking nose following a traumatic collapse of one side.

San Diego Consultation for Revision Rhinoplasty Reconstruction

If you are interested in undergoing revision rhinoplasty reconstruction of the nose for a cosmetic or functional problem, contact one of San Diego’s best rhinoplasty and revision rhinoplasty surgeons – Dr. John Hilinski.

#### Reconstruction
Facial Reconstructive Plastic Surgery in San Diego with Dr. John Hilinski

Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, specializes in facial reconstructive plastic surgery, offering advanced procedures to help restore both the form and function of the face. Whether due to trauma, skin cancer removal, or congenital deformities, facial reconstructive surgery can be life-changing for patients. Dr. Hilinski's extensive training in both cosmetic and reconstructive facial surgery allows him to provide natural-looking, balanced results that restore facial aesthetics and functionality.

What is Facial Reconstructive Surgery?

Facial reconstructive surgery is a specialized field of plastic surgery focused on repairing deformities, defects, or damage to the facial structure. These surgeries may be needed due to injury, congenital disabilities, or after the removal of skin cancer. The goal of facial reconstructive surgery is not only to improve aesthetic appearance but also to restore the functional capabilities of the face, such as speech, eating, and breathing.

Benefits of Facial Reconstructive Surgery

Restores normal appearance and facial symmetry

Improves functionality, including speech, breathing, and chewing

Minimizes the visibility of scars or deformities

Enhances self-confidence and quality of life

Facial Reconstructive Surgery Procedures:

Schedule Your Consultation with Dr. Hilinski

If you're considering facial reconstructive surgery, it's essential to work with a surgeon who has specialized expertise in this complex field. Dr. Hilinski will conduct a thorough consultation to discuss your needs, evaluate your facial structure, and develop a personalized treatment plan tailored to achieve the best results. Contact our San Diego office today to schedule your consultation.

#### Reconstructive Rhinoplasty Tip Asymmetry
There are a lot of patients who undergo rhinoplasty or septorhinoplasty surgery for functional reasons. Here is a great example of this operation, which can result in some nice passive changes to the appearance of the nose.

This patient was having trouble breathing through his nose – largely due to the fact that his tip cartilages were markedly abnormal. When you looked closely, his tip was quite asymmetrical – meaning, it was very different side to side. This was the root cause of his nose not functioning well – because the collapsed tip cartilage wasn’t allowing for air to be passed through in an easy manner.

Normally, the tip is made up of relatively symmetrical, or even, cartilage on each side. These are called the lower lateral cartilages in the world of plastic surgery. In most cases, this pair sits in a stable position near the tip of the nose. In situations, like this one here, where one of the paired cartilage segments drops down, it can result in a smaller nostril opening. You can see in the adjacent oblique photo of his nose that the left side of his tip (right side in the photo) is literally hanging down, or drooping. This type of problem can impede proper breathing through the nose. No matter how much medication is tried, the abnormal structural problem will simply not allow ideal breathing. In these situations, surgical reconstruction of the nose is really the only option.

This particular patient was evaluated by a local board certified ENT/Head and Neck Surgeon in San Diego – who subsequently referred him to Dr. Hilinski given his widespread reputation as a rhinoplasty expert. Dr. Hilinski recommended an open reconstructive rhinoplasty where an incision was used under the tip of the nose to create proper exposure of the cartilage.

In the adjacent photo taken during his actual surgery, you can see just how twisted and asymmetrical the cartilage was upon exposure. Normally, these two segments would be much more equal in size, shape and location. In this case, his left side (your right side) extended further down toward his lip and his right side was pushed over to the side. These surgical findings were no surprise when the skin was lifted up. But this still required a fairly complex reconstructive effort by Dr. Hilinski to restore proper structural integrity to his nasal tip.

Reconstructive Rhinoplasty Results

Here are some results of this effort by Dr. Hilinski. As you can readily see, there is a dramatic improvement in the shape and position of his nasal tip. He now has a much more normal nasal tip that is fairly equivalent from left to right. When you look at the oblique view seen above, you can easily appreciate how his left side has been brought up nicely to project out in a proper manner. The end result of this type of work is a nose that has improved structural support with markedly better function.

#### Renuva
Renuva Injections at Hilinski Medspa: Revolutionary Fat Restoration for Volume Enhancement

At Hilinski Medspa, part of John Hilinski Facial Plastic Surgery in San Diego, we are excited to offer Renuva, a cutting-edge, long-lasting injectable filler by MTF Biologics designed to restore lost volume by promoting your body's natural fat production. Whether you're looking to address facial volume loss, body contour irregularities, or even scarring from liposuction, Renuva offers a non-surgical solution that mimics the effects of natural fat transfer, providing smooth and lasting results.

What Is Renuva?

Renuva is an innovative cosmetic filler that stimulates the production of new fat cells in the area of injection, helping correct volume deficiencies and enhance your natural contours. Unlike traditional dermal fillers, Renuva works by encouraging your body to replace fat loss with its own natural fat and collagen, resulting in long-term volume restoration.

How Does Renuva Work?

When Renuva is injected into the soft tissue, it acts as an adipose matrix, or scaffold, which supports and promotes the repopulation of fat cells. The injected matrix consists of proteins, growth factors (such as FGF-2 and VEGF), and collagen subtypes that mirror your body's natural adipose tissue. Over the course of 6-12 weeks, your body replaces the Renuva matrix with new fat cells, resulting in increased volume and improved skin texture. The entire process enhances blood flow and encourages natural remodeling, providing long-lasting and natural-looking results.

Renuva is often described as an "off-the-shelf" fat transfer since it achieves the same effect as traditional fat transfer but without the need for surgery.

Common Renuva Treatment Areas

Renuva is an excellent option for both facial and body rejuvenation, restoring volume and improving contours in areas such as:

Cheeks

Smile lines (nasolabial folds)

Jawline and jowls

Chin

Neck

Hands

In addition to facial rejuvenation, Renuva can be used on the body to correct depressions or irregularities caused by liposuction, scarring, or aging. It's commonly injected into areas like the breasts, abdomen, hips, and thighs to smooth out divots and restore a more uniform contour.

What to Expect During Renuva Treatment

Your Renuva treatment will take place in our medspa and is completed in just 15-30 minutes, depending on the treatment area. Similar to other injectable procedures, Renuva requires no downtime, and most patients can return to their normal daily activities immediately following the session.

After the injection, the Renuva matrix gradually dissolves over the next few months, and your body naturally replaces it with fat cells. These newly generated fat cells can last up to 5-10 years, providing long-term volume enhancement.

FAQs About Renuva

Schedule Your Renuva Consultation

Are you ready to restore lost volume and enhance your natural beauty? Contact Hilinski Medspa today to schedule your personalized consultation with Dr. Hilinski or one of our skilled medspa staff members. Find out if Renuva is the right treatment for you!

#### Reshaping A Hanging Columella
This is a great case example of how rhinoplasty can help in reshaping a hanging columella. A hanging columella refers to an overly prominent columella – the column of tissue that sits between the two nostril openings. This ethnic, female patient from San Diego desired to have her heavy columella reshaped at the same time as her bridge was made straighter and her tip was defined.

If you look at her preoperative photo, you can see on her front view how the columella region is quite prominent. We often refer to this as a hanging columella since it appears to hang down from the tip of the nose. Others will reference this type of cosmetic nose deformity as simply a heavy columella. Either way, it refers to an overly prominent and visible segment that draws unwanted attention.

Hanging Columella Surgery

Upon opening her nose during the rhinoplasty surgery, one could easily appreciate why this area was so prominent. Here are some intraoperative views of her nose when Dr. Hilinski performed the surgery. On the profile view, you can tell how the columella cartilage seemed to extend out and away from the rest of the nose – explaining why the columella looked so heavy.

The rhinoplasty procedure was done with an open approach so that this entire region could be best visualized and could be reshaped with excellent surgical exposure. Dr. Hilinski ended up using what is commonly called a tongue-in-groove rhinoplasty technique to reposition and reshape the two segments of cartilage that largely comprise the columella. In doing so, the heavy columella was able to be adequately addressed as is seen in the second intraoperative photo near the end of the actual surgery.

You can also see how the nasal tip cartilage was made to look more angulated, or defined. Where her nose started off quite round and bulbous, the cartilage was ultimately reshaped to give a more defined and refined look.

Before & After Rhinoplasty

The overall appearance of her nose has been improved following Dr. Hilinski’s rhinoplasty surgery. But look more closely at her columella and you can see how it no longer appears heavy or hanging. It now sits in a more desirable position – which further contributes to her improved nasal tip shape. But more importantly, her nose still looks quite natural for her face and is in balance with her surrounding ethnic facial features.

#### Restore Your Dorsal Hump or Bump
Over this past decade, our San Diego office has seen an increasing number of rhinoplasty patients seeking revision surgery with Dr. Hilinski to restore a dorsal hump, or bump, on their nose. Yes, you heard that correctly – putting a bump back on the bridge of the nose. You are thinking – why? Why would anyone want to have rhinoplasty surgery to create a hump on their nose? Most rhinoplasty patients are looking to have a bump or hump removed. And that is certainly the case. But the reality is there are patients out there who have undergone prior rhinoplasty surgery where their hump was removed – who go on to suffer serious regrets about ever having the bump taken down.

Psychology of ‘Missing The Nose Bump’

The psychology behind patients wanting to have their hump put back on their nose can be quite deep. Often times, it is multi-factorial – meaning, there are a number of different reasons behind their dissatisfaction with their new nose.

In many instances, these patients are left with an identity crisis following rhinoplasty – they simply don’t identify with their new look. For so many years they lived with a nose that had a bump or a hump. This is also referred to as a dorsal convexity by many rhinoplasty surgeons. Following rhinoplasty surgery to reshape the nose, the bump is often times reduced or removed to try and create a straighter looking profile. In most cases, the nasal tip is also reshaped at the same time.

Once the smoke clears from the early swelling and initial recovery process, some of these patients begin to miss their old nose. And more specifically, it is the nasal hump they begin missing in particular. Commonly, these patients note that their nasal hump gave their face character. Or that their entire family has a nasal hump and now they are considered an outcast since their bump is gone. One patient who consulted with Dr. Hilinski years ago openly stated that he felt uncomfortable at family gatherings when he realized he was the only one there without a dorsal hump on his nose.

Why Remove the Bump to Begin With?

You might be asking a logical question at this point – why did these patients have their nasal bump taken down in the first place? Well, in some cases, these patients thought they were unhappy with appearance of their nose partly because of the bump on the bridge. At the time, it sounded like a reasonable thing to do – have the nasal bridge height taken down to create a different profile. After all, this is done quite commonly in the world of rhinoplasty. Only after this was done and the healing process unfolded did they begin to realize this was a mistake. This is not the only situation when a plastic surgery patient has ‘buyer’s remorse’ following a procedure. There are, for example, a number of breast implant patients who regret having augmentation and elect to get them removed. In a similar manner, these rhinoplasty patients just never ‘got used to’ their new nose without the bump. As time goes on and they realize they will simply not ever adjust psychologically, the focus then becomes putting the bump back on the nose.

In other cases, rhinoplasty patients will tell you that they don’t regret having the bump removed. They are more unhappy with the fact the bump was taken down too much. This is referred to as over-correction or overly aggressive reductive rhinoplasty. In looking back on their decision to undergo rhinoplasty in the first place, they wanted their bump taken down – but only partly. In these instances, rhinoplasty patients will say they just wanted the nasal bump to be less obvious. Unfortunately, either this was not made patently clear to their rhinoplasty surgeon and the bump was removed completely. Or it was agreed upon that some of the bump would be left behind. But, regretfully, their rhinoplasty surgeon just took too much off of the nasal bridge. Either way, the bump was taken down too much – leaving them yearning to have it put back on the nasal bridge.

Dr. Hilinski Restoring Nasal Humps

So how did Dr. Hilinski become known as one of the few rhinoplasty surgeons in the United States that was willing to help these individuals who wanted to have nasal hump put back on their nose? It started around 2010 with an online female patient who went by the fictitious name of ‘Helen’ in one of the early online plastic surgery chat sites. Helen had undergone a prior cosmetic rhinoplasty by a surgeon in the Philadelphia area. During the surgery, her nasal hump was removed. Subsequently, she just didn’t like the appearance of her nose. For years she struggled with this problem – not being able to pinpoint the exact problem that made her so unhappy with her rhinoplasty outcome. She ended up undergoing more rhinoplasty surgery by other plastic surgeons in pursuit of making her happy. Unfortunately, she was left disappointed even after these revision procedures.

Finally, she realized that a huge component of her unhappiness was related to the fact her bump had been removed. In looking around at her relatives, they all had the family nose she once had prior to rhinoplasty surgery. A light went off in her head. That convex, high bridge contour she once had was a huge part of her identity and character. After many years of struggling to find the source of her frustration with her nose, she honed in on the fact she missed her nasal hump.

Helen went on a national search to try and find the right revision rhinoplasty expert to help her out by putting a bump back on her bridge. Not surprisingly, many great rhinoplasty experts declined to operate on her. She then discovered Dr. Hilinski who was willing to listen to her whole story with a more open mind. After several discussions with Helen, Dr. Hilinski agreed to examine her nose. Upon initial inspection, her nose looked quite nice in terms of the bridge contour and tip shape. In fact, it was the type of rhinoplasty result that most patients would be quite content with after surgery. But this was the problem – she didn’t want a nose like everyone else. She wanted her old nose that had a dorsal bump. After further detailed discussion, Dr. Hilinski agreed to try and put a bump back on her nose in an attempt to restore some of her past identity. It was made very clear that her original nose would never be restored. The realistic goal was to get some of her old features back by re-creating a dorsal hump on her bridge.

Helen flew to San Diego and underwent the revision rhinoplasty performed expertly by Dr. Hilinski. During the surgery, Dr. Hilinski utilized cartilage grafting technique to augment her nasal bridge height. In the process, the cartilage was shaped so that it restored more of a convex profile view. Using photos of Helen prior to any rhinoplasty surgery, Dr. Hilinski was able to accurately gauge how much to add to her nasal bridge. Although it is impossible to restore the bridge to its exact prior state, it is possible to recreate a new bridge height that mimics the old convex shape. Fast forward several months into the healing process – and Helen was quite happy with the final results of her revision reconstructive rhinoplasty performed by Dr. Hilinski. As the years went on, the office heard less and less from Helen – which is quite normal for rhinoplasty patients. Years later, though, Dr. Hilinski received a very thoughtful and unexpected email from Helen. The just of her message was that she had not thought about her nose for a very long time – simply because she was so happy her identity had been essentially restored and she was able to move on with life. In a brief moment of reflection, she remembered her nose journey ending with Dr. Hilinski and wanted to let him know she was doing just fine with her new old hump!

Pre-Requisite of Prior Rhinoplasty

One very important consideration here is the fact that all of these patients once had a dorsal hump or bump. Would Dr. Hilinski consider putting a hump on someone who never had a bump? Absolutely not. These patients being discussed here all have one thing in common – they used to have a bump on their nose, which was taken off during a rhinoplasty procedure. To a great degree, the type of revision rhinoplasty Dr. Hilinski is performing here is restorative or reconstructive.

Not a Saddle Nose Deformity

It is also worth noting here that this type of revision rhinoplasty surgery is NOT the same as correction of a saddle nose deformity. A saddle nose deformity can certainly come about as a result of prior rhinoplasty surgery. But surgical repair of a saddle nose deformity involves restoring a straight dorsal profile – not creation of a dorsal hump or bump.

Example Restoration of a Dorsal Hump

Here are a few case examples highlighting how Dr. Hilinski has been able to replace a dorsal hump on a nose following prior resection during rhinoplasty.

Case Example 1

This male patient here had prior rhinoplasty surgery performed by a different plastic surgeon. His nose originally had a bump on it, which was taken down. Unfortunately, the patient was not happy with the outcome of his first rhinoplasty and desired to have a second surgery to restore the hump on the bridge. Dr. Hilinski ended up using his own cartilage to rebuild the bridge. This included placement of cartilage along the bridge to help recreate the dorsal convexity – or hump. Many years later, the patient is doing well and is quite happy with how his nose turned out.

Case Example 2

This female patient had prior rhinoplasty surgery by a different plastic surgeon who took off her nasal hump. You can see to the right what her nose looked like prior to having any plastic surgery. Indeed, she had a dorsal hump, or convexity, on her nose.

Unfortunately, her rhinoplasty surgeon was over-aggressive in reducing her nasal bridge – leaving her unhappy with her nose and wanting to restore the bump. Yearning to have some degree of a nasal hump put back on her nose, she sought out Dr. Hilinski to perform a revision rhinoplasty procedure on her. This was done with a closed approach using a diced-cartilage fascia (DCF) graft to raise her nasal bridge back up. A decision was made to try and restore a convex bridge – without making it too high. Within weeks of having her revision performed, she was already feeling much more comfortable with her new old look.

#### Restylane® Case Study
Many patients in today’s day and age are looking for office-based, non-invasive options to help rejuvenate their lower eyelid region. Restylane® injection along the lower eyelid region is a great choice to help reshape this area with minimal downtime. Keep in mind that this is considered an ‘off label’ indication for use of Restylane® – meaning, injection of Restylane® into the lower eyelid was not officially approved for this purpose by the FDA. However, over the years the technique for injecting the dermal filler in this area has become increasingly refined to the point it is now considered a widely accepted method for eyelid enhancement among board certified facial plastic surgeons.

Why Treat The Lower Eyelid With Restylane?

Most patients looking to have Restylane® treatment for the lower eyelid typically present with unwanted shadowing or hollowing in this area. The adjacent photo example shows this point more visually. On the left you can see the unwanted shadowing under the eyes of this younger female patient. This usually is seen as a curved line coming down from the corner of the eye across the cheek region. Typically there is some degree of hollowing immediately above this line that contributes to the shadowing effect that bothers so many patients. In the right photo you can see this as a red line coursing across the lower eyelid and cheek with shadowing seen above this level.

As you can see in this patient example, you do not necessarily have to be older to see this type of hollowing effect under the eyelids. In fact, there are many patients who present for Restylane® lower eyelid rejuvenation who are quite young (20s and 30s). In this patient population the normal soft tissue layer in lower eyelid-cheek junction simply begins to atrophy, or shrink. The end result of this process is the shadowing effect that draws unwanted attention and makes people look excessively tired or prematurely aged.

Restylane® Injections For The Lower Eyelid

Restylane® injections to the lower eyelid region can help by plumping up the hollowed areas. By adding volume to the lower eyelid region with an injectable filler like Restylane®, the lower eyelid is lifted out to be more even with the surrounding cheek soft tissue. In doing so, the shadowing effect can be minimized and the eyelid looks more rejuvenated and rested.

So how much Restylane® is need for lower eyelid enhancement? The answer depends on how much hollowing exists. In some patients who are younger and have only mild shadowing, one syringe total of Restylane® may be sufficient to achieve the desired eyelid enhancement. In others who are older and/or have more hollowing of the lower eyelid, one or more syringes of Restylane® may be needed on each side.

Before & After Restylane® Eyelid Lift Photos

The following photos are actual results from our San Diego facial plastic surgery office showing the benefits of Restylane® injection for lower eyelid hollowing. Notice how natural the transformation appears with a notable improvement in the hollowing and shadowing under the eyes.

#### Reverse Otoplasty
Reverse Otoplasty with Dr. John Hilinski: Correcting Overly Pinned Ears in San Diego

While traditional otoplasty aims to pin the ears closer to the head to reduce prominence, reverse otoplasty does the opposite--it repositions the ears to stick out further from the head. This procedure is often necessary for individuals with congenital ear deformities or those who have undergone an overly aggressive otoplasty, resulting in ears that appear too close to the head.

Dr. John Hilinski, a double board-certified facial plastic surgeon, is a specialist in both otoplasty and reverse otoplasty. His extensive experience ensures that each patient receives personalized care and natural-looking results, restoring balance and symmetry to the face.

What is Reverse Otoplasty?

Reverse otoplasty, as the name suggests, is the opposite of ear pinning surgery. Instead of bringing the ears closer to the head, the goal of reverse otoplasty is to lateralize the ears--repositioning them so they stick out further from the head. This procedure is necessary for patients with congenital ear deformities where the ears did not develop properly, or for individuals whose previous otoplasty was over-corrected, causing the ears to appear too tight against the head.

In some cases, reverse otoplasty also addresses complications from previous surgeries, such as the telephone ear deformity, where the ear has an unnatural curvature resembling the shape of an old-fashioned telephone handset.

Why is Reverse Otoplasty Necessary?

Reverse otoplasty is often needed in two primary cases:

Congenital Ear Deformities

Some patients are born with underdeveloped ear cartilage, causing the upper portion of the ear to appear too close to the side of the head. This results in an abnormal ear shape that can affect overall facial symmetry.

Over-Corrected Otoplasty

Patients who have undergone ear pinning surgery may find that their ears were pinned too closely to the head. This can occur when too much cartilage was removed or the sutures were placed too tightly during the original surgery, leading to an unnatural appearance.

How is Reverse Otoplasty Performed?

In reverse otoplasty, the first step is to release the ear from its overly pinned position. This involves surgically mobilizing the ear by freeing up the scar tissue, cartilage, or sutures that are holding the ear too close to the head. In congenital cases, less release is needed, but it is still essential to reposition the cartilage correctly.

Cartilage grafting is often necessary to support the ear in its new position. Grafts act like support beams, helping to hold the ear in place. These grafts can be taken from other parts of the body, such as the ribs, or from tissue-banked sources. The cartilage grafts are strategically placed to give the ear a more natural, balanced appearance.

Telephone Ear Correction

One of the complications reverse otoplasty addresses is telephone ear deformity, a condition where the ear develops an unnatural inward curve in the middle, resembling an old telephone handset. This deformity often results from a previous otoplasty where the central portion of the ear was over-pinned. Dr. Hilinski can correct this condition using cartilage grafts and other techniques to restore a more vertical, natural ear shape.

FAQ: Reverse Otoplasty

Schedule a Consultation with Dr. Hilinski

If you're seeking to correct ears that are positioned too closely to the head, whether from a congenital deformity or a previous over-correction, schedule a consultation with Dr. John Hilinski, San Diego's leading ear surgery specialist. With his expertise in reverse otoplasty, Dr. Hilinski can help you achieve a more balanced and natural ear appearance. Contact us today to learn more about your options for ear correction.

#### Revision Rhinoplasty
Revision Rhinoplasty by Dr. John Hilinski: Expert Secondary Nose Surgery in San Diego, CA

Rhinoplasty, commonly known as nose reshaping surgery, is intended to enhance the appearance and function of the nose. While many patients are pleased with the results of their initial surgery, others may find themselves dissatisfied due to cosmetic irregularities or functional issues that arise over time. Revision rhinoplasty, or secondary rhinoplasty, is a specialized procedure designed to correct or improve the results of a previous rhinoplasty. Dr. John Hilinski, one of the few board-certified facial plastic surgeons in San Diego with advanced training in revision rhinoplasty, offers expert care for these complex cases.

Dr. Hilinski's extensive training includes mentorship under the internationally renowned facial plastic surgeon Dr. Dean M. Toriumi, who is widely regarded as one of the best revision rhinoplasty surgeons in the world. With this background, Dr. Hilinski utilizes the latest and most sophisticated surgical techniques to achieve beautiful and functional results, even in the most challenging revision cases.

What Is Revision Rhinoplasty?

Revision rhinoplasty, also known as secondary rhinoplasty, is a corrective procedure performed to reshape or resize the nose following a previous rhinoplasty. This surgery addresses persistent cosmetic issues such as asymmetry, irregular contours, or unwanted shape changes, as well as functional problems like breathing difficulties that can result from suboptimal surgical techniques used in the initial procedure.

Often, initial rhinoplasty results may seem satisfactory, but issues can arise months or even years later due to changes in the nose's structural support. Many surgeons may achieve early aesthetic results by compromising the underlying support mechanisms of the nose, which can lead to unwanted changes as scar tissue forms and alters the nose's shape over time. Revision rhinoplasty patients typically seek correction several months to years after their first surgery when they begin noticing irregularities or experience breathing problems.

Revision rhinoplasty is inherently more complex than primary rhinoplasty due to variations in the types of abnormalities encountered and the technical challenges posed by scar tissue from the initial surgery. This complexity makes it essential to choose a surgeon with specialized expertise in revision cases, such as Dr. Hilinski, who is known for his ability to handle even the most difficult revision rhinoplasty procedures.

Who Is a Candidate for Revision Rhinoplasty?

Good candidates for revision rhinoplasty are individuals who are dissatisfied with the results of their previous nose surgery and have realistic expectations about what can be achieved. Candidates typically include men and women who wish to refine or reshape their noses following prior rhinoplasty, addressing issues such as asymmetry, irregular contours, or breathing problems.

Patients considering revision rhinoplasty should understand that these procedures are significantly more complex and challenging than primary rhinoplasty. It is generally recommended that patients wait a minimum of 10 to 12 months after their initial surgery before undergoing revision rhinoplasty to ensure that the nose has fully healed and stabilized.

FAQ: Revision Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering revision rhinoplasty and want to explore your options, schedule a consultation with Dr. John Hilinski, San Diego's expert in secondary nose surgery. With his advanced training and personalized approach, Dr. Hilinski is dedicated to helping you achieve a nose that looks beautiful and functions well. Contact us today to learn more about how revision rhinoplasty can improve your appearance and quality of life.

#### Revision Rhinoplasty Tip Rebuilding
This is a great case example of how revision rhinoplasty can help correct functional problems following previous, unsuccessful rhinoplasty surgery. This patient was referred to my office by a past rhinoplasty patient of mine. He had undergone nose surgery that was performed by a plastic surgeon in the Orange County area. Unfortunately, in the process of reshaping his nasal tip, something was done to the cartilage support resulting in collapse of his right side.

Cosmetically, this created an abnormal shadow along the right side of his tip, which was more obvious since there was such asymmetry between the right and left sides. In addition to the cosmetic concerns, the collapse contributed to trouble breathing through that side of his nose. This is because there was limited support over the nostril to prevent collapse as he breathed inward through the nose. This is a medical condition referred to by plastic surgeons as vestibular stenosis or external nasal valve stenosis. This term, stenosis, implies there is some sort of narrowing. In this case, the nasal airway was, indeed, narrowed just inside of the nostril opening. Unfortunately, when this circumstance arises, there is very little that medication will do to help improve the subjective symptoms of obstructed airflow. The only real solution is reconstructive surgery to help rebuild the deficient area of the nose.

An Over Projected Nasal Tip

In addition to the issues seen on his frontal view, this patient also had what is called an over-projected nasal tip – over overly projected nasal tip. This means that the tip of his nose stuck out too far from the plane of his face. This is shown more visually in the adjacent photo diagram by the green lines that indicate what we are looking at when we judge the projection of a nasal tip. In this particular instance, the projection of the nasal tip is excessive. So we also discussed making adjustments to the position of the nasal tip cartilage in the process of restoring proper tip support.

Revision Open Rhinoplasty Surgery

He ended up undergoing an open revision rhinoplasty – meaning I made an incision across the bottom of his nose and reflected the skin upward to expose the cartilage framework. Upon opening the nose during surgery, it was confirmed that the right side of his tip was notably collapsed. This is shown in the adjacent intraoperative photo. As the arrow indicates, he had a marked collapse in the cartilage contour on this side of the tip. You can even see how this side of his nasal tip shadows more so even with the skin reflected back.

The main focus of the surgery was to help rebuild the depressed segment of cartilage. This was accomplished with use of cartilage grafting technique. Fortunately, his prior surgeon did not remove much of his septal cartilage. Therefore, there was plenty of septal cartilage available for harvesting and use. Had the septal cartilage been depleted from his prior surgery, I would have had to look elsewhere for sufficient cartilage to do the grafting.

In the process of repairing the collapsed external nasal valve, I also was able to reposition his nasal tip. This was done by bringing the entire tip complex closer to the face. One of the main considerations in being able to accomplish this successfully was the thickness of his skin. He happened to have medium thickness skin, which was more amenable to ‘shrink wrapping’ down to the new, smaller sized tip. If he had thicker nasal skin, this shrinking effect would be much less likely – making it much more challenging to reduce the projection of his nasal tip.

Before & After Revision Rhinoplasty

Here are this patient’s revision rhinoplasty results showing his outcome greater than 1 year following his surgery. As you can now see, his nasal tip is much more symmetrical than it was prior to surgery. This translates into a much more stable nasal airway for him – meaning, he can now breathe much better.

On his oblique and profile views, you can appreciate how his nasal tip projection was decreased. In other words, his nasal tip was brought closer to the face to create more harmony overall. In the diagrammed profile view shown below, you can even see how much his tip was de-projected. Although this amount translates into a matter of millimeters – rhinoplasty is a game of millimeters. And, as exemplified here in this case, that is all that was needed to make his nasal tip projection appear more appropriate and balanced for his face.

Most importantly, he still looks quite natural following this type of complex revision rhinoplasty procedure.

#### Revision Skincare Products
Elevate Your Skincare Routine with Medical-Grade Products

At Dr. John Hilinski’s facial plastic surgery practice, we are committed to helping our patients achieve healthy, radiant skin that complements their natural beauty. One of the key ways we do this is by offering Revision Skincare, a trusted line of medical-grade products backed by scientific research and designed to deliver visible, long-lasting results. Whether you’re recovering from a cosmetic procedure or simply looking to enhance your daily skincare regimen, Revision Skincare products provide powerful solutions tailored to your unique needs.

Featured Revision Skincare Products

1. C+ Brightening Eye Complex™

Brighten, firm, and refresh the delicate skin around your eyes with this advanced eye treatment.

2. C+ Correcting Complex 30%™

Achieve a radiant, even skin tone with this powerhouse antioxidant serum.

3. CMT Post Procedure Cream

Designed specifically to support and accelerate the healing process after aesthetic treatments.

4. D·E·J Boosting Serum™

Rejuvenate your skin at a cellular level with this advanced anti-aging serum.

5. D·E·J Face Cream®

A powerful daily moisturizer that addresses multiple signs of aging while strengthening the skin’s natural barrier.

6. Intellishade® TruPhysical™ Sunscreen SPF 45

Protect your skin with this award-winning, tinted, mineral-based sunscreen.

7. Nectifirm® Advanced

Firm and smooth the delicate skin of the neck and décolletage with this revolutionary product.

Why Choose Revision Skincare with Dr. Hilinski?

Dr. John Hilinski is a renowned facial plastic surgeon with extensive expertise in both surgical and non-surgical aesthetic treatments. He carefully selects skincare products that align with his commitment to natural-looking, long-lasting results. When you choose Revision Skincare through Dr. Hilinski’s practice, you benefit from:

Frequently Asked Questions (FAQs)

Schedule Your Skincare Consultation Today

Ready to achieve healthier, more radiant skin with Revision Skincare? Contact Dr. John Hilinski’s office today to schedule your personalized skincare consultation. We’ll help you select the right products to meet your skin’s unique needs, whether you’re recovering from a procedure or enhancing your daily routine.

#### Rhinophyma Treatment
Rhinophyma is an abnormal skin condition that can affect the nose – leading to significant problems in terms of cosmetic appearance. The adjacent photo is a great example of rhinophyma can cause the nose skin to look overgrown and excessively thick. This usually involves the lower one-half of the nose skin – and can often times have dramatic effects on the appearance of the nostril skin. Sometimes, the rhinophyma can become so severe that the nose skin appears almost mulberry-like from the overgrowth of the sebaceous glands.

There are a good number of rhinophyma patients who also have trouble breathing through their nose as a result of the overly active skin. When rhinophyma becomes advanced, the skin can thicken to the point where it literally causes the nostril openings to collapse inward under the dense weight. When this occurs, patients with rhinophyma will note some degree of subjective nasal obstruction.

Fortunately, Dr. Hilinski is a known expert when it comes to treating rhinophyma patients and correcting both the cosmetic and functional problems. To learn more about rhinophyma and the various treatment options, click here to read Dr. Hilinski’s ultimate guide to rhinophyma.

#### Rhinophyma Treatment
Rhinophyma Treatment by Dr. John Hilinski: Advanced Surgical Solutions in San Diego, CA

Rhinophyma is a rare but impactful disorder that causes thickening and enlargement of the nasal skin, often resulting in a bulbous, red, and nodular appearance of the nose. This condition predominantly affects the nasal tip and nostril base due to the higher density of glands in these areas, leading to a noticeable and sometimes embarrassing change in nasal contour. While the exact cause of rhinophyma is unknown, it is closely linked to acne rosacea, with many patients developing the condition after long-standing rosacea. Rhinophyma can not only cause cosmetic concerns but may also impair nasal function, making breathing difficult due to the increased weight and overgrowth of the nasal skin.

As a leading facial plastic surgeon in San Diego, Dr. John Hilinski offers advanced surgical treatments for rhinophyma, using cutting-edge techniques to improve both the appearance and function of the nose. With his extensive experience and specialized training, Dr. Hilinski provides patients with effective, precise, and safe solutions to manage and treat rhinophyma, helping them achieve a more natural and balanced nasal appearance.

What is Rhinophyma?

Rhinophyma is a condition characterized by the thickening of nasal skin, especially around the tip and nostrils, due to the overactivity of sebaceous glands. This leads to a bulbous, ruddy appearance that can become progressively severe over time. Commonly referred to by other names such as "drinker's nose" or "brandy nose," rhinophyma is not caused by alcohol consumption, as once believed, but is often associated with chronic acne rosacea.

Rhinophyma can also impact nasal function, as the thickened skin may weigh down the nasal structure, leading to nostril collapse and breathing difficulties. In severe cases, the overgrowth can even obstruct the line of vision. The condition affects men more frequently than women, with studies indicating that around 90% of rhinophyma patients are male.

Surgical Treatments for Rhinophyma

While topical medications may be helpful in very mild cases, most rhinophyma patients require surgical intervention to address the condition effectively. Dr. Hilinski specializes in three primary surgical methods to reduce the excessive glandular tissue and reshape the nose:

Laser Surgery for Rhinophyma

Laser surgery is Dr. Hilinski's preferred method for treating rhinophyma. Using CO2 or Erbium lasers, this approach ablates the diseased tissue with high precision and minimal bleeding. The laser allows for incremental removal of the thickened skin, providing controlled and predictable results that restore a more natural nasal contour. Patients benefit from reduced bleeding, less tissue trauma, and faster recovery times compared to other methods.

Dermabrasion for Rhinophyma

Dermabrasion involves using a scalpel or dermabrader device to gradually sand down the affected skin. While effective, this method can lead to more bleeding during the procedure and the production of aerosolized particles, which can be a concern for surgical staff. Although dermabrasion is not unsafe for the patient, laser surgery offers a more controlled and efficient alternative.

Powered Microdebrider for Rhinophyma

The powered microdebrider is another option for treating rhinophyma, using a rotating cutting burr connected to a suction device to remove the thickened tissue. This method helps reduce the risk of aerosolized particles by immediately suctioning debris, though it may result in more bleeding compared to laser treatment. Dr. Hilinski uses this technique when appropriate, ensuring each patient receives the most effective treatment for their specific condition.

Rhinophyma Laser Surgery Case Example

One of Dr. Hilinski's patients presented with moderately severe rhinophyma, characterized by thickened, irregular nasal skin and breathing difficulties. Dr. Hilinski performed laser ablation using a CO2 laser to remove the diseased tissue while preserving the natural nasal structure. The surgery took approximately 45 minutes, and the patient was able to see significant improvements within weeks. Post-surgery, the nose appeared smoother, more symmetrical, and smaller in size, with a marked enhancement in nasal breathing due to the reduction of excess tissue.

Rhinophyma Treatment FAQ

Schedule a Consultation with Dr. Hilinski

If you are affected by rhinophyma and seeking an effective treatment to improve your nose's appearance and function, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in rhinophyma treatment, Dr. Hilinski combines advanced techniques and a compassionate approach to deliver the best possible care. Contact us today to learn more about how Dr. Hilinski can help you achieve a smoother, more natural-looking nose.

#### Rhinoplasty
Rhinoplasty by Dr. John Hilinski: San Diego's Expert in Natural-Looking Nose Reshaping

Dr. John Hilinski, a double board-certified facial plastic surgeon based in San Diego, is renowned for his exceptional skill in delivering natural-looking rhinoplasty results. With advanced training from Harvard Medical School, a residency in Head and Neck Surgery at UCSD Medical Center, and a prestigious fellowship in Facial Plastic & Reconstructive Surgery under Dr. Dean M. Toriumi, Dr. Hilinski combines surgical precision with personalized care to help patients achieve their aesthetic goals. His comprehensive expertise in both cosmetic and functional nasal surgery ensures that your rhinoplasty results not only look great but also maintain optimal nasal function.

What is Rhinoplasty?

Rhinoplasty, commonly known as a nose job or nose reshaping surgery, is a procedure that alters the size, shape, or proportions of the nose to achieve facial harmony. Many individuals seek rhinoplasty because they feel their nose is disproportionate or does not complement their overall facial features. Even subtle adjustments can enhance facial symmetry and bring out the beauty of other features. Rhinoplasty is one of the most sought-after cosmetic procedures in the U.S., with over 200,000 performed each year. However, choosing the right surgeon is crucial. If you are in the San Diego area, Dr. Hilinski's extensive credentials and commitment to patient care make him an excellent choice for those considering rhinoplasty.

Why Get Rhinoplasty?

Patients in San Diego choose Dr. Hilinski for rhinoplasty to address various concerns, such as a nose that is out of balance with their facial proportions, a crooked bridge, or a dorsal hump deformity. Others seek to refine the nasal tip, improving its definition, symmetry, or position. Whether the goal is to address isolated concerns or multiple irregularities, the ultimate aim of rhinoplasty is to create a nose that is balanced and naturally enhances the overall appearance of the face.

Rhinoplasty is not just about aesthetics; it also plays a critical role in maintaining nasal function, including breathing. Dr. Hilinski's dual expertise in cosmetic and functional nasal surgery sets him apart, as he understands the intricate balance between appearance and function. This makes rhinoplasty one of the most complex and challenging facial surgeries, and Dr. Hilinski's advanced training ensures that patients achieve both aesthetic and functional success.

How Does Rhinoplasty Work?

Rhinoplasty can be performed using two primary techniques: open and closed rhinoplasty.

Dr. Hilinski will determine the best technique for your needs during your consultation, ensuring the approach aligns with your specific anatomy and goals. Most rhinoplasty procedures are conducted in an outpatient surgery center under deep sedation or general anesthesia, typically taking two to two and a half hours to complete, with patients returning home the same day.

Rhinoplasty Recovery

Recovery from rhinoplasty generally involves a period of five to seven days. Significant swelling and bruising are uncommon, and stitches are usually removed within this timeframe. While many patients take a week off work or school, some feel well enough to resume their activities within just a few days. Regular activity can typically resume after two weeks, though strenuous exercise should be avoided for four to six weeks. Although most patients feel comfortable appearing in public within seven to ten days, the nose will continue to refine and heal for up to a year or more, with subtle changes over time as soft tissue swelling gradually resolves.

For additional information on rhinoplasty, including detailed tutorials and the latest insights, you can visit our San Diego rhinoplasty blog. To see the transformative results that Dr. Hilinski has achieved, browse our rhinoplasty before and after photo gallery.

Who is a Good Candidate for Rhinoplasty?

Ideal candidates for rhinoplasty include individuals who:

Are in good general health and non-smokers

Have completed their facial growth

Seek to refine and reshape their nose

Have realistic expectations for the outcomes

Dr. Hilinski's expertise ensures that candidates receive tailored care and advice, helping them make informed decisions that align with their aesthetic and functional needs.

FAQ: Rhinoplasty with Dr. John Hilinski

Schedule a Consultation with Dr. Hilinski

If you are considering rhinoplasty and want to explore your options, schedule a consultation with Dr. John Hilinski, San Diego's leading rhinoplasty expert. With a personalized approach and extensive experience, Dr. Hilinski is dedicated to helping you achieve the results you desire. Contact us today to learn more about how rhinoplasty can enhance your appearance and boost your confidence.

#### Rhinoplasty & Smoking
Our office just got an email inquiry from a patient who desired cosmetic rhinoplasty surgery from Dr. Hilinski. In her inquiry she noted that she was a smoker. This was a nice opportunity for us to clarify our stance and opinion regarding rhinoplasty surgery and smokers.

The bottom line is – smoking is not good for you. But it is really, really bad for you when considering any type of elective cosmetic surgery, such as rhinoplasty. The negative effects of smoking are well-established and widely known. And one of the major risks has to do with reducing the blood supply to certain tissues. The other is the direct toxic effects nicotine and its byproducts can have on human tissue. Patients who currently smoke should realize that smoking will significantly complicate your recovery process – and will lead to unwanted complications with your rhinoplasty surgery.

As the adjacent photo shows, so much of the toxic smoke goes right up your nose. If you just had rhinoplasty surgery, there are a number of incisions and cuts inside (and sometimes outside) of the nose that are then subject to the direct, negative effects of the smoke. In so many cases, this toxic smoke will lead to real complications with your healing. And this can occur even weeks out from rhinoplasty surgery. Meaning, if you resume smoking after weeks out following rhinoplasty surgery, you are putting yourself at risk of complications – including a less than optimal cosmetic rhinoplasty result that may lead to you having to have a revision rhinoplasty procedure.

#### Rhinoplasty Incision Cleaning
Maintaining a clean incision line following open rhinoplasty surgery is one of the keys to achieving an ideal outcome. This is so important that my staff and I will emphasize proper cleaning technique verbally and in writing – repeatedly. Unfortunately, despite redundant discussions, including black and white handouts, a good number of patients will still present 5-7 days out from rhinoplasty with suboptimal care of their incision line.

Previously we have added a video that shows proper rhinoplasty incision cleaning, but this point cannot be emphasized enough. I added this blog entry into our rhinoplasty tutorial as a reinforcement so that patients can visually see what the goal is when cleaning an open rhinoplasty incision line.

This photo is one of my past rhinoplasty patients who had done a particularly good job in terms of cleaning her open rhinoplasty incision. She is just a few days out from the surgery and demonstrates what proper cleaning technique can accomplish.

It really distills down to a 3-step process when cleaning your rhinoplasty incision. First, you clean the suture line and incision using a q-tip saturated in hydrogen peroxide. There should be a sufficient amount of hydrogen peroxide that allows for thorough chemical cleaning of any dried blood or debris. You should also take care to avoid getting any fibers of the cotton tip stuck on the sutures. If this occurs, you must clean these off as well. This may require you to gently rub the incision line, but you should not, by any means, be heavy-handed when doing this – as you will risk damaging the actual underlying surgical alterations that were made. Second, you should dry the incision line with a new q-tip so that the hydrogen peroxide is removed. Third, you should apply a thin layer of bacitracin ointment – not neomycin – along the entire area that was just cleaned. If you do this properly, this cleaning should only be done 3-4 times per day. If you are doing it more frequently than 3-4 times per day – you are not doing it correctly.

The endpoint of rhinoplasty incision cleaning is to clearly see the suture tails and knot (the black material in the adjacent photo) along with surrounding skin. There should be no scabbing, dried blood, crusting or other debris around the sutures and incision. This includes absence of any of this within the nostril opening. This, too, should be incredibly clean.

If your open rhinoplasty incision does not look like this – you are doing something wrong and you will risk having a less than optimal scar once all healing has occurred. In some cases, improper cleaning of the incision line can also lead to other complications, such as wound infection and distortion of the nasal shape.

I hope this additional information will help that minority of rhinoplasty patients who need added guidance when it comes to cleaning their incisions.

#### Rhinoplasty Transformation
In some cases of cosmetic rhinoplasty, the changes made to the shape of the nose can have a much more dramatic impact on the overall facial appearance. This is a great example of such a case.

This young lady from San Diego consulted with me in the hopes of having cosmetic nose reshaping surgery. More specifically, she did not like the bump on the bridge and the wide appearance as seen from the frontal view. In addition, she desired tip reshaping to match the changes being made to the nasal bridge.

We discussed at length the various changes that were possible in terms of cosmetic rhinoplasty surgery. This included the goal of trying to reduce the bump, narrow the bridge, and define the tip – all the while creating a nose that looked in natural balance with her underlying facial features.

Rhinoplasty Computer Imaging

As part of the rhinoplasty consultation process, the patient was provided computer imaging of what her nose may look like following surgery. These images are shown here. On her frontal view, the idea was to narrow the nasal bones to create more shadowing along the sides of the nose – thus giving her more definition as seen from the front.

Frontal Before Surgery

Computer Imaged Photo

Now many patients may look at the computer enhanced photo from the front and wonder why there is not a more dramatic change. There are number of reasons to explain this. One of them relates to the inherent limitations of computer imaging. Making computer enhanced modifications to the nose from the front view can be fairly difficult to do in some cases. The program certainly allows me to create additional shadows while erasing others. But doing this in a manner where the visual result is realistic is the challenge. Imaging the lateral view is much easier given the contrasting background color. Unfortunately, all too often you see other rhinoplasty surgeons perform imaging of someone’s nose where the computer enhanced version is simply unrealistic. In fact, in some offices the surgeon is not even the one doing the imaging for the patient. If rhinoplasty surgery is so complex and individualized, how can someone with absolutely no surgical training be the person showing you what might happen with a complex series of surgical maneuvers? Making sure the computer enhanced images are realistic and achievable is really important when it ultimately comes to assessing the surgical outcome of a particular case.

Lateral Before Surgery

Computer Imaged Photo

Therefore, I am a big proponent of trying to ‘under image’ rather than ‘over image’ patients’ photos. Meaning, I would rather show a rhinoplasty patient a more conservative computer enhanced image that they would be satisfied with after cosmetic nose surgery. If I can provide them an even better result than the computer image, then great. But I would want the patient going into surgery with the mindset they will still be content with the more conservative result as imaged with the computer program.

With the above imaged photos presented to her, this patient was quite happy with the surgical goals I had outlined and was ready to proceed with her rhinoplasty surgery.

Rhinoplasty Hump Reduction

One of the main goals in this particular case was to reduce the dorsal hump – or bump along the upper bridge. As was shown to her in the imaged photos, the goal was to create a straighter looking profile view without over-reducing her bridge, thus avoiding a scooped appearance. This was done during her surgery using a rasping technique whereby the excess bony prominence is sanded down. Once this was done, the nasal bones were then fractured, or intentionally broken, to narrow the bridge. If the nasal bones were not broken in her case, the nose would appear much wider from the front since the bridge height was taken down.

This part of her rhinoplasty procedures brings up a great point that is worth further discussion. Unfortunately, many patients (and even plastic surgeons) are under the false impression that hump reduction rhinoplasty, or removal of a hump from the nose, is a ‘simple thing’ to perform. In fact, I hear it all the time from my patients that other surgeons comment to them regarding how easy it is to ‘just take down the bump’ on the bridge of their nose. Sadly, it is this type of erroneous thinking that is what gets many patients (and plastic surgeons) into trouble. The cold, hard truth is that hump reduction in rhinoplasty is one of the most challenging types of cosmetic nose surgery to perform while achieving consistently, beautiful results.

The reasoning behind this relates to the fact that the bump, or nasal hump, is not just an issue that impacts the profile view of a rhinoplasty patient. Almost any nasal hump impacts both the side view as well as the front view of any patient. Once the nasal hump has been removed or sanded down, you also have to take into consideration what this does to the front view of that patient. In a good majority of cases, once the hump has been reduced, the surgeon will then break the bones in order to maintain an appropriate width to the nose as seen from the front. When you begin breaking the bones, this triggers a whole new set of variables involved in the surgery and healing process that can significantly impact how the nose looks from the frontal view. For example, breaking the bones in this situation requires cutting the nasal pyramid bone on both sides. As the bones are repositioned it should be done in a manner where the bridge alignment is kept as symmetrical as possible. If the bones start off relatively symmetrical, the alignment needs to be maintained. If the bones start off crooked, they should be moved such that the alignment is made more symmetrical. To complicate matters further, the lower part of the nose will usually follow where the upper part moves in terms of alignment. Meaning, shifting the upper one-third of the nose (the bones) will often times impact the position and shape of the lower two-thirds of the nose. So, as you can now appreciate, there is somewhat of a domino effect in play when a hump is removed – the bones then need to be broken, which can affect the alignment of the bridge, which can then alter the shape of the middle and lower part of the nose. This series of considerations hardly makes hump removal a simple proposition.

Proof of this concept can be seen in the many plastic surgery and rhinoplasty galleries online that show before and after photos of a patient undergoing hump reduction surgery. In a great number of these cases, the plastic surgeon will only show you the profile, or side, view of the nose before and after hump reshaping. But, as a potential rhinoplasty patient, you should really ask yourself, “Why did the surgeon not show the front view of that same patient?” If the frontal view of that patient looked improved (or even the same), you would think the surgeon would be showing you that view as well, right? The reason it is not online on their website is usually because the front view doesn’t look so good following hump reduction rhinoplasty. That’s because it is, indeed, quite a challenge getting the frontal view of the nose to look symmetrical and proportional following hump reduction. I have gone so far to even dare potential rhinoplasty patients to call those surgeons’ offices and inquire about seeing the frontal view of those same patients on their websites. In all likelihood, the frontal views of those hump reduction patients will not be shown to you because they simply don’t look right. If you look at my gallery of rhinoplasty photo examples, you will see the patients undergoing hump reduction have a frontal view accompanying the profile view in nearly all cases. That is because having multiple photo angles of the rhinoplasty patient undergoing reduction of the hump deformity tells a much more accurate story of what type of changes were really made to that particular nose.

Rhinoplasty Transformation

In this rhinoplasty patient, the hump reduction was done in conjunction with tip reshaping as was planned. The amount of hump reduction of the bridge can be seen diagrammatically in the adjacent photo diagram as designated by the red dashed line on her profile view. As was discussed previously, her nasal bones then required osteotomies (intentional cutting) as designated by the red dashed curves seen on her frontal view). The nasal bones were then pushed inward as shown by the yellow arrows to create improved shadowing of the upper bridge region. The nasal tip was refined primarily by use of permanent sutures that were strategically placed to reshape her native cartilage. At the same time, I brought her nasal tip upward as shown by the blue arrows. If you look at her profile view, you can see that her nasolabial angle (the angle formed by the junction of the bottom of the nose and the upper lip) is just under 90 degrees. Ideally, in a female this nasolabial angle should be closer to 95-105 degrees. Bringing her nasal tip up just a bit would open this angle up, thus creating a more pleasing appearance. All of these changes were done using an open rhinoplasty approach that provided me with optimal exposure of her nasal framework.

Cosmetic Rhinoplasty Results

Shown here are the rhinoplasty results following the surgical changes noted above. As you can see, her nose has been transformed to create a fairly obvious change in her facial appearance. On the front view, her bridge and tip are now more narrow with improved shadowing on both sides due to increased definition. In addition, her nasal tip has been brought upward just enough to match the other changes noted. Her oblique (45 degree) view really shows how much the bridge has been brought down as the previously noted bump is now gone. Her profile view confirms this transformation with a bridge that is now much straighter and a tip that is more ideally positioned as seen from the side. Her base view (under the nose) shows how the overall shape of her nasal tip has been transformed. Previously her base view showed a more rounded, wide shape to the tip region. Following cosmetic rhinoplasty, it is now more ideally like a soft triangle.

Rhinoplasty Imaged Photos

We previously discussed the exercise of imaging rhinoplasty patients’ photos to give them an idea of what they might expect following surgery. So here are the imaged photos of this particular rhinoplasty patient shown in sequence with her preop photo and actual surgical result. As you can see on both the frontal and profile views, her final rhinoplasty result is fairly close to what was envisioned during the computer imaging process. In fact, as noted above, I somewhat ‘under imaged’ her photos preoperatively. In the end, though, I believe the rhinoplasty surgery provided her with a nose that was even better than the imaged photos in terms of overall improved definition and shape.

San Diego Rhinoplasty Consult

If you are considering cosmetic nose reshaping surgery and looking for a more dramatic type of outcome as discussed here in this case example, do not hesitate in contacting my San Diego office today to schedule a rhinoplasty consult.

#### Rhinoplasty Tutorial
The Rhinoplasty Tutorial was developed and published online by Dr. John Hilinski to help prospective rhinoplasty and revision rhinoplasty patients better understand what is involved in undergoing this unique plastic surgery procedure.

There are many challenges involved in rhinoplasty and we firmly believe the more knowledgeable you are, the more capable you are of making an informed decision regarding your nose. If you have any additional questions or concerns regarding rhinoplasty or revision rhinoplasty that are not covered in the Rhinoplasty Tutorial, please do not hesitate in contacting our office today.

Sincerely,

John M. Hilinski, M.D.

#### Rib Rhinoplasty
Rib Rhinoplasty with Dr. John Hilinski: Advanced Nasal Reshaping in San Diego, CA

Rib rhinoplasty is an advanced form of nose reshaping surgery that uses a patient's own rib cartilage to reconstruct and enhance the nasal structure. This technique is particularly beneficial for patients who require significant augmentation or repair, such as those with a collapsed nasal bridge, complex revision rhinoplasty cases, or those born with congenital nasal deformities. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in rib rhinoplasty, offering a highly customized approach to achieve natural, durable, and aesthetically pleasing results.

What is Rib Rhinoplasty?

Rib rhinoplasty is a specialized rhinoplasty procedure that involves using rib cartilage to reconstruct or augment the nose. This technique is often used in cases where there is insufficient nasal cartilage to achieve the desired results, such as in patients with severely damaged or weakened nasal structures from prior surgeries, trauma, or congenital deformities.

Rib cartilage offers an abundant and sturdy source of graft material, making it ideal for reconstructing and reshaping the nasal framework. The procedure typically involves harvesting cartilage from the patient's own rib, which is then shaped and used to build up or repair the nasal structure. Since rib cartilage is autologous (from the patient's own body), it is highly biocompatible, reducing the risk of rejection or complications.

Why Choose Rib Rhinoplasty?

Patients may choose rib rhinoplasty for several reasons, including:

By utilizing rib cartilage, Dr. Hilinski can achieve long-lasting, natural-looking results that enhance both the appearance and function of the nose. Rib rhinoplasty is a highly specialized procedure that requires advanced surgical expertise, making Dr. Hilinski's experience and skill essential for successful outcomes.

Special Considerations for Rib Rhinoplasty

Rib rhinoplasty involves some unique considerations that differentiate it from traditional rhinoplasty procedures:

Cartilage Harvesting

One of the key components of rib rhinoplasty is harvesting the rib cartilage. This is typically done through a small incision made in the chest area, usually along the lower rib cage. Dr. Hilinski takes great care to minimize scarring and discomfort during this process.

Cartilage Harvesting

One of the key components of rib rhinoplasty is harvesting the rib cartilage. This is typically done through a small incision made in the chest area, usually along the lower rib cage. Dr. Hilinski takes great care to minimize scarring and discomfort during this process.

More Extensive Procedure

Rib rhinoplasty is often more complex and extensive than standard rhinoplasty because it involves both the cartilage harvesting and the nasal reconstruction itself. As a result, the procedure may take longer, and the recovery period can be slightly more involved.

Durability

Rib cartilage provides excellent long-term stability and durability. Once the rib cartilage is used to rebuild the nasal structure, it offers strong support that can maintain the desired shape for years to come.

Scarring

While Dr. Hilinski uses precise techniques to minimize scarring from rib cartilage harvesting, there may be a small scar on the chest. Most patients find this scar to be discreet and easily hidden.

FAQ: Rib Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If you are considering rib rhinoplasty and want to learn more about how this advanced procedure can help restore or enhance your nasal structure, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in complex rhinoplasty, Dr. Hilinski offers personalized care and advanced surgical techniques to achieve natural, long-lasting results. Contact us today to take the next step toward achieving your ideal nose.

#### Saddle Nose Deformity
A saddle nose deformity refers to a marked depression or collapse along the mid portion of the nasal bridge. It is described as such because it resembles the look of a saddle when looking at the nose from the side view. This is visually demonstrated in the adjacent diagram showing precisely where the nose collapses in most cases of a saddle nose deformity. Because of the appearance, this type of abnormality has been also referred to as a ‘pug nose’ or ‘boxer’s nose’ deformity.

What Causes A Saddle Nose?

A saddle nose deformity can be caused by a variety of factors.

In some cases, a saddle nose deformity can arise from an underlying medical condition that affects the cartilage structure of the nose. These include Wegener’s granulomatosis, leprosy (also known as Hansen’s disease), relapsing polychondritis, and even syphilis. With each of these medical conditions, the end result is severe damage to the cartilage structure of the nose with subsequent collapse of the nasal bridge. Fortunately, these medical diseases are quite rare overall and account for a minority of saddle nose deformities.

A majority of saddle nose deformities result from prior trauma to the nose. This can be from previous nose surgery (yes – nose surgery can be traumatic) or an actually injury to the nose (such as a boxer or mixed martial artist getting punched). Saddle nose deformity as a result of prior nose surgery can arise if excess cartilage is inadvertently removed from the nose. This happens most commonly when a rhinoplasty surgeon reduces the bridge height by an excessive amount. In this particular case of a saddle nose deformity, the nasal bone, dorsal cartilage and/or upper lateral cartilage can be compromised to the point where there is insufficient structural support to maintain proper bridge height. The result is collapse of the nasal bridge through the mid portion as seen on profile view. This same thing can result when someone suffers blunt trauma to the nose, such as a boxer. In this type of saddle nose deformity, it is usually the septal cartilage that becomes damaged and weakened. Consequently, the bridge support is compromised (as is seen with surgical trauma), resulting in a saddle nose deformity. In either case (saddle nose following surgery or trauma), the bone and/or cartilage support of the nasal bridge is damaged to the point of causing a collapse.

Saddle Nose Deformity Presentation

There is actually a grading system developed to rate the severity of a saddle nose deformity. However, in most rhinoplasty practices, they are basically two types of saddle nose presentation – one that involves only the nasal bridge and the other that also involves changes to the nasal tip as well as the bridge.

The first type of saddle nose deformity involving only the nasal bridge is depicted in the adjacent diagrams where the left side is normal. On the right you can see the red arrow showing how the bridge cartilage collapses and the overlying soft tissue essentially sinks inward leaving a saddle deformity. As is shown, the nasal bone can be involved in many cases as it junctions with the upper lateral cartilage and dorsal septum. All three of these anatomical structures can collapse leaving the bridge with a saddle deformity. A real patient example of this type of saddle nose deformity was shown above at the start of the discussion.

In the second type of saddle nose deformity, the nasal tip is affected along with the bridge. Like the first type of saddle deformity, the nasal bridge collapses inward due to compromise of the nasal bone, upper lateral cartilage and dorsal septum. However, in this type of saddle deformity the damage to the bridge cartilage is so severe the adjacent tip cartilage is also affected. In this situation, scarring begins to affect the nasal tip, which starts to rotate upward in an abnormal fashion. This means the nasal tip begins to look too short – similar to a pig nose deformity. In fact, this is largely why a saddle nose deformity has also been described as a pug or boxer’s nose as seen on profile view.

This concept is demonstrated in the adjacent diagram showing how the nasal bridge can collapse while the nasal tip rotates upward (two red arrows showing the direction of change seen in this type of saddle nose deformity). Compare this diagram with the one shown above without any nasal tip alteration. You can see in this second type of saddle nose deformity that the lower lateral cartilage is displaced from its normal position, causing the nasal tip to rotate upward. The adjacent patient examples show this type of saddle nose deformity where the bridge has collapsed and the nasal tip has rotated upward at the same time.

On frontal view, a saddle nose deformity appears too flat and wide across the area where the bridge is collapsed. This is because the depression creates unwanted shadowing in between areas of the nose that have maintained proper height (namely the upper bridge and tip). This is analogous to looking at an aerial view of the Grand Canyon, for instance. The river flowing through the canyon is like the saddle deformity where collapse has occurred. In contrast to the surrounding rim of land, there is an obvious shadowing effect that can be seen because the canyon floor is much lower. You can imagine there would not even be a shadow if the land were the same height all the way across.

The adjacent photo example of the same female rhinoplasty patient featured above demonstrates this point precisely. As is indicated by the shaded trapezoid, you can appreciate that this area of her nose where it is saddled appears flatter and wider than desired. It also shadows more across the nasal bridge where the saddle deformity exists. On frontal view, this type of deformity will cause a significant disruption of the brow-tip esthetic line, which detracts from the ideal appearance of the nose.

The adjacent male rhinoplasty patient is another good example visually demonstrating what a saddle nose deformity looks like on frontal view. This patient, also shown above, has an even more dramatic saddle deformity with more severe flattening of the nasal bridge. This patient suffered a traumatic blow to the nose that resulted in collapse of both the bone and cartilage along the bridge area. This caused a severe saddle nose deformity, which was accompanied by distortion of his nasal tip. As the bridge began to collapse, the associated scarring, in combination with lack of cartilage support, lead to abnormal displacement and rotation of the nasal tip.

Surgery For Saddle Nose Deformity

Correction of a saddle nose deformity involves fairly complex rhinoplasty or revision rhinoplasty technique. Thus, this type of cosmetic nose reshaping should only be performed by a facial plastic surgeon who is well versed in advanced rhinoplasty procedures.

The most important goal in correcting a saddle nose deformity is restoring proper bridge support. In many cases, this involves reconstruction of the nasal bone as well as the bridge cartilage (dorsal septal cartilage and upper lateral cartilage). In nearly all cases of a saddle nose deformity, surgical correction will involve some form of augmentation of the nasal bridge. This means that something has to be added to the nose to help restore proper shape and support.

The most common technique used in my rhinoplasty practice to correct a saddle nose deformity is cartilage grafting. In some cases of a mild saddle nose deformity, septal or ear cartilage grafting may be sufficient to rebuild the nasal bridge. This is shown in the adjacent diagram and indicated by the yellow shaded area corresponding to a cartilage graft. In this type of rhinoplasty for a saddle nose deformity where the tip is not involved, a segment of cartilage can be placed directly over the depression to restore a normal bridge height. This is commonly referred to as ‘dorsal augmentation’ since the bridge of the nose is being elevated or built up. It is also known as a ‘dorsal onlay graft’ because the cartilage is being gently placed on the bridge to overlay the defect. Because the area that requires elevation is fairly limited, septal or ear cartilage is sufficient when reshaping this type of saddle nose.

In rhinoplasty patients who have a saddle nose deformity that also involves abnormal rotation of the nasal tip, more extensive cartilage is necessary to achieve a natural looking nose. In these rhinoplasty patients septal and/or ear cartilage is usually not strong enough for the reconstruction. In addition, this type of saddle nose deformity repair typically requires a larger graft than is available from the septum and ear. With this type of saddle nose correction, the bridge has to be augmented as noted above. However, the graft used to build up the bridge has to be longer to accommodate the more extensive saddle deformity seen in these patients.

Furthermore, the tip also has to be reconstructed by lengthening the nose back to its original position. In this rhinoplasty population rib grafting (also known as costal cartilage grafting) is usually necessary to provide sufficient amounts of a resilient cartilage that will maintain proper strength and shape over time. This concept is shown in the adjacent diagram where you can appreciate how much more cartilage grafting is often necessary in this type of saddle nose correction. For instance, the dorsal onlay graft in this case is much longer and needs to often times extend into the nasal tip region in order to help reposition the tip. You can also see a second cartilage graft that is frequently placed under the nasal tip to provide further support for the reconstruction.

Many rhinoplasty patients with a saddle nose deformity inquire about other types of material that can be used to reconstruct the nose besides cartilage. Although there are other biocompatible materials, such as goretex, porex and silicone implants, I prefer to avoid these if cartilage grafting is a viable option. And even in cases where these types of nasal implants are used, they should only be placed overlying the bridge and must be avoided in the nasal tip region.

Nasal Obstruction And A Saddle Nose Deformity

A significant number of patients with a saddle nose deformity also note subjective feelings of nasal obstruction, or difficulty breathing through the nose. This is not surprising given the area of collapse involves the internal nasal valve (middle vault). To read more about the internal nasal valve and its implications in nasal breathing, please refer to our rhinoplasty tutorial chapter on middle vault reconstruction using spreader grafts. In a good majority of patients undergoing surgical reconstruction for a saddle nose deformity, there is passive improvement in their nasal breathing following the procedure. And this is without placement of spreader grafting. This is most likely due to the fact that re-elevating the bridge height helps to reopen the internal nasal valve much like popping up a collapsed tent.

Correction Of Saddle Nose Deformity

These photos here show how the above mentioned techniques can be used successfully to correct a saddle nose deformity.

This first example was done using a closed rhinoplasty technique where cartilage grafts were used as described above to augment, or build-up, the bridge height. As you can see, she now has a more favorable appearing nose as seen from all three standard angles.

This second example demonstrates use of an open rhinoplasty technique where the bridge and the nasal tip were reconstructed concurrently to restore proper support. As you can readily see, there is a marked improvement in terms of the previously collapsed nasal bridge. There is also better nasal tip support. These anatomical alterations translate into a bridge and nasal tip that now look much more natural and harmonious with his face.

Saddle Nose Rhinoplasty Consult

If you have a saddle nose deformity and are considering rhinoplasty repair of your nose, do not hesitate in contacting our office today to discuss your concerns with one of regions best nose surgeons.

#### Saddle Nose Repair/Collapsed Nose Repair
Saddle Nose Repair and Collapsed Nose Repair with Dr. John Hilinski: Expert Nasal Reconstruction in San Diego, CA

Saddle nose, also known as a collapsed nose, occurs when the nasal bridge becomes sunken or flattened, creating a "saddle-like" appearance. This condition not only affects the appearance of the nose but can also cause breathing difficulties due to the structural weakness of the nasal framework. Saddle nose can result from trauma, previous rhinoplasty, or congenital defects. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, is a leading expert in saddle nose repair and collapsed nose reconstruction. With his extensive experience and advanced surgical techniques, Dr. Hilinski can restore both the form and function of the nose, helping patients achieve natural, long-lasting results.

What is Saddle Nose Repair/Collapsed Nose Repair?

Saddle nose repair is a reconstructive procedure designed to correct a collapsed nasal bridge. The surgery typically involves rebuilding the nasal framework using grafts, often from the patient's own rib cartilage, ear cartilage, or septal cartilage. This approach strengthens the weakened nasal structure, restores the nose's natural shape, and improves overall nasal function.

A collapsed nose can occur for a variety of reasons, including:

Saddle nose repair requires precise surgical expertise, as the goal is to restore both the cosmetic appearance and the functional support of the nose. Dr. Hilinski's approach focuses on using biocompatible grafts to ensure long-term stability, while also creating a nose that looks natural and blends harmoniously with the patient's facial features.

Why Choose Saddle Nose Repair?

Patients may choose saddle nose repair for several reasons, including:

Restoring Nasal Shape

A sunken or collapsed nasal bridge can create an imbalanced or irregular appearance. Repairing the nasal structure can restore a natural, proportional shape.

Improving Breathing

A collapsed nose often affects nasal function, leading to breathing difficulties. Reconstructing the nasal bridge can improve airflow and alleviate functional problems.

Correcting Trauma or Surgical Complications

Many patients seek saddle nose repair after experiencing trauma or complications from previous rhinoplasty surgeries. Repairing the nasal bridge can resolve these issues and restore both form and function.

Enhancing Self-Confidence

Correcting a saddle nose can significantly improve a patient’s confidence by creating a more aesthetically pleasing appearance and resolving functional concerns.

Special Considerations for Saddle Nose Repair

Saddle nose repair is more complex than standard rhinoplasty procedures and requires careful planning and advanced surgical techniques. Some special considerations for this surgery include:

FAQ: Saddle Nose Repair

Schedule a Consultation with Dr. Hilinski

If you are experiencing a collapsed nose or saddle nose deformity and are seeking a skilled surgeon to restore the appearance and function of your nose, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in saddle nose repair, Dr. Hilinski offers personalized care and advanced surgical techniques to help you achieve natural, long-lasting results. Contact us today to take the next step toward a fully restored nasal structure and improved quality of life.

#### Scar Revision
Expert Scar Revision in San Diego with Dr. John Hilinski

Scar revision surgery aims to improve the appearance of scars resulting from injuries, surgeries, or other skin trauma. Whether the scar is raised, discolored, depressed, or poorly aligned, scar revision can minimize its visibility and help blend it more naturally with the surrounding skin. Dr. John Hilinski, a board-certified facial plastic surgeon, specializes in advanced scar revision techniques that provide patients with natural-looking improvements. With his extensive experience in facial plastic and reconstructive surgery, Dr. Hilinski is highly skilled in addressing a wide range of scars, including those caused by past injuries and unsatisfactory surgical repairs.

Types of Scar Revision Procedures

Scar Excision and Closure

For scars that are raised or poorly aligned, surgical excision may be the best option. This process involves carefully removing the scar tissue and closing the area with meticulous suturing to create a more refined appearance. Dr. Hilinski's expertise ensures precise alignment and attention to detail, resulting in a scar that is significantly less visible.

Z-Plasty

Z-Plasty is a scar revision technique that involves rearranging the surrounding skin to break up a straight scar line, helping it blend more naturally with the skin's contours. This approach is particularly useful for scars that restrict movement or are located in highly visible areas.

Dermabrasion

For scars that are raised or have an abnormal skin texture, dermabrasion is a non-surgical option that can improve the skin's surface. Dermabrasion can also be combined with surgical scar revision for optimal results, helping to further smooth the skin and make the scar less noticeable.

What to Expect from Scar Revision

Scar revision is typically performed in the office under local anesthesia, minimizing discomfort during the procedure. It's important to note that scars may appear slightly worse before they begin to improve. Recovery can take several weeks to months, depending on the size and severity of the scar. Patience is key during the healing process, as final results will take time to develop.

Scar Revision FAQs

Schedule Your Consultation

If you are considering scar revision surgery, contact Dr. John Hilinski in San Diego to schedule a personalized consultation. During your consultation, Dr. Hilinski will thoroughly assess your specific concerns, review your medical history, and discuss the most suitable treatment options tailored to your needs. 

Whether your scar is the result of an injury, surgery, or another cause, Dr. Hilinski's vast experience in facial plastic surgery ensures that each patient receives a customized plan designed to achieve optimal results. With a compassionate approach and attention to detail, Dr. Hilinski is dedicated to helping you regain confidence by improving the appearance of your scars. Trust in his expertise to guide you through every step of the process, from consultation to post-surgical care, ensuring you achieve a smoother, more natural-looking appearance. Reach out today to begin your journey toward looking and feeling your best.

#### Scarless Incisionless Otoplasty
Scarless & Incisionless Otoplasty with Dr. John Hilinski: Expert Ear Pinning in San Diego

Prominent ears can be a source of self-consciousness for both children and adults, but with advances in ear surgery, the solution doesn't have to be invasive. Scarless otoplasty--also known as incisionless otoplasty--is a minimally invasive ear pinning procedure that can improve the appearance of prominent ears without the need for large incisions or extensive scarring.

Dr. John Hilinski, a double board-certified facial plastic surgeon, specializes in this innovative technique, offering patients a quicker recovery and more subtle results compared to traditional otoplasty. While this procedure may not be suitable for everyone, it's an excellent option for patients who need minor adjustments to their ear shape and prominence.

What is Scarless Otoplasty?

Scarless otoplasty, or incisionless otoplasty, is a minimally invasive ear pinning surgery designed to reshape and reposition prominent ears without large cuts or visible scars. Unlike traditional otoplasty, which requires incisions behind the ear to access the cartilage, scarless otoplasty uses permanent sutures to reshape the ear cartilage through small piercings or tiny incisions.

By placing sutures that gently pull the ear back, Dr. Hilinski is able to achieve the desired shape and position of the ear. While some cases may require a small incision to hide the suture knot, the overall approach is far less invasive, resulting in minimal visible scarring.

Watch the video below in which Dr. Hilinski explains the incision-less ear pinning procedure.

#### Scarless Rhinoplasty
Increasingly patients are seeing the term ‘scarless rhinoplasty’ used to describe a new method of performing cosmetic nose reshaping. The reality is that scarless rhinoplasty is nothing new at all. Scarless rhinoplasty is simply another way of describing a closed, or endonasal, rhinoplasty procedure.

There are basically two different ways of performing a rhinoplasty surgery. One is referred to as an ‘open’ and the other as a ‘closed’ rhinoplasty. Open rhinoplasty just means that a cut is made in between the nostrils allowing the skin of the nose to be lifted up for exposure of the cartilage and bone. A closed, on the other hand, involves making all of the cuts inside of the nose so there is no external scarring. This is why more and more plastic surgeons are referring to their closed technique as a ‘scarless’ rhinoplasty.

As a marketing tool, being able to say you perform scarless rhinoplasty may be a huge selling point for patients who would prefer not to have any visible scarring from their nose job procedure. In fact, there are some plastic surgeons out there who advertise that they ONLY perform scarless rhinoplasty because they would never want to make an ‘unnecessary’ scar on someone’s face. The truth of the matter is that open rhinoplasty is still alive and well – and the resulting scar across the columella (in between the nostrils) actually heals quite nicely in a great majority of cases to the point where it is barely visible. But if you can avoid making a scar – and get the same great results from rhinoplasty surgery – then, by all means, why not consider the closed approach?

Beyond the issue of visible scarring, scarless rhinoplasty’s real main advantage is less swelling during the initial healing process. Much of this has to do with the fact the lymphatic drainage channels are largely preserved during a scarless rhinoplasty. In an open approach, these are cut as the skin incision is made and the skin is lifted up. Although the skin edges are realigned at the end of the procedure, the lymphatic channels don’t reconnect for many more months. This can contribute to more swelling, especially in the tip region, after an open rhinoplasty. With a scarless rhinoplasty approach – because these channels are not cut – there is usually less swelling in and around the nasal tip compared with the open approach. It still takes upwards of one year or longer to fully heal from even a scarless rhinoplasty. But less initial swelling translates into a faster early recovery period.

Male Scarless Rhinoplasty

This is a great case example of scarless rhinoplasty performed on this male patient from San Diego.

He presented to our office with a main complaint of a larger dorsal hump, or bump on his nose. In addition, he was unhappy with how his nasal tip drooped down – particularly when he smiled. He was also noted to have crooked nose as seen from the front view where the nose leaned to the patient’s left side. This is actually a common triad of nasal deformities that we see in our office on a regular basis – a dorsal hump, droopy tip and crooked alignment.

Dr. Hilinski certainly recommended he undergo rhinoplasty surgery. But the big question was whether or not all of these issues could be addressed with a scarless rhinoplasty approach. In the end, that is precisely what Dr. Hilinski recommended based on his anatomical examination.

Scarless Rhinoplasty Approach

So how is scarless rhinoplasty performed? This is shown in the adjacent photo diagram where the red, curved lines correspond to incisions made on the inside of the nose. These incisions are made in strategic locations that allow Dr. Hilinski to have adequate exposure (visibility) of the cartilage and bone. In addition, these carefully placed internal cuts allow for access to certain areas of the nose, such as the bridge, that need reshaping.

The lower cut that is made along the inner lining of the nostril arch provides access to the nasal tip area (white shaded zone in the diagram). The upper cut is made in between two segments of cartilage (and is called an inter-cartilaginous incision) and provides easy access to the entire bridge (yellow shaded zone in the diagram). These different zones of dissection do communicate with one another underneath the skin, which helps to facilitate movement and relocation of the nasal framework.

In this particular case, Dr. Hilinski used the yellow shaded area to reduce the height of his bridge. This rhinoplasty maneuver is also referred to as nasal bridge reduction or dorsal hump reduction. Once the cartilage and bone were brought down to the desired height, the bones were then cut internally to allow for movement and reshaping. In this instance, the bones were realigned to help improve his overall symmetry as seen from the front view.

The nasal tip was then reshaped using what is called a nasal tip delivery maneuver in the world of rhinoplasty. This means that the cartilage, which forms the shape of the nasal tip, is pulled out through those internal incisions. Wait. What? Yes. The cartilage is actually pulled out through those cuts a sufficient distance so that they can be readily seen in the nostril opening. The cartilage is then sutured (stitched) to reshape the tip and/or trimmed to allow for improved definition. If needed, cartilage can also be taken from elsewhere inside of the nose (called a septoplasty) and used to graft the tip cartilages.

After the nasal cartilage and bone have been altered to the desired shape, the overlying skin is allowed to simply re-drape over the new framework. As the skin shrink wraps down onto the freshly redone, underlying skeleton, the shape of the nose becomes more manifest. The internal incisions, or cuts, are typically stitched up with an absorbable suture so that nothing has to be removed in the office in terms of stitching.

Scarless Rhinoplasty Results

Here are the results of this patient’s scarless rhinoplasty surgery. As you can see right off, his alignment has been improved very nicely where his nose now sits more in the midline of his face. As you begin to turn his head, the oblique view starts to show just how much change was made in terms of the bridge height. Whereas he previously had an obvious dorsal hump, his nasal bridge is now much straighter. Yet, his bridge wasn’t taken down so much that Dr. Hilinski risked creation of any feminine features. In fact, when performing male rhinoplasty surgery, it is so important to maintain an adequate bridge height that keeps that face looking masculine and strong. As this patient turned to the side, you could really appreciate how his tip was lifted up to help correct the drooping deformity. In concert with his new bride height, his newly reshaped tip gives him a marked overall improvement. Not bad for a procedure that doesn’t create any external scarring, right? If you have considered rhinoplasty surgery and are looking for an expert plastic surgeon who has true experience in scarless rhinoplasty, don’t hesitate to contact San Diego’s best rhinoplasty surgeon, Dr. John Hilinski.

#### Sculptra Injections
Sculptra Injections at Hilinski Medspa:Achieve Long-Lasting Facial Rejuvenation

Sculptra® is a revolutionary injectable treatment offered at Hilinski Medspa that helps rejuvenate the face by stimulating your body's natural collagen production. Unlike traditional dermal fillers like Restylane® or JUVÉDERM®, Sculptra® works as a bio-stimulant, encouraging collagen production deep within the skin to restore volume and create a youthful, refreshed appearance. With board-certified facial plastic surgeon Dr. John Hilinski leading the way, patients in San Diego can achieve gradual and long-lasting results that improve the overall structure and fullness of the face.

What is Sculptra®?

Sculptra® is an FDA-approved injectable made from poly-L-lactic acid, a biocompatible substance used in medical applications for decades. It is designed to restore facial volume by stimulating collagen growth in the skin. Rather than providing immediate volume like traditional fillers, Sculptra® works gradually over time, enhancing the skin's structural integrity and natural plumpness as collagen production increases.

Key Benefits of Sculptra®:

Gradual, natural-looking volume enhancement

Long-lasting results (up to 2 years)

Stimulates your body's natural collagen production

Minimal downtime with an office-based procedure

Safe and effective with minimal side effects

How Does Sculptra® Work?

Sculptra® is not an immediate filler. When injected, it stimulates the skin's collagen production over time, gradually improving volume and softening wrinkles and folds. Patients often notice that while the initial plumping effect from the injection disappears after a few days, their skin begins to look fuller and more youthful as collagen is produced over the following weeks and months. Most patients require multiple treatments to achieve optimal results, with sessions spaced 4-8 weeks apart.

The Sculptra® Treatment Process

FAQs About Sculptra®

Schedule Your Sculptra® Consultation at Hilinski Medspa

If you're ready to achieve long-lasting facial rejuvenation with Sculptra®, contact Hilinski Medspa today to schedule a consultation. Let Dr. John Hilinski and his expert team help you enhance your natural beauty with this innovative injectable treatment.

#### Septoplasty
Septoplasty, or septal reconstruction, surgery is largely considered a functional, or medically necessary, procedure intended to help straighten a deviated septum, or crooked septum. Many patients have at one time or another heard of friends or family members who have been diagnosed with a deviated septum.

What Exactly Is The Septum?

Simply put, the septum is the wall that divides the left and right sides of the nose internally. If you look into the nostril opening with a light, you should see a vertical structure, or wall, that physically divides the left and right sides starting from just behind the columella (the fleshy column of skin that separates the two nostrils). The septum extends from just behind the columella going backward into the nose and stops at the nasopharynx (the common cavity in the extreme back of the nose, which communicates below into the back of the mouth). The septum is naturally a three layered structure that is almost like a sandwich turned vertically. There is a mucosal lining on each side that would be the bread. In between the two mucosal linings in the middle is the cartilage and bone of the septum. A majority of the septum is made of cartilage, which comprises the anterior 2/3 of the entire septum. The adjacent diagram is a side view of the inside of the nose showing the septum from the nostrils all the way back as it approaches the nasopharynx. In the diagram, the cartilage is represented by the yellow shaded area and the bone by the gray shaded area. The bone is divided into two segments – the upper a portion from the ethmoid bone and the lower termed the vomer. What does this look like in real life? The adjacent photo demonstrates what the actual bone and cartilage look like from a patient who had nasal surgery where the bone and cartilage were explanted temporarily. It is a great visual showing the bone of the septum on the left side and the cartilage on the right. This amount of cartilage and bone is not actually removed in standard septoplasty surgery. It is simply shown for demonstration purposes only.

What Is A Deviated Septum?

A deviated septum is simply one that is crooked to one side and/or the other and obstructs the nasal passageway used for breathing. In most patients, a deviated septum is congenital, meaning they were born with the abnormality. At some later date, they begin to notice some difficulty breathing through the nose from one or both sides. Usually this is appreciated as someone begins to exercise more regularly and notices a significant difference in airflow between the two sides. In other cases, the deviated septum becomes apparent during evaluation for other medical conditions, such as sinus inflammation (sinusitis) or allergies. In other patients, a traumatic injury to the nose can cause a shift in the positioning of the septum, resulting in a deviation that causes nasal obstruction symptoms. Normally the septum is oriented in a relatively straight line as it goes back into the nose. In situations where a deviation exists, the septum can be curved, crooked or displaced to one or both sides. The deviation usually involves mostly cartilage but can involve both cartilage and bone in some circumstances. When the septal cartilage and bone deviate from the middle, the normal airflow through the nose can be disrupted. When this occurs, patients subjectively feel as if they are unable to breathe sufficiently through one or both sides of their nose. If this happens in the setting of other medical conditions, like sinusitis and allergies, the deviated septum can make matters worse.

Diagnosis Of A Deviated Septum

The diagnosis of a deviated septum is best done through a physical examination performed by a qualified nasal specialist – either a board certified otolaryngologist (ENT surgeon) or a board certified facial plastic surgeon. On physical examination, your doctor will use what is called a nasal speculum to prop open your nostril on each side as a light is used to visually inspect the nasal passageway.A septal deviation will be seen as a curvature or displacement of the septum into the nasal passageway. The adjacent photo of one of my San Diego septoplasty patients shows this visually. As you can easily appreciate, there is a significant curvature of this patient’s septum into their left nasal passage causing a rather obvious blockage. In fact, you can see a very narrow vertical slit of darkness in the left nasal passage, corresponding to the only area where airflow can get through this particular patient’s nose. Although a deviated septum is typically easily diagnosed on physical examination, some patients end up getting a CT (CAT) scan of their nose as part of the diagnostic evaluation. In my opinion, this is usually not necessary. However, many insurance companies require that a CT scan be done in order to objectively confirm the existence of a septal deviation.

What Is A Septoplasty?

Septoplasty, or septal reconstruction, is a surgical treatment for a deviated septum. The surgery is usually performed thru the nostrils without having to make any external incisions on the nose. In short, the mucosal lining covering the septum is elevated, or lifted, off of the cartilage and bone. It is actually lifted off of both sides in order to fully expose the deviated segments of cartilage and bone. The deviated portions of the septum are then carefully trimmed and removed in most cases. Septoplasty surgeons have to be very careful, however, to preserve what is termed the L-strut of the septum whenever they are performing surgery. The L-strut is represented by the blue L-shaped figure in the adjacent diagram. As you can see, the long portion of the L-strut provides support for the nasal bridge and the short portion of the L-strut provides support for the nasal tip. It is critical that a sufficiently strong L-strut is preserved during septoplasty. If not, the support of the nasal bridge and tip can be significantly compromised, resulting in collapse of the nose. As long as an adequate L-strut is preserved in septoplasty, you can feasibly remove the deviated portions of the septum with relative impunity without changing the cosmetic appearance of the nose. In fact, in standard cases of septoplasty there should be no change in the appearance of the nose.

Many surgeons will say they simply ‘score’ the septal cartilage and thereby weaken it, instead of actually removing the deviated segment. Scoring the cartilage means they make partial cuts into the cartilage using a scalpel with the cuts made only on one side of the deviation. This can help straighten the curved portion of cartilage. On the operating room table, the cartilage does, indeed, appear much straighter from the scoring process. Unfortunately, cartilage has what is called ‘memory’ – meaning it wants to go back to its original shape if left intact. In cases where scoring is performed over a deviation, the cartilage will often times simply bend back to its crooked position once the healing process takes place. This is why some patients (and surgeons) mistakenly say their septum ‘grew back’ after a prior septoplasty. In fact, what happened is that the septal memory kicked in and resulted in the deviation returning to its original position (along with recurrent symptoms of nasal obstruction). It is for this reason that most experienced septoplasty surgeons will remove the deviated portions of cartilage and not rely on scoring as a reliable method of straightening the nasal airway. In some cases, portions of the septal bone in the back of the nose also need to be addressed. In these patients, the bone can be cut with specialized surgical instruments to strategically remove the deviated segments. Once the cartilage and bone are straightened out, the mucosal lining on each side is redraped, or put back into position. The mucosal lining is the sewn together using a specially designed needle just for this purpose. The suture thread used to sew the lining together is absorbable – usually dissolving within 10-14 days following the surgery.

Do You Pack The Nose Following Septoplasty?

I actually do not pack the nose routinely following septoplasty, or septal reconstruction. Many septoplasty surgeons use packing to help hold the lining together following surgery. Others will place a splint inside of the nose along each side of the septum to hold things in place during the early healing process. Unfortunately, packing and splints can both be quite uncomfortable. In fact, the packing and splints can account for a majority of pain and discomfort following routine septoplasty surgery. Because of this reason, I normally rely on my internal suture technique to carefully sew the lining back together in a fairly complete fashion. In doing so, this precludes me from having to place packing in the nose. In cases where there is slightly more bleeding than anticipated, I might put an absorbable material inside the nose to help control unwanted bleeding. But, fortunately, this material dissolves on its own with use of saline sprays inside of the nose and does not have to be removed.

How Long Is The Recovery After Septoplasty?

Most patients undergoing septoplasty surgery will have a downtime of around 5-10 days. The recovery is mainly limited by mild discomfort, which is fairly well controlled with low dose narcotic pain medication such as Vicodin or Tylenol with codeine. As noted above, there is no change to the appearance of the nose with standard septoplasty, you should not notice any external swelling or bruising. Because of this, most patients feel quite comfortable in the public eye fairly soon after surgery.

Does Health Insurance Cover Septoplasty Surgery?

In most cases where there is a deviation of the septum and the patient has trouble breathing through the nose as a result of this, health insurance should cover you to have the septoplasty performed. Many insurance companies like to see that you have been tried on other medical treatments (such as topical nasal steroids) before they consider you a candidate to undergo a septoplasty. Although the medications will not do anything to correct your deviated septum, some medications might help open up your nasal passages in other ways to at least allow some degree of improvement. The thought is that this might provide you sufficient relief that surgery may not be needed after all. It is my recommendation that you consult with a board certified otolaryngologist (ENT surgeon) or board certified facial plastic surgeon in your area to determine whether or not you are a candidate for septoplasty.

#### Short Or Over-Rotated Nose
Short or Over-Rotated Nose Correction with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A short or over-rotated nose can disrupt the harmony of facial features, leading to an overly upturned nasal tip that may appear unnatural or disproportionate. This condition can be the result of genetics, trauma, or previous rhinoplasty where too much cartilage was removed, causing the nose to appear excessively short or upturned. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in short or over-rotated nose correction surgery. His advanced rhinoplasty techniques help restore balance, structure, and a natural nasal appearance, ensuring the nose complements the rest of the face.

What is Short or Over-Rotated Nose Correction?

Short or over-rotated nose correction is a type of rhinoplasty designed to lengthen the nose or correct an excessively upturned nasal tip. This surgery typically involves reconstructing the nasal tip and restoring proper rotation and alignment. In cases where the nose appears too short, Dr. Hilinski uses cartilage grafting techniques to lengthen the nasal structure, creating a more proportional and aesthetically pleasing appearance.

Why Would Someone Need This Surgery?

Patients opt for short or over-rotated nose correction for several reasons:

Special Considerations for Short or Over-Rotated Nose Correction

FAQ: Short or Over-Rotated Nose Correction

Schedule a Consultation with Dr. Hilinski in San Diego

If you're considering short or over-rotated nose correction surgery and want to learn how Dr. John Hilinski can help you achieve a more balanced, natural-looking nose, schedule a consultation today. As San Diego's leading rhinoplasty expert, Dr. Hilinski offers personalized care and advanced techniques to deliver long-lasting, natural results. Contact us today to begin your journey toward a confident, enhanced appearance.

#### Sitemap
HomeAbout Us

	Medical Malpractice Expert
	Meet Dr. John Hilinski
	Specials & Events
	Surgery Center
	Testimonials

Accessibility Policy
Contact
Hilinski Foundation for Surgery
Links
Lop Ear Surgery with Dr. John Hilinski
Macrotia Ear Reduction Surgery with Dr. John Hilinski
Medspa

	Ariessence PDGF
	Botox & Dysport
	
		Botox Cosmetic
		
			Baby Botox
			Botox & Forehead Movement
			Botox for Bunny Lines
			Botox Lip Flip
			Truth About Diluting
		

		Dysport
	

	EZ Gel
	Injectable Fillers
	
		Bellafill
		Liquid Rhinoplasty
		Radiesse
		
			Radiesse Chin Injection
			Radiesse Hand Injection
		

		Renuva
		Restylane® Case Study
		Sculptra Injections
	

	Jeuveau Injections
	Lasers
	
		Erbium Laser
		Laser Hair Removal
		Laser Tattoo Removal
		Pix:E
		Skin Resurfacing
		Vein Treatment
	

	Lip Enhancement
	Nutrafol
	Pain Free Nitrous Oxide
	Plated™ Exosomes by Rion
	PRF (Platelet-Rich Fibrin)
	Skin Rejuvenation
	
		Pixel 8 RF Microneedling
	

	Upneeq
	VI Peel

Newsletter
Notice of Open Payments Database
Patient Info

	Alle
	Aspire Galderma Rewards
	Consultations
	Evolus Rewards
	Financing Options
	Out of Town Patients
	Patient Forms & Instructions
	Virtual Online Consultation

Privacy Policy
Revision Skincare Products
Rhinoplasty Tutorial

	African American Nose Case
	African American Nose Job
	African American Rhinoplasty
	Artistry or Engineering?
	Asian Nose Case
	Asian Revision Rhinoplasty
	Asian Rhinoplasty
	Asian Rhinoplasty Silicone Implants
	Asymmetric Tip Collapse
	Base Reduction Narrowing
	Bridge, Tip and Base Narrowing
	Bulbous Wide Nasal Tip
	Bulbous, Rounded Nasal Tip
	Calvarial Bone Graft Revision
	Caudal Septum Deviation
	Cephalic Orientation of Tip Cartilage
	Challenges Involved in Rhinoplasty
	Changes to the Upper Lip
	Chin Implant with Rhinoplasty
	Classic Hump/Bump Reduction
	Complete Overhaul
	Composite Ear Grafts to the Nose
	Confirming Septoplasty Repair
	Crooked Nose Correction
	Crooked Nose Surgery
	Dorsal Hump Deformity
	Droopy Nasal Tip Correction
	Droopy Nasal Tip Rhinoplasty
	Droopy Tip Raised Up
	Female Hump and Tip Refinement
	Finesse Female Ethnic Rhinoplasty
	Finesse Female Rhinoplasty
	Functional Septorhinoplasty Surgery
	Hispanic Rhinoplasty Case
	Hump Reduction Without Breaking Bones
	Indian Rhinoplasty
	Insurance & Nose Surgery
	Lengthening a Short Nose
	Male Rhinoplasty San Diego
	Nasal Analysis in Rhinoplasty
	Nasal Base Reduction
	Nasal Exercises
	Nasal MOHS Cancer Repair
	Nasal Tip Deprojection
	Nasal Tip Ptosis
	Not Your Usual Septoplasty
	Open Rhinoplasty Incision Cleaning
	Osteotomies – Narrowing a Wide Nasal Bridge
	Persian Female Rhinoplasty
	Persian Middle Eastern Rhinoplasty
	Pinched Nasal Tip
	Pinched Nasal Tip Repair
	Placing Spreader Grafts
	Pollybeak Deformity
	Preservation Rhinoplasty
	Preservation Rhinoplasty Bridge Reduction
	Preserving One’s Overall Look
	Rebuilding One Side of the Nose
	Reconstructive Rhinoplasty Tip Asymmetry
	Reshaping A Hanging Columella
	Restore Your Dorsal Hump or Bump
	Revision Rhinoplasty Tip Rebuilding
	Rhinophyma Treatment
	Rhinoplasty & Smoking
	Rhinoplasty Incision Cleaning
	Rhinoplasty Transformation
	Saddle Nose Deformity
	Scarless Rhinoplasty
	Septoplasty
	Spirox Latera Implant
	Steroid Injections
	Taping After Rhinoplasty
	Taping The Nose
	Teenage Crooked Nose Repair
	Teenage Ethnic Rhinoplasty
	Teenage Rhinoplasty San Diego
	Teenage Tip Rhinoplasty
	Tertiary Revision Rhinoplasty
	Truncated Short Nasal Tip
	Turbinate Reduction Surgery Procedure
	Wide Nasal Bones and Wide Tip
	Widening the Tip

Stahl’s Ear Correction
Surgical

	Ear
	
		Cauliflower Ear
		Chondrodermatitis Nodularis Helicis (CNH) Treatment in San Diego, CA
		Darwins Tubercle Correction
		Ear Reduction (Macrotia)
		
			Ear Reduction Case Study
		

		Ear Trauma
		Earlobe Reshaping
		Gauge Earlobe Repair
		
			Large Gauge Repair Case Study
		

		Keloid Removal
		Lop Ear
		Otoplasty
		
			Otoplasty Case Study 1
			Otoplasty Case Study 2
			Otoplasty Case Study 3
		

		Preservation Otoplasty
		Reverse Otoplasty
		Scarless Incisionless Otoplasty
		Torn Earlobe Repair
	

	Eyes & Brows
	
		Asian Eyelid Surgery
		Browlift
		Excess Eyelid Skin
		Eyelid Surgery
		Functional Upper Eyelid Surgery
		Non-Surgical Eye Lift
		Upper Eyelid Lift Ptosis Repair
	

	Face & Neck
	
		Cheek Reduction (Buccal Fat Removal)
		Chin Augmentation / Implants
		Croton Peel
		Facelift & Mini Face Lift
		
			Facelift/Necklift Case Study
			Facial Rejuvenation Case Study
		

		Fat Transfer
		Liposuction
		
			Neck Liposuction Case Study 1
			Neck Liposuction Case Study 2
		

		Mid Facelift
		Mole Removal
		Neck Lift
		Neck Liposuction
		Profound RF
		Smile Line Correction
	

	Hair Transplant
	Lips
	
		Lip Injections
		Lip Reconstruction
		Lip Reduction
		Lower Lip Advancement
		Upper Lip Lift
		
			Upper Lip Lift Case Study
			Upper Lip Lift Case Study 2
			Upper Lip Lift Case Study 3
		

	

	Male Plastic Surgery
	
		Male Eyelid Surgery
		Male Facelift Surgery
		Male Rhinoplasty
	

	Non Surgical Hair Growth in San Diego
	Nose
	
		African American Rhinoplasty
		Asian Rhinoplasty
		Bulbous Tip Rhinoplasty
		Cosmetic Rhinoplasty
		
			Droopy Tip
			Flaring Or Wide Nostrils
			Flat Or Depressed Bridge
			Nose Hump
			Pinched Nose
			Short Or Over-Rotated Nose
			Twisted Nose
			Wide Bridge
			Wide Tip
		

		Crooked Nose Surgery
		Ethnic Rhinoplasty
		Piezo Rhinoplasty
		Preservation Rhinoplasty
		Revision Rhinoplasty
		Rhinophyma Treatment
		Rhinoplasty
		Rib Rhinoplasty
		Saddle Nose Repair/Collapsed Nose Repair
		Teen Rhinoplasty
	

	Reconstruction
	
		Facial Reconstruction
		Scar Revision
		Skin Cancer Reconstruction
	

Terms of Use
BlogWhat Today’s Rhinoplasty Trends Reveal — and Why Some Patients Are Asking to Restore Their Original NoseCan Men Benefit from Neck Liposuction?How Pix:E Can Change Your Skin with Minimal DowntimeAchieve Fuller Lips with a Lower Lip AdvancementWhy Dilution Matters When It Comes to Botox TreatmentRhinoplasty Recovery Timeline & Tips: Expert Advice from Dr. John Hilinski, California’s Leading Rhinoplasty SurgeonHow a Mini Facelift Can Maintain Your Youthful AppearanceRefresh Your Eyes with Non-Surgical BlepharoplastyHow FUE Hair Transplant Procedures Can Hide Scars from Previous Cosmetic SurgeriesDefine Your Face with Facial LiposuctionHow Profound RF Can Rejuvenate Your Face and Neck Without SurgeryHow Millennials Can Benefit from Baby BotoxThe Advantages of Choosing Preservation RhinoplastyLop EarFixing Protruding Ears in San DiegoGlacial Rx for Inflamed SkinEar Pinning for KidsOne-Sided Ear PinningEar Reduction ExperienceOtostick for Big EarsShaving Your Hair For Transplant?Do Hair Grafts Look Natural?Does Coolsculpting Actually Work?Pinning Effect of Ear ReductionEar Pinning ExpertExosomes in Plastic SurgeryExcess Neck FatEvening Out Upper EyelidsAmazing Eyelid RejuvenationMedical Spa Services in San DiegoFacial Slimming TreatmentTMJ TreatmentHaving Smaller Ears is Possible!Video TestimonialLiposuction for Chipmunk Cheeks?Chipmunk Cheek TreatmentPrice in San DiegoRestylane Eyelid LiftEar Reduction ExpertGet Your COVID Creases TreatedCombining Fat Grafting and Skin LaserNon-Surgical Cheek Face LiftingWaist Fat Begone!Plasma Pen Eyelid LiftFreezing Flank Fat in San DiegoMinimally-Invasive Neck Skin Tightening OptionsIncredible Ear Pinning Results!Smaller Ears From Macrotia SurgeryEyelid EnhancementBack Fat ReductionGet Rid of Smoker’s LinesSan Diego’s #1 Cosmetic Ear SpecialistEyelid Surgery San DiegoSmaller EarlobesIncredible Tummy Flattening ResultsNatural Facelift Anti-Aging SurgeryFibroblast Plasma for Perioral LinesCO2 Laser for RhinophymaEyelid Lift and Fat Transfer in San DiegoAmazing Neck Skin Tightening Results!Neck Skin Tightening and LiftingResults! Results! Results!Lip FlipGoodbye Crow’s Feet!Tighter TummyPower of Fat Transfer and LaserNeck Skin TighteningNon-Surgical Eyelid & Brow Lift!Best Fat Freezing Team | Mission Valley | DowntownFlatter Toned Tummy | Downtown | Point LomaLook 10 Years Younger!Tighter, Smoother Neck!Hand RejuvenationUpper Eyelid LiftBeautiful Facelift and Neck Lift Results!Tummy Goes Flat to FlatterFlatter Tummy Over TimeLip Injections San DiegoNon-Surgical Facial VolumizingPlasma Eyelid LiftLower Eyelid HollowsCombined Laser PeelVolume Is A Sign of YouthThigh Fat ReductionFreezing Fat in Older PatientsDual Sculpting Arm FatCoronado Botox TreatmentFlabby ArmsLip Filler in CoronadoToner Flatter Tummy at 67!CoolMini Better Than KybellaToner Tighter TummyFlatter Tighter TummyInner Thigh SlimmingSlimmer ThighsRenuvion J Plasma Neck TighteningGauge Repair in San DiegoAmazing Upper Lip TransformationNever Too Old For Eyelid LiftTummy Tuck Without  SurgeryDouble Chin Cool MiniCool Mini Double Chin TreatmentAbdominal Etching in Fit MaleRenuvion Skin RejuvenationNefertiti Neck LiftLaser Mole RemovalLarge Ear Made SmallerMaking A Large Ear SmallerMicroneedling Hand RejuvenationBest Microneedling in San DiegoAmazing Neck Lift Results!Non-Surgical Fat ReductionLatera Nasal Valve ProcedureSlimmer HipsFlatter TummyAn Even Better BodyJ Plasma Erases Smoker’s LinesFirst Plastic Surgeon Offering J PlasmaBioCorneum® Available Online!Flatter Stomach No Surgery!Non-Surgical Tummy FlatteningAmazing Results After One Treatment!Revision of Nose Done in MexicoFreeze Fat or SculpsureZwivel’s Guide To Facelift Surgery Featuring Dr. HilinskiLose Your Flank FatRepeat Treatment of an AreaFlatter, Tighter Stomach in Your 40sMixing Botox and DysportMelt Your Flank and Back Fat AwayShrink the Size of Your Ear?Latest in Body ContouringBrotox for MenLatest Rhinoplasty Case ExampleIcing On The CakeChoosing Your Botox DoctorMassageBotox for MenSummer Body Ready#1 Coolsculpting TeamWrinkle-Free WednesdaysArm Fat ReductionTreatment AreasThe New LiposuctionCoolsculpt Away Your Belly FatAvoiding the Spock LookExercising After Botox?Get Rid of Bra FatDouble Chin TreatmentRealSelf RankingCoolsculpting for Men?Migraine Headaches and BotoxLose Weight Without SurgeryCoolsculpting Summer Body!Botox Versus Dysport UnitsTip Rhinoplasty Case ExampleAdvantages of Dysport Over Botox?5 Common Myths About BotoxNeck Liposuction and Jaw DefinitionUnder Eye Wrinkles and BotoxScheduling Botox TreatmentsNatural Looking BotoxLower Eyelid Filler InjectionGreat Botox Results in San DiegoSan Diego’s Bellafill ExpertReduced Pain with VibrataLip Lift Cupid’s BowBaby Botox?Bellafill Leading ExpertOver 200 Rhinoplasty ExamplesMake Money Getting Botox!Non-Surgical Eyelid LiftBotox Getting Even More PopularRhinoplasty Still ReignsImproving Response to BotoxSeptoplasty Repair in San Diego, CABotox by Dentists?Most Popular Injectable Filler LatelyMacrotia Surgery Instant ChangeThe Truth About Botox®Botox for SweatingScapha Reduction Macrotia SurgeryBigger Lips With FillerIs Laser Skin Resurfacing Right for Me?What Are the Benefits of Laser Skin Resurfacing?Juvederm Lip Filler TreatmentRestylane Wrinkle FillerHow Can I Tighten Skin on My Neck?Am I a Good Candidate for a Facelift?How Long Should Swelling and Numbness Last After a Facelift?Otoplasty Helical Rim ReshapingJuvederm Lip PlumpingMale Rhinoplasty vs Female RhinoplastyWhy Rhinoplasty May be Better Than the Non-Surgical Nose JobMacrotia (Scapha Reduction) Case ExampleFacelift Necklift RejuvenationHow Much Does Eyelid Surgery Cost?Can Blepharoplasty Improve My Vision?Can I Reduce the Size of My Ears?Fixing a Droopy Nasal TipEar Reduction HealingBeautiful Lip Implant ResultsNasal Valve Stenosis CorrectionHow Old Do You Have to Be for Otoplasty?What Are the Benefits of Otoplasty Surgery?Narrowing a Wide Nasal TipWhat is the Difference Between BOTOX® Cosmetic and Dysport®?Long Term Rhinoplasty ResultsHow to Eliminate a Double ChinPinched Nose RepairComplimentary Vial of Sculptra Aesthetic®!The Truth Behind Rhinoplasty PhotosRevision Upper Lip LiftGetting to Know Sculptra Aesthetic!CO2 Laser Rhinophyma TreatmentFollow Us On Facebook!What To Expect During Your Sculptra TreatmentGalderma PreferredTip Rebuilding and DeprojectionHow Long Do Results Last After Facelift Surgery?Abnormal Smile After Rhinoplasty?What Is the Best Age for a Facelift?Success with Botox & Dysport InjectionsGetting Rid of Sagging Face and Neck Skin?Follow Us on Instagram!Kybella Double Chin Fat TreatmentSculptra Facial EnhancementAm I a Good Candidate for Rhinoplasty?Can I Afford Rhinoplasty?Facial Mole Shave RemovalPermanent Lower Lip EnhancementImproving Neck DefinitionDr. Hilinski Presents Latest on Cosmetic InjectablesThe Unique Benefits of Sculptra® and Radiesse®Nip and TuckCosmetic Injectables: How Long Do Results Last?Rhinoplasty Tip ReshapingGetting Rid of Extra BaggageAvoiding the Stigma of Male Cosmetic SurgeryRhinoplasty Patient ExamplesEarlobe Reduction SurgeryLower Eyelid Muscle TuckNarrowing a Wide Nasal BridgeSculptra Cheek ContouringThe Ultimate Aesthetic WorkshopWhat A Nice Surprise!Removal of Facial MolesCephalic Orientation of CartilageTeenage Nose Job SurgeryTransformative Cosmetic Nose ReshapingRhinophyma Laser TreatmentBullhorn Upper Lip LiftLook What Sculptra Cosmetic Can Do For You!Persian or Iranian Nose Job SurgeryHow Long Will Sculptra® Aesthetic Results Last?Wow! See What Upper Eyelid Blepharoplasty Can Do!Combining Chin Implants with Rhinoplasty for Improved ResultsTop 3 Areas Facial Implants Can EnhanceReconstructive Rhinoplasty for MOHS DefectAfrican-American Nose JobCosmetic Rhinoplasty for a Bulbous Wide TipPermanent Lip EnhancementInsurance-Based Nose JobDr. Hilinski Published in JAMA for Gauge Earlobe RepairSan Diego Facial Plastic Surgeon FeaturedImproved Vision From Eyelid Plastic SurgeryMerry Christmas From Dr. Hilinski and Staff!Persian Rhinoplasty Nose ReshapingThe Hilinski Foundation for SurgerySubnasale Upper Lip ShorteningGuess the Difference!Sculptra Liquid Facelift TreatmentNatural Facelift ResultsLarge Gauge Earlobe DefectMagazine Features Dr. Hilinski for His Practice SoftwareDr. Hilinski Lectures at UCSD on Nasal Tip RefinementTransformative RhinoplastyWhat is a Mid Facelift?The Difference Between Facelift & Mini Lift ProceduresComposite Ear Graft SurgeryHispanic Ethnic Cosmetic RhinoplastyImmediate Effects of Lower Eyelid Restylane InjectionSpot the Difference in the Before and After Photos?Upper Lip Lift Techniques For Best ResultsCan An Upper Lip Lift Improve Your Facial Balance?Appearance 1 Day After OtoplastyLatest Photo Example of Cosmetic RhinoplastyConsidering A Facelift: What Should I Expect?Macrotia Ear Plastic Surgery to Actually Make an Ear SmallerRepair of the Broken Crooked Twisted NoseSuture Reshaping of the EarHispanic Male SeptorhinoplastyCosmetic Surgery to Shorten the Lip?Rhinophyma Surgical Treatment in San DiegoUpper Lip Lift – Cosmetic Lip Shortening SurgeryAfrican American Ethnic Cosmetic RhinoplastyHow Can You Best Prepare For Rhinoplasty? Dr. John Hilinski Answers Your QuestionsSan Diego Plastic Surgeon Answers Your Questions About Rhinoplasty ConsultationsCosmetic Ear Reshaping Otoplasty Incision PlacementDr. Hilinski to Give Lecture on the Ethnic Rhinoplasty ProcedureDr. John Hilinski Answers Frequently Asked Questions About Ear SurgerySan Diego Facial Plastic Surgeon Compares Dermal FillersOne Year Anniversary Rhinoplasty ResultsAsian Rhinoplasty Surgery Examples Dr. HilinskiExpert Ear Pinning Otoplasty SurgeryRhinoplasty Incision CleaningMole Removal Without Obvious ScarringPreserving One’s Look in RhinoplastySan Diego Facial Plastic Surgeon on Benefits of Eyelid SurgeryAnother Gauge Piercing RepairNo, It’s Not Photoshop!Neck Lift Without Facelift Surgery in San DiegoRevision Rhinoplasty: San Diego Facial Plastic Surgeon Reveals Common Patient ConcernsRevision Reconstructive Nose Surgery for Pinched Nasal Tip and Collapsed NostrilsAfrican American Nose Job Rhinoplasty TutorialSubnasale Upper Lip Lift to Shorten An Elongated Upper LipFemale Middle Eastern Cosmetic Nose SurgeryUndergoing Primary Tip Open Rhinoplasty in San Diego, CAStretched Earlobe Laceration RepairFacial Implants Offer Long-Term Solution to Volume Loss Says San Diego Facial Plastic SurgeonLimited Otoplasty for Keloid Scarring of Ear in San Diego, CASan Diego Facial Plastic Surgeon Launches Mobile Website to Aid Patients on the GoGauge Earring Repair UpdatesHealing From Cervical Liposuction and Lipocontouring Double Chin SurgerySan Diego Facial Plastic Surgeon Lectures on Ethnic Rhinoplasty at CSPS MeetingRise in Chin Augmentation with Chin Implant SurgeryRead About This Amazing Case of Revision RhinoplastyGauge Earring Repair – Torn Earlobe Repair in San Diego, CAFacial Reconstructive Plastic Surgery in San Diego, CA – Forehead OsteomaEar Lobe Reshaping Otoplasty Surgery in San Diego, CAInjectable Filler for Deep Forehead Wrinkles in San Diego, CAUpper Lip Lift – Lip Shortening Procedure by John Hilinski, M.D.Neck Liposuction in San Diego by Dr. John HilinskiEthnic Upper Eyelid Enhancement in San Diego, CARebuilding One Side of the NoseSan Diego Female Rhinoplasty Bridge & Tip ReshapingLook Younger With Rhinoplasty?Rhinoplasty Healing 1 Month Out in San Diego, CAPlaying Sports After Nose Fracture in San Diego, CALooking Age Appropriate Following Facelift Surgery in San Diego, CARhinoplasty Nose Reconstruction Following MOHS Surgery San Diego, CASan Diego Facial Plastic Surgeon Discusses Common Misconceptions About Rhinoplasty RecoverySan Diego Earlobe Repair Gauge Piercings CorrectedYoungest Age for Rhinoplasty in San Diego, CADouble Chin Liposuction in San Diego, CA by Dr. HilinskiRhinoplasty Healing San Diego Nose Job Surgery by Dr. HilinskiSan Diego Finesse Rhinoplasty Surgery ExpertDoes My Neck Get Lifted With A Facelift?Happy Holidays to All Of Our Patients and Colleagues!Cosmetic Rhinoplasty Updates in San Diego, CAFacial Filler FactsWearing Glasses After Cosmetic Ear ReshapingFacial Plastic Surgeon in San Diego Discusses How to Choose the Right Practice for RhinoplastySave $50 on Botox Cosmetic For Frown LinesUpper Eyelid Lift – Droopy Eyes San Diego, CATip Rhinoplasty Following Nasal Cancer in San Diego, CAInjectable Silicone for Facial Enhancement of the CheekChin Implant to Enhance Facial Harmony and BalanceForehead Lift Suspension For Crooked Eyebrow PositionNeck Lifting Using Liposuction, Platysmaplasty and Chin ImplantNew Case of The Over Projected Nasal TipPediatric Ear Pinning in San Diego, CA by Dr. HilinskiAnother Very Happy San Diego Otoplasty Patient!Short and Long-term Ear Pinning Results in San Diego, CASubnasale Lip Lift Surgery in San DiegoEar Pinning (Otoplasty) in San Diego, CAFacial Plastic Surgeon Discusses Choosing Cosmetic ProcedureFacial Scar Revision in San Diego, CACosmetic Facial Mole Removal in San Diego, CAFinesse Female Rhinoplasty in San DiegoRhinoplasty Imaging Versus Real Life ResultsNew San Diego Online Rhinoplasty Tutorial Chapter on Nasal DeprojectionFacial Appearance 10 Days After Facelift Necklift in San Diego, CAAsian Rhinoplasty in San Diego, CASubtle Deprojection of the Nasal Tip in RhinoplastySan Diego Eyelid Lift To Improve VisionLower Eyelid Lift To Rejuvenate The Eyes – Case ExampleDr. Hilinski on NBC News Discussing Botox InjectionsInjection Revision Rhinoplasty – But Not What You Think!The Hilinski Foundation In the San Diego NewsNasal Exercises in Rhinoplasty and Revision RhinoplastyManagement of Turbinate Hypertrophy in Rhinoplasty & Revision RhinoplastySan Diego Nasal Tip Rhinoplasty For A Wide TipSan Diego Revision Rhinoplasty Specialist Discusses Secondary Rhinoplasty SurgeryEar Reshaping (Otoplasty) Immediate Recovery PeriodNeck Liposuction & Platysmaplasty For Improved Jawline DefinitionAnatomy of a Female Facelift Necklift Patient in San DiegoPlastic Surgery Virtual Consultation With SkypeEar Pinning Example (Otoplasty) in San DiegoSkin Pinch Lower Eyelid Lift (Blepharoplasty) in San DiegoPinched Nasal Tip in Rhinoplasty & Revision RhinoplastyRejuvenating TCA Chemical Peel For Aging Spots & Facial HyperpigmentationSan Diego Rhinoplasty (Nosejob) Healing From Closed ApproachAm I Too Old To Have A Facelift Procedure In My 60s?Smiling After Rhinoplasty/Nose ReshapingRhinoplasty Imaging & Realistic Nose Reshaping ResultsSan Diego Plastic Surgery Expert in Revision Rhinoplasty Nostril ReshapingSpreader Grafting in Rhinoplasty (Nose Reshaping)Rhinoplasty Before & After GalleryPlastic Surgery for Earlobe Gauging – A Unique Case of Ear Reshaping or OtoplastyCosmetic Nose Reshaping Without Altering Facial Identity – Finesse RhinoplastyAre The Changes From A Facelift (Face lift) Permanent?Post Rhinoplasty Appearance Two Weeks OutScar Revision Wound HealingEar Plastic Surgery ReshapingPost Open Rhinoplasty Appearance Less Than One Week OutSpreader Grafting in Rhinoplasty & Revision RhinoplastyRemoving Tape After Rhinoplasty or Revision RhinoplastyMyths About Pain Following Rhinoplasty & Revision RhinoplastyChin Augmentation/Implant ConsultationCurrent Restylane, Perlane & Dysport Specials!Plastic Surgery Skype ConsultNew Rhinoplasty Tutorial Chapter On Steroid Injections In Nose SurgeryAccepting Nostril Asymmetry Following RhinoplastyRevision Rhinoplasty For Pollybeak DeformityNon-Surgical Lower Eyelid Lift With RestylaneNot The ‘Occasional’ Rhinoplasty SurgeonRhinoplasty Refinement of the Ethnic NoseThe Dramatic Impact of Upper Blepharoplasty (Eyelid Lift)Revision Rhinoplasty For A Severely Pinched Nasal TipCreating An Inconspicuous Well Healed Facelift IncisionCombining Facelift Surgery With Otoplasty (Ear Reshaping)Dr. Hilinski In the News: UCSD Rhinoplasty LectureBone Resorption After A Chin ImplantCan Ear Reshaping, or Otoplasty, Be Performed on a 10-Year-Old?Cosmetic Reshaping of the Crooked Ethnic NoseProud To Be An AmericanInjection Rhinoplasty To Reshape The Asian NoseCast Falling Off After Rhinoplasty – What Should I Do?Cosmetic Rhinoplasty At 77 Years Old!Should I Have A Chin Implant or Chin Liposuction?Rhinoplasty Results 3 Years OutHow Long Do I Need To Wear Bandages After Ear Reshaping?Pinched Nasal Tip & Hanging Columella In Revision RhinoplastyLip Enhancement Augmentation With JuvedermRhinoplasty For Moderately Complex Asymmetry Of The NoseHow Long Do Surgeons Generally Follow Up After a Face Lift?Anesthesia Choices for FaceliftAvoiding A Hollow or Sunken Eye Look With BlepharoplastyEar Reshaping/Otoplasty Debate Over Dissolvable Versus Permanent SuturesLower Age Limit For Eyelid Lift Blepharoplasty?How Swollen Am I 3 Months After A Closed Rhinoplasty?Update On Necklift With Platysmaplasty & Neck LiposuctionRhinoplasty Correction – Crooked Nose DeformityEthnic Revision RhinoplastyTaping the Nose Following RhinoplastyNeck Liposuction Versus Having a Neck LiftHow Soon Can I Run After Rhinoplasty?Am I Able To Have Rhinoplasty At 18 Years Old?San Diego Otoplasty UpdateRevision Rhinoplasty To Create A More Feminine Profile ViewSeptoplasty (Septal Reconstruction) TutorialLengthening The Short Nose in RhinoplastyAsian Rhinoplasty SurgeryBlepharoplasty Eyelid Lift Cold CompressesRhinoplasty Incision CareRhinoplasty Fascia GraftingRhinoplasty For Hump & Poorly Projected Nasal TipNasal Base Reduction in Ethnic RhinoplastySan Diego Ethnic Rhinoplasty Case StudyAppearance of Ear After Rhinoplasty With Auricular GraftingThree Weeks Post Rhinoplasty – Nose Looks Wider Than PreviouslyEar Lobe Reshaping/ReductionMerry Christmas To AllHow To Narrow A Wide Middle Vault With RhinoplastyExample of Reconstructive SeptorhinoplastyCan You Alter The Nose Height & Length At The Same Time?Male, Ethnic Revision Open Rhinoplasty Case ExampleImaging Example In Ethnic RhinoplastyOtoplasty (Ear Reshaping) PrimerAlar Base Reduction Following RhinoplastyColumella Scar Following RhinoplastyInfluence of Scar Tissue Development on Rhinoplasty HealingMy Nose Is Numb One Month Following Rhinoplasty. Is This Normal?Is It Normal To Have Swelling After Removal Of My Cast Following Rhinoplasty?Unilateral OtoplastyWidening the Narrow Nasal TipWhat Is A Lip Lift Procedure?Reconstructing A New Nasal TipUpdate On Dermal FillersDo I Have to Be Careful With My Ears All my Life Following Otoplasty?Combining Chin Implant with Platysma Muscle TighteningWhen Do Rhinoplasty Patients Typically Become Happy With Their Noses?Rhinoplasty Lecture at UCSD School of MedicineDr. Hilinski to Discuss Rhinoplasty at Upcoming Plastic Surgery SymposiumFree Latisse! Get Longer, Fuller, Darker Lashes…Get $50 Off Dsyport And Get Ready For The Holidays!Rhinoplasty For Just Hump ReductionHow Do You Choose Your Rhinoplasty Surgeon?Stopping Blood Thinners For Rhinoplasty SurgeryIncreased Comfort For Botox and Dysport TreatmentReverse Brow Lift For Excessively Long ForeheadSteroid Injections for Thick Skin in Revision RhinoplastyFall Specials on Juvederm at the Hilinski ClinicSkype for Rhinoplasty Consultations!Artefill Medical Advisory BoardCase Example of Hanging Columella Revision RhinoplastyDr. Hilinski Among Three Rhinoplasty Surgeons Recognized In This RegionDysport Is Back And On the Rise!San Diego Facial Plastic Surgeon Launches New WebsiteIPL & Microdermabrasion Specials at the Hilinski ClinicBizymoms Online Interview With Dr. HilinskiA New Face For Our New OfficeFacelift Technique UpdateAppearance After Blepharoplasty (Eyelid Lift)Rhinoplasty and Revision Rhinoplasty PhotosIs It Normal to Have My Ear Look Overcorrected After Otoplasty Procedure?Cast After Rhinoplasty or Revision Rhinoplasty?Nasal Base Reduction in Rhinoplasty and Revision RhinoplastyStraightening a Crooked Septum With Suture TechniqueTemporary Injectable Fillers for the NoseAsian RhinoplastyPain with nasal exercises after revision rhinoplastyEar Pain Following Complex RhinoplastyWhat Do I Look Like After Rhinoplasty?Does Insurance Pay for Septoplasty?Rhinoplasty and Steroid InjectionsWhat is Artefill?Facial Plastic Surgery and Upcoming Holiday SeasonHow To Minimize Bruising Following Rhinoplasty and Revision RhinoplastyRhinoplasty and Spreader GraftsEar Grafting (Auricular Cartilage Grafting) and Revision RhinoplastyArtefill – Permanent Dermal Filler UpdateTaping The Nose After RhinoplastyKaro Syrup and Eyelid Swelling After BlepharoplastyHow Common Is Rhinoplasty Done With A Chin Implant?Are There Visible Incisions With Otoplasty (Ear Reshaping)?Can I Do An Upper Eyelid Lift In The Office?What Are Nasal Exercises For After Rhinoplasty?Do You Pack The Nose After Rhinoplasty or Septoplasty?Downtime After RhinoplastyChin Implant Placement and StabilizationRhinoplasty Bridge Augmentation QuestionGalleryCase-15261Case-15251Case-15171Case-15170Case-15099Case-15096Case-15086Case-15073Case-15031Case-15030Case-15012Case-15009Case-15006Case-15003Case-14997Case-14930Case-14925Case-14914Case-14955Case-14948Case-14941Case-14936Case-14933Case-14930Case-14925Case-14920Case-14917Case-14914Case-14911Case-14906Case-14899Case-14892Case-14884Case-14877Case-14872Case-14840Case-14770Case-14767Case-14758Case-14755Case-14748Case-14683Case-14642Case-14639Case-14631Case-14623Case-14620Case-14617Case-14570Case-14566Case-14547Case-14518Case-14516Case-14503Case-14500Case-14490Case-14487Case-14479Case-14452Case-14398Case-14379Case-14374Case-14344Case-14330Case-14325Case-14311Case-14301Case-14279Case-14273Case-14264Case-14256Case-14192Case-14185Case-10133Case-10132Case-10131Case-10130Case-10129Case-10128Case-10127Case-9951Case-4258Case-4257Case-4256Case-4255Case-4254Case-4253Case-4252Case-4251Case-4250Case-4249Case-4248Case-4247Case-4246Case-4245Case-4244Case-4243Case-4242Case-4241Case-4240Case-4239Case-4238Case-4237Case-4236Case-4235Case-4234Case-4233Case-4232Case-4231Case-4230Case-4229Case-4228Case-4227Case-4226Case-4225Case-4224Case-4223Case-4222Case-4221Case-4220Case-4219Case-4218Case-4217Case-4216Case-4215Case-4214Case-4213Case-4212Case-4211Case-4210Case-4209Case-4208Case-4207Case-4206Case-4205Case-4204Case-4203Case-4202Case-4201Case-4200Case-4199Case-4198Case-4197Case-4196Case-4195Case-4194Case-4193Case-4192Case-4191Case-4190Case-4189Case-4188Case-4187Case-4186Case-4185Case-4184Case-4183Case-4182Case-4181Case-4180Case-4179Case-4178Case-4177Case-4176Case-4175Case-4174Case-4173Case-4172Case-4171Case-4170Case-4169Case-4168Case-4167Case-4166Case-4165Case-4164Case-4163Case-4162Case-4161Case-4160Case-4159Case-4158Case-4157Case-4156Case-4155Case-4154Case-4153Case-4152Case-4151Case-4150Case-4149Case-4148Case-4147Case-4146Case-4145Case-4144Case-4143Case-4142Case-4141Case-4140Case-4139Case-4138Case-4137Case-4136Case-4135Case-4134Case-4133Case-4132Case-4131Case-4130Case-4129Case-4128Case-4127Case-4126Case-4125Case-4124Case-4123Case-4122Case-4121Case-4120Case-4119Case-4118Case-4117Case-4116Case-4115Case-4114Case-4113Case-4112Case-4111Case-4110Case-4109Case-4108Case-4107Case-4106Case-4105Case-4104Case-4103Case-4102Case-4101Case-4100Case-4099Case-4098Case-4097Case-4096Case-4095Case-4094Case-4093Case-4092Case-4091Case-4090Case-4089Case-4088Case-4087Case-4086Case-4085Case-4084Case-4083Case-4082Case-4081Case-4080Case-4079Case-4078Case-4077Case-4076Case-4075Case-4074Case-4073Case-4072Case-4071Case-4070Case-4069Case-4068Case-4067Case-4066Case-4065Case-4064Case-4063Case-4062Case-4061Case-4060Case-4059Case-4058Case-4057Case-4056Case-4055Case-4054Case-4053Case-4052Case-4051Case-4050Case-4049Case-4048Case-4047Case-4046Case-4045Case-4044Case-4043Case-4042Case-4041Case-4040Case-4039Case-4038Case-4037Case-4036Case-4035Case-4034Case-4033Case-4032Case-4031Case-4030Case-4029Case-4028Case-4027Case-4026Case-4025Case-4024Case-4023Case-4022Case-4021Case-4020Case-4019Case-4018Case-4017Case-4016Case-4015Case-4014Case-4013Case-4012Case-4011Case-4010Case-4009Case-4008Case-4007Case-4006Case-4005Case-4004Case-4003Case-4002Case-4001Case-4000Case-3999Case-3998Case-3997Case-3996Case-3995Case-3994Case-3993Case-3992Case-3991Case-3990Case-3989Case-3988Case-3987Case-3986Case-3985Case-3984Case-3983Case-3982Case-3981Case-3980Case-3979Case-3978Case-3977Case-3976Case-3975Case-3974Case-3973Case-3972Case-3971Case-3970Case-3969Case-3968Case-3967Case-3966Case-3965Case-3964Case-3963Case-3962Case-3961Case-3960Case-3959Case-3958Case-3957Case-3956Case-3955Case-3954Case-3953Case-3952Case-3951Case-3950Case-3949Case-3948Case-3947Case-3946Case-3945Case-3944Case-3943Case-3942Case-3941Case-3940Case-3939Case-3938Case-3937Case-3936Case-3935Case-3934Case-3933Case-3932Case-3931Case-3930Case-3929Case-3928Case-3927Case-3926Case-3925Case-3924Case-3923Case-3922Case-3921Case-3920Case-3919Case-3918Case-3917Case-3916Case-3915Case-3914Case-3913Case-3912Case-3911Case-3910Case-3909Case-3908Case-3907Case-3906Case-3905Case-3904Case-3903Case-3902Case-3901Case-3900Case-3899Case-3898Case-3897Case-3896Case-3895Case-3894Case-3893Case-3892Case-3891Case-3890Case-3889Case-3888Case-3887Case-3886Case-3885Case-3884Case-3883Case-3882Case-3881Case-3880Case-3879Case-3878Case-3877Case-3876Case-3875Case-3874Case-3873Case-3872Case-3871Case-3870Case-3869Case-3868Case-3867Case-3866Case-3865Case-3864Case-3863Case-3862Case-3861Case-3860Case-3859Case-3858Case-3857Case-3856Case-3855Case-3854Case-3853Case-3852Case-3851Case-3850Case-3849Case-3848Case-3847Case-3846Case-3845Case-3844Case-3843Case-3842Case-3841Case-3840Case-3839Case-3838Case-3837Case-3836Case-3835Case-3834Case-3833Case-3832Case-3831Case-3830Case-3829Case-3828Case-3827Case-3826Case-3825Case-3824Case-3823Case-3822Case-3821Case-3820Case-3819Case-3818Case-3817Case-3816Case-3815Case-3814Case-3813Case-3812Case-3811Case-3810Case-3809Case-3808Case-3807Case-3806Case-3805Case-3804Case-3803Case-3802Case-3801Case-3800Case-3799Case-3798Case-3797Case-3796Case-3795Case-3794Case-3793Case-3792Case-3791Case-3790Case-3789Case-3788Case-3787Case-3786Case-3785Case-3784Case-3783Case-3782Case-3781Case-3780Case-3779Case-3778Case-3777Case-3776Case-3775Case-3774Case-3773Case-3772Case-3771Case-3770Case-3769Case-3768Case-3767Case-3766Case-3765Case-3764Case-3763Case-3762Case-3761Case-3760Case-3759Case-3758Case-3757Case-3756Case-3755Case-3754Case-3753Case-3752Case-3751Case-3750Case-3749Case-3748Case-3747Case-3746Case-3745Case-3744Case-3743Case-3742Case-3741Case-3740Case-3739Case-3738Case-3737Case-3736Case-3735Case-3734Case-3733Case-3732Case-3731Case-3730Case-3729Case-3728Case-3727Case-3726Case-3725Case-3724Case-3723Case-3722Case-3720Case-3719Case-3718Case-3717Case-3716Case-3715Case-3714Case-3713Case-3712Case-3711Case-3710Case-3709Case-3708Case-3707Case-3706Case-3705Case-3704Case-3703Case-3702Case-3701Case-3700Case-3699Case-3698Case-3697Case-3696Case-3695Case-3694Case-3693Case-3692Case-3691Case-3690Case-3689Case-3688Case-3687Case-3686Case-3685Case-3684Case-3683Case-3682Case-3681Case-3680Case-3679Case-3678Case-3677Case-3676Case-3675Case-3674Case-3673Case-3672Case-3671Case-3670Case-3669Case-3668Case-3667Case-3666Case-3665Case-3664Case-3663Case-3662Case-3661Case-3660Case-3659Case-3658Case-3657Case-3656Case-3653Case-3652Case-3651Case-3650Case-3648Case-3647Case-3645Case-3644Case-3642Case-3641Case-3640Case-3639Case-3638Case-3637Case-3636Case-3635Case-3633Case-3632Case-3629Case-3628Case-3626Case-3625Case-3624Case-3623Case-3621Case-3620Case-3618Case-3617Case-3615Case-3613Case-3612Case-3611Case-3610Case-3609Case-3608Case-3607Case-3606Case-3605Case-3597Case-3596Case-3595Case-3594Case-3593Case-3592Case-3589Case-3588Case-3587Case-3584Case-3583Case-3581Case-3580Case-3579Case-3578Case-3577Case-3576Case-3575Case-3574Case-3572Case-3571Case-3570Case-3569Case-3568Case-3567Case-3566Case-3565Case-3564Case-3563Case-3562Case-3559Case-3558Case-3557Case-3556Case-3555Case-3554Case-3553Case-3552Case-3551Case-3549Case-3547Case-3546Case-3544Case-3543Case-3542Case-3541Case-3540Case-3539Case-3538Case-3537Case-3535Case-3534Case-3533Case-3531Case-3530Case-3529Case-3528Case-3527Case-3524Case-3523Case-3522Case-3521Case-3520Case-3519Case-3518Case-3517Case-3516Case-3515Case-3514Case-3513Case-3512Case-3511Case-3510Case-3509Case-3508Case-3507Case-3506Case-3505Case-3504Case-3503Case-3502Case-3501Case-3499Case-3498Case-3497Case-3496Case-3495Case-3494Case-3493Case-3492Case-3491Case-3490Case-3489Case-3488Case-3487Case-3486Case-3485Case-3484Case-3482Case-3481Case-3480Case-3479Case-3478Case-3477Case-3476Case-3475Case-3474Case-3473Case-3472Case-3471Case-3470Case-3469Case-3468Case-3467Case-3466Case-3465Case-3464Case-3463Case-3462Case-3461Case-3460Case-3459Case-3458Case-3457Case-3456Case-3454Case-3453Case-3452Case-3451Case-3450Case-3449Case-3448Case-3447Case-3446Case-3445Case-3444Case-3443Case-3442Case-3441Case-3440Case-3439Case-3438Case-3437Case-3436Case-3435Case-3434Case-3433Case-3432Case-3431Case-3430Case-3429Case-3428Case-3427Case-3426Case-3425Case-3424Case-3423Case-3422Case-3421Case-3420Case-3419Case-3418Case-3417Case-3416Case-3415Case-3414Case-3413Case-3412Case-3411Case-3410Case-3409Case-3408Case-3407Case-3406Case-3405Case-3404Case-3403Case-3402Case-3401Case-3400Case-3399Case-3398Case-3397Case-3396Case-3395Case-3394Case-3393Case-3392Case-3391Case-3390Case-3389Case-3388Case-3387Case-3386Case-3385Case-3384Case-3383Case-3382Case-3381Case-3380Case-3379Case-3378Case-3377Case-3376Case-3375Case-3374Case-3373Case-3372Case-3371Case-3370Case-3369Case-3368Case-3367Case-3366Case-3365Case-3364Case-3363Case-3362Case-3361Case-3360Case-3359Case-3358Case-3357Case-3356Case-3355Case-3354Case-3353Case-3352Case-3351Case-3350Case-3349Case-3348Case-3347Case-3346Case-3345Case-3344Case-3343Case-3342Case-3341Case-3340Case-3339Case-3338Case-3337Case-3336Case-3335Case-3334Case-3333Case-3332Case-3331Case-3330Case-3329Case-3328Case-3327Case-3326Case-3324Case-3323Case-3322Case-3321Case-3320Case-3319Case-3318Case-3317Case-3316Case-3315Case-3314Case-3312Case-3311Case-3310Case-3309Case-3308Case-3307Case-3306Case-3305

#### Skin Cancer Reconstruction
As a leading expert in nose surgery and facial reconstruction, Dr. John Hilinski specializes in both cosmetic and reconstructive nose surgery following skin cancer removal. Many patients come to him for his vast experience in rhinoplasty and revision rhinoplasty, making him the go-to surgeon for those needing reconstructive nose surgery. This case showcases how Dr. Hilinski's expertise helps patients regain their appearance and function following skin cancer treatment.

Case Study: Skin Cancer Reconstruction After MOHS Surgery

In this case, a patient from San Diego, CA, was diagnosed with skin cancer on the bridge of her nose. After her dermatologist performed MOHS surgery to remove the cancer, she was referred to Dr. Hilinski for reconstructive surgery. MOHS surgery is a common technique used to remove cancer while preserving as much healthy tissue as possible. However, in this patient's case, the procedure left a significant defect in the middle of her nasal bridge. The defect involved both the skin and the underlying bone and cartilage.

Faced with concerns about both function and appearance, the patient sought Dr. Hilinski's expertise. His specialized training and experience in reconstructive rhinoplasty allowed him to develop a successful surgical plan to restore her nose's structure and aesthetics.

Paramedian Forehead Flap Surgery

Given the complexity and size of the defect, Dr. Hilinski chose to perform a paramedian forehead flap. This advanced reconstructive technique involves transferring a section of skin, along with its blood supply, from the forehead to the nose. This method provides the nose with robust tissue and a reliable blood supply, ensuring a successful outcome.

Skin grafts were not an option due to the depth of the defect and the need for cartilage and bone reconstruction. With the paramedian forehead flap, Dr. Hilinski was able to effectively rebuild the nose with a natural look while preserving functionality.

Before and After Photos

The patient's journey included multiple stages of surgery, allowing her nose to heal and integrate the flap. As shown in her before and after photos, Dr. Hilinski's technique restored both the aesthetic appearance of her nose and the underlying structure. Today, she has no visible signs of the cancer removal surgery.

FAQs: Skin Cancer Reconstruction

Schedule a Consultation for Skin Cancer Reconstruction

If you've undergone MOHS surgery or another skin cancer treatment and are seeking reconstructive surgery, schedule a consultation with Dr. John Hilinski in San Diego. His experience in both cosmetic and reconstructive nose surgery will help you restore your facial appearance and confidence.

#### Skin Rejuvenation
Skin Rejuvenation in San Diego at Hilinski Medspa

At Hilinski Medspa, we specialize in advanced skin rejuvenation treatments that are designed to enhance the natural beauty of your skin. Whether you're looking to improve fine lines, texture, or overall skin tone, our expert team offers a wide variety of non-surgical skin rejuvenation options to help you achieve a youthful, radiant complexion. Led by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, we are committed to providing the highest standard of care and results.

What is Skin Rejuvenation?

Skin rejuvenation refers to a collection of treatments that target various skin concerns such as wrinkles, fine lines, acne scars, hyperpigmentation, and uneven skin texture. These treatments work by promoting collagen production, increasing cell turnover, and revitalizing the skin for a healthier, younger appearance. At Hilinski Medspa, we tailor each rejuvenation treatment to meet the unique needs of your skin, providing a comprehensive solution for lasting beauty

Skin Rejuvenation Treatments Offered at Hilinski Medspa

At Hilinski Medspa, we offer a range of skin rejuvenation treatments that can be customized to suit your individual needs, including the following advanced options:

EZ Gel

EZ Gel is an autologous, filler-like treatment created from your body’s own proteins to restore soft, natural volume while improving skin hydration and smoothness. Ideal for areas such as the under-eyes, cheeks, and smile lines, EZ Gel provides subtle contouring and long-lasting rejuvenation without synthetic ingredients.

Injectable PRF

Injectable PRF uses a concentrated portion of your own blood to deliver powerful growth factors that naturally improve skin tone, texture, and elasticity. This regenerative treatment supports collagen production and enhances overall skin quality, helping soften fine lines and brighten areas like the under-eyes.

Each of these treatments is designed to address specific skin concerns, and our team will work closely with you to determine the best solution for your skin type and aesthetic goals.

Benefits of Skin Rejuvenation at Hilinski Medspa

Contact Hilinski Medspa To Schedule a Consultation

To learn more about how skin rejuvenation can improve your complexion, schedule a consultation at Hilinski Medspa in San Diego. Our expert team, led by Dr. John Hilinski, is here to provide personalized treatment plans that help you look and feel your best. Contact us today to begin your journey to healthier, more youthful skin.

#### Skin Resurfacing
Laser Skin Resurfacing in San Diego at Hilinski Medspa

At Hilinski Medspa, we specialize in advanced laser skin resurfacing treatments designed to rejuvenate your skin and restore a youthful glow. Whether you're looking to reduce fine lines, improve skin texture, or correct sun damage, our team is here to help. Under the expert guidance of board-certified facial plastic surgeon Dr. John Hilinski, we offer patients in San Diego state-of-the-art laser treatments using the renowned Lumenis® Ultrapulse Encore carbon dioxide (CO2) laser.

What is Laser Skin Resurfacing?

Laser skin resurfacing is a non-invasive procedure that targets the outer layers of the skin to rejuvenate and repair aged or sun-damaged skin. This treatment is particularly effective for diffuse, fine wrinkles and is often considered an ideal solution for individuals not yet ready for more invasive procedures like a facelift.

Dr. Hilinski utilizes the Lumenis® Ultrapulse Encore CO2 laser, which comes in two configurations: Active FX and Deep FX. These configurations allow for customized treatment, carefully removing damaged skin in a fractionated manner, leaving tiny areas of healthy skin untouched to promote faster healing and reduced downtime. This advanced approach ensures precise, targeted results with minimal side effects.

Benefits of Laser Skin Resurfacing at Hilinski Medspa

Laser skin resurfacing offers numerous benefits for those seeking to improve the quality of their skin. Some of the key advantages include:

Whether you’re looking to address age-related skin concerns or simply want to refresh your skin’s appearance, laser skin resurfacing in San Diego at Hilinski Medspa can deliver long-lasting, noticeable improvements.

Laser Skin Resurfacing Procedure

At Hilinski Medspa, most laser skin resurfacing procedures are performed under local anesthesia in a comfortable, minimally invasive setting. During the procedure, Dr. Hilinski will use the CO2 laser to emit concentrated beams of light that carefully remove the outer layer of damaged skin while stimulating the growth of new collagen beneath the surface. This process helps to tighten the skin, creating a smoother, firmer complexion.

The entire treatment typically lasts between 30 minutes and two hours, depending on the treatment area. Results are often dramatic, with many patients noticing an immediate improvement in skin texture and tone.

Laser Skin Resurfacing Recovery

Following laser skin resurfacing, patients may experience mild redness and swelling. Healing times can vary depending on the intensity of the treatment–ranging from a few days for light treatments to up to 10-14 days for deeper treatments. It’s crucial to protect your skin from the sun during the recovery period, as the newly resurfaced skin will be more sensitive to UV exposure.

Once healed, your skin will appear more youthful, with a smoother texture and improved elasticity. As a bonus, laser skin resurfacing can help reduce the appearance of pre-cancerous skin lesions, such as actinic keratosis, and may even delay the need for more invasive surgical procedures.

Laser Skin Resurfacing Results

Patients typically notice smoother, healthier skin immediately after treatment, with results continuing to improve over the following months as collagen production increases. While the effects of laser resurfacing can last for several years, it's important to maintain good skincare habits and protect your skin from the sun to maximize long-term results. Many patients opt for maintenance treatments every few years to keep their skin looking youthful and vibrant.

FAQ: Laser Skin Resurfacing in San Diego

Contact Hilinski Medspa to Schedule a Consultation

Hilinski Medspa offers San Diego's top laser skin resurfacing treatments, led by Dr. John Hilinski, a board-certified facial plastic surgeon with extensive expertise in facial rejuvenation. His years of specialized training, combined with the latest laser technologies, ensure that you achieve safe and stunning results.

For more information or to schedule a consultation for laser skin resurfacing in San Diego, contact Hilinski Medspa today. Achieve radiant, youthful skin with the guidance of San Diego's trusted facial expert, Dr. John Hilinski.

#### Smile Line Correction
Smile Line Treatment with Dr. John Hilinski

What are Smile Lines?

Smile lines, also known as nasolabial folds or laugh lines, are the natural skin creases located where the upper lip meets the cheek. These lines often become more pronounced with age or due to genetics, contributing to an aged or tired appearance. As you smile or laugh, these lines can deepen, making them more noticeable even when the face is at rest. Deep smile lines often lead patients to seek treatment to soften their appearance.

Dr. John Hilinski, a board-certified facial plastic surgeon in San Diego, specializes in the treatment of deep smile lines. Using advanced techniques, he offers both temporary and permanent solutions to improve facial symmetry and create a refreshed, youthful appearance.

Non-Surgical Smile Line Treatment

One of the most common treatments for deep nasolabial folds is the injection of dermal fillers. These fillers, such as Restylane®, JUVÉDERM®, Radiesse®, and Artefill®, work by adding volume beneath the skin, effectively pushing the crease outward and making the smile line less visible.

Dr. Hilinski is known for his precision in filler placement, providing natural-looking results that reduce shadowing and soften deep creases. For many patients, injectable fillers offer a quick, non-invasive solution to rejuvenate their smile lines.

Permanent Smile Line Treatment

For patients seeking a more permanent solution, surgical excision of smile lines is an option. This procedure involves carefully removing the deep folds and realigning the skin to create a smoother appearance.

Surgical excision of smile lines offers:

Permanent correction for deep smile lines.

A hidden scar that blends into the natural crease between the cheek and lip.

A one-time procedure compared to the need for repeated filler treatments.

Dr. Hilinski performs this procedure under local anesthesia in an accredited surgical center, and patients typically return home the same day.

Benefits of Smile Line Treatment

Smile Line Treatment FAQs

Schedule a Consultation With Dr. John Hilinski in San Diego

If you're considering smile line treatment and want to explore the best options for your unique needs, scheduling a consultation with Dr. John Hilinski is the first step. During your consultation, Dr. Hilinski will evaluate your facial structure, discuss your goals, and recommend a personalized treatment plan. With his expertise in both non-surgical and surgical options, Dr. Hilinski will help you achieve a natural, refreshed look.

To schedule your consultation, contact our office today and take the first step toward a more youthful appearance.

#### Specials & Events
Check back soon for our latest specials and events!

#### Spirox Latera Implant
Dr. Hilinski now offers the Spirox Latera procedure to help with your chronic nasal obstruction and difficulty breathing through the nose. If you notice that pulling on the side of your nose helps your nasal function – or you benefit from using Breathe Right strips – you may be a good candidate to under the Spirox Latera minimally invasive procedure.

What is Spirox Latera?

The Spirox Latera is a nasal implant that is FDA approved to help in the treatment of chronic nasal obstruction due to weak nasal valve structure. The nasal valve area is actually two different critical zones within the nose that play an important role in terms of proper nasal breathing. The external valve area primarily involves the lower lateral cartilage – the support structures that keep the nostrils open while breathing into the nose. The internal valve area corresponds to an even more delicate region where the upper lateral cartilage and nasal septum converge. In many patients, one or both of these areas can be weakened (congenitally or from prior surgery), which leads to trouble breathing through the nose.

The Spirox Latera implant can be used to help reinforce both of these areas so that proper support (and resistance to collapse) is achieved. The Latera device is inserted on the inside lining of the nose and strategically positioned along the deep tissues of the nasal side wall. The upper end of the Latera sits over the dense nasal bone – allowing the remainder of the Latera device to cantilever out and over the weakened cartilage. Essentially, this provides much needed rigidity that helps keep the nasal airway more open.

Does Insurance Cover Latera?

Because of the implications for improved nose function and nasal breathing, the Spirox Latera procedure is often times covered by your medical insurance carrier. Of course, you would need to have a personalized consultation and examination by Dr. Hilinski in order to determine your candidacy and coverage for the procedure. Our office accepts most PPO insurance plans.

Latera Anesthesia

The Spirox Latera implant procedure can be done under local anesthesia. However, most patients will have the Latera procedure done under IV sedation or general anesthesia because it is commonly performed in combination with septoplasty work (for a deviated nasal septum) and/or inferior turbinate work.

Results from Latera

The results from the Spirox Latera implant procedure can be appreciated almost immediately. Many patients who undergo placement of the Latera implant note a marked, obvious improvement in their breathing right after the procedure has been completed.

Latera Side Effects

Side effects from Latea can include bruising and discomfort in the region where the Latera implant was placed. This usually resolves with 1-3 days of the procedure. In some cases, patients can also notice a visible swelling that corresponds to the position of the Latera implant. However, in a great majority of cases, this swelling will subside within a few weeks.

Latera Expert Consultation

Contact our office today to arrange for a personalized consult with expert nasal surgeon and double board certified facial plastic surgeon, Dr. John Hilinski. As a regional specialist and authority in reconstructive nose surgery to help with nasal obstruction, he will help guide you in making the right decision for your particular situation.

#### Stahl's Ear Correction
If you or your child has a noticeable ear deformity resembling a pointed or elf-like shape, you're not alone. Stahl's ear, also known as “Spock ear”, is a congenital condition that can impact confidence and self-esteem. At Dr. John Hilinski's renowned cosmetic surgery practice in San Diego, CA, we offer advanced Stahl's ear correction to restore a natural ear contour and improve overall appearance.

What Is Stahl’s Ear? 

Why Choose Dr. John Hilinski for Stahl's Ear Correction?

Surgical Approach to Reshaping Stahl's Ear

Benefits of Stahl's Ear Surgery

Ideal Candidates for Stahl's Ear Correction

What to Expect During Recovery

FAQs About Stahl’s Ear

What Is Stahl's Ear?

Stahl's ear is a rare congenital ear anomaly characterized by an extra cartilage fold across the scaphoid fossa, which gives the upper ear a pointed appearance. This distinctive shape often resembles an elf-like ear and can occur in one or both ears. While the condition is not medically harmful, many individuals seek reshaping to achieve a more natural ear shape.

Surgical Approach to Reshaping Stahl's Ear

Correcting Stahl's ear typically involves reshaping the excess cartilage and reconstructing the scaphoid fossa to eliminate the pointed appearance. Dr. Hilinski performs this outpatient procedure under local or general anesthesia, depending on the patient's age and comfort level. Incisions are strategically placed behind the ear and/or hidden along the natural shadows of the ear to ensure minimal visibility and a smooth, natural ear contour post-surgery.

Stahl's ear is a rare congenital ear anomaly characterized by an extra cartilage fold across the scaphoid fossa, which gives the upper ear a pointed appearance. This distinctive shape often resembles an elf-like ear and can occur in one or both ears. While the condition is not medically harmful, many individuals seek reshaping to achieve a more natural ear shape.

Benefits of Stahl's Ear Surgery

Restores a natural, curved ear shape

Reduces elf-like or Spock ear appearance

Boosts self-esteem and confidence

Customized reshaping for balanced facial aesthetics

Performed by an expert in congenital ear anomalies

Ideal Candidates for Stahl's Ear Correction

This procedure is suitable for both children and adults with visible signs of Stahl's ear. Early intervention in infants may involve non-surgical molding, but older patients typically require surgery to achieve long-lasting results. Dr. Hilinski provides a thorough consultation to determine the best approach based on age, ear shape, and individual goals.

What to Expect During Recovery

Following Stahl's ear surgery, patients can expect mild swelling and discomfort for the first few days. A protective dressing may be applied to support healing. Most individuals resume normal activities within a week, although strenuous activities should be avoided for several weeks. Dr. Hilinski and his team provide detailed aftercare instructions and follow-up visits to monitor progress.

Before and After

Frequently Asked Questions (FAQ)

Schedule a Consultation in San Diego, CA

If you’re seeking a compassionate and skilled surgeon for Stahl's ear correction, Dr. John Hilinski in San Diego, CA, offers the expertise you can trust. Contact us to book a consultation to explore your options and achieve a natural, symmetrical ear shape.

#### Steroid Injections
Steroid injections should be considered an important tool in the armamentarium of any rhinoplasty expert or revision rhinoplasty specialist. When we use the term steroids in the world of rhinoplasty and nose surgery we are referring to a very specific type of steroid. The word ‘steroid’ in laymen’s terms often conjures up images of increased muscle growth in body builders. But this actually refers to a different type of steroid called an anabolic steroid that is, indeed, used to build up body mass. The type of steroids we are referring to in rhinoplasty and revision rhinoplasty are called corticosteroids. They are also sometimes referred to as glucocorticoids. Corticosteroids are a certain class of steroids that have a very potent anti-inflammatory effect on our body’s tissues. This can be considered almost the opposite effect of anabolic steroids, in that corticosteroids’ primary effect is to reduce soft tissue volume. Many corticosteroids come in pill form while others are used as an injectable solution. Either way, the main goal when using these type of steroids is to reduce inflammation. When injected into the body, for example, in the nose following rhinoplasty, steroids can help reduce scar tissue and swelling.

Steroid Injections And Nasal Reshaping

The main indication for using steroid injections in the nasal reshaping process is to reduce unwanted swelling. Whenever anyone undergoes a rhinoplasty or revision rhinoplasty procedure, they will inevitably develop some degree of swelling in the nose following surgery. We also refer to this postoperative swelling as edema. Rhinoplasty patients will develop edema of the nose to various degrees depending on the skin type and what was performed during the nose reshaping process. In most rhinoplasty patients, there is an initial phase of edema that resolves within 10-14 days. It is this initial edema that usually keeps rhinoplasty patients from being seen in the public eye immediately after surgery. Fortunately, this edema resolves on its own.

There is a secondary phase of edema that will persist for months to years following a rhinoplasty or revision rhinoplasty procedure. It is this type of persistent edema that we normally target with steroid injections following rhinoplasty. So why do we even inject the nose with steroids following rhinoplasty? In some cases, it is because we simply want to speed up the healing process and provide our patients with the desired nasal appearance sooner rather than later. Much of the edema that might be seen months out from rhinoplasty will typically resolve on its own eventually. But some rhinoplasty patients would rather not wait 6-12 months to see this process take place. In these instances, a steroid injection into the nose might be beneficial.

In other cases, steroid injections into the nose are utilized to prevent unwanted scar tissue from forming. Some rhinoplasty patients have moderately thick (or thicker) soft tissue that is more predisposed to laying down dense scar tissue between the cartilage or bone and the skin. This population mostly includes ethnic rhinoplasty patients (such as Hispanic rhinoplasty, Asian rhinoplasty, Middle Eastern rhinoplasty, African-American rhinoplasty patients). In these ethnic noses, the thicker soft tissue is more prone to scarring in certain areas, such as the supratip region. If this scarring process is excessive, the nasal skin will be prevented from shrink wrapping down to the desired shape of the underlying cartilage and/or bone. If this occurs, the nose will not achieve the desired definition and refinement that would, otherwise, be possible. In these ethnic rhinoplasty patients, a strategically placed steroid injection can be used to prevent this unwanted scar tissue from forming at all. The benefit is that the patient will then have maximal chance of achieving the best possible rhinoplasty result.

Still in other cases, steroid injections are used to treat scar tissue that has already formed in the nose following rhinoplasty. In these patients, the scar tissue has already been established and is preventing the nose from looking its best in terms of definition and refinement. This is typically the same rhinoplasty population as noted above in terms of ethnic noses (such as Hispanic nose, Asian nose, Middle Eastern nose, African-American nose patients). In patients with scar tissue that has already formed in the nose, a steroid injection can be used to dissolve the dense scar effectively allowing further contouring and shaping of the nose.

Choice Of Steroids Used In Rhinoplasty

There are many different steroids that one can choose from to help reduce inflammation. Cortisone is probably the most popular example of a corticosteroid used in medicine, however, it is not the preferred choice when it comes to rhinoplasty and revision rhinoplasty. My preference is triamcinolone, which is also known as Kenalog (its brand name). Kenalog is a synethetic corticosteroid that is commercially available in various concentrations. It is measured in milligrams (mg) per milliliter (ml) with higher numbers representing a more concentrated solution. The higher the concentration, the more potent the steroid injection will be. Injecting a higher volume of Kenalog will also great a greater impact in terms of the anti-inflammatory effect that is seen. Most rhinoplasty specialists and nose reshaping experts will use a range of Kenalog concentrations depending on the type of scar tissue or amount of swelling that is noted. This can range from Kenalog 05 (5 mg/ml) up to Kenalog 40 (40 mg/ml) in most offices.

Timing Of Steroid Injections Following Nose Surgery

Timing of steroid injections following nose surgery is somewhat of a controversial topic in rhinoplasty and revision rhinoplasty. The following information is based on my own personal experience as a rhinoplasty expert and revision rhinoplasty specialist.

Some rhinoplasty specialists feel that if you are going to use steroid shots, or injections, in the nose you have to do it within the first 1-2 months in order for them to be effective. They base this on the fact that the body is laying down most of the new collagen during these first two months of healing following reshaping of the nose. It is this collagen that eventually forms scar tissue. These rhinoplasty surgeons believe that steroids are best used during this early healing phase since this is the beginning of the scar tissue development process. Frankly, I don’t agree with this philosophy at all. In my opinion, most swelling you see in the nose during the first few months is edema that is going to resolve on its own anyway. In addition, much of the scar tissue that is formed in these first few months is good scar tissue. Keep in mind that not all scar tissue is bad. If you prevent this good scar tissue from forming by injecting a steroid too early, you can actually jeopardize what would have been a beautiful rhinoplasty result. Don’t get me wrong. There are those rare cases in rhinoplasty where you might need to inject a steroid into the nose within the first 1-2 months, but this is quite unusual in my practice.

I normally prefer to wait at least 3-4 months out from nasal reshaping surgery before considering a steroid injection in the nose. By this point in the healing process, most rhinoplasty patients are beginning to really see the change in contour of the nose. It is also at this point where you can better appreciate subtle changes in the shape of the nose. Steroid injections work wonderfully here to help further contour the nose. Waiting to inject at this point is also considered safer in my opinion since you are less likely to jeopardize formation of the good scar tissue.

Contrary to popular belief, steroid injections in the nose at this point in the healing process can also effectively treat already established scar tissue (see case example below). In fact, I have used steroid shots in rhinoplasty patients who are years out from surgery and still see a nice improvement from the injections. It is all a matter of what steroid concentration you use and how much you put in. For instance, in mature, established scar tissue I will often opt to use a more moderate amount of K40 since it is much stronger solution. In the experienced hands of a rhinoplasty expert, steroid injections can be a great tool to further refine the nose even long after scar tissue has formed.

Series of Steroid Injections

In many rhinoplasty patients, steroid injections are done as part of a series of steroid shots. There are definitely nose reshaping patients who have one injection and that is all they need. But more commonly, I perform a series of steroid injections over time to achieve the desired result. In fact, I will usually wait 6-8 weeks in between steroid injections in the nose. In this manner, I feel more confident that I can make incremental changes in the shape of the nose in parallel with the natural healing process.

Potential Complications of Steroid InjectionsOne of the potential complications of steroid shots in the nose is development of a depression in the area of the injection. Just as steroids can work to dissolve mature scar tissue, they can also cause normal soft tissue to dissolve away. This process where soft tissue shrinks down is also known as atrophy. This can occur if the steroid solution gets into the surrounding skin and fat and causes the soft tissues to atrophy. If this does occur, we normally wait several weeks and simply observe the tissues. In most cases, your body will rebound on its own and restore some, if not all, of the lost soft tissue volume. Fortunately, unwanted soft tissue atrophy following a steroid injection is not very common, especially if your rhinoplasty specialist takes a more conservative approach with choice of steroid concentration and volume.

Rhinoplasty Photo Example Of Steroid Injections

This patient is a great example of how steroid injections can be used to modify and optimize a rhinoplasty outcome. This young lady is one of my San Diego nose reshaping patients who had a dorsal hump deformity and tip ptosis. As you can see from her preoperative profile view, there is a convexity along her bridge and her tip is not as projected out as far as it should be. In addition, she had moderately thick nasal skin consistent with her ethnic background. Going into her rhinoplasty procedure, I knew the surgical goal was going to be reduction of her bridge height and elevation of her nasal tip. But I also had planned in my head that we were likely going to use postoperative steroid injections at some point to help her skin adapt to the new shape of her nose. Thicker ethnic nose skin like hers is not going to easily reshape on its own. In addition, there is a risk of her developing unwanted, excess scar tissue under the skin before it finishes shrinking down. As a rhinoplasty expert who does nasal reshaping surgery on a very regular basis, I could tell just from experience that this was an issue I needed to keep in mind during her healing process.

Indeed, 6 or so months into her recovery from nose reshaping surgery, she had signs of unwanted persistent edema and early scar tissue. Overall, she was doing fine but I could just tell by feeling her nasal skin that she might benefit from doing a series of steroid injections. As a rhinoplasty specialist, you can feel the nose and get a sense of how the healing is coming along. In this particular case, the soft tissue over the bridge felt a little ‘full’ as if there was some resistance when I pushed down lightly on the skin. When you look at her photos from 7 months out (see below), you can appreciate that there is a definite improvement in her overall nasal shape. But, as indicated by the red arrows, she still had a slightly high bridge and her tip was not as defined as we wanted.

Because of the persistent edema and scar tissue development, we decided to begin doing steroid injections. After a series of conservative steroid injections underneath her nasal bridge skin, she began to notice even more obvious skin shrink wrapping. This included further refinements in terms of both the bridge and the supratip area (between her tip and bridge). As you can see from her before and after rhinoplasty photo series below, her nose now looks much better overall.

#### Surgery Center
The Hilinski Ambulatory Surgery Center in San Diego

At The Hilinski Ambulatory Surgery Center, we are committed to providing patients with the highest standard of care in a state-of-the-art facility. Our on-site operating room, where Dr. John Hilinski performs surgeries, is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), also known as Quad A. This accreditation is the gold standard in plastic surgery facilities, signifying that our center has met rigorous safety and quality standards, ensuring patients receive the best possible care.

Why Choose The Hilinski Ambulatory Surgery Center?

Dr. John Hilinski, a Harvard-educated, double board-certified facial plastic surgeon, has designed our surgery center to prioritize patient safety, comfort, and satisfaction. With advanced technology and a private, serene environment, our center provides a personalized experience for all cosmetic and reconstructive procedures. Quad A accreditation further ensures that our surgery center meets the highest regulatory requirements, placing it among the top facilities in the country.

Benefits of Choosing The Hilinski Ambulatory Surgery Center

Dr. John Hilinski's Expertise

Dr. John Hilinski is renowned for his expertise in facial plastic and reconstructive surgery. With education from Harvard Medical School and double board certification in Facial Plastic and Reconstructive Surgery and Head and Neck Surgery, he offers advanced techniques in a variety of procedures, including:

Rhinoplasty and revision rhinoplasty

Facelift surgery

Eyelid surgery (blepharoplasty)

Non-surgical facial rejuvenation treatments

Dr. Hilinski's experience and dedication to patient care ensure that every procedure performed at our AAAASF-accredited surgery center is tailored to meet the specific aesthetic goals of each patient.

FAQs About The Hilinski Ambulatory Surgery Center

Schedule a Consultation

If you're considering a facial plastic surgery procedure, trust the expertise of Dr. John Hilinski and the safety of The Hilinski Ambulatory Surgery Center. Contact us today to schedule a consultation and learn more about our state-of-the-art facility and the facial plastic surgery procedures we offer. Let us help you achieve your aesthetic goals with precision, safety, and care!

#### Surgical
Facial Plastic Surgery Procedures by Dr. John Hilinski

Dr. John Hilinski offers a comprehensive range of cosmetic and reconstructive facial procedures designed to enhance natural beauty and boost confidence. As a double-board-certified facial plastic surgeon, Dr. Hilinski is renowned for his advanced expertise in helping both men and women improve their facial appearance through innovative surgical techniques. His goal is to provide the most natural-looking results, tailored to each patient's unique features and aesthetic goals.

Personalized Care and Advanced Techniques

Dr. Hilinski believes that the key to achieving outstanding results lies in personalized care and a deep understanding of each patient's desires. During the consultation process, Dr. Hilinski takes the time to listen closely to what each patient hopes to achieve through surgery. He then creates a customized treatment plan that aligns with their vision, using state-of-the-art techniques to deliver outcomes that are both transformative and natural.

Whether you're seeking to refine your nose, rejuvenate your face, correct prominent ears, or restore hair, Dr. Hilinski offers the expertise and compassionate care you need. Explore our diverse range of procedures to learn how Dr. Hilinski can help you unlock your true potential through personalized facial aesthetics.

Explore Our Facial Plastic Surgery Procedures

Schedule a Consultation with Dr. John Hilinski

Ready to take the next step? Contact us today to schedule a consultation with Dr. John Hilinski and explore how personalized facial plastic surgery can help you achieve the look you desire. At our San Diego practice, we are committed to helping you feel confident and beautiful through expert care and customized treatment plans.

#### Taping After Rhinoplasty
Rhinoplasty Taping Video

Here is a nice video demonstration of how Dr. Hilinski prefers his patients tape their nose following rhinoplasty surgery. This case example focuses on a young lady who underwent revision rhinoplasty surgery (prior nose job performed by a different plastic surgeon) and was recommended to tape her nose after the bandages came off at 5 days out. She had moderately thicker skin, which is one of the indications for patients to tape their nose after rhinoplasty. In the video, the nuances and specifics of how and why to tape are covered along with a few tricks and recommendations.

Keep in mind that this video is intended for Dr. Hilinski’s patients, following surgery he has performed. You should check with your own rhinoplasty surgeon before using Dr. Hilinski’s taping technique on your own nose.

#### Taping The Nose
In many cases following rhinoplasty and revision rhinoplasty it is recommended that patients begin taping their nose. The primary reason to tape the nose is to encourage the skin to shrink wrap down on to the underlying bone and cartilage. This is particularly helpful in rhinoplasty and revision rhinoplasty patients who have medium to moderately thick skin. These patients have skin that takes longer than average to shrink down following surgery. Their skin is also more prone to forming denser scar tissue between the bone/cartilage skeletal structure and the skin. If this occurs before the skin actually shrink wraps down, unwanted excess scar tissue will be laid down and inhibit any further shrink wrapping. In some cases, the unwanted scar tissue will contribute to development of prominent contours and bumps that can distract from the final rhinoplasty result. Taping the nasal skin can minimize the likelihood of these undesirable occurrences.

I will usually recommend that my rhinoplasty and revision rhinoplasty patients begin taping 2-3 weeks following surgery. There are cases, however, when I will wait longer before recommending patients begin taping the nose. Once started, it is best to continue taping for several months in order to gain maximal benefit from this exercise. Patients are recommended to tape the nose prior to going to bed every night. The tape can then be removed in the morning before starting your normal daily routine. If you are able to keep the tape on the nose longer than just overnight, all the better.

Make sure you clarify with your rhinoplasty or revision rhinoplasty surgeon that taping the nose is, indeed, indicated in your case. In addition, your rhinoplasty surgeon should direct you specifically on his or her desired technique for taping the nose.

Choice of Tape

Using one of my own San Diego revision rhinoplasty patients as an example, I have outlined and explained the general steps involved with taping the nose.

In terms of choice of tape, I now recommend that patients get a roll of 1/2 inch medical grade paper tape at your local pharmacy. In my office, I happen to use a micropore paper tape made by 3M that is hypoallergenic and gentle on the nasal skin when used repeatedly. In addition, this type of paper tape is relatively inexpensive. I have found that 1/2 inch tape is much better for our purpose compared with tape that is thinner or wider.

Clean Your Skin

Prior to applying the tape, make sure to clean the skin over your nose and cheeks thoroughly with an alcohol pad. This helps to remove all oils, grease and make-up that would, otherwise, inhibit the tape from sticking properly.

Application of Tape

I recommend patients perform the nasal taping while in front of a mirror to ensure proper placement. The adjacent photo diagram is one of my San Diego revision rhinoplasty patients who had a primary rhinoplasty performed by a different plastic surgeon. I performed a revision rhinoplasty to reduce her upper bridge height further (as well as further tip reshaping). Going into her revision procedure we both knew that postoperative management of her skin was going to be part of the process. In this particular case, we are trying to tape just the upper bridge skin. But you can use this same technique even if you are taping lower down on the bridge near the nasal tip. When you begin the actual taping process, cut the piece of tape to be sufficiently long so that it can drape over the nose and extend onto the cheeks on each side. You will have to adjust the length of the each piece of tape as you go up or down along the bridge since the lower bridge near the tip is obviously wider. As you can see in the adjacent photo you want to stretch the piece of tape out maximally as you position it over the nose. Bring the tape down to contact the nose but do not attach the sides of the tape yet. Make sure you pull the tape very tightly on the skin and then attach the sides down to the cheek. Keep in mind the whole idea is to compress the skin down onto the underlying bone and cartilage. Once the first piece of tape is securely placed, you can start going down (or up) the nasal bridge with more pieces. Make sure to overlap the tape by 30-50% with each new strip as shown in the diagram. Once completed, the tape should look like the third photo below with a nice flush fitting over the skin. In fact, it should appear that the tape is tightly fitted and truly compressing the skin down.

Removal of Tape

Removing the tape must be done very carefully. You cannot simply grab the end of the tape and just pull it off the nose. This would defeat the purpose of taping exercises, which is to encourage the skin to adhere further to the nose. In the adjacent photos I show you how to remove the tape with proper technique. It helps if you can apply an over-the-counter adhesive removal solution that aids in loosening the tape from the skin. Alternatively, you can remove the tape while in a hot shower with lots of soap and lather having been applied to the nose. I recommend using a tweezer or equivalent instrument to grasp the edge of the tape as shown in the adjacent photos. Gently peel the tape off the skin but immediately try and pull the tape back over itself 180 degrees. Maintain this orientation as you remove the rest of the tape so you are essentially pulling the tape off parallel to the skin surface. This helps to minimize any chances of you pulling the skin up and off the underlying cartilage and bone.

Repeat this process on a daily basis until your rhinoplasty surgeon directs you to stop. If done consistently and correctly, taping the nose following rhinoplasty and revision rhinoplasty can significantly improve your final surgical outcome.

#### Teen Rhinoplasty
Teen Rhinoplasty with Dr. John Hilinski: Specialized Nose Surgery for Teens in San Diego, CA

Rhinoplasty, commonly known as a "nose job," is a highly sought-after procedure for teens who wish to refine the shape, size, or function of their nose. Whether for cosmetic reasons or to correct breathing issues, teen rhinoplasty is a personalized procedure that requires careful consideration to ensure the best outcomes for younger patients. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in rhinoplasty for teens, offering a compassionate approach that takes into account both the physical and emotional needs of adolescents. With his extensive expertise, Dr. Hilinski provides safe and effective rhinoplasty that helps teens feel more confident in their appearance while maintaining their natural features.

What is Teen Rhinoplasty?

Teen rhinoplasty is a form of nose reshaping surgery specifically tailored to younger patients who have either cosmetic or functional concerns about their nose. Common reasons for teen rhinoplasty include refining a bulbous or wide nasal tip, reducing a nasal hump, correcting nasal asymmetry, or addressing breathing issues caused by structural abnormalities.

This procedure is particularly beneficial for teens who feel self-conscious about their nose or experience nasal function problems, such as difficulty breathing. Since the nose plays a central role in the overall balance of the face, even slight modifications can significantly improve facial harmony and boost self-esteem.

Why Choose Teen Rhinoplasty?

Many teens choose rhinoplasty for a variety of reasons, including:

While cosmetic goals are often the primary reason for teen rhinoplasty, functional concerns like breathing problems can also be addressed during surgery, leading to both aesthetic and health benefits. Dr. Hilinski works closely with teens and their families to ensure that the surgery is appropriate for their needs and desires, offering personalized care and expert guidance throughout the process.

Special Considerations for Teen Rhinoplasty

Rhinoplasty for teens requires a thorough understanding of both the physical and emotional aspects of this procedure. Some important considerations include:

Dr. Hilinski takes great care to ensure that teen rhinoplasty is the right choice for each individual, focusing on achieving natural-looking results that enhance the patient's overall appearance and boost self-confidence.

FAQ: Teen Rhinoplasty

Schedule a Consultation with Dr. Hilinski

If your teen is considering rhinoplasty and wants to learn more about how this procedure can improve their appearance and confidence, schedule a consultation with Dr. John Hilinski. As San Diego's leading expert in teen rhinoplasty, Dr. Hilinski offers compassionate, personalized care designed to meet the unique needs of younger patients. Contact us today to take the next step toward a balanced and refined nasal appearance.

#### Teenage Crooked Nose Repair
Here is a great case example of teenage rhinoplasty to repair a crooked nose. This young lady from San Diego suffered trauma to her nose resulting in a fracture. As a consequence of the injury, her nose shifted over to the side. This led to trouble breathing through the nose (a deviated septum inside) as well as the cosmetic issue noted here. You can see in her before photo just how crooked her nose is when seen from the front. About one-third of the way down her bridge (starting from the top), it starts to angle off to the opposite side. It almost appears like an elbow within the middle of her nose. This type of crookedness in the nose can be really distracting as it shadows abnormally and draws unwanted attention.

Crooked Nose Surgery

Dr. Hilinski performed reconstructive nose surgery on her – not much different than what would be performed during rhinoplasty. This included complete reshaping of her nasal bones as well as restructuring of the cartilage framework of her nose. This is what was needed in order to try and straighten her bridge to create more symmetry.

Here results are shown here. You can readily see that her nasal alignment has been markedly improved. The bones are now more equal in shape from left to right. Plus, her cartilage contour has bee greatly enhanced to give her nose much better alignment down the middle. This includes the abnormal shadowing she previously had that was drawing unwanted attention to her nose. She now has a great looking nose (that functions better as well) that simply allows people to look more directly at her beautiful eyes without getting distracted.

#### Teenage Ethnic Rhinoplasty
Over the past decade (and even more so in the last 5 years), my practice has seen a steady rise in the number of teenage patients seeking cosmetic nose job, or rhinoplasty surgery. This observation is backed up by a number of recent studies that have confirmed the increasing number of teenage patients seeking cosmetic nose reshaping surgery. Such a trend is really not surprising, though, given the rapid growth of various social media platforms, such as Snapchat, Instagram and Facebook. There is no denying that, increasingly, teenagers are becoming more and more aware of their noses (along with other facial features) in this era of selfies and candid social photography. According to the American Academy of Facial Plastic and Reconstructive surgery, this exact trend is behind much of the spike in teenagers seeking cosmetic facial surgery in recent years. Combining this image consciousness with the fact the nose is so central to one’s facial appearance and there is no wonder that large numbers of teens are consulting doctors like me to have their noses reshaped.

Teenage Rhinoplasty Example

One example of a San Diego teenager seeking rhinoplasty surgery is presented here. This very pleasant young lady consulted with me to discuss changing the appearance of her nose. She was mostly bothered by the simple fact her nose was too big for her face. Indeed, when looking at her nose from the frontal view, you can see that it is a bit wide for her overall facial appearance. This was especially true for the nasal tip region where I would describe her tip as being somewhat broad and flat. On her side view, her bridge demonstrates a slight convexity, or hump, which further contributes to the nose looking too big. All in all, she desired to have rhinoplasty surgery to make the nose appear smaller and more feminine in shape.

It is import to note that this patient clearly has underlying ethnic facial features that needed to be appreciated when considering the nose reshaping process. It would look quite unusual if a rhinoplasty surgery was to put a largely Caucasian-looking nose on this face, right? Believe it or not, this is still done all the time by some plastic surgeons even in today’s day and age of advanced rhinoplasty technique. For example, some rhinoplasty surgeons have a ‘signature’ nose they create on a consistent basis – regardless of the facial features. They try and create a certain bridge height coupled with a particular angulation to the nose that is done in conjunction with a specific pointed tip shape. Try doing this and you will quickly find that a great majority of your ethnic rhinoplasty patients will be quite dissatisfied with their outcomes. Instead, all rhinoplasty surgeons should make it their goal to create a nose that is ethnically consistent in context with the surrounding facial features. In this case, for example, it would be a nose that ultimately still appears as if she could have been born with it.

Timing of Teenage Rhinoplasty

So what about timing of teenage rhinoplasty surgery? I happen to consult with quite a few teenage patients seeking cosmetic rhinoplasty surgery. Plus I see this exact question all the time in online rhinoplasty chat sites and forums. When it comes to timing for cosmetic nose reshaping surgery, I usually will recommend females wait until they are somewhere between 15-17 years of age at the earliest. Male rhinoplasty candidates should wait a few years later until somewhere between 17-18 years of age. Much of this reasoning relates to making sure the nose is not going to continue growing much after the surgery – which could significantly affect the healing process if this were the case.

Teenage Rhinoplasty Surgery

After discussing the possibilities of cosmetic rhinoplasty with the patient, she elected to proceed with the surgery. I ended up performing an open rhinoplasty approach – mostly based on the fact I needed to reshape her tip to create more definition. Had I been doing mostly bridge work, I would likely have recommended a closed rhinoplasty approach. Ultimately, the open approach provided me with excellent exposure and access to her nasal tip cartilages and bridge – along with the opportunity to make much more precise changes to the nose.

As part of her rhinoplasty procedure, I did reduce her bridge height just a bit. This primarily involved rasping the bridge of the nose using specialized instruments to create a smoother profile view. Once this was done, I then had to ‘break’ her nasal bones. Meaning, I had to move the nasal bones inward so that we maintained a nice, narrow frontal view. The precise location of the break is noted in the adjacent photo diagram and represented by the hashed yellow, curved lines. Had I not broken her bones after rasping the bridge, her nose would likely have appeared excessively wide – the exact opposite of what we were trying to achieve in the first place. In addition, her bridge was actually crooked. Although certainly not as crooked as many noses I repair, it was nonetheless asymmetrical. This is noted in the diagram by the red arrow showing how her nasal bridge was displaced off to her left side – creating an overall curved contour as indicated by the blue hashed line. So in the process of breaking her nasal bones to narrow them, I also was able to draw the alignment into a more midline orientation – making her bridge essentially straighter.

Once these changes were made to the bridge, attention was focused on her nasal tip region with the goal being a more defined looking nose. Some intraoperative photos of the nasal tip region are shown here for better understanding of how these changes were accomplished surgically. If you look on the left side, you will see the tip cartilages after the skin and soft tissue were pulled back. On the right side you will see these same tip cartilages after they were reshaped during the rhinoplasty procedure. The blue markings seen on the cartilage are actually from the surgical marking pen used to map out the specific changes being made to the tip. The overall sense you will get comparing the left and right photos is that the tip cartilages are now in a more narrowed shape and orientation. For example, the yellow line indicates just how wide the lateral crus segment was upon opening the nose. Looking at the right side you can easily appreciate how much the cartilage was narrowed – in this case using a cephalic trimming technique – by seeing how wide it used to be based on the same yellow line. Before surgery the domal region (indicated by the red/white arrow) was not only asymmetrical, it was also poorly defined. In an attempt to correct these issues, I ended up using a series of permanent sutures (green/white arrows) to make the tip more symmetrical and refined. On the right side, you can appreciate how the tip cartilages have been made to be nearly equivalent in shape and size while also appearing as if they are projecting out toward you now. This is precisely what was done with the suture reshaping – an established rhinoplasty technique called dome-binding sutures whereby the cartilage is crimped in precise locations to create the desired tip definition.

When looking at these same tip cartilages from below, you can also see a marked change in how the nasal tip has been reshaped. The left side, again, shows what her tip cartilages looked like upon opening the nose. On the right side you can see what these same tip cartilages looked like during the rhinoplasty surgery. Before surgery you can see how the overall shape of both lower lateral cartilages was more rounded (as indicated by the curved yellow lines). Once the cartilage was trimmed and the sutures were placed during surgery, the shape and orientation of the cartilage was greatly improved. For instance, you can easily appreciate how the lateral crus on each side is now a more ‘linear’ instead of being rounded (as shown by the green lines). In addition, the domes that comprise the nasal tip have now been brought together very nicely, which has also improved her nasal tip projection. The summary effect from this series of rhinoplasty maneuvers is a nasal tip that is more triangular in terms of overall shape – exactly what we were trying to achieve.

What you will quickly realize in looking at these intraoperative photos is that absence of any cartilage grafting. This is actually a bit unusual when it comes to ethnic rhinoplasty technique. In a good number of ethnic rhinoplasty patients, cartilage grafting is routinely used in order to make the desired changes in shape – especially in the tip region. Fortunately, in this case her nasal tip cartilages were sufficiently stiff that cartilage grafting was not needed to accomplish the surgical goals.

Teenage Rhinoplasty Photos

Attached are the before and after teenage rhinoplasty photos showcasing the overall changes that were made to her nose.

As you can see comparing the before and after images, the goals of the surgery were successfully accomplished. In particular, you can see how her nasal tip is much improved with a more defined shape. One of my favorite views in this case example is the base view of her nose before and after surgery. In the after photo, you can really see the difference in terms of the tip shape – where she was quite wide and flat before surgery and is now more triangular following rhinoplasty. When you look back at the intraoperative photos shown above, you can really see how the cartilage reshaping process correlates with the final shape that is seen here.

In addition, the bridge has been straightened and narrowed on the frontal view while giving her a smoother contour as seen on the profile view. As I always try to emphasize, it is important to nose that these changes were made while maintaining a very natural, ethnically consistent look to her nose.

Teenage Rhinoplasty Consult

If you are a teenager who is unhappy with the appearance of your nose and interested in undergoing cosmetic rhinoplasty, feel free to contact my office today to schedule a personalized consultation with me. Keep in mind that all minors must be accompanied to the consultation by a parent or legal guardian.

#### Teenage Rhinoplasty San Diego
This is a great example of teenage rhinoplasty in this young, ethnic female patient who desired a nose that looked smaller and more defined overall.

Her nose was rather broad as seen from the frontal view. On her oblique and side views, you can see how the bridge height was a bit excessive with poor shape. In addition, you can see how her nasal tip was a bit ptotic – also called a droopy nasal tip.

An open rhinoplasty was performed to reduce the height of the bridge. Osteotomies were then performed to narrow the bridge. At the same time, the nasal tip was lifted slightly and narrowed to make her nose look significantly smaller.

Teenage Rhinoplasty Results

#### Teenage Tip Rhinoplasty
The patient presented here is an illustrative case of teenage rhinoplasty with specific focus on cosmetic nasal tip reshaping. She is a very pleasant young lady who consulted with me (along with her parents) to see if she was a candidate for rhinoplasty surgery. Her main complaint was that her tip region drooped down excessively.

Teenage Rhinoplasty Before and After

#### Terms of Use
Introduction

This website is operated by John Hilinski, M.D. (collectively the “Company”, “We” or “Us”). The use of our website is subject to the following terms and conditions of use, as amended from time to time (the “Terms”). The Terms are to be read together by you with any terms, conditions or disclaimers provided in the pages of our website. Please review the Terms carefully. The Terms apply to all users of our website, including without limitation, users who are browsers, customers, merchants, vendors and/or contributors of content. If you access and use this website, you accept and agree to be bound by and comply with the Terms and our Privacy Policy. If you do not agree to the Terms or our Privacy Policy, you are not authorized to access our website, use any of our website’s services or place an order on our website.

Use of Our Website

You agree to use our website for legitimate purposes and not for any illegal or unauthorized purpose, including without limitation, in violation of any intellectual property or privacy law. By agreeing to the Terms, you represent and warrant that you are at least the age of majority in your state or province of residence and are legally capable of entering into a binding contract.

You agree to not use our website to conduct any activity that would constitute a civil or criminal offense or violate any law. You agree not to attempt to interfere with our website’s network or security features or to gain unauthorized access to our systems.

You agree to provide us with accurate personal information, such as your email address, mailing address and other contact details in order to complete your order or contact you as needed. You authorize us to collect and use this information to contact you in accordance with our Privacy Policy.

General Conditions

We reserve the right to refuse service to anyone, at any time, for any reason. We reserve the right to make any modifications to the website, including terminating, changing, suspending or discontinuing any aspect of the website at any time, without notice. We may impose additional rules or limits on the use of our website. You agree to review the Terms regularly and your continued access or use of our website will mean that you agree to any changes.

You agree that we will not be liable to you or any third party for any modification, suspension or discontinuance of our website or for any service, content, feature or product offered through our website.

Links to Third-Party Websites

Links from or to websites outside our website are meant for convenience only. We do not review, endorse, approve or control, and are not responsible for any sites linked from or to our website, the content of those sites, the third parties named therein, or their products and services. Linking to any other site is at your sole risk and we will not be responsible or liable for any damages in connection with linking. Links to downloadable software sites are for convenience only and we are not responsible or liable for any difficulties or consequences associated with downloading the software. Use of any downloaded software is governed by the terms of the license agreement, if any, which accompanies or is provided with the software.

Use Comments, Feedback, and Other Submissions

You acknowledge that you are responsible for the information, profiles, opinions, messages, comments and any other content (collectively, the “Content”) that you post, distribute or share on or through our website or services available in connection with our website. You further acknowledge that you have full responsibility for the Content, including but limited to, with respect to its legality, and its trademark, copyright and other intellectual property ownership.

You agree that any Content submitted by you in response to a request by us for a specific submission may be edited, adapted, modified, recreated, published, or distributed by us. You further agree that we are under no obligation to maintain any Content in confidence, to pay compensation for any Content or to respond to any Content.

You agree that you will not post, distribute or share any Content on our website that is protected by copyright, trademark, patent or any other proprietary right without the express consent of the owner of such proprietary right. You further agree that your Content will not be unlawful, abusive or obscene nor will it contain any malware or computer virus that could affect our website’s operations. You will be solely liable for any Content that you make and its accuracy. We have no responsibility and assume no liability for any Content posted by you or any third-party.

We reserve the right to terminate your ability to post on our website and to remove and/or delete any Content that we deem objectionable. You consent to such removal and/or deletion and waive any claim against us for the removal and/or deletion of your Content.

Your Personal Information

Please see our Privacy Policy to learn about how we collect, use, and share your personal information.

Errors and Omissions

Please note that our website may contain typographical errors or inaccuracies and may not be complete or current. We reserve the right to correct any errors, inaccuracies or omissions and to change or update information at any time, without prior notice (including after an order has been submitted). Such errors, inaccuracies or omissions may relate to product description, pricing, promotion and availability and we reserve the right to cancel or refuse any order placed based on incorrect pricing or availability information, to the extent permitted by applicable law. We do not undertake to update, modify or clarify information on our website, except as required by law.

Disclaimer and Limitation of Liability

You assume all responsibility and risk with respect to your use of our website, which is provided “as is” without warranties, representations or conditions of any kind, either express or implied, with regard to information accessed from or via our website, including without limitation, all content and materials, and functions and services provided on our website, all of which are provided without warranty of any kind, including but not limited to warranties concerning the availability, accuracy, completeness or usefulness of content or information, uninterrupted access, and any warranties of title, non-infringement, merchantability or fitness for a particular purpose. We do not warrant that our website or its functioning or the content and material of the services made available thereby will be timely, secure, uninterrupted or error-free, that defects will be corrected, or that our websites or the servers that make our website available are free of viruses or other harmful components.

The use of our website is at your sole risk and you assume full responsibility for any costs associated with your use of our website. We will not be liable for any damages of any kind related to the use of our website.

In no event will we, or our affiliates, our or their respective content or service providers, or any of our or their respective directors, officers, agents, contractors, suppliers or employees be liable to you for any direct, indirect, special, incidental, consequential, exemplary or punitive damages, losses or causes of action, or lost revenue, lost profits, lost business or sales, or any other type of damage, whether based in contract or tort (including negligence), strict liability or otherwise, arising from your use of, or the inability to use, or the performance of, our website or the content or material or functionality through our website, even if we are advised of the possibility of such damages.

Certain jurisdictions do not allow limitation of liability or the exclusion or limitation of certain damages. In such jurisdictions, some or all of the above disclaimers, exclusions, or limitations, may not apply to you and our liability will be limited to the maximum extent permitted by law.

Indemnification

You agree to hold us and our affiliates harmless against any losses, liabilities, claims, expenses (including legal fees) in any way arising from, related to or in connection with your use of our website, your violation of the Terms, or the posting or transmission of any materials on or through the website by you, including but not limited to, any third party claim that any information or materials provided by you infringe upon any third party proprietary rights.

Entire Agreement

The Terms and any documents expressly referred to in them represent the entire agreement between you and us in relation to the subject matter of the Terms and supersede any prior agreement, understanding or arrangement between you and us, whether oral or in writing. Both you and we acknowledge that, in entering into these Terms, neither you nor we have relied on any representation, undertaking or promise given by the other or implied from anything said or written between you and us prior to such Terms, except as expressly stated in the Terms.

Waiver

Our failure to exercise or enforce any right or provision of the Terms will not constitute a waiver of such right or provision. A waiver by us of any default will not constitute a waiver of any subsequent default. No waiver by us is effective unless it is communicated to you in writing.

Severability

If any of the provisions of the Terms are determined by any competent authority to be invalid, unlawful or unenforceable, such provision will to that extent be severed from the remaining Terms, which will continue to be valid and enforceable to the fullest extent permitted by law.

Questions or Concerns

Please send all questions, comments and feedback to us using the information provided on the contact page of our website.

#### Tertiary Revision Rhinoplasty
This is a quick example of a tertiary rhinoplasty outcome. So what is tertiary? Tertiary means this is the third time this young lady has had nose surgery. Unfortunately, she was involved in an accident many years ago that resulted in a number of cosmetic deformities to her nose. She underwent unsuccessful attempted rhinoplasty on two different occasions – performed by other surgeons.

Despite the prior surgeries, her nose was left as you see it here in the adjacent photo. At first glance, you will see that her nose is definitely deviated off to her right side. Everyone’s nose is deviated to some degree – even after very good facial plastic and rhinoplasty surgery. But, in this particular case, the nose is still pretty far off the midline and is quite noticeable. In addition, her nose is fairly broad and flat across the tip region. In fact, she has what I would say is very poor tip definition. If you look at her nose more closely, you will literally see the outline of her lower lateral cartilages. These borders are indicated by the curved, red lines in the adjacent photo diagram. Normally, these segments of cartilage would be much closer together – near the middle of the nose. Unfortunately, in this case, they are spread out or splayed fairly wide apart – creating the look that her nasal tip is too broad.

External Revision Rhinoplasty

I ended up recommending an external revision rhinoplasty surgery to help reconstruct the nose. An external rhinoplasty is simply another term for an open rhinoplasty. Both names refer to a rhinoplasty where an incision is made between the nostrils – along the columella – and the skin is lifted up to expose the underlying anatomy. Although there is great debate as to whether or not this is the best way to perform revision rhinoplasty, I happen to believe this approach affords me better visibility.

In this case, I needed to fully deconstruct her nasal tip before reconstructing it. This means that the whole nasal tip had to be disassembled and put back together – but in a more appropriate manner. In cases like this where two prior, unsuccessful rhinoplasty surgeries were performed, it usually means there is insufficient amount of cartilage remaining to reconstruct the nose. Therefore, I ended up using cadaveric rib cartilage to rebuild her nasal tip region.

Dramatic Revision Rhinoplasty Results

Here are what I happen to think are her fairly dramatic revision rhinoplasty results. On her frontal view, you will appreciate just how much better her nasal tip is now – much better symmetry along with markedly improved nasal tip definition. In fact, her new nose now looks much more natural without any real distracting features – the essence of doing great rhinoplasty work in my opinion.

San Diego Revision Rhinoplasty

If you are looking to undergo revision rhinoplasty, do not hesitate in contacting our office today to schedule a personalized consultation with me – Dr. John Hilinski – one of region’s leading experts in cosmetic nose reshaping surgery.

#### Testimonials
Video Testimonials
Online Reviews
Testimonies
Patient Profile Stories

Video Testimonials

Online Reviews

[flc-testimonials-widget]

Testimonies

Hello Dr. Hilinski,

Well it has been about a year and a half since my rhinoplasty surgery, and I don’t think that I ever returned for photos, so I wanted to send you my own. Also, I would like to thank you so much for making my dream come true. The surgery has definitely boosted my confidence, and it was one of the best decisions that I have ever made.

P.S. I also recommend a friend who got rhinoplasty from you about 3 months ago.

– Rachel (San Diego Rhinoplasty Patient)

Dear Dr. Hilinski,

Just a note to say Thank You for the wonderful job you did with my mini face lift procedure. I know it has been less than a week but I feel great and the procedure turned out even better than I had hoped. I so enjoyed your cozy office, wonderful staff (especially Tara) and your kind and reassuring manner every step of the way.

I look forward to referring you to others with the utmost confidence. Again, thank you so much!

– Jan (La Jolla Mini Face Lift Patient)

Dear Dr. Hilinski,

Just a quick update. Everything seems to be healing very nicely and my nose looks great! This is the happiest I have been in 6 years! You have truly given me my life back! I know you went out on a limb, but you have changed my life for the better. I can’t believe that I found you – truly divine intervention.

Rich and I were so pleased with you and he was blown away by your credentials and skills. I feel so blessed. I no longer look in the mirror and see a stranger! I see the old Paula – I missed that look for so long. No more depression, anxiety, and obsessing. I never thought I could feel so good again. I can’t tell you how many tears of joy I have cried over the past couple of weeks.

– Paula (Michigan Revision Rhinoplasty – flew to San Diego for surgery)

Dear Dr. Hilinski,

I don’t have the words to express my gratitude for the magnificent job you performed preventing terrible scarring on my son’s face. You are truly a miracle worker. The awful deep jagged cut above my son’s eye was sure to leave a terrible scar. You took sixteen meticulous, unbelievable stitches and the wound healed in less than two weeks – no scar! I am amazed and so thankful!

Thank you from the bottom of my heart. I know countless children and adults alike will be saved disfigurement and scarring, for as long as you practice medicine.

No words can thank you adequately.

– Kassy (Mother of a San Diego Facial Reconstruction Patient)

Dear Dr. Hilinski,

While I am only 5 days post op, I would like to extend to you my gratitude for the care and treatment I received during the entire process. I did ‘peek’ at the results and am amazed at the wonderful healing process and changes I am seeing.

Today, I was discussing with my husband why I chose you for this procedure. As you well know, changing one’s face is a very scary prospect. I think you should know that I  ’interviewed’ 7 doctors in 8 months. Your education and reputation could have been enough, except there was one particular reason that stood head and shoulders (excuse the pun) above the others. Simply stated, you are a good listener. You never interrupted a single question, nor did you assume what I was going to ask before I asked it. This is a very rate quality.

Also, the honesty and integrity you displayed in helping me to make decisions along the way are what will standout in our relationship. I didn’t know what to do regarding my nose and you sincerely advised me that if I were on the fence, to not do it. This was a very wise perspective. I didn’t want to change what nature gave me, I only wanted to fix what it forgot about it.

I need to thank you also because I stopped smoking. After thirty years of smoking (and hating myself for it) I sat with you and you looked directly at me and said you would not operate if I continued to smoke. I believed you and knew you meant it. I now consider this face lift a gift for quitting.

Your staff treated my husband and me with genuine care and concern. They answered our questions with patience and always returned our calls.

In thinking about this process, I came to the conclusion that if more doctors were to treat their patients in the manner in which I have been treated, more people would not be as reluctant to seek out their doctors and in the process many lives would be saved. I feel very blessed that I found you. Thank you, doctor for a truly wonderful experience.

– Eileen (San Diego Face Lift Patient)

The deviation of my septum was so bad that left my nostril was almost 100% blocked. As long as I can remember I had a problem breathing through my nose. I saw different surgeons and I guess they were not confident enough to fix my problem. I was referred to Dr. Hilinski by my primary physician. He was so confident that he could fix my problem and sure enough he did. He made me able to breathe after 32 years. Visit him and you never want to see any other surgeon.

Trust him, he’s the best.

– Mehrnaz (San Diego Septoplasty Patient)

The deviation of my septum was so bad that left my nostril was almost 100% blocked. As long as I can remember I had a problem breathing through my nose. I saw different surgeons and I guess they were not confident enough to fix my problem. I was referred to Dr. Hilinski by my primary physician. He was so confident that he could fix my problem and sure enough he did. He made me able to breathe after 32 years. Visit him and you never want to see any other surgeon.

Trust him, he’s the best.

– Mehrnaz (San Diego Septoplasty Patient)

Dr. Hilinski,

… if one more person asks me where I got my hair cut! Hey, it’s great… People can’t figure out what happened, but everyone who didn’t know I had a facelift (all three of them!) tell me I look so good… Long story short, I just got asked on a date… I haven’t been on a date in 14 years. Of course, I said I couldn’t, due to the fact that I am old enough to be his mother! But I am so jazzed that someone would even look at me twice now and not think of Depends and walkers! Bless you Dr. Hilinski and thanks!

– Kathy (San Diego Face Lift Patient)

Dear Mr. & Mrs. Hilinski [Dr. Hilinski’s parents]

I am a patient of your son who desires to provide you with what I believe to be an almost universal view of his character and talents: “A kind man who is much more than a brilliant surgeon and sculptor.” That probably the best summation of your son but permit me to elaborate.

Since I was a teen I was overwhelmed by a lack of confidence in personal relationships as a result of my receding chin. My inability to “hide” my profile was a part of my everyday experience. I had little or no confidence in dating, socializing etc. I always tried to sit facing people avoiding mirrors that reflect my profile and any other situation where my profile was highlighted. Then three years ago I saw a program entitled “Extreme Makeovers,” where plastic surgery was done to replace a man’s receding chin. The next week I went to my physician (Dr. Harry Alders, Scripps Rancho Bernardo) who encouraged me to wait five months until “the most talented, effective plastic surgeon I’ve ever known returns to San Diego.” How fortunate I became, to meet your son.

Upon meeting him I was touched by his kind manner and the care he took to be certain I understood what my procedure would entail. I left his office walking with two feet off the ground (I am still there). The sculptor did his work and “Oh how well he did it.” It is all like a wonderful dream. I date, I like to have people sit next to me, love three way mirrors and am comfortable in all social situations – a whole new existence for me. I know mine is only one instance of what he does for others but I believe mine to be typical.

His ability as a sculptor may be matched by someone somewhere but when you combine that with his kind, caring approach to patients he has no match. Thank you for raising him to be such a fine person.

I am certain you, as parents, know any imperfection that may be his but for his patients I can only say “we are still searching” and to you (and the Lord) we say thank you – A job well done.

– Tom (70 years young)

I started doing research for ear surgery about 20 years ago. I had a consultation with a surgeon and she recommended otoplasty, but I knew that’s not what I wanted. When I asked about making my ears SMALLER, she said it wasn’t possible. I lost hope and shelved the idea until last year when I started researching again, and after 20 years, and I happened upon Dr. Hilinski’s practice. I was amazed at what I saw. Not just otoplasty, but macrotia surgery to reduce the size of ears. I looked at his gallery and my mouth dropped. Where has Dr. Hilinski been my whole life?

Fast forward to the day of surgery, you wouldn’t have even known I was having surgery. Dr. Hilinski, Andrew and I listened to country music, chatted and laughed the whole time and I just had such a wonderful, fun experience. I felt comfortable and knew I was in great hands. Everything was explained in depth, from the initial consultation, to the pre-op, during surgery and even after. No question or concern went unanswered. His entire staff, Nicole, Ariana, and Andrew are just wonderful.

Today I had my post surgery appointment and after Dr. Hilinski removed the bandages, I cried tears of happiness. I couldn’t believe my eyes. My hair was up, and even though my ears were moderately swollen and bruised, I could see beyond that and that my ears were beautiful! I am so happy with the results, it’s an understatement. For the remainder of the day I couldn’t stop staring at my ears. I kept thinking, “So THIS is what it’s like to have normal sized ears…”

My new, “designer ears” will go perfectly with my designer shoes, ha! I can’t wait to fully heal so I can experiment with all sorts of updos, something I’ve never been able to do, but have always dreamed of.Dr. Hilinski has changed my whole life and it’s only 3 days post-op. It was like waking up on Christmas morning, and what I imagine Cinderella felt like after the proverbial Bippity Boppity Boo… Only at the stroke of midnight my ears will still be fabulous.

I’m eternally grateful to Dr. Hilinski for working his magic as well as to his entire staff who are just SO pleasant and put up with my million plus questions. I’ve waited my whole life for this.. THANK YOU Dr. Hilinski for not only making it possible, but for making my dreams come true.

– Diana H.

Patient Profile Stories

The entries below are from past patients who wanted to share their stories after undergoing facial plastic surgery procedures from Dr. John Hilinski. These stories reveal the impact surgery can have on one’s self-confidence and how this can translate to so many other areas of life. Seeing the excitement on our patients’ faces when they see their results for the first time is what we love most about helping them achieve their aesthetic goals. If you are interested in sharing your story, please email Dr. Hilinski with an update on life after surgery. We would love to hear from you!

Samantha

Hi Dr. Hilinski,

I just wanted to reach out to you quickly. I am still doing clinical research but I wanted to let you know that I started to do some fitness modeling part–time and will be featured in a couple of magazines! It’s been very exciting and I felt compelled to tell you because you should get partial credit. I can’t tell you how many makeup artists have complemented your natural work. I will be in the July 2014 issue of Max Sports and Fitness and also a Canadian fashion magazine called Ellements.

Thanks again for all your good workSamantha

Photo Credit: James Patrick, of James Patrick Photography

Michelina

It is always a nice surprise to see one of my past patients gracing the cover of a magazine. This one is Michelina James, a model and registered nurse, on the recent cover of San Diego Magazine. Great job Michelina!

-–Dr. Hilinski

#### Torn Earlobe Repair
Torn Earlobe Repair with Dr. John Hilinski: Expert Ear Restoration in San Diego

A torn earlobe can occur for various reasons, such as trauma, heavy earrings, or stretching from gauged piercings. This type of injury not only affects the appearance of your ear but can also make it difficult to wear earrings or feel confident about your appearance. Dr. John Hilinski, a renowned facial plastic surgeon in San Diego, specializes in torn earlobe repair procedures that restore the natural shape of the earlobe with minimal scarring. With extensive experience in facial reconstructive surgery, Dr. Hilinski can help you regain both function and aesthetic appeal through advanced techniques.

What Causes Torn Earlobes?

Torn earlobes are most commonly caused by:

Benefits of Torn Earlobe Repair Surgery

Restored Aesthetic

Dr. Hilinski carefully reconstructs the earlobe, ensuring a natural and symmetrical appearance.

Minimal Scarring

Using advanced surgical techniques, Dr. Hilinski minimizes visible scarring for a seamless repair.

Improved Confidence

Repaired earlobes can significantly boost self-esteem, especially for those who want to wear earrings again.

Quick Procedure and Recovery

Torn earlobe repair is a quick, minimally invasive procedure with a short recovery time.

Torn Earlobe Repair Procedure

The torn earlobe repair procedure is a straightforward outpatient surgery that is typically performed under local anesthesia. Dr. Hilinski begins by carefully removing any damaged tissue and reshaping the earlobe to its natural contour. In more severe cases, such as fully torn earlobes, he will reconstruct the earlobe using precise suturing techniques.

The procedure typically takes about 30 minutes to an hour, and patients can return home the same day. Stitches are usually removed within 5-7 days, and most patients can expect minimal discomfort during recovery.

FAQ: Torn Earlobe Repair

Schedule a Consultation with Dr. Hilinski

If you have a torn earlobe and are seeking a skilled facial plastic surgeon in San Diego, schedule a consultation with Dr. John Hilinski. His extensive experience in ear reconstruction and minimally invasive techniques ensure the best possible outcomes for your earlobe repair. Contact our office today to learn more about the procedure and how Dr. Hilinski can help you restore the natural beauty of your ears.

#### Truncated Short Nasal Tip
Here is a great example of how Dr. Hilinski can make you a new nasal tip. This female patient underwent prior rhinoplasty in Iran and was left with a nasal tip that was truncated. When we describe a tip as being truncated what we are referring to as shortening of the end of the nose. If you look at her profile view, you can appreciate how the tip of her nose appears cut off. This is indicated by the redline that shows where her nasal tip stops. Because the nose appears too short, we describe this as being truncated.

When you look at a nose like this from the front view, it usually will appear wider than desired. The nasal tip will also appear less defined. This is because there is a relative lack of structure and form to the tip region.

Why does something like this occur? Usually this is a result of excess manipulation of the lower lateral cartilages of the nasal tip. When these cartilages are repositioned and/or reshaped incorrectly, the tip of the nose will move backward – leaving the patient with a truncated tip.

Lengthening a Truncated Tip

So how does Dr. Hilinski go about fixing a shortened nose such as this one? In this particular case, he utilized an open rhinoplasty approach where the skin was lifted off of the nasal framework using an access incision made in between the nostrils. Once this was done, he then harvested some septal cartilage that she still had left inside of the nose and combined this with some ear cartilage. He needed this amount of cartilage in order to actually lengthen her nose by making her a new nasal tip.

In order to establish proper support for her new nasal tip, Dr. Hilinski first placed what is called a caudal septal extension graft. This is a piece of cartilage that was sewn to her native septum. It is strategically shaped and positioned so that it juts out into the area where she was previously truncated. This would serve as a sufficiently strong support mechanism for her new nasal tip. The paired segments of cartilage that usually form the nasal tip shape (called the lower lateral cartilages) were then attached to the caudal septal extension graft. All of these changes occur in a 1-2 centimeter area of the nose. But as we always preach, rhinoplasty and revision rhinoplasty are all about millimeters of detailed alterations.

Here in the adjacent photo comparison you can see just how much the tip of her nose changed on the operating room table. What you can readily appreciate is just how much length was added to her truncated nasal tip. This is all due to the caudal septal extension graft that was added to her nose to extend the tip outward. Whereas her tip was too short for her nose, after surgery it is now positioned just right to give it the much needed length and projection it was lacking.

Nasal Tip Lengthening Results

And here are her actual before and after tip lengthening photos. From all angles you can see just how much better she looks after fixing the short nose caused by her prior rhinoplasty. On her front view, you can see that she now has a nasal tip! There is also more symmetry seen from this angle since Dr. Hilinski was able to build her a new nasal tip. As you turn her head to the side, the oblique angle is even better at showing how much tip lengthening and projection was accomplished with the revision rhinoplasty. And as you look at her true side view, you can see that her cosmetic improvement is maintained and consistent with the results seen on the operating room table. Overall, her nose now has an entirely new tip with greatly enhanced cosmetic results.

#### Truth About Diluting
The Truth About Botox Diluting: What You Need to Know with Dr. John Hilinski at Hilinski Medspa

When it comes to Botox injections, proper dilution is key to achieving safe, consistent, and effective results. At Hilinski Medspa, we are committed to providing transparent information about the Botox injection process, including how Botox is properly diluted for different treatment areas. Led by board-certified facial plastic surgeon Dr. John Hilinski, our team ensures that each patient receives the appropriate number of units for their specific cosmetic needs.

Understanding Botox Dilution: Why It Matters

Botox comes in a concentrated form and must be diluted before it is administered. The dilution process involves adding a sterile saline solution to reconstitute the Botox, making it ready for injection. Proper dilution is critical because it ensures that the Botox is evenly distributed, allowing for precise treatment and consistent results.

Unfortunately, not all practitioners follow the correct dilution protocols, leading to suboptimal results or even the need for more frequent treatments. At Hilinski Medspa, we always adhere to the correct standards for diluting Botox to give our patients the best outcomes possible.

What Is the Proper Botox Dilution?

According to the manufacturer, Allergan, the standard dilution for Botox is adding 2.5 cc to 4 cc of sterile saline solution to a 100-unit vial of Botox. This creates a concentration of 25 units per 1 cc of solution when using 4 cc of saline. This dilution is commonly used for most cosmetic treatments, such as forehead lines, crow's feet, and frown lines.

However, certain treatment areas or goals may require different dilutions. For example, more concentrated dilutions may be used for smaller treatment areas that need more precise control, such as around the eyes. Alternatively, a more diluted Botox solution may be used for broader areas that need lighter treatment, such as the neck or jawline

Customized Botox Dilution for Different Treatments

At Hilinski Medspa, we take an individualized approach to Botox injections, adjusting the dilution based on the specific area being treated and your unique anatomy.

By customizing the dilution of Botox based on your treatment area, Dr. Hilinski and his expert team ensure that you receive the right amount of product for optimal, natural-looking results.

How to Tell If Botox Has Been Over-Diluted

Some practices may over-dilute Botox in an effort to stretch the product, leading to less effective treatments. This is why it's important to choose a provider who is transparent about the number of units being used in your treatment.

At Hilinski Medspa, we always charge by the unit, not by the syringe or area. This way, you know exactly how much Botox you are receiving, and you can be confident that you're getting the proper amount for your treatment goals. Over-diluted Botox may result in:

FAQ: Botox Dilution

Schedule Your Botox Consultation at Hilinski Medspa

If you're interested in learning more about how Botox can help you achieve a refreshed, youthful appearance, schedule a consultation with Dr. John Hilinski and the expert team at Hilinski Medspa. We are dedicated to providing the highest standard of care, ensuring that each patient receives properly diluted Botox for safe, effective results.

#### Turbinate Reduction Surgery Procedure
Turbinate reduction surgery is a very common procedure that is done as part of reconstructive nose surgery performed by facial plastic surgeons and otolaryngologists (ENT surgeons). To understand what turbinate reduction surgery really is, you first have to understand exactly what the inferior turbinate is and what we are trying to accomplish with the surgery.

What Is The Inferior Turbinate?

The inferior turbinate is an elongated, almost tubular structure inside of the nose that is intended to humidify air as it passes through the nasal passageway. In addition to humidification, the inferior turbinate also helps with heating and filtering the air breathed in through the nose. Therefore, it is considered a necessary anatomical component that is vital to having optimal nasal breathing. Without an inferior turbinate, you would have less humidification, heating and filtering of the air you take in through the nose and, therefore, less than ideal physiological breathing.

The inferior turbinate is approximately the size of an adult index finger. It is positioned against the side of the nasal passageway and runs parallel to the nasal septum, which is the wall that separates the left and right nasal passageway. As is shown in the adjacent diagram, there is an inferior turbinate on each side of the nose, although they are not necessarily the same size. There are actually three paired sets of turbinates in the nose – the superior (uppermost), middle (in between), and inferior (lowermost) – as is also depicted in the diagram. But of the three pairs, the inferior turbinates are typically more involved in routine nasal breathing and more often evaluated in conjunction with the septum.

The inferior turbinate is composed of an inner floating bone (white) wrapped on the outside by a mucosal lining (pink). When assessing the inferior turbinate, both the bone and lining should be considered since each contributes to the overall size, shape and function.

What Is Turbinate Hypertrophy?

Inferior turbinate hypertrophy simply means that the turbinate has increased in size. Turbinate hypertrophy can occur as a result of number of medical conditions. These include chronic nasal allergies and vasomotor rhinitis (which is abnormal nerve innervation that results in enlargement of the inferior turbinate). In addition, the inferior turbinate hypertrophy can result from deviation of the septum. For instance, if the nasal septum is deviated to the right side of the nose, the left inferior turbinate is going to ‘see’ more airflow since the opposite side is relatively obstructed. Since turbinates naturally respond to airflow by enlarging, they will swell more on the side that does not have the septal deviation.

So what does this mean if the inferior turbinate enlarges and swells? This usually translates into some form of nasal congestion, or difficulty breathing through the nose. This can occur on one side or the other. In some instances this may be bilateral and in others it may alternate between the left and right sides. Whenever this type of turbinate enlargement or swelling occurs, the patient will note some degree of nasal obstruction because the nasal airway becomes tighter or even closed off in some cases.

The adjacent diagram shows this visually where the turbinates enlarge and now occupy more space in the nose. You can imagine what might occur if there is a septal deviation on top of all this. If the septum is deviated and already causing some degree of nasal obstruction, the turbinate hypertrophy will just compound this problem.

Turbinate Reduction Surgery

In many cases, turbinate hypertrophy can be successfully treated with topical medications, such as nasal steroid and antihistamine sprays. In other cases oral antihistamines can be used to control the symptoms of turbinate hypertrophy. But there is a significant number of patients who simply don’t respond favorably to the medications to reduce the size and activity of the turbinates. In these patients who have what is termed ‘refractory symptoms’ of turbinate hypertrophy, surgery may help provide them more long-term relief.

The surgery to reduce the size of the turbinate is referred to as a ‘turbinoplasty’ by some surgeons. Others refer to this as ‘submucous resection’ of the turbinate. There are a wide variety of surgical procedures intended to treat turbinate hypertrophy. All of them are performed through the nostrils so there is no external incisions or scarring. Some involve use of a cautery type of device to heat the inside of the turbinate, thereby shrinking it down in size. Others, like Coblation, involve a technology called radiofrequency ablation, which also reduces the size of the turbinate from inside out. These methods for inferior turbinate reduction primarily target the mucosal component and do very little to the bone. In some patients, this is adequate to reduce the size of the turbinate and can result in significant improvement in their breathing. The following diagrams visually demonstrate this on the side view of the inside of the nose. On the left you can see how the inferior turbinate is enlarged along its entire length. The middle diagram shows a bipolar cautery device being inserted into the inferior turbinate just underneath the outer mucosal lining as part of the reduction surgery. On the right is the inferior turbinate now reduced in size. Compare this with the turbinate in the first diagram.

In other patients, however, the bony component of the turbinate has to be addressed as well. In these cases, the inferior turbinate can be approached by making a small incision along the front border to expose the underlying bone. The bone can then be partially resected and/or moved out to the side to help improve the nasal breathing. With time, this type of inferior turbinate reduction surgery will also see the mucosal lining shrink wrap down as the tissues scar inward progressively.

In some patients, a combination of these techniques may be utilized to obtain the most optimal surgical result.

So what is the best technique for inferior turbinate reduction surgery? The answer is – it is not known at this time. In the hands of a well-trained nose specialist, most patients with inferior turbinate hypertrophy are going to see a notable improvement in nasal congestion in a majority of cases. Your best bet is to consult with a board certified facial plastic surgeon or otolaryngologist-head and neck surgeon to determine what technique would suit your specific problem.

Does Insurance Cover Turbinate Surgery?

The answer is – yes. In most cases where the diagnosis of inferior turbinate enlargement or hypertrophy has been made and the patient has not responded ideally to use of topical nasal medications, health insurance should cover the surgery. In a good number of patients, inferior turbinate reduction surgery is commonly combined with septoplasty, or septal reconstruction, for a deviated septum. As always, you need to check with your insurance carrier to confirm actual coverage for these individual procedures.

#### Twisted Nose
Twisted Nose Correction Surgery with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A twisted nose, also known as a crooked nose, can cause both cosmetic and functional issues. For some individuals, a twisted nose is a result of genetics, while for others, trauma or injury may have caused the nasal deviation. Twisted nose correction surgery aims to realign and straighten the nose, improving both its appearance and function. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in twisted nose correction using advanced rhinoplasty techniques to deliver natural-looking, long-lasting results.

What is Twisted Nose Correction Surgery?

Twisted nose correction surgery, or rhinoplasty for nasal deviation, involves straightening and reshaping the nose to achieve a more symmetrical appearance. This surgery often involves addressing the underlying bone and cartilage structure to realign the nose. In addition to cosmetic improvements, patients who suffer from breathing difficulties due to nasal deviation often experience enhanced nasal function following surgery.

Why Would Someone Need Twisted Nose Correction Surgery?

Patients opt for twisted nose correction surgery for several reasons:

Special Considerations for Twisted Nose Correction Surgery

FAQ: Twisted Nose Correction Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you're considering twisted nose correction surgery to improve the appearance and function of your nose, schedule a consultation with Dr. John Hilinski today. As one of San Diego's leading experts in rhinoplasty, Dr. Hilinski offers personalized care and advanced surgical techniques to deliver natural-looking, long-lasting results. Contact us to learn more about how this procedure can help you achieve a more symmetrical, functional nose.

#### Upneeq
Upneeq Therapy in San Diego at Hilinski Medspa

If you're looking for a non-surgical solution to lift and open your eyes, Upneeq therapy at Hilinski Medspa may be the perfect option. Designed for those with droopy upper eyelids who aren't ready for surgical correction, Upneeq is a simple, once-daily, FDA-approved eye drop that helps lift the upper eyelid, giving your eyes a more open, brighter, and youthful appearance. Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, proudly offers this innovative treatment to help patients achieve beautiful results without surgery.

Non-Surgical Treatment for Droopy Eyelids

Upneeq provides an easy, non-invasive solution for droopy upper eyelids, also known as acquired ptosis. Acquired ptosis often develops later in life as the eyelid muscles stretch or weaken, leading to a sagging, tired appearance. With the introduction of Upneeq eye drops, patients can now achieve a more open, refreshed look without the need for surgery. The active ingredient in Upneeq works by lifting the eyelid muscles, allowing for a subtle yet significant lift that can last throughout the day.

What is Upneeq?

Upneeq (oxymetazoline hydrochloride ophthalmic solution) is a prescription eye drop specifically designed to treat acquired ptosis, a condition characterized by droopy or sagging upper eyelids. By targeting the Müller's muscle--a tiny muscle within the upper eyelid--Upneeq helps elevate the lid, creating a more alert and youthful appearance.

When applied, Upneeq begins to work within minutes, lifting the eyelid by 1-3 millimeters. Most patients see the full effect within 2-3 hours, and the results can last for 8+ hours. This makes Upneeq an ideal option for patients looking to refresh their appearance without the downtime or commitment of surgical procedures.

Benefits of Upneeq Eye Drops

Non-surgical

No need for anesthesia, cutting, or recovery time.

Quick results

See noticeable eyelid lift within hours.

Daily use

Simple, once-a-day application.

FDA-approved

Safe and effective for treating acquired ptosis.

With Upneeq, patients can enjoy brighter, more open eyes that look refreshed and youthful–all without the need for surgery.

FAQs About Upneeq

Schedule a Consultation for Upneeq

If you're interested in learning more about Upneeq therapy for droopy upper eyelids, Hilinski Medspa is here to help. Our experienced team, led by Dr. John Hilinski, is ready to answer any questions you have and guide you through the process. Contact us today to schedule your consultation and take the first step toward brighter, more youthful eyes with Upneeq therapy in San Diego!

#### Upper Eyelid Lift Ptosis Repair
Upper Eyelid Lift Ptosis Repair in San Diego with Dr. John Hilinski

What is Upper Eyelid Ptosis?

Upper eyelid ptosis, also known as "blepharoptosis," is a condition where the upper eyelid droops abnormally low, covering part of the iris (colored portion of the eye) and, in severe cases, approaching the pupil. This condition is typically caused by a weakening or separation of the levator muscle and its connective tissue, the levator aponeurosis, which are responsible for lifting the eyelid. When these tissues become elongated or detached, the eyelid droops, resulting in both a functional impairment (obstructed vision) and an aesthetic issue, often giving a tired or aged appearance.

Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in upper eyelid lift ptosis repair. He is highly skilled in this delicate procedure, helping patients regain both their vision and a more youthful appearance.

How Upper Eyelid Ptosis is Corrected

Levator Shortening Procedure

In cases of upper eyelid ptosis, the levator muscle and aponeurosis must be surgically corrected. During the ptosis repair procedure, Dr. Hilinski makes a small, hidden incision in the natural crease of the upper eyelid. Through this incision, the levator muscle and aponeurosis are carefully shortened or tightened to lift the eyelid to a more appropriate height. The aim is to restore normal function, improving peripheral vision while achieving a more open, youthful appearance.

Dr. Hilinski's extensive expertise ensures that the procedure is performed with precision, leading to natural-looking results with minimal scarring.

Benefits of Upper Eyelid Ptosis Repair

Improved vision

By lifting the drooping eyelid, patients experience better peripheral vision, which can significantly improve daily activities like reading and driving.

Enhanced appearance

The procedure rejuvenates the eye area, making the eyes appear more open and alert.

Minimal scarring

Incisions are hidden in the natural crease of the eyelid, ensuring discreet results.

Insurance coverage

Since this is a functional surgery, many insurance plans will cover ptosis repair if it is medically necessary.

Why Choose Dr. Hilinski for Upper Eyelid Ptosis Repair?

Dr. John Hilinski is a highly accomplished, double board-certified facial plastic surgeon specializing in both aesthetic and functional eyelid surgery. His extensive training and experience make him one of the leading experts in the field of facial plastic and reconstructive surgery, particularly in upper eyelid ptosis repair.

Dr. Hilinski earned his medical degree from the prestigious Harvard Medical School, where he built a strong foundation in surgical techniques and patient care. Following medical school, he completed a rigorous residency in Head and Neck Surgery at the University of California, San Diego (UCSD) Medical Center, focusing exclusively on facial and reconstructive surgeries. His residency allowed him to hone his skills in advanced surgical techniques for the face, head, and neck.

To further specialize in facial plastic surgery, Dr. Hilinski completed a fellowship in Facial Plastic and Reconstructive Surgery under the mentorship of Dr. Dean M. Toriumi, a world-renowned expert at the University of Illinois, Chicago. This advanced training provided Dr. Hilinski with in-depth expertise in upper eyelid surgery, including complex ptosis repairs, blepharoplasty, and brow lifts.

In addition to his clinical practice, Dr. Hilinski has made significant contributions to the field of facial plastic surgery through numerous publications, lectures, and workshops. He has been invited to speak at national and international conferences, sharing his expertise in advanced surgical techniques, including eyelid surgery and ptosis repair.

FAQ: About Upper Eyelid Lift Ptosis Repair

Schedule Your Consultation with Dr. Hilinski

If you are experiencing drooping upper eyelids and want to explore ptosis repair, contact Dr. Hilinski's San Diego office today to schedule a personalized consultation. As a leading facial plastic surgeon, Dr. Hilinski will help you achieve improved vision and a refreshed appearance.

#### Upper Lip Lift
Upper Lip Lift Surgery with Dr. John Hilinski

An upper lip lift, also known as upper lip shortening, is a popular procedure aimed at enhancing facial aesthetics by reducing the length of the upper lip and improving the definition of the vermillion (the border between the lip and facial skin). San Diego Lip Lift Specialist Dr. John Hilinski, a board-certified facial plastic surgeon, has extensive experience performing lip lift surgeries with a focus on delivering natural-looking, balanced results.

What is an Upper Lip Lift?

The upper lip lift, also called a subnasal lip lift or bullhorn lip lift, shortens the distance between the base of the nose and the upper lip. The ideal length for this area is typically 12-15 millimeters, but this may vary depending on the patient's individual facial proportions. An elongated upper lip can affect facial harmony and reduce tooth visibility when smiling, leading many patients to seek this procedure.

Who is a Candidate for Lip Lift Surgery?

Patients considering an upper lip lift are often bothered by:

An elongated upper lip that creates imbalance in the lower face.

Minimal upper lip movement during facial expressions, such as smiling, resulting in reduced tooth visibility.

A desire to achieve a more youthful, defined upper lip.

Whether caused by aging or genetics, an upper lip lift can restore balance and enhance the overall aesthetic of the face.

What to Expect During Lip Lift Surgery

Dr. Hilinski typically performs the upper lip lift procedure in about 30 minutes. There are two primary techniques used:

The preferred method is the subnasal lift, as it provides natural-looking results while minimizing visible scarring.

Recovery from an Upper Lip Lift

Patients can expect a recovery period of 5-7 days. Swelling is most prominent in the first 72 hours and can be controlled with cold compresses. Dr. Hilinski will provide instructions to manage pain and swelling. Sutures are usually removed around day 5, and patients can return to their normal activities soon after.

While the initial swelling subsides within a week, final results may take several months to fully emerge as the incision continues to heal and the scar fades.

Upper Lip Lift FAQs

Schedule a Consultation with Dr. John Hilinski

If you are considering an upper lip lift and want to explore how this procedure can enhance your facial harmony, Dr. John Hilinski is here to help. As a board-certified facial plastic surgeon with extensive expertise, Dr. Hilinski will guide you through the process, answer any questions, and create a personalized treatment plan tailored to your unique aesthetic goals.

During your consultation, Dr. Hilinski will evaluate your facial structure, discuss your desired outcome, and determine the most appropriate surgical approach. Whether you're looking to reduce the length of your upper lip, enhance your smile, or achieve a more youthful appearance, Dr. Hilinski's experience and precision will ensure you receive the best possible care.

To schedule your consultation with one of San Diego's leading facial plastic surgeons, contact our office today. Let us help you achieve the results you've always wanted!

#### Upper Lip Lift Case Study
This is a great case example of an upper lip lift procedure using a subnasale approach. This particular patient from San Diego, CA came to our office to consult about her excessively long upper lip. She is a very attractive female who simply did not like the fact that her upper lip was too long for her face. As you can see in the photos below taken prior to surgery, her upper lip did, in fact, appear too long. Some people describe this as an excessively long upper lip while others call it an elongated upper lip. What this really refers to is the vertical height of the upper lip being excessive in relation to the remainder of the lower one-third of the face.

Before Photos

Subnasale Upper Lip Lift

After consulting with her, our facial plastic surgeon, Dr. John Hilinski, recommended that she undergo a subnasale upper lip lift procedure. Subnasale refers to placement of the incision under (sub) the nose (nasale) where the upper lip meets the base of the nose. Some facial plastic surgeons refer to this as a bullhorn incision since the outline of the skin being removed mimics the shape of bullhorns. In this particular patient, the upper lip was measured carefully prior to the upper lip lift to determine how much skin would be left behind. Ultimately, we decided to leave approximately 14 mm of upper lip skin behind while removing the remainder using the subnasale approach. The actual upper lip shortening procedure was performed under local anesthesia in our own ambulatory surgery center procedure room. After placement of the numbing medication along the upper lip, an incision was made along the natural contour of the base of the nose.

The bullhorn subnasale approach was completed by extending the incision across the remaining portion of the upper lip. Once the excess upper lip skin was removed, the lip was lifted upward. Effectively, this shortens the vertical height of the upper lip – which is why many call this an upper lip shortening procedure.

Small sutures (stitches) were hidden under the skin while lifting the lip, which adds stability to the tissue so that scarring is minimized. Even finer sutures are then carefully placed to close the skin edges together.To give you an idea of what this looks like just prior to removing the sutures 5-6 days later, I have provided the adjacent photo. As you can see, the final incision (scar) is fairly well concealed under the nose in the natural junction zone where the upper lip meets up. At 5-6 days out, you can still see some redness and swelling, which is completely normal healing for this stage of the healing process. But even with that present, she looks quite presentable overall. The blue strings that can be seen in the photos are the finer skin sutures that were placed during the final closure of the upper lip lift.

Before and After Photos

This patient’s before and after photos of her subnasale upper lip shortening procedure are shown below. As you can see, her upper lip has been lifted up to create a shorter vertical height overall. When you look at her upper lip now, you simply do not see anything unusual or abnormal. The length of her upper lip is now much more appropriate for her facial proportions and appears very natural looking. If you look specifically at the lip itself, you can also appreciate how the pink portion of the upper lip has been turned up and out in a modest fashion – to give a slightly more pouty and feminine look. If you look closely, you can see a hint of where the incision was made underneath the nose, but it is not really obvious to someone who did not know what she had done.

Consultation for Subnasale Upper Lip Lift

If you happen to have an upper lip that is excessively long for your face, come visit with one of the experts in the subnasale upper lip lift, or lip shortening procedure. We are conveniently located in central San Diego in the Bankers Hill area. We look forward to meeting you!

#### Upper Lip Lift Case Study 2
This is another patient of mine who underwent a subnasale upper lip lift procedure to shorten her upper lip. Like many patients seeking upper lip lift surgery, this young lady desired to have a more proportional upper lip in comparison with her surrounding lower facial features.

As you can see in her pre lip lift photographs, her upper lip, indeed, appears elongated. When analyzing the lower face (from just under the nose down to the chin), we normally divide it up into horizontal thirds. This can be seen in the adjacent photo diagram as indicated by the green markings divided into three horizontal sections. The first section goes from just under the nose (the subnasale) down to the junction of the upper and lower lip. The second section goes from this junction down to the mental crease (the depressed area of skin just above the chin). The third section goes from the mental crease down to the bottom of the chin. Ideally, these three horizontal sections are equal in height – so equal one-thirds. That being said, it is quite rare to see anyone that naturally has ideal proportions with equal one-thirds. But there are many patients, like this patient seeking a lip lift, where the first horizontal section is longer (or higher when looking at her from the front). In fact, the blue in the diagram shows the true distance of her upper one-third. As you can see, it is several millimeters longer than it ideally should be. Even several millimeters like this can be the difference between an esthetically pleasing upper lip and a lip that is excessively long. In this particular patient example, this excess upper lip length was bothersome and brought out the disproportion in her lower face region. Because of this, she decided to consult with my facial plastic surgery office for a possible upper lip lift.

Other Considerations in Upper Lip Lift

In addition to issues with excess length, many patients seeking upper lip lift surgery desire other changes to this region. For example, some patients also want a more volume-enhanced upper lip. By this, I am referring to the red (or pink) portion of the upper lip. It is generally thought that an upper lip that has more red (or pink) as seen from the different angles is more desirable, or esthetically pleasing. This typically goes hand in hand with a well-defined cupid’s bow where most lips that have good volume and red show also have a nicely shaped cupid’s bow.

In addition, some lip lift patients would like to have more of a symmetrical shape to the upper lip. For instance, in this case example here, the patient’s upper lip is asymmetrically – which is much more the rule rather than the exception. You can see this in the adjacent photo diagram where the white arrow points out how her left upper lip arch is more pronounced versus her right side. In some cases of upper lip lift surgery, this can be improved in the process of shortening the upper lip.

Another consideration in upper lip lift surgery is dental show. This refers to visibility of the teeth, especially when one smiles. Many patients feel as if they have too little dental show when smiling and animating. In some cases, a subnasale upper lip lift can make it so there is more visibility of the teeth when smiling. Unfortunately, this does not happen in all cases and is more dependent on individual anatomy when it comes to shortening the upper lip.

Subnasale Upper Lip Lift

In this particular case example, a subnasale lip lift was performed for many of the indications noted above. Primarily, the procedure was being done to shorten her upper lip distance to create better balance. In addition, she did have the asymmetry with plans for improving this issue during the lip lift.

As in nearly all cases, I performed the lip lift with what is called a bullhorn incision. This is an incision (cut) that is made along the border of the bottom of the nose (where it junctions with the white portion of the upper lip). The photo diagram to the left visually demonstrates this incision. You can see from the superimposed bullhorn why the surgery is commonly referred to as a bullhorn lip lift procedure. The outline of the actual incision in the upper lip appears very similar to the shape of a bullhorn. In this particular case, you can see the see that has been removed from the upper lip. Underlying this area (the red tissue between the cut edges) is a portion of the orbicularis oris muscle – the oval shaped muscle that forms the opening of the mouth.

One of the few controversial topics in the world of upper lip lift surgery is whether or not this muscle should be cut at the time of the operation. In my humble opinion, I do not recommend cutting or hemming this muscle. I realize there are other plastic surgeons out there who do perform muscle tailoring (hemming) with lip lift surgery and achieve very nice surgical results. But I prefer not to cut or hem the muscle because of my concern with creating an abnormal smile after surgery.

I have seen this type of outcome on occasion (from other plastic surgeons’ work) and would like to avoid it if possible. Since it is possible to attain very nice results without cutting the orbicularis oris muscle, I choose to avoid this maneuver. Instead, I lift the lip by placing several strategic sutures deep underneath the skin but above the muscle layer. In this manner I can lift the lip up and close the incision line with minimal tension. This is demonstrated here to the right. In this photo you can see how the bullhorn incision has now been closed and the upper lip has been lifted. You also see how there is some degree of dental show where her teeth are peaking out through her lips. The red (pink) lip is more visible now and the cupid’s bow is more defined. Symmetry from left to right is also better. Looking at these photos from her actual upper lip lift surgery, you can certainly see there is some degree of swelling and tissue distortion. This is fairly normal for this type of upper lip enhancement surgery.

Recovery From Upper Lip Lift Surgery

Recovery from upper lip lift surgery using the subnasale (bullhorn) incision approach can take upwards of 7-10 days before the initial swelling settles down. Keep in mind that within the first few days there can be a moderate amount of swelling involving the upper lip to where it even looks quite concerning in some cases. Usually 72 hours is the point of maximal swelling before it begins to decrease. Thereafter, the swelling typically resolves in a timely manner.

Scars from the incision will take upwards of a full year to fully heal, but the upper lip really begins to look pretty good within a few weeks. Nowadays, most patients will begin using a topical silicone gel on the incision line to help promote better scarring. Sun precautions are also very important for the entire first year of healing to minimize chances of abnormal pigment and excess redness.

Before and After Upper Lip Lift Surgery

These photos here show this patient before and after subnasale upper lip lift surgery using the bullhorn incision approach and no muscle hemming. As you can see, her upper lip has been shortened very nicely without leaving her looking surgically done. Her incision (scar) hides very nicely along the junction of her nose and upper lip with minimal visibility as seen here. Her red (pink) lip has more show with a more feminine looking and defined cupid’s bow. Additionally, her upper lip is now more symmetrical when comparing the left and right. Overall, this patient is quite happy with her upper lip lift surgical result.

Subnasale Upper Lip Lift Consult

If you are considering upper lip lift surgery, feel free to contact our office today. We happen to be one of the few practices in this region of the United States that offers this very niche procedure to patients with an elongated upper lip.

#### Upper Lip Lift Case Study 3
This is another example of cosmetic upper lip enhancement using a bullhorn upper lip lift surgical technique. This very pleasant lady consulted with me to discuss the elongated appearance of her upper lip. Like many of my upper lip lift patients, she was actually from outside of the San Diego area and discovered me after researching the procedure online. Although there are other plastic surgeons performing bullhorn upper lip lift surgery, there are not a lot of us who do lip shortening surgery on a regular, consistent basis.

As you can see from the preoperative frontal photo, her upper lip does appear long. In addition, the pink portion of her upper lip (called the mucosal lip) did not have the desired fullness or volume. The patient and I discussed in detail the possibility of undergoing a bullhorn upper lip lift procedure to enhance the appearance of this region. The goals were to shorten her upper lip while making the mucosal portion of her upper lip appear fuller and more volumized.

Bullhorn Upper Lip Lift

She ultimately decided to proceed with the surgery. This was performed using my standard technique with what is called a subnasale incision. This incision involves making a cut along the natural border that sits between the bottom of the nose and the superior margin of the upper lip. A mirrored incision, or cut, is then made between the nose and the pink border of the upper lip (called the vermillion border). This second cut is calculated and measured based on how much shortening of the upper lip is desired. It also takes into consideration how much of the upper lip should remain in terms of length. The intervening excess upper lip skin is then removed.

The underlying muscle, called the orbicularis oris muscle, is typically left alone when I perform upper lip shortening surgery. There are plastic surgeons out there who will attempt to ‘hem’ the orbicularis oris muscle as part of their upper lip lift technique. In my experience, this maneuver is not always necessary and, in some cases, can result in undesirable changes to one’s smile. Therefore, in a great majority of my upper lip lift surgeries I will leave the orbicularis oris muscle alone.

The remaining cut skin edges are then brought together very carefully. This has to be done in a manner where the upper lip becomes ‘suspended’ to the undersurface of the nose using long-term sutures (stitches) that are strategically positioned. It is important to point out that these are the sutures that must be placed such that the bottom of the nose is not significantly altered as a result of the upper lip lift. Meaning – there are some plastic surgeons who do not pay close attention to this detail and simply place the sutures to approximate the skin edges. If this is done carelessly, the surgeon may inadvertently ‘pull’ the nostrils down, thus creating an abnormal appearance to the nose where there is more nostril ‘show’ or visibility. With more meticulous technique in closing the bullhorn lip lift incision, this problem can usually be minimized if not avoided altogether.

The bullhorn upper lip lift surgery took approximately 1.5 hours to complete and was able to be done under local anesthesia only. This meant she was able to avoid having a general anesthetic and had minimal risk in terms of the anesthesia being used.

Bullhorn Upper Lip Lift Results

Here are the results of her bullhorn upper lip lift several months after having the surgery.

In the diagrammed photo below, you can see where the bullhorn incision was made along the lower border of her nose (otherwise referred to as the nasal base). The red arrows indicate the approximate bottom of the incision line and the amount of upper lip skin that was removed to shorten the lip. On the right side of the diagrammed photo, you can see where the central portion of the upper lip was raised maximally. This is the area of the upper lip referred to as cupid’s bow – where the double curvature of the vermillion border of the lip creates a cosmetic landmark seen as a key esthetic feature. As you can readily see, the bullhorn upper lip lift procedure has now provided her with a more pronounced, pleasing cupid’s bow.

Her frontal, smiling and oblique views demonstrates the overall cosmetic improvement from the bullhorn upper lip shortening surgery. She now has an upper lip length that is much more appropriate and in balance with her surrounding facial features. Her upper lip volume (as gauged by the visibility of her ‘pink’ lip) has also been enhanced considerably – giving her the appearance of having a fuller, more voluptuous lip.

As you can appreciate, her scar is very well hidden – even when looking up close. In addition, there is little distortion of the nasal base contour and shape. Meaning – her nostrils have not been inadvertently pulled downward and are essentially in the same position as they were prior to the upper lip lift. Most importantly, the patient still looks quite natural without any real obvious signs of having had an upper lip lift procedure.

Bullhorn Upper Lip Lift Consultation

If you have an excessively long upper lip and feel that a bullhorn lip lift procedure may improve your appearance, contact my facial plastic surgery office today to schedule a consultation.

#### Vein Treatment
Laser Vein Treatment in San Diego at Hilinski Medspa

Are you troubled by visible veins on your face or body? Whether it's prominent blood vessels on your nose, unsightly spider veins, or red discoloration from rosacea, Hilinski Medspa offers effective solutions for laser vein treatment in San Diego. Led by Dr. John Hilinski, a Harvard-trained, board-certified facial plastic surgeon, our team uses advanced laser technology to safely reduce the appearance of unwanted veins, helping you achieve clearer, smoother skin.

How Does Laser Vein Removal Work?

At Hilinski Medspa, we use a state-of-the-art long-pulsed YAG laser to treat a variety of vascular skin concerns. The laser's energy is absorbed by hemoglobin--the red pigment found in blood--causing the targeted vein to heat up and collapse. Over time, the treated vein becomes less visible, allowing your skin to regain a more even tone and texture.

Conditions Treated with Laser Vein Removal

Our laser vein treatment is ideal for reducing the appearance of:

Spider veins

Telangiectasias (small, dilated blood vessels near the surface of the skin)

Facial veins

Leg veins

Rosacea-related redness

By targeting these problematic veins, laser vein removal can restore a smoother, more youthful complexion.

What Skin Types Can Be Treated?

Thanks to the advanced technology of the long-pulse YAG laser, we can treat a wide range of skin types safely and effectively. Whether you have lighter or darker skin, laser vein removal can provide significant cosmetic improvements.

What to Expect During Laser Vein Treatment

Laser vein treatment is a fast, minimally invasive procedure that typically lasts between 20 and 30 minutes. Most patients describe the sensation as similar to a rubber band snapping against the skin. While the treatment is well-tolerated by the majority of patients, topical numbing agents can be applied to ensure comfort.

After the procedure, some patients may experience mild redness and swelling in the treated area, but this usually resolves within a few days. If you notice scabbing, avoid picking at it and apply a soothing emollient like Aquaphor to aid in healing.

What to Expect During Laser Vein Treatment

Laser vein treatment is a fast, minimally invasive procedure that typically lasts between 20 and 30 minutes. Most patients describe the sensation as similar to a rubber band snapping against the skin. While the treatment is well-tolerated by the majority of patients, topical numbing agents can be applied to ensure comfort.

After the procedure, some patients may experience mild redness and swelling in the treated area, but this usually resolves within a few days. If you notice scabbing, avoid picking at it and apply a soothing emollient like Aquaphor to aid in healing.

How Many Laser Vein Treatments Will I Need?

In many cases, a single laser vein treatment session is sufficient to significantly reduce the appearance of veins. However, some patients may require additional treatments to achieve optimal results, especially for larger or more stubborn veins. During your consultation, Dr. Hilinski will assess your specific condition and create a customized treatment plan based on your goals.

FAQ: Laser Vein Treatment in San Diego

Call for a Consultation for Laser Vein Treatment at Hilinski Medspa

If you're ready to say goodbye to unwanted veins and experience the confidence that comes with clearer, more radiant skin, don't hesitate to reach out. Contact us today to schedule your consultation and learn more about how our laser vein treatment in San Diego can benefit you. Our friendly staff will walk you through the process, answer any questions you have, and help you take the first step toward healthier-looking skin.

At Hilinski Medspa, we believe in empowering our patients with effective, non-invasive treatments that deliver results. Book your consultation now and let us help you reveal your most confident, beautiful self.

#### VI Peel
Revitalize your skin with the VI Peel, a medium-depth chemical peel that improves skin texture, pigmentation, and early signs of aging. This advanced treatment, developed by the Vitality Institute, is a top choice for achieving youthful, radiant skin in San Diego and La Jolla. Whether targeting fine lines, acne scars, or pigmentation issues, a VI Peel offers visible results with minimal downtime.

Dr. John Hilinski, a double board-certified facial plastic surgeon and head and neck specialist, brings his expertise to every treatment, ensuring your skin receives the highest standard of care and attention. With prestigious training from Harvard Medical School and extensive experience as a Clinical Instructor in facial plastic surgery, Dr. Hilinski is a trusted name in San Diego and La Jolla for advanced skin treatments.

How Does a VI Peel Work?

The VI Peel contains a unique blend of powerful ingredients:

Trichloroacetic Acid (TCA) – 10-12%

Phenol – 10-12%

Salicylic Acid – 10-12%

Vitamin C – 10-12%

Tretinoin – 0.1-0.4%

This carefully designed formula exfoliates the skin’s top layers, prompting the body to produce collagen and elastin, essential proteins for youthful, firm skin. The peel’s effectiveness is amplified by the presence of phenol for pigmentation, salicylic acid for acne-prone skin, and vitamin C for skin brightening.

Benefits of the VI Peel in San Diego

The VI Peel is ideal for individuals with:

Uneven skin tone and texture

Fine lines and wrinkles

Acne and acne scarring

Hyperpigmentation, including melasma

With a series of VI Peels, patients can expect a gradual improvement in skin clarity, tone, and texture, making it one of the most popular choices for facial rejuvenation in San Diego and La Jolla.

Why Choose Dr. John Hilinski for Your VI Peel?

Dr. Hilinski has earned a reputation as one of San Diego’s leading experts in facial aesthetics, and his credentials underscore his dedication to excellence:

Dr. Hilinski’s practice exclusively focuses on the face, ensuring that each treatment is tailored to enhance natural beauty while respecting the skin's health and integrity.

What to Expect with a VI Peel

The VI Peel process is quick, usually lasting 30-45 minutes and involves minimal discomfort. After the peel, you can expect some mild peeling within three days, with optimal results visible after a few weeks as collagen and elastin rebuild. The treatment is suitable for various skin types and can be applied to the face, neck, chest, and even the hands and back, making it versatile for different aesthetic goals.

Frequently Asked Questions About VI Peel

Book Your VI Peel Consultation in San Diego or La Jolla

With a wealth of experience and a patient-centered approach, Dr. John Hilinski is here to help you achieve beautiful, healthy skin through the transformative benefits of the VI Peel. Schedule a consultation today to learn how this powerful, scientifically formulated peel can enhance your skin's natural radiance.

Contact Dr. Hilinski’s office in San Diego to experience the benefits of a professional-grade VI Peel performed by one of the region’s top facial plastic surgeons.

#### Virtual Online Consultation
A significant percentage of Dr. Hilinski’s patients reside outside of the San Diego and southern California area. In fact, many of this patients are international and come from overseas to have Dr. Hilinski perform their surgery. Since establishing his practice, he has had patients from literally all over the world come to San Diego for facial plastic surgery.

Most of these patients discover Dr. Hilinski after conducting online research regarding their procedure of interest. Given the obvious difficulties associated with traveling to California for a consultation, Dr. Hilinski offers virtual, online consultations for out-of-town patients. These consults are conducted via our private, secure electronic medical record system. Please note, we do not offer Zoom nor Skype.

Virtual Consultation

For those traveling from out of town, our team offers virtual consultations with Dr. John Hilinski. Although this is not a substitute for an in-person meeting with him, we understand it can be beneficial to have an initial “online screening consultation” before making plans to travel to Southern California. During the virtual consultation, patients will typically exchange emails with Dr. Hilinski and send photos for review along with their medical history and surgical goals. To schedule your virtual consultation, please fill out the form below.

#### Wide Bridge
Wide Bridge Nose Correction with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A wide nasal bridge can create an unbalanced facial appearance, causing the nose to appear too broad in proportion to other facial features. This condition can be due to genetics, trauma, or previous surgeries. Wide bridge correction surgery, also known as nasal bridge narrowing, is designed to reshape and refine the nasal bridge, helping create a more symmetrical and harmonious facial appearance. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in rhinoplasty for wide bridge correction, offering personalized solutions to achieve natural-looking, proportional results.

What is Wide Bridge Correction Surgery?

Wide bridge correction surgery is a rhinoplasty procedure aimed at reducing the width of the nasal bridge, bringing it into better proportion with the rest of the face. This surgery often involves a combination of techniques, such as narrowing the nasal bones and adjusting cartilage, to create a refined and aesthetically pleasing nasal structure.

Why Would Someone Need Wide Bridge Correction Surgery?

Patients seek wide bridge correction surgery for various reasons:

Special Considerations for Wide Bridge Correction Surgery

FAQ: Wide Bridge Correction Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you are considering wide bridge correction surgery to achieve a more balanced and refined nasal appearance, schedule a consultation with Dr. John Hilinski today. As San Diego's leading rhinoplasty expert, Dr. Hilinski offers personalized care and advanced surgical techniques to deliver natural, long-lasting results. Contact us to learn more about how this procedure can enhance your facial harmony and confidence.

#### Wide Nasal Bones and Wide Tip
This is a great case study on how Dr. Hilinski used great rhinoplasty technique to narrow this San Diego lady’s broad, wide nose. She consulted with Dr. Hilinski and noted how unhappy she was with the bulbous, wide nasal tip. When you looked closely at her nasal tip region, one could readily see how the nasal tip was lacking in definition.

In addition, she had fairly wide, or splayed, nasal bones. She has obvious freckling of the nose that helps in ‘mapping’ out the actual width of her nose. In this particular case, her nasal bones were nearly as wide as the nasal base – which should not be the case. Ideally, the nasal bones will be more narrow than the nasal base – contributing to a nice, elegant brow-tip aesthetic line along the bridge of the nose.

When looking at the oblique view of her nose, you can see just how broad and wide her nose really is from this angle. Although she doesn’t have something like a huge nasal hump deformity or drooping nasal tip, she was still a great candidate to undergo finesse rhinoplasty surgery by Dr. Hilinski.

Intraoperative Rhinoplasty

Once in surgery, Dr. Hilinski was able to readily see just how bulbous her nasal tip was when he saw the lower lateral cartilages that comprise the nasal tip. This is seen here in the adjacent photo taken during the actual nose job surgery.

As you can see, her nasal tip cartilages were, indeed, quite rounded and broad. They almost appear as two arches. Their overall outline is far from the ideal shape of a soft triangle. Instead, they form more of an overall trapezoidal shape to the nasal tip. No wonder her nose appeared so wide and bulbous from the frontal view! Dr. Hilinski ended up performing quite a bit of change to her nasal tip to make it more narrow and defined. But he was quite careful in making sure that she did not develop any unwanted pinching or collapse as a result of the nose job.

During the rhinoplasty surgery, Dr. Hilinski also focused his attention on making the nasal bones more narrow. This is a common nose job maneuver and is referred to as osteotomies. This is essentially breaking of the nasal bones to bring them in closer together. The smeared purple markings in the adjacent photo correspond to the where the lateral cuts were made to break her nasal bones. These are the bone cuts on the side of the nose that allow the rhinoplasty surgeon to really move the bones inward. There is obviously some degree of surgical swelling seen in the photo – but you can still tell how her nasal bones are nicely narrowed on the operating room table. If you look at her nasal tip you can also appreciate how it has been defined and refined on the operating room table.

Early Rhinoplasty Recovery

As with most of his nose job patients, Dr. Hilinski saw her on a regular basis after her rhinoplasty procedure. When Dr. Hilinski breaks a nose, he likes to see patients several times within the first few weeks so he can assess how the nasal bones are positioned. There is actually a window of opportunity within the first 6-9 weeks after a nose job where the nose bones are still mobile – before they fuse and heal in place.

During this early rhinoplasty recovery period, patients can push or press on the nasal bones to help get them in an even more optimal position. Dr. Hilinski calls these ‘digital pressure exercises’ for rhinoplasty patients. Although the nasal cast is placed at the end of the nose job to help keep the bones in their new position, inevitably some rhinoplasty patients will see their bones move once the cast comes off. This is not in the majority of cases, but it can occur in a minority of rhinoplasty patients. When it does occur, Dr. Hilinski will likely recommend the digital pressure exercises to try and get the best rhinoplasty result possible. In some cases, nose job patients will push on both sides of the nose. In others, Dr. Hilinski will have patients only pushing on one side of the nose – or more on one side of the nose. Dr. Hilinski will show you in the office how to do these exercises properly. Do not attempt to to do these independent of an expert nose job surgeon’s recommendations – or you will risk damaging your nose.

The adjacent photo is the same patient only weeks out from her nose job by Dr. Hilinski. As you can easily see, her nose is quite puffy and swollen. This is not unusual, which is why Dr. Hilinski is showing this type of photo here. Some patients should expect their nose to be this swollen even weeks out from surgery. Some are not as swollen – and others are even more puffy after rhinoplasty. But be prepared.

When Dr. Hilinski saw her at this point in his San Diego office, he recommended she begin doing the digital exercises for nose job patients. He guided her to the exact technique and recommended she do this 10-15 x per day to try and get her nasal bones in a more ideal position after breaking her nose.

Wide Nose Rhinoplasty Results

Fast forward to her long-term results and you can very easily see just how much change happened with her nose job. Looking at her nose from all these angles, you can readily see how it just looks smaller in size – and that is because it is a smaller nose! More specifically, the nose tip has been defined and narrowed – yet doesn’t look pinched and fake. And her nasal bones have been brought in very nicely by Dr. Hilinski. On the oblique view, you can even see how the nose is overall smaller in size. The nose tip is no longer bulbous in shape and the bridge is sleeker in appearance. Her side view did not change a whole lot – but you can even see here how the nose is more refined. Looking back at her nose job photos from just weeks out from Dr. Hilinski’s rhinoplasty, you see how much swelling has gone down and how the skin has truly shrunk wrap around the new smaller nose size. Look even closer at the nasal bones on her front view and you can appreciate the difference between where her nose was a few weeks out and how it looks after appropriate amount of time to heal.

#### Wide Tip
Wide Tip Nose Correction Surgery with Dr. John Hilinski: Expert Rhinoplasty in San Diego, CA

A wide or bulbous nasal tip can affect the overall balance and appearance of the face, making the nose appear larger and less refined. Wide tip correction surgery is a type of rhinoplasty that focuses on reshaping and refining the nasal tip, giving it a more defined and proportional appearance. Dr. John Hilinski, a double board-certified facial plastic surgeon in San Diego, specializes in wide tip correction surgery, offering customized procedures that help patients achieve a more balanced and aesthetically pleasing nose.

What is Wide Tip Nose Correction Surgery?

Wide tip correction, also known as tip rhinoplasty, is a surgical procedure designed to narrow and refine a broad or bulbous nasal tip. The goal of this surgery is to create a more contoured and harmonious nasal tip that complements the rest of the face. Depending on the patient's anatomy, this procedure may involve reshaping or removing excess cartilage in the tip of the nose, while preserving structural integrity to maintain natural-looking results.

Why Would Someone Need Wide Tip Correction Surgery?

Patients seek wide tip correction surgery for a variety of reasons:

Special Considerations for Wide Tip Correction Surgery

Why Choose Dr. John Hilinski for Wide Tip Correction in San Diego?

Dr. John Hilinski is a double board-certified facial plastic surgeon with extensive experience in rhinoplasty, including wide tip correction. His credentials include:

Dr. Hilinski's personalized approach ensures that every patient receives a treatment plan tailored to their specific needs and goals, helping them achieve a more refined and harmonious nasal tip.

FAQ: Wide Tip Correction Surgery

Schedule a Consultation with Dr. Hilinski in San Diego

If you are considering wide tip correction surgery to refine the shape of your nose, schedule a consultation with Dr. John Hilinski today. As San Diego's leading rhinoplasty expert, Dr. Hilinski offers personalized care and advanced surgical techniques to achieve natural-looking, long-lasting results. Contact us to learn more about how this procedure can help you achieve a more defined and balanced nasal appearance.

#### Widening the Tip
This is a somewhat rare type of rhinoplasty that involves making the nasal tip a bit wider. This young lady consulted with Dr. Hilinski after she was referred to him by another surgeon in the San Diego area. One thing that immediately jumped out at Dr. Hilinski was the fact her nasal tip appeared to skinny, or pointed, for her face. This appearance was also confirmed on her lateral view where you can see how the tip of the nose indeed looks pointed.

As part of the effort to reshape her nose, Dr. Hilinski recommended widening of the nasal tip to give her nose overall better balance and harmony. He also recommended giving her nasal tip a bit more roundness at the same time.

Open Rhinoplasty

An open rhinoplasty procedure was performed to give optimal exposure to her tip region. Maneuvers performed during the nose job included bringing her tip slightly closer to the face – also called deprojection of the nasal tip.

The actual nasal tip was also rotated slightly in the process of reshaping the nose. Using a technique called lateral crural overlay, the tip was also made to be slightly wider in size and shape. In the adjacent photo you can see how her nose looked at the conclusion of the rhinoplasty surgery – and how the fresh, new nose compared with her profile view prior to rhinoplasty surgery.

Before & After Rhinoplasty

Her before and after rhinoplasty photos are shown here. As you can see, her nasal tip no longer appears too narrow or pointed. She now has a more rounded, yet natural looking shape to the tip of her nose. Plus her tip has been rotated and deprojected slightly.

### Gallery

#### Case-10127
Amazing skin tightening treatment using Profound RF (microneedling with RF).

#### Case-10128
This patient was so bothered by her nostril deformity following prior rhinoplasty surgery performed by a different plastic surgeon. Check out this beautiful result where I was able to make her nostrils much more symmetrical while maintaining a natural looking result as if she was born like this.

#### Case-10129
Classic macrotia ear reduction case in a male patient who flew from Ireland to have his ears reduced in size by Dr. Hilinski.

#### Case-10130
Great example of lop ear correction on her left side. This is a highly specialized type of cosmetic ear reshaping that is only performed by a few plastic surgeons out there. See how her left ear (right side of the photo) has been made taller by correcting the lop deformity. This involved reshaping the cartilage framework and moving her skin around to create a normal looking ear. On her right side, classic otoplasty (ear pinning) was performed to try and make both ears look as symmetrical as possible.

#### Case-10131
Long-term results following a closed, scarless rhinoplasty surgery. Her bridge height was reduced to create a more pleasing and feminine profile while her tip was projected to give it more definition. She was actually a relatively tough case, given the fact that her skin is much thicker than the average rhinoplasty patient. Fortunately with time her skin began to shrink wrap around the new underlying framework, giving her a beautiful new result.

#### Case-10132
Check out this beautiful transformation along the lower face and upper neck region using a minimally invasive surgical approach. This was NOT achieved with facelift surgery. Her outcome was realized by liposuctioning her neck and using sutures to reshape the muscle and an energy-based device to tighten the skin.

#### Case-10133
Before and after lower face and upper neck lift. Note how natural he looks following surgery, which is so important especially when performing male anti-aging surgery.

#### Case-14185
URL: https://www.drhilinski.com/gallery/patient/case-14185/

#### Case-14192
URL: https://www.drhilinski.com/gallery/patient/case-14192/

#### Case-14256
Facial Pix:E treatment - micro needling with radiofrequency combined with erbium laser treatment to improve overall skin texture while tightening.

#### Case-14264
Example of face and neck lift in this female patient who desired more jawline and neckline definition. Note how natural she still looks.

#### Case-14273
Looking more rested and youthful following lower face and upper neck lift.

#### Case-14279
Closed rhinoplasty in this female patient with very thick nasal skin, which made this case particularly challenging in terms of creating more tip definition. Here she is over 1 year out from surgery showing a beautiful, natural looking improvement.

#### Case-14301
Fat transfer to the midface region to help restore proper volume to the cheek and lower eyelid region. Still her. Just better.

#### Case-14311
Years out from combined ear reduction and ear pinning (otoplasty) in this young lady who now has absolutely fabulous ears!!!

#### Case-14325
Just another remarkable case of ear reduction - this time mostly the top of the ear was reduced in size but the earlobes were shrunk just slightly as well. So incredibly natural.

#### Case-14330
Great example of how Dr. Hilinski can help patients whose ears have been overdone by other plastic surgeons. In this case, the ears were left with a telephone deformity - where the center of the ear is stuck back so far versus the upper and lower poles. Using rib cartilage grafts, Dr. Hilinski was able to help restore a much more normal looking position and shape.

#### Case-14344
Beautiful, classic example of how powerful the CO2 laser can be in treating unwanted facial wrinkles.

#### Case-14374
Great example of how Dr. Hilinski can actually make ears smaller in size. This young patient from Miami flew to San Diego to have her large ears made normal in size. So Dr. Hilinski performed his famed macrotia ear reduction surgery from top to bottom to give her a pair of ears that simply look normal in size and natural in contour.

#### Case-14379
Such a natural looking transformation for this patient who had a bulbous nasal tip - that you can really see on the oblique or 45 degree angle view. Check out her new tip that Dr. Hilinski created that has no bulbosity and looks entirely natural for her face.

#### Case-14398
Beautiful results from Radiesse injection to the lower face (lower cheek and jawline) to help restore lost volume in her face. As you can see, she doesn’t look like she had filler injected. She simply looks incredibly natural - but with much better contour and volume versus prior to treatment.

#### Case-14452
Helping to improve acne scarring can be incredibly challenging and often requires a multi-modality approach as is shown here. This patient was bothered by her deep acne scars around the mouth and jawline. I ended up performing Bellafill injections to first help give a bit more soft tissue support under the scars. We then performed a croton chemical peel to help improve the skin appearance. As you can see here, there is an obvious improvement with much less unwanted attention being drawn to the area. Is it perfect skin? No. But patients with severe acne scarring like this need to be realistic and adjust their expectations.

#### Case-14479
Great example of incision-less or scarless otoplasty ear pinning. This patient came to California from out of state to have Dr. Hilinski perform this minimally invasive variation of ear pinning surgery. No cartilage was removed - just strategic reshaping of the cartilage with carefully placed sutures. Here he is months into the healing process with an amazing result!

#### Case-14487
Refined, not redefined. This ethnic rhinoplasty patient came to us hoping to smooth out a prominent dorsal hump and soften a bulbous nasal tip—while still preserving their unique identity. The result? A beautifully balanced profile and a tip that looks like they were born with it. Still them… just better.

#### Case-14490
Another beautiful ear pinning result from Dr. Hilinski - helping to bring in only the one side in this female patient who was so bothered for years and years at the fact her ears were just so different in appearance.

#### Case-14500
Incredible transformation for this female patient who sought out Dr. Hilinski to perform rhinoplasty surgery on her. The end goal was a more defined nose. Mission accomplished

#### Case-14503
Complete tip reconstruction in this male patient who had trouble breathing through his nose and had significant asymmetry in terms of the tip shape and contour. When performing male rhinoplasty it is so important that we maintain a natural looking nose in the end.

#### Case-14516
Not all ear pinning patients need or want drastic change. This is a great example where he thought his ears were a bit too prominent - and they did stick out too far. The worst case of prominent ears? No. But enough that bothered him - so we pinned them back on both sides to simply look less obvious - yet still natural.

#### Case-14518
Nice example of male rhinoplasty in a patient with very thick skin who wanted to simply have a less bulbous, rounded tip - but wanted to sill look like himself. And that is precisely what we were able to give him following tip rhinoplasty surgery.

#### Case-14547
Nice example of how Bellafill can be used to treat acne scars. This patient had a number of depressed, atrophic acne scars, which were injected to efface and lift them out using Bellafill.

#### Case-14566
Another beautiful ear pinning case in a male patient who had severe asymmetry from left to right. Dr. Hilinski was able to pin his ears back closer to the side of the head while also making his ears look much more symmetrical.

#### Case-14570
Making the world smaller one ear at a time. Another phenomenal result of ear reduction surgery performed by Dr. Hilinski in this male patient.

#### Case-14617
Beautiful example of how Dr. Hilinski  corrected a lop ear deformity. This patient was so bothered by the abnormal shape and contour of his ears - until he found Dr. Hilinski! Check out this amazing transformation.

#### Case-14620
Erbium laser skin resurfacing in a younger female patient seeking refined texture and enhanced luminosity without dramatic changes. The treatment gently addressed early signs of sun damage, fine lines, and uneven tone—revealing smoother, more radiant skin while preserving her natural beauty.

#### Case-14623
Upper eyelid lift to address heavy, weighted skin that was making her look tired

#### Case-14631
Yet another stunning example of ear reduction surgery performed by Dr. Hilinski. This patient flew from Germany to get his new, smaller, designer ears! He now has ears that are proportional and fitting for his face - but they still look like he could have been born with them.

#### Case-14639
Example of Pix:E treatment using RF microneedling combined with erbium laser treatment. This patient also had Bellafill and Ariessence injections as part of a more regenerative effort to give him a non-surgical facial rejuvenation.

#### Case-14642
Example of lop ear corrective surgery where the helical rim was 'lidded' and did not have a proper curvature. Here she is months out from surgery showing a much more normal looking helical rim contour.

#### Case-14683
For the macrotia ear reduction gallery. This patient felt their ears were simply too big in size from top to bottom, not just protruding. Through Dr. Hilinski’s specialized macrotia ear reduction surgery, the ears were artistically reshaped and made smaller. The result? Designer ears that look natural — as if they were born this way.

#### Case-14748
Amazing example of lop ear correction performed by Dr. Hilinski in this male patient. He was really bothered by the abnormal shape and outline of his ear as is seen in the before photos. Dr. Hilinski reconstructed his ear to make it look more normal by expanding the deformed segment using his own cartilage. Check out just how natural his ear now looks!!!

#### Case-14755
Great example of finesse rhinoplasty is this beautiful young lady who went from pretty to prettier. Dr. Hilinski performed a closed rhinoplasty on her that included lifting up her heavy columella and reshaping her boxy looking tip to make the nose more defined - while keeping her still looking like herself. As he says all the time - still her, just better!

#### Case-14758
Amazing case where Dr. Hilinski had to use rib grafts to reconstruct this ear that collapsed after another plastic surgeon reshaped it. This is not too different than a form of lop ear, which Dr. Hilinski has lots of experience repairing. Check out this result on the table at the conclusion of the surgery.

#### Case-14767
Example of a patient who had cancer removed from his ear - but was left with a significant defect that drew unwanted attention. I ended up performing reconstruction using macrotia ear reduction technique to create an ear that looks nearly perfect now!

#### Case-14770
Great example of an early case of rhinophyma - before and after laser treatment with Dr. Hilinski. Notice how his new nose looks more refined due to the skin being much thinner and healthier.

#### Case-14840
Rhinoplasty Gallery. Example of teenage rhinoplasty where the goal is to create subtle yet distinct changes to the nose while maintaining a natural look overall.

#### Case-14872
Super tough case due to issues going on inside of her nose - but Dr. Hilinski was able to create a more defined nasal tip despite these challenges. Now she has a nose that looks more refined yet still looks quite natural.

#### Case-14877
Not all noses need drastic change as exemplified here where Dr. Hilinski made her nose more refined - but still preserved her naturally beautiful features.

#### Case-14884
The ‘boxy’ nasal tip - great example of how Dr. Hilinski was able to reshape this male patient’s nose to look naturally defined - removing all the sharp angles associated with his boxy, squared nasal tip.

#### Case-14892
Finesse rhinoplasty to create a smoother bridge contour while also bringing the nasal tip in closer to the face.

#### Case-14899
Amazing outcome following cosmetic rhinoplasty performed by Dr. Hilinski. This patient has very thick, sebaceous skin (along the lines of rhinophyma). Dr. Hilinski ended up reducing the volume in his tip while creating a shape and size that look more appropriate for his facial features.

#### Case-14906
Just getting rid of the distracting features - which is what Dr. Hilinski talks about all the time with his rhinoplasty patients. In this case it was moving her tip to a more appropriate location, reducing the bridge height and making the tip look more defined - all the while maintaining a very natural look.

#### Case-14911
Classic type of cosmetic rhinoplasty to reduce the bridge height to give the nose better shape - in conjunction with bringing the tip up to make the nose look more refined overall.

#### Case-14914
Such a beautiful transformation for this patient who simply wanted to look more rested and youthful around the eyes. Dr. Hilinski performed a brow lift in combination with an upper eyelid lift to achieve the desired goal.

#### Case-14914
Such a beautiful transformation for this patient who simply wanted to look more rested and youthful around the eyes. Dr. Hilinski performed a brow lift in combination with an upper eyelid lift to achieve the desired goal.

#### Case-14917
This patient was unhappy with the excess folds she had along the upper eyelid region. Dr. Hilinski performed an upper eyelid lift to restore a crisp yet natural looking upper eyelid contour.

#### Case-14920
This patient had significant skin laxity along the lower eyelid region - making them looked quite wrinkled and prematurely aged. Dr. Hilinski performed a subciliary lower eyelid lift to smooth them out nicely.

#### Case-14925
This patient felt like her lower eyelids made her look prematurely aged and tired. Dr. Hilinski performed a lower eyelid lift to remove some of the bags - but combined this with fat transfer techniques to restore much need volume in the junction of her lower eyelid and cheek.

#### Case-14925
This patient felt like her lower eyelids made her look prematurely aged and tired. Dr. Hilinski performed a lower eyelid lift to remove some of the bags - but combined this with fat transfer techniques to restore much need volume in the junction of her lower eyelid and cheek.

#### Case-14930
This patient had excess facial wrinkles and fine lines (called rhytids) that she wanted addressed. She also had typical volume loss in the midface region from aging. Although she could have undergone lower eyelid surgery, she decided against that - opting for combined laser skin tightening and fat transfer. The latter involved restoring natural volume under her lower eyelids into the cheek region. Her results are nothing short of transformative - taking at least 10 years off of her!

#### Case-14930
This patient had excess facial wrinkles and fine lines (called rhytids) that she wanted addressed. She also had typical volume loss in the midface region from aging. Although she could have undergone lower eyelid surgery, she decided against that - opting for combined laser skin tightening and fat transfer. The latter involved restoring natural volume under her lower eyelids into the cheek region. Her results are nothing short of transformative - taking at least 10 years off of her!

#### Case-14933
Over a year out from an upper lip lift to shorten the upper lip length but to also create a more defined pink upper lip. Not all patients need to be shortened maximally. This is a great example of how natural an upper lip lift can appear while achieving the desired goal of improved proportions.

#### Case-14936
This young lady was super bothered by the fact her left ear stuck out more than her right. This is not unusual to see where people have one ear that is significantly more prominent. Dr. Hilinski performed an incision-less or scarless otoplasty on the one ear to create a much needed fold that helped bend the ear back into a more normal position. She is super happy now and can wear her hair up without being so self conscious!

#### Case-14941
This patient flew out from Tennessee to have his ears made smaller in size and more normal in shape. Post photos were taken during his virtual follow up appointment - but show utterly normal looking ears now!

#### Case-14948
Prior rhinoplasty surgery was performed by a different facial plastic surgeon. She was left with moderately severe pinching and distortion of her nasal tip that can really be seen on the oblique views. From the front view, her tip was quite twisted and asymmetrical. Dr. Hilinski ended up revising her nose using rib grafting techniques to help create a more natural looking yet defined nasal tip with improved symmetry.

#### Case-14955
This patient had her nose done by a different plastic surgeon and left her with a pinched tip with a heavy columella and unnatural look overall. Dr. Hilinski was able to revise her nose to create a much more natural looking contour and shape.

#### Case-14997
Another beautiful example of Dr. Hilinski’s famed ear reduction surgery. This patient came out from Kentucky to get his ears made smaller in size. As you can see in the after photos, you can’t even tell where we made the incisions!!

#### Case-15003
Just a beautiful example of cosmetic rhinoplasty in this young lady who simply wanted a more refined nose that complemented her overall facial features

#### Case-15006
Just another great example of cosmetic ear reduction surgery for macrotia. This young man was so bothered by the size and shape of his ears that he finally decided to have them reduced in size. Check out this amazing transformation!

#### Case-15009
Great example of how Dr. Hilinski is able to reverse the effects of previous ear pinning surgery that was done over aggressively.

#### Case-15012
Just a beautiful example of ear pinning to make her ears less prominent

#### Case-15030
URL: https://www.drhilinski.com/gallery/patient/case-15030/

#### Case-15031
URL: https://www.drhilinski.com/gallery/patient/case-15031/

#### Case-15073
Great example of scarless ear reduction surgery that included making the scapha smaller in combination with earlobe reduction.

#### Case-15086
Case of finesse ear reduction to create smaller ears from top to bottom.

#### Case-15096
Beautiful case example of how lasers can help significantly improve those pesky smoker's lines around the mouth - even if you were not a smoker!!

#### Case-15099
Stunning example of incision-less ear pinning to make this male patients ears less prominent. Amazing when you think there were no cuts or incisions made in the ear!!!

#### Case-15170
Moderately severe rhinophyma disease that caused significant deformity to his nose. Results shown are months after undergoing rhinophyma laser surgery to give him a nose that simply looked normal.

#### Case-15171
Moderately severe rhinophyma disease that caused significant deformity to his nose. Results shown are months after undergoing rhinophyma laser surgery to give him a nose that simply looked normal.

#### Case-15251
Example of lower face and neck lift in a male patient.

#### Case-15261
Beautiful example of female, ethnic rhinoplasty with creation of a nose that has less distracting features (hump, bulbous tip etc) but is natural looking and congruent with her overall facial features.

#### Case-3305
Mole removal performed with the plasma pen device.

#### Case-3306
Face and neck lift with amazingly natural looking results!

#### Case-3307
Renuva Hand Rejuvenation

#### Case-3308
Closed, preservation rhinoplasty

#### Case-3309
Simply stunning transformation for her ears!!

#### Case-3310
Beautiful example of scarless, closed preservation rhinoplasty

#### Case-3311
Beautiful results following lower face and upper neck lift surgery

#### Case-3312
URL: https://www.drhilinski.com/gallery/patient/case-3312/

#### Case-3314
URL: https://www.drhilinski.com/gallery/patient/case-3314/

#### Case-3315
This patient had 2 prior attempts at otoplasty by a different plastic surgeon - but was still unhappy with the shape and size of his ears. Fortunately, I was able to make his ears smaller in size and better in shape!

#### Case-3316
URL: https://www.drhilinski.com/gallery/patient/case-3316/

#### Case-3317
Preservation rhinoplasty. Such natural results.

#### Case-3318
Face and neck lift combined with laser skin resurfacing

#### Case-3319
Keeping it so natural. Not every nose should be completely reshaped so that it looks so different. Here is a great case example of ethnic rhinoplasty to create a nose that is different - yet still natural and compatible with her overall facial features.

#### Case-3320
Revision rhinoplasty to fix several issues leftover from her prior rhinoplasty (performed by a different plastic surgeon)

#### Case-3321
Beautiful case of macrotia ear reduction in a male patient.

#### Case-3322
Example of 'incision-less' ear pinning to bend the ear back. This shows her result just 3-4 days after surgery with minimal recovery because the approach was much less invasive than traditional otoplasty.

#### Case-3323
This is a patient who already had prior otoplasty - that left him unhappy. I was able to revise his ears and get them to a much more desirable shape and position.

#### Case-3324
Otoplasty reversal performed on his right side, and revision pinning done on his left side - prior surgery performed by a different plastic surgeon.

#### Case-3326
Scarless ear reduction - no cuts made across the helical rim!

#### Case-3327
Classic ear pinning showing a beautiful, natural looking cosmetic change in this young lady.

#### Case-3328
Finesse natural rhinoplasty results

#### Case-3329
Great example of correction of a Darwinian, or Darwin's, tubercle deformity. This is a fairly uncommon congenital deformity involving the ear that was previously described in detail by the famed James Darwin. Check out how I was able to make this abnormal ear look essentially normal.

#### Case-3330
Case of revision rhinoplasty - her primary was performed by a different plastic surgeon - to help open up her nostrils. She developed pinching and collapse of the nostrils following her prior work. As you can see in her before photo here, she literally looks like her nostrils are being sucked inward. Following revision rhinoplasty with me, she now has a nose that has proper structural support and looks much more natural and normal.

#### Case-3331
CO2 laser treatment for extreme recurrent rhinophyma. This patient had prior laser work done by a different plastic surgeon and then developed severe recurrent rhinophyma. He sought out Dr. Hilinski because of his reputation for treating this particular problem - and came to town to have surgery. Here he is just months after hugely successful laser surgery. Truly life altering.

#### Case-3332
Volume augmentation with Renuva to help restore proper fat contours in the midface region. A total of 2 syringes were used in this case - one on each side.

#### Case-3333
Left > right brow lifting to create more symmetry

#### Case-3334
After one session of Profound RF skin tightening to help improve her neck line

#### Case-3335
URL: https://www.drhilinski.com/gallery/patient/case-3335/

#### Case-3336
Large ears to normal ears!!

#### Case-3337
Great example of how African American rhinoplasty has to be done by a true rhinoplasty specialist who can preserve one's look while making a nose more defined yet balanced with the entire face.

#### Case-3338
Upper eyelid lift to give her a more rested look

#### Case-3339
All this from just hump reduction via closed, scarless rhinoplasty. She looks simply more beautiful!!

#### Case-3340
Only 48 hours after I repaired her lop ear deformity. No incisions made on the front of the ear. They are all hidden behind the ear. Pretty amazing reconstruction!!!

#### Case-3341
Neck reshaping using only 3 small incisions - 1 under the chin and 1 behind each earlobe. Incredible improvement seen months out from surgery.

#### Case-3342
Renuvion plasma energy deep under the skin - combined with liposuction and suture tightening of the neck muscles

#### Case-3343
Dramatic example of what otoplasty (ear pinning) can do for some patients.

#### Case-3344
So natural looking!!

#### Case-3345
URL: https://www.drhilinski.com/gallery/patient/case-3345/

#### Case-3346
URL: https://www.drhilinski.com/gallery/patient/case-3346/

#### Case-3347
Upper lip reduction to help remove excess upper lip tissue

#### Case-3348
URL: https://www.drhilinski.com/gallery/patient/case-3348/

#### Case-3349
URL: https://www.drhilinski.com/gallery/patient/case-3349/

#### Case-3350
Complex revision rhinoplasty to help this patient out after she had unsuccessful surgery with a different plastic surgeon.

#### Case-3351
Patient who fly to San Diego from London to get his ears made smaller. His postop photo was taken from a screenshot during his telehealth follow-up visit.

#### Case-3352
URL: https://www.drhilinski.com/gallery/patient/case-3352/

#### Case-3353
Combined lower eyelid skin pinch blepharoplasty with fat transfer to the area just under the eyelids.

#### Case-3354
Preservation rhinoplasty to help create a smoother, straighter profile - while preserving the frontal view

#### Case-3355
Combined upper eyelid lift (blepharoplasty) and lower face, upper neck lift

#### Case-3356
Another phenomenal example of cosmetic ear pinning - otoplasty surgery - to help make this patient's ears less prominent.

#### Case-3357
Upper and lower blepharoplasty with laser skin resurfacing done

#### Case-3358
Classic ear pinning case for prominent, large ears.

#### Case-3359
Amazing changes seen following neck liposuction, suture placement under the chin and Profound RF skin tightening

#### Case-3360
URL: https://www.drhilinski.com/gallery/patient/case-3360/

#### Case-3361
Amazing transformation for this young lady and her ears!!

#### Case-3362
Great case of trying to match one ear with the other - in this case I brought in his left side to better match his right one. So happy for this young guy!!

#### Case-3363
URL: https://www.drhilinski.com/gallery/patient/case-3363/

#### Case-3364
Patient who flew from Israel to have his ears made smaller in size

#### Case-3365
Macrotia ear reduction - NOT EAR PINNING - to make his ears smaller and more proportional

#### Case-3366
Beautiful example of bulbous tip cosmetic rhinoplasty with a closed, scarless approach

#### Case-3367
Male, ethnic rhinoplasty to smooth the bridge and refine the tip - while maintaining a natural look

#### Case-3368
After single Profound RF treatment - note how much smoother and tighter looking her skin is after the procedure

#### Case-3369
Still looks himself - just a more rested version of it!!

#### Case-3370
Prior attempted surgery done in France with unsuccessful results. She flew to the U.S. to have me revise her ears to give them a normal shape and size. Mission accomplished!

#### Case-3371
Classic case of otoplasty or ear pinning

#### Case-3372
Finesse rhinoplasty to create more tip symmetry.

#### Case-3373
Results after complex revision rhinoplasty

#### Case-3374
Frontal view after revision rhinoplasty (first surgery done in La Jolla)

#### Case-3375
Check out that new neckline!! These results were obtained with a combination of neck liposuction and MyEllevate suture contouring

#### Case-3376
Classic case of ear pinning with Dr. Hilinski's specialized otoplasty technique

#### Case-3377
Macrotia ear reduction to improve the shape & size - results at just 2 days out from surgery!!

#### Case-3378
Neck J plasma Renuvion treatment

#### Case-3379
Close-up of ear pinning without taking any cartilage away!

#### Case-3380
URL: https://www.drhilinski.com/gallery/patient/case-3380/

#### Case-3381
URL: https://www.drhilinski.com/gallery/patient/case-3381/

#### Case-3382
Such beautiful finesse changes to her frontal view!! And check out the columella changes on that side view.

#### Case-3383
Just stunning results of this young lady who had her bulbous nose reshaped

#### Case-3384
URL: https://www.drhilinski.com/gallery/patient/case-3384/

#### Case-3385
Such a beautiful example of an upper lip lift procedure that keeps it looking natural!

#### Case-3386
Example of macrotia ear reduction surgery.

#### Case-3387
Side view of an ear with milder lop 'cup' ear deformity. In this case the helical rim was excessively thick but not folded over or constricted. Nonetheless, it was considered abnormal development and required cosmetic reshaping to make it look more normal.

#### Case-3388
Correction of lop 'cup' ear deformity by reshaping and lengthening the upper portion of the ear

#### Case-3389
Lop 'cup' ear correction. Also known as constricted ear deformity, this is a condition where the top portion of the ear is folded over.

#### Case-3390
Restylane Kysse to the lips

#### Case-3391
The patient flew out from England to have surgery with Dr. Hilinski - which is why his postoperative photo is not the usual and standard.

#### Case-3392
URL: https://www.drhilinski.com/gallery/patient/case-3392/

#### Case-3393
Unilateral ear pinning done

#### Case-3394
Example of ear reduction and helical reshaping.

#### Case-3395
Case of otoplasty reversal in a patient who had her ears over corrected by a different plastic surgeon years ago. I was able to release and reverse the prior ear pinning to give her an ear that now has a much more natural shape and position.

#### Case-3396
Pollybeak, over projected (stuck out too far), and blunted angle between the nose and upper lip.

#### Case-3397
Check out that tip refinement!!

#### Case-3398
Repair of a congenital 'dent' in the tip region

#### Case-3399
URL: https://www.drhilinski.com/gallery/patient/case-3399/

#### Case-3400
Otoplasty reversal for telephone ear deformity resulting from surgery performed by a different plastic surgeon.

#### Case-3401
URL: https://www.drhilinski.com/gallery/patient/case-3401/

#### Case-3402
URL: https://www.drhilinski.com/gallery/patient/case-3402/

#### Case-3403
Making the nose smaller by bringing in the tip closer to the face - following prior rhinoplasty by a different plastic surgeon

#### Case-3404
Bilateral otoplasty with creation of an actual antihelical fold

#### Case-3405
URL: https://www.drhilinski.com/gallery/patient/case-3405/

#### Case-3406
Arched nostril repair with hump reduction

#### Case-3407
Rhinoplasty to mainly correct the columella after she had it pulled down from an upper lip lift performed by a different plastic surgeon.

#### Case-3408
Actual ear reduction surgery for macrotia to make the ear smaller in size from top to bottom. The excess portion of the ear was taken away while creating a natural curvature.

#### Case-3409
After just one (1) Profound RF skin tightening procedure of the jawline and upper neck.

#### Case-3410
URL: https://www.drhilinski.com/gallery/patient/case-3410/

#### Case-3411
Combined scapha and earlobe reduction

#### Case-3412
Squared and large to curved and normal

#### Case-3413
URL: https://www.drhilinski.com/gallery/patient/case-3413/

#### Case-3414
URL: https://www.drhilinski.com/gallery/patient/case-3414/

#### Case-3415
It is all about the ear fold when it comes to otoplasty like this one!

#### Case-3416
Look at the overall height reduction in this macrotia ear reduction case

#### Case-3417
URL: https://www.drhilinski.com/gallery/patient/case-3417/

#### Case-3418
Prior Artefill (Bellafill) injection in the lip that created unwanted fullness. I was able to cut this out and restore a proper lip contour.

#### Case-3419
Squared, large ear reduced in size and given a better curvature

#### Case-3420
URL: https://www.drhilinski.com/gallery/patient/case-3420/

#### Case-3421
Chin augmentation using Bellafill injection (the only FDA approved non-absorbable filler)

#### Case-3422
Neck liposuction combined with MyEllevate lifting

#### Case-3423
URL: https://www.drhilinski.com/gallery/patient/case-3423/

#### Case-3424
2 prior rhinoplasty surgeries performed by a different plastic surgeon. Fortunately, Dr. Hilinski was able to create a much more beautiful, defined nasal tip for her the 3rd time around!

#### Case-3425
Laser mole removal. Poof! Gone!

#### Case-3426
Crooked nose repair, hump reduction and better tip projection/position

#### Case-3427
URL: https://www.drhilinski.com/gallery/patient/case-3427/

#### Case-3428
Looks younger and more refreshed!

#### Case-3429
URL: https://www.drhilinski.com/gallery/patient/case-3429/

#### Case-3430
URL: https://www.drhilinski.com/gallery/patient/case-3430/

#### Case-3431
URL: https://www.drhilinski.com/gallery/patient/case-3431/

#### Case-3432
Check out how her nasal base looks more narrow from the frontal view after the tip has been projected outward

#### Case-3433
Fat transfer to the lower eyelid, cheek junction to help 'frame' the eyes a bit more while addressing volume loss from aging

#### Case-3434
Over 1 year out from bilateral ear pinning to give this very natural look.

#### Case-3435
Renuvion J Plasma sub dermal neck skin tightening. Just wow!!

#### Case-3436
Plasma pen for smoker's lines around the mouth.

#### Case-3437
URL: https://www.drhilinski.com/gallery/patient/case-3437/

#### Case-3438
Combined ear pinning and ear reduction on the right side with just ear reduction on her left side. Just 48 hours after surgery!

#### Case-3439
URL: https://www.drhilinski.com/gallery/patient/case-3439/

#### Case-3440
URL: https://www.drhilinski.com/gallery/patient/case-3440/

#### Case-3441
URL: https://www.drhilinski.com/gallery/patient/case-3441/

#### Case-3442
URL: https://www.drhilinski.com/gallery/patient/case-3442/

#### Case-3443
Finesse tip rhinoplasty

#### Case-3444
URL: https://www.drhilinski.com/gallery/patient/case-3444/

#### Case-3445
URL: https://www.drhilinski.com/gallery/patient/case-3445/

#### Case-3446
72 hours after ear reduction surgery

#### Case-3447
'Scarless' ear reduction done in this case where the incisions (and scars) were kept on the back of the ear.

#### Case-3448
URL: https://www.drhilinski.com/gallery/patient/case-3448/

#### Case-3449
Unilateral otoplasty or ear pinning in an attempt to make his ears look more symmetrical

#### Case-3450
Top to bottom ear reduction procedure. After photos are just 48 hours following surgery - so there is obvious swelling and bruising, which will resolve with time.

#### Case-3451
After 1 Renuvion skin tightening treatment to help tighten up the neck and jawline skin.

#### Case-3452
URL: https://www.drhilinski.com/gallery/patient/case-3452/

#### Case-3453
URL: https://www.drhilinski.com/gallery/patient/case-3453/

#### Case-3454
URL: https://www.drhilinski.com/gallery/patient/case-3454/

#### Case-3456
Combined chin implant, neck liposuction and rhinoplasty surgery to give her a more balanced profile

#### Case-3457
URL: https://www.drhilinski.com/gallery/patient/case-3457/

#### Case-3458
URL: https://www.drhilinski.com/gallery/patient/case-3458/

#### Case-3459
URL: https://www.drhilinski.com/gallery/patient/case-3459/

#### Case-3460
URL: https://www.drhilinski.com/gallery/patient/case-3460/

#### Case-3461
Look at that improvement in her lower eyelid festoons after just one plasma pen treatment! Can't wait to see her results after a completed series of plasma pen skin tightening treatments.

#### Case-3462
URL: https://www.drhilinski.com/gallery/patient/case-3462/

#### Case-3463
URL: https://www.drhilinski.com/gallery/patient/case-3463/

#### Case-3464
URL: https://www.drhilinski.com/gallery/patient/case-3464/

#### Case-3465
Before and after (selfie) months out from ear reduction surgery

#### Case-3466
Look at how much better her ears now look from the frontal view after being reduced in size

#### Case-3467
Beautiful chin and jowl sculpting with Restylane Defyne

#### Case-3468
URL: https://www.drhilinski.com/gallery/patient/case-3468/

#### Case-3469
URL: https://www.drhilinski.com/gallery/patient/case-3469/

#### Case-3470
URL: https://www.drhilinski.com/gallery/patient/case-3470/

#### Case-3471
URL: https://www.drhilinski.com/gallery/patient/case-3471/

#### Case-3472
Ear reduction that also helps to bring the top of the ear in closer to the side of the head

#### Case-3473
URL: https://www.drhilinski.com/gallery/patient/case-3473/

#### Case-3474
URL: https://www.drhilinski.com/gallery/patient/case-3474/

#### Case-3475
URL: https://www.drhilinski.com/gallery/patient/case-3475/

#### Case-3476
URL: https://www.drhilinski.com/gallery/patient/case-3476/

#### Case-3477
Beautiful example of how liposuction and platysma muscle tightening can help bring out that much desired jawline definition

#### Case-3478
Beautiful example of earlobe reduction surgery

#### Case-3479
URL: https://www.drhilinski.com/gallery/patient/case-3479/

#### Case-3480
Revision rhinoplasty - prior nose job performed by a different plastic surgeon - with use of rib graft

#### Case-3481
Reversal of overcorrected otoplasty utilizing rib cartilage grafting

#### Case-3482
Amazing case of preservation otoplasty where Dr. Hilinski pinned the ears in closer to the side of the head without removing any cartilage!

#### Case-3484
Bulbous to refined tip reshaping

#### Case-3485
Fat transfer for her lower eyelids, smile lines and jawline contour.

#### Case-3486
Can you see the scar? I didn't think so!

#### Case-3487
URL: https://www.drhilinski.com/gallery/patient/case-3487/

#### Case-3488
Bulbous nasal tip reshaping

#### Case-3489
Lop ear correction in this male patient who was unhappy with the congenital ear deformity that caused an excessively thick helical rim

#### Case-3490
Very interesting case of a patient who needed 'reverse otoplasty' to help bring an ear out. This was a congenital case - meaning he was born like this. Fortunately, using cartilage grafting technique, Dr. Hilinski was able to make his ear look more normal!

#### Case-3491
URL: https://www.drhilinski.com/gallery/patient/case-3491/

#### Case-3492
URL: https://www.drhilinski.com/gallery/patient/case-3492/

#### Case-3493
Incredible transformation for this young lady!

#### Case-3494
Macrotia ear reduction

#### Case-3495
Great example of finesse rhinoplasty to create a more shapely nose for this 61 year old female patient

#### Case-3496
Crow's feet correction after just one (1) session of the plasma pen! Imagine how much better this would look like after several treatment sessions.

#### Case-3497
Prior rhinoplasty by a different plastic surgeon leaving her with an abnormally sharp and angulated tip. Dr. Hilinski helped to provide her with a much softer looking nose that appears much more natural.

#### Case-3498
Great example of how ear reduction surgery by Dr. Hilinski can help bring the ears inward while also making them smaller top to bottom. No otoplasty done here - just macrotia ear reduction.

#### Case-3499
Check out the asymmetry of her nasal tip and how displaced her nostrils were prior to Dr. Hilinski fixing them with a reconstructive septorhinoplasty

#### Case-3501
Restylane injection for a non-surgical lower eyelid rejuvenation

#### Case-3502
URL: https://www.drhilinski.com/gallery/patient/case-3502/

#### Case-3503
Example of chin augmentation using long-lasting filler (5+ years) Bellafill

#### Case-3504
Great case that demonstrates how macrotia ear reduction can be used to also 'pin' the ear closer to the side of the head

#### Case-3505
URL: https://www.drhilinski.com/gallery/patient/case-3505/

#### Case-3506
48 hours after ear reduction surgery

#### Case-3507
URL: https://www.drhilinski.com/gallery/patient/case-3507/

#### Case-3508
Another great example of ear reduction surgery to 'take a little off the top' in this patient who had prior otoplasty by a different plastic surgeon. Unfortunately, she still had large ears after the ear pinning - so she came to Dr. Hilinski to have them reduced in size.

#### Case-3509
Fantastic example of how an upper eyelid lift can bring out the best in someone's eyes!

#### Case-3510
A beautiful example of a crooked nose deformity repaired by Dr. Hilinski

#### Case-3511
Example of preservation rhinoplasty technique used to reduce the bridge height of this female patient

#### Case-3512
Crooked nose repair

#### Case-3513
Otoplasty to make the ears less prominent while also creating more symmetry

#### Case-3514
Revision rhinoplasty to completely reshape the bridge and tip following prior surgery performed by a different plastic surgeon. This patient came to Dr. Hilinski to have her nose revised given his reputation as one of San Diego's best cosmetic nose surgeons and someone who has true, dedicated experience in fixing botched nose jobs.

#### Case-3515
Example of how Dr. Hilinski shrinks ears down in size

#### Case-3516
Actual ear reduction in this male patient who wanted smaller ears - not ears that were just pinned back

#### Case-3517
Upper eyelid lift to give a more rested, rejuvenated appearance.

#### Case-3518
Scapha reduction for a macrotic ear in this patient who had prior otoplasty surgery performed by a different plastic surgeon that left him with elf-like ears. Notice how much improvement has been made and how much more natural-looking his ears are following surgery with Dr. Hilinski

#### Case-3519
Just 48 hours after having ear reduction surgery. You can see how the ear is still quite red - but that is totally expected. What you can really see is that she now has a much smaller ear from top to bottom - including the earlobe.

#### Case-3520
Example of nasal bridge hump reduction without breaking the nasal bones. This was done in an effort to actually make his nose appear less narrow on the frontal view.

#### Case-3521
Example of macrotia - scapha reduction surgery - changes in an effort to make a large ear smaller in size. The results shown are less than 48 hours after surgery, so there is expected swelling and distortion. But even then, her ears look pretty darn good!

#### Case-3522
Plasma pen of the cheeks and lower face - plus the periorbital region (around the eyes). Notice how much better her jawline now looks and how the wrinkles around the side of her mouth have been greatly diminished.

#### Case-3523
Fantastic example of how a little fat transfer combined with laser skin resurfacing can really turn back the clock. When you look at her, you just know she looks better - more rested, more youthful and more rejuvenated. But you can't necessarily tease out what she had done and where it was done. But that is precisely the goal of cosmetic face surgery - to not be able to tell, right?

#### Case-3524
Amazing results with plasma pen skin tightening to provide this patient with an upper eyelid lift. Look closely and see how much improvement was made in the redundant upper eyelid skin folds without having to undergo any surgery.

#### Case-3527
Use of J Plasma (Renuvion) energy to help tighten and lift the neck and jawline.

#### Case-3528
Fantastic example of how cosmetic ear surgery can transform your overall look. This is classic ear pinning surgery that was performed by Dr. Hilinski.

#### Case-3529
Another fantastic example of how an ear can be reshaped to be smaller in size. This patient flew to San Diego from outside of the United States to have his one ear reshaped. As you can see, Dr. Hilinski was able to create a much more natural looking shape and contour with an ear that was now smaller in size - Dr. Hilinski's famed macrotia ear reduction surgery! Of note, the postop photo was provided by the patient, which explains the difference in the photography.

#### Case-3530
Great example of how an upper and lower eyelid lift can be combined with some fat transfer (to the lower eyelid-cheek junction) to help provide a nice facial rejuvenation

#### Case-3531
Example of neck J Plasma Renuvion treatment to tighten the neck skin

#### Case-3533
After just 1 plasma pen treatment session to help smooth out the upper lip vertical lines.

#### Case-3534
Example of earlobe reduction surgery

#### Case-3535
URL: https://www.drhilinski.com/gallery/patient/case-3535/

#### Case-3537
URL: https://www.drhilinski.com/gallery/patient/case-3537/

#### Case-3538
URL: https://www.drhilinski.com/gallery/patient/case-3538/

#### Case-3539
Nice example of how a CO2 laser can be used to treat rhinophyma - a skin condition that causes the nose skin to look thickened and rough.

#### Case-3540
Example of lower eyelid rejuvenation using a combination of fat removal (through the lower eyelid) and replenishment of volume below the lower eyelid with fat transfer.

#### Case-3541
Fantastic example of fibroblast - plasma pen - treatment around the mouth. Check out how much improvement was made in the wrinkle formation around this area - and this is after just 1 treatment!

#### Case-3542
Great example of how the plasma pen can tighten and smooth neck skin. Just look at how much improvement is noted in her neck - from the jawline down to the clavicle. And this is done with only topical numbing cream and few days of downtime!

#### Case-3543
Great example of how Dr. Hilinski can significantly reduce the size of someone's earlobes - giving them a nice, natural contour

#### Case-3544
Great example of how Dr. Hilinski can help patients who have a markedly crooked and asymmetrical nose achieve a much improved alignment. This type of nose job also plays into a significant improvement in terms of function. At the same time, Dr. Hilinski also brought her bridge height down to create a more proportional nose for her face.

#### Case-3546
Example of revision rhinoplasty (prior surgery performed by a different plastic surgeon) to create more tip and nostril symmetry in this female patient.

#### Case-3547
Great example of a 'lip flip' procedure using the plasma pen by Louise Walsh. Just look at how her upper and lower lip were enhanced by tightening the skin above the upper and below the lower. The end result is that the lips look fuller and plumper without having any injectable filler placed!

#### Case-3549
Nearly 2 months after plasma pen crow's feet treatment in this female patient - notice how much smoother her skin looks with marked reduction in wrinkle formation even at rest!

#### Case-3551
Example of combined fat transfer to the face (to provide needed volume and plumping especially around the lower eyelid-cheek) and laser skin resurfacing (to make her skin look smoother and less blotchy). Look more closely at her lower eyelid area where the power of these two procedures combined can be readily seen. Her lower eyelids were tightened nicely with the laser while the deeper tissues were augmented with her own fat to provide much needed plumping.

#### Case-3552
Fantastic example of how J plasma energy by Renuvion can work to help tighten and lift face and neck skin using limited incisions. Notice how much tighter this patient's skin now looks following this minimally invasive office-based procedure.

#### Case-3553
Example of macrotia ear reduction to make the whole ear smaller in size. The postoperative photo was taken off of a Skype follow-up visit with Dr. Hilinski since the patient was from outside of California and couldn't make it back to San Diego for a visit.

#### Case-3554
Great example of how J Plasma energy can be used to tighten up loose neck skin without having to undergo deep anesthesia. Using just 3 small hidden incisions, the procedure is done by going underneath the skin.

#### Case-3555
Example of CO2 laser mole removal.

#### Case-3556
Look at this amazing, life-changing transformation for this young lady!

#### Case-3557
Great example of how Juvederm can plump the lips - results shown immediately after our medical spa RN treatment

#### Case-3558
Beautiful plasma pen results at just 2 weeks showing a nice elevation in the eyebrow (a non-surgical brow lift) with a more open upper eyelid (a non-surgical blepharoplasty)

#### Case-3559
Lips shown 11 years - yes, 11 years - after injection using micro droplet silicone technique

#### Case-3562
Face and neck lift combined with laser skin peel - results shown just months after her procedure. She looks at least 10 years younger!

#### Case-3563
Take a look at what Restylane can do for your lips! Visit our medical spa today for your treatment!

#### Case-3564
Revision open rhinoplasty to help create a more natural looking tip and base for this female patient who had undergone prior rhinoplasty by a different plastic surgeon

#### Case-3565
Scarless rhinoplasty in this younger male patient who wanted changes to the shape of his nose yet still wanted a masculine, natural appearance

#### Case-3566
Example of J Plasma Renuvion treatment of the neck. In this particular case, the skin was tightened up quite nicely with subdermal J Plasma. Just compare the mid to lower neck skin in the before and after photo - with marked improvement noted in the skin wrinkling.

#### Case-3567
Fantastic example of how Radiesse can be used to rejuvenate your hands!

#### Case-3568
Great example of 'scarless' rhinoplasty where no external cuts/incisions are made. Overall, this male patient has a beautiful transformation while still preserving his overall look.

#### Case-3569
Example of Radiesse filler injection to augment this female's chin - achieving results that are just as nice as a chin implant - without undergoing the knife!

#### Case-3570
URL: https://www.drhilinski.com/gallery/patient/case-3570/

#### Case-3571
Earlobe reduction to make this patient's lobe much smaller in size

#### Case-3572
Example of upper eyelid ptosis repair to lift the eyelid margin up - thus creating an eye that looks more open and rested. Even without makeup, her after photo shows a marked aesthetic improvement.

#### Case-3574
J plasma skin resurfacing to help rejuvenate this female patient's overall look. Notice how much her eyelid has lifted just from J Plasma resurfacing!

#### Case-3575
Complex revision rhinoplasty performed by Dr. Hilinski to help create a more normal, natural looking nose for this female patient

#### Case-3576
Results from lip injection with Juvederm.

#### Case-3577
Improved alignment from revision rhinoplasty in this young lady who had 2 prior nose jobs by other plastic surgeons before having her nose revised by Dr. Hilinski

#### Case-3578
Restylane filler injection for lower eyelid hollows

#### Case-3579
Renuvion J Plasma skin rejuvenation to reduce harsh appearance of facial wrinkles. Also note how powerful Renuvion can be in terms of tightening skin - just look at her upper eyelid and note how much skin was tightened in the process! It literally looks like she had an upper eyelid blepharoplasty.

#### Case-3580
Scapha reduction or macrotia ear reduction surgery to make the ear smaller in size

#### Case-3581
Combined CO2 laser of the lower eyelid skin with some fat transfer to give her more volume

#### Case-3583
URL: https://www.drhilinski.com/gallery/patient/case-3583/

#### Case-3584
Great example of how a bulbous nose can be narrowed and defined in conjunction with reduction of a dorsal hump.

#### Case-3587
URL: https://www.drhilinski.com/gallery/patient/case-3587/

#### Case-3588
Example of Juvederm Ultra used to plump up the lips - creating a more beautiful, shapely smile

#### Case-3589
URL: https://www.drhilinski.com/gallery/patient/case-3589/

#### Case-3592
URL: https://www.drhilinski.com/gallery/patient/case-3592/

#### Case-3593
Results only 1 month out from cosmetic ear reduction surgery

#### Case-3594
Macrotia reduction in this African American male who flew into California to have his ears reduced in size. The follow-up photo was not taken in the office since he was from out of town. This happens quite frequently with our office as so many patients fly into San Diego to have surgery performed by Dr. Hilinski.

#### Case-3595
Not all upper lip lift patients need to have shortening down to 15-18 millimeters in length. In some cases, like this middle-aged female, you just want to shorten the lip in a more modest manner - while still giving them a more defined cupid's bow and vermillion border.

#### Case-3596
This patient had prior otoplasty and was still unhappy with his ears. He traveled to San Diego to have Dr. Hilinski perform scapha reduction combined with earlobe reshaping to give him smaller ears.

#### Case-3597
Beautiful results from microneedling with PRP to create improved skin texture with reduction of rolling acne scars.

#### Case-3605
Results of combined scapha ear reduction for macrotia with earlobe reduction. Note, his results are only days after the surgery. Like so many of Dr. Hilinski's macrotia patients, this one flew from outside of the United States to have his ears reduced. This is largely because there just aren't any other true experts out there when it comes to making the ear smaller in size.

#### Case-3606
URL: https://www.drhilinski.com/gallery/patient/case-3606/

#### Case-3607
J Plazty to help define and refine the jawline and upper neck using helium plasma energy. J Plazty utilizes Renuvion under the skin (not over the skin surface) to help tighten and lift tissue.

#### Case-3608
Nasal fracture repair to straighten the bridge while also reducing the bump on her bridge

#### Case-3609
Great example of how a crooked nose can be straightened to create more symmetry

#### Case-3610
Amazing what a little upper lip shortening can do for you.

#### Case-3611
Upper and lower eyelid rejuvenation - removal of upper eyelid sagging skin combined with laser resurfacing of the lower eyelids.

#### Case-3612
Dr. Hilinski fixed this lady's short nose after she had prior rhinoplasty by a different plastic surgeon. Notice how her tip was left too short - as if it just stops. Dr. Hilinski completely rebuilt her nasal tip with complex cartilage grafting to help restore a more normal looking nose.

#### Case-3613
This patient had an asymmetrical, droopy tip that was contributed to anatomical obstruction. Dr. Hilinski performed a reconstructive rhinoplasty on him to help create a more symmetrical (even) tip structure. Quite a bit of improvement was seen as is shown here.

#### Case-3615
Example of an upper eyelid tuck in a male patient - where it is quite important that your surgeon doesn't over resect the skin - making you look like you had surgery.

#### Case-3617
This rhinoplasty patient had 2 prior nosejobs before she underwent her 3rd one with Dr. Hilinski. This involved making her nasal tip look less pinched and pointed - giving her a much more natural, slightly rounded nose.

#### Case-3618
CO2 laser assisted mole removal. Results shown are 8 weeks out.

#### Case-3620
Example of Renuvion J Plasma used to resurfacing the skin - getting rid of unwanted lines and improving skin color and texture.

#### Case-3621
Example of tip rhinoplasty in a patient who has very thick skin. Thicker nose skin really limits the amount of change a surgeon can create for you. Fortunately, Dr. Hilinski was able to get her tip more defined - yet keep it looking natural.

#### Case-3623
URL: https://www.drhilinski.com/gallery/patient/case-3623/

#### Case-3624
URL: https://www.drhilinski.com/gallery/patient/case-3624/

#### Case-3625
URL: https://www.drhilinski.com/gallery/patient/case-3625/

#### Case-3626
Combined upper ear reduction with earlobe reduction

#### Case-3628
Hump reduction, smoothing of the bridge and slight tip elevation and narrowing

#### Case-3629
URL: https://www.drhilinski.com/gallery/patient/case-3629/

#### Case-3632
Example of fat transfer to the lower eyelid - cheek region to give her a more rejuvenated look

#### Case-3633
Finally able to pierce the ear after having her earlobe reconstructed!

#### Case-3635
The power of Renuvion's J Plasma skin resurfacing technology to help erase away unwanted deeper wrinkles and skin creases around the mouth. Even though patient's don't necessarily smoke - these are commonly referred to as smoker's lines.

#### Case-3636
Laser skin resurfacing to reduce the appearance of fine and coarse facial wrinkles. Overall, you can appreciate how her skin just looks smoother and more rejuvenated. Note these changes especially around the lower eyelids and crow's feet.

#### Case-3637
Example of reconstructive nose surgery to make this male patient's nose more structurally stable. In the process, the entire framework of the nose was brought closer to his face - but made stronger with placement of several cartilage grafts.

#### Case-3638
Example of lip reduction in the process of removing Aquamid filler that was placed by a different plastic surgeon elsewhere.

#### Case-3639
Example of ear reduction surgery for macrotia and enlarged earlobes - reducing the overall size of the ear by nearly 1.5 centimeters!

#### Case-3640
URL: https://www.drhilinski.com/gallery/patient/case-3640/

#### Case-3641
URL: https://www.drhilinski.com/gallery/patient/case-3641/

#### Case-3642
URL: https://www.drhilinski.com/gallery/patient/case-3642/

#### Case-3644
Example of laser mole removal using the Lumenis CO2 laser

#### Case-3645
No - the photos are not transposed! This is actually a great example of how Dr. Hilinski has helped many patients get some of their old nose back following prior rhinoplasty where a hump was removed. This patient was distraught for years after her old bump was taken down. She finally discovered Dr. Hilinski who helped restore a dorsal convexity on her bridge. To learn more about this type of revision rhinoplasty, use this link here.

#### Case-3647
Prior rhinoplasty done in Mexico. Dr. Hilinski performed a revision open rhinoplasty to help restore a more natural, beautiful looking nose.

#### Case-3648
Example of macrotia ear reduction surgery to make this male patient's ear smaller and less peaked at the top

#### Case-3650
This is an unusual primary rhinoplasty - no prior nose surgery. This patient had a severely asymmetrical and displaced nasal tip - in addition to a heavy columella. Dr. Hilinski was able to fix these issues while providing her a much more balanced and symmetrical looking nose. Results are nearly 3 years out from surgery.

#### Case-3651
Example of laser mole treatment

#### Case-3652
Example of how a laser can be used to remove a mole with minimal signs of any scarring

#### Case-3653
URL: https://www.drhilinski.com/gallery/patient/case-3653/

#### Case-3656
Combined otoplasty reshaping - including macrotia ear reduction and earlobe reduction

#### Case-3657
Example of Lumenis CO2 fractionated laser skin resurfacing to provide smoother, more youthful skin.

#### Case-3658
Lower eyelid cheek junction filler using blunt tipped cannulas to take years off of the aging process.

#### Case-3659
URL: https://www.drhilinski.com/gallery/patient/case-3659/

#### Case-3660
URL: https://www.drhilinski.com/gallery/patient/case-3660/

#### Case-3661
Great example of lip filler injection. So many patients are worried that their lips will look overblown and overdone following lip filler. This shows you how something like Juvederm can be injected to give plumper, fuller, more shapely lips without looking excessive.

#### Case-3662
Some say you can never really fix a crooked nose deformity. Here is proof you can make a significant improvement to help those with crooked noses. Everyone's nose will remain somewhat asymmetrical - even after great plastic surgery. But an improvement like this is quite realistic and can be done routinely.

#### Case-3663
Ethnic rhinoplasty with thicker skin. Using an open rhinoplasty approach, the bridge was reduced, the alignment was improved and her tip was refined nicely.

#### Case-3664
Example of female rhinoplasty in this young lady from San Diego who desired a straighter nasal tip and reshaping of the columella region. Fixing a crooked nasal tip is one of the most challenging types of cosmetic nose surgery. See how she still looks very natural even after complete nasal reshaping.

#### Case-3665
Great example of how combining liposculpture with tightening of the platysma muscle can create much better neck contour and definition. Notice how much better her jawline now looks!

#### Case-3666
Great example of how an upper lip lift can give someone the appearance of permanent lip augmentation - while shortening the distance between the nose and pink lip. Yet, you can see how she still looks quite natural.

#### Case-3667
URL: https://www.drhilinski.com/gallery/patient/case-3667/

#### Case-3668
URL: https://www.drhilinski.com/gallery/patient/case-3668/

#### Case-3669
URL: https://www.drhilinski.com/gallery/patient/case-3669/

#### Case-3670
Making a female nose smaller looking - mainly on the frontal view - by narrowing her wide nasal tip and bringing her bones in on each side.

#### Case-3671
URL: https://www.drhilinski.com/gallery/patient/case-3671/

#### Case-3672
Fairly dramatic revision rhinoplasty transformation by Dr. Hilinski following prior unsuccessful rhinoplasty by a different plastic surgeon.

#### Case-3673
Botox to help create more symmetry in this young lady's brow - notice how her right brow was much higher prior to the Botox treatment.

#### Case-3674
Revision rhinoplasty to correct a saddle nose deformity. Surgery performed with use of cadaveric rib cartilage.

#### Case-3675
URL: https://www.drhilinski.com/gallery/patient/case-3675/

#### Case-3676
Cosmetic rhinoplasty combined with chin implant placement

#### Case-3677
URL: https://www.drhilinski.com/gallery/patient/case-3677/

#### Case-3678
URL: https://www.drhilinski.com/gallery/patient/case-3678/

#### Case-3679
URL: https://www.drhilinski.com/gallery/patient/case-3679/

#### Case-3680
Example of finesse open rhinoplasty to make her tip more defined and the bridge smoother. Notice how her nose still looks like her old one - just better.

#### Case-3681
Example of a finesse rhinoplasty to make the tip look more refined and defined

#### Case-3682
Fat transfer to help revolumize this young lady's midface/lower eyelid region.

#### Case-3683
Laser mole removal performed

#### Case-3684
URL: https://www.drhilinski.com/gallery/patient/case-3684/

#### Case-3685
Classic hump reduction and tip refinement using open rhinoplasty technique

#### Case-3686
Example of filler injection to the lower eyelid, cheek region to create a more rested, youthful appearance in this patient. This is a classic example of how fillers, like Restylane and Juvederm, can be used as a non-surgical method for eyelid rejuvenation.

#### Case-3687
Dramatic improvement in his ears following cosmetic otoplasty or ear pinning surgery

#### Case-3688
Facial and neck rejuvenation as a result of a lower face, upper neck lift surgery - including platysmaplasty.

#### Case-3689
Example of reconstructive rhinoplasty and nasal valve repair to help improve congenital weakness of the nasal tip region. In addition, this patient had a bulbous nasal tip shape that was improved in the process of doing the reconstruction. Notice on her base view, in particular, how the overall shape of the tip went from being more squared to being more triangular.

#### Case-3690
MOHS reconstruction following resection/removal of a skin cancer from the right side of her nose.

#### Case-3691
Complete tip and columella reshaping for this young lady who had prior rhinoplasty surgery performed by a different plastic surgeon before coming to Dr. Hilinski for a revision.

#### Case-3692
Subnasale upper lip lift to shorten this young lady's lip to be more proportional - while also creating more pink show and dental exposure. Note how her cupid's bow is more defined and prominent following the upper lip lift.

#### Case-3693
See more detailed information on this case example in our Rhinoplasty Tutorial

#### Case-3694
Lumenis Encore laser treatment to provide overall improved skin appearance. More specifically, the laser was used to tighten her lower eyelids - including some festoons (a variant of lower eyelid bags) along the lower eyelid-cheek junction.

#### Case-3695
Lumenis Encore CO2 laser peel to help smooth out the lower eyelid wrinkles.

#### Case-3696
Lower eyelid rejuvenation with laser treatment using the Lumenis Encore system. Notice how her lower eyelids look so much smoother and rested with less wrinkling following this special type of laser peel.

#### Case-3697
Upper and lower lip enhancement using Juvederm injectable filler.

#### Case-3698
Example of a subnasale upper lip lift to shorten her upper lip while creating a bit more 'mucosal show' to give the illusion of more volume.

#### Case-3699
Example of how some filler injection treatments can literally give you smoother looking skin. This is an example of how Restylane injections around the jowl and cheek can help improve wrinkled skin in this older, female patient. Should she have had laser skin resurfacing? Yes - but she wasn't ready to have the recovery involved with this, so she elected to do office-based fillers.

#### Case-3700
Revision rhinoplasty to help create a more defined and refined looking nose in this young lady who had her prior nosejob done by a different plastic surgeon. In some cases - like this one here - you can dramatically change the entire appearance of the nose.

#### Case-3701
This is an example of a female patient who was born with marked pinching, or collapse, of her right nostril rim and tip region. You can see from her photos just how abnormal the right nostril is with significantly asymmetrical shadowing easily seen. This is the type of deformity I often see in patients who had prior, failed surgery by a different plastic surgeon. Fortunately, I was able to reconstruct her nose with cartilage grafting technique and an open rhinoplasty approach to create a much more symmetrical tip with proper tip support.

#### Case-3702
Classic example of ear pinning, or otoplasty, to make her ears less prominent. In this particular case, ear reshaping was performed with suture contouring and cartilage reduction.

#### Case-3703
This is an example of lower eyelid filler injection (using Restylane in this case) to help correct abnormal and unwanted shadowing from loss of volume. The filler was used to augment the soft tissue layers under the eye - creating a much more rested and youthful look.

#### Case-3704
Example of cosmetic nose work to address an overly bulbous and asymmetrical nasal tip. You can see on her oblique view just how bulbous the tip was prior to reshaping. In addition, the bridge was smoothed out to create a straighter, yet natural-looking, profile.

#### Case-3705
Surfboard

#### Case-3706
Example of a revision open rhinoplasty to help improve the symmetry of this lady's nose following prior nosejob surgery performed by a different plastic surgeon.

#### Case-3707
Example of what Juvederm lip injections can do to help create fuller, smoother lips. Note how her lips are enhanced in shape and size - yet still look like she could have been more with them.

#### Case-3708
Example of Botox cosmetic injection to the forehead region to help reduce wrinkles and creases. Before and after are shown for the frown and frontalis muscles - the muscles responsible for creating the unwanted '11s' and the horizontal forehead wrinkles. Both sets of photos show the patient animating to to try and create the wrinkles. Notice just how effective Botox cosmetic can be in controlling these muscles and creating a much smoother forehead.

#### Case-3709
Example of macrotia surgery or scapha reduction surgery where the upper segment of the ear is reduced in size. This is NOT classic otoplasty surgery - or ear pinning. It is actual reduction in the size of the ear in terms of vertical height. You can readily see how - after surgery - the top of the ear has been truncated to create a more proportional size and shape. I happen to be one of the few plastic surgeons in the country who performs scapha reduction surgery - or macrotia - on a regular basis.

#### Case-3710
Example of cosmetic rhinoplasty to reduce the bridge height, bring the tip closer to the face, reshape the bulbous nasal tip and soften the overall appearance.

#### Case-3711
Example of chin augmentation using Juvederm filler injection to contour the jawline of this very pleasant young lady. Instead of placing an implant along the front of her jaw, she opted to have an injectable filler done in the office to give her better chin definition. In addition, as can be appreciate on the front view, I was able to create more symmetry for her as well. This was completed in 10 minutes while she was wide awake - with essentially no downtime.

#### Case-3712
Example of Radiesse cheek augmentation to create a fuller, plumper midface contour. Notice how her lower eyelid-cheek complex is now much smoother with less shadowing.

#### Case-3713
Example of male ethnic (Indian) rhinoplasty surgery to create more tip and bridge definition.

#### Case-3714
Example of ethnic rhinoplasty to create more tip narrowing and definition. These patients tend to have much thicker nasal skin - especially in the tip region. Therefore, creating a more defined nasal tip can be significantly more challenging. At the same time, it is important to maintain ethnic consistency. The desired goals were met here as you can see in her before and after photos.

#### Case-3715
Great example of local skin flap reconstruction used to repair this very large defect involving her left nasal side wall. This patient had a skin cancer removed days prior to the surgery. Here she is nearly 1 year out from my surgical reconstruction. The scars should continue to get better as further time goes on.

#### Case-3716
Example of how the helical rim can be contoured to reduce a prominent curvature - thus making the outer border of the ear appear more vertically oriented.

#### Case-3717
Example of macrotia, or scapha reduction surgery, to help make the upper segment of the ear smaller. This is NOT traditional otoplasty surgery where the ear is pinned closer to the head. Rather, macrotia surgery actually makes the ear smaller by removing a crescent-shaped segment along the upper half of the auricle.

#### Case-3718
Example of lip filler injection to create fuller, plumper, and smoother looking lips in this young lady from San Diego. Juvederm was used to fill the upper and lower lip to obtain the results shown.

#### Case-3719
Example of lower facelift with upper necklift combined with platysmaplasty to provide this already attractive lady with a more refreshed appearance.

#### Case-3720
Another example of lip filler to create more definition along the vermillion border while also plumping the lips just a bit.

#### Case-3722
Example of Juvederm lip injections to provide a more defined, volumized look in this female patient. Notice how her lips have improved size and shape - yet still look quite natural. This is a great case that shows patients can have lip filler placed without an excessively puffy, overdone appearance.

#### Case-3723
This is an example of a quad blepharoplasty - meaning the upper and lower eyelids were lifted on both sides. You can see the fairly dramatic improvement noted - especially in her upper eyelid on the right side where the excess skin has now been removed. These photos actually show her results years later - confirming a sustained, long-term improvement in her appearance. Yet she doesn't look like she has had plastic surgery of the eyes.

#### Case-3724
Another example of cosmetic ear pinning, or otoplasty, to make this little guy's ears less prominent.

#### Case-3725
Example of reconstructive plastic surgery to remove a fairly large keloid scar from this young lady's ear. Notice how her ear now looks normal - without any significant distortion of the underlying, native anatomy - with no recurrence of the keloid scar. In the hands of a board certified plastic surgeon, this type of outcome is considered the standard.

#### Case-3726
This is a great example of macrotia, or ear reduction surgery. This patient was bothered by the fact his ears were just too large for his taste. I performed a standard scapha ear reduction surgery on him to reduce the upper portion of the auricle - thus giving him an overall smaller ear. If you look closely at these photos, you can also appreciate how the shape of the upper ear is improved - less 'pointed' and now with a more gentle arching curve. I happen to be one of the few surgeons in the country at this time that offers this surgery and has performed macrotia scapha ear reduction on a regular basis.

#### Case-3727
Example of lip implants to enhance the size and shape of this young lady's lips using Surgisil Permalip silicone implants. Notice that, even with smiling, her lips look quite naturally augmented.

#### Case-3728
Example of revision open rhinoplasty to further reshape a nose following prior, unsuccessful rhinoplasty performed by a different plastic surgeon. In this case, I ended up lengthening her nose - which is fairly unusual in the world of rhinoplasty - to bring the tip downward just a bit. I also helped to create just a bit more tip definition and symmetry. Overall, you can readily see the improvements - but she still looks like this is a nose she could have been born with years ago.

#### Case-3729
This is a great example of how a traumatic laceration can be repaired to show minimal signs of the injury. This patient suffered a deep laceration over the brow region playing water polo. I was able to repair the cut using a layered suture technique that left minimal signs of scarring years later.

#### Case-3730
This is an example of closed rhinoplasty to help rebuild this young lady's bridge. Cartilage grafting was placed thru the nostrils to help restore a proper shape. Notice how her nose now looks more narrow from the front while the oblique and side views reveal a marked improvement in smoothing (with correction of the depression).

#### Case-3731
Example of subnasale upper lip lift to create a shorter upper lip length while also giving the pink (mucosal) lip a bit more definition and fullness. Notice how her proportions are now in better balance. She still looks like herself - just a more refined and defined version when it comes to the upper lip shape.

#### Case-3732
This is an example of a somewhat rare chin implant placement. This Asian patient from San Diego desired a chin implant to augment the pre jowl area on both sides - not to project the chin outward any further. This was accomplished with a Mittelman Prejowl Chin Implant by Implantech. This implant was specifically designed to augment the chin in the pre jowl zone only - indicated by the red arrows on her preoperative view. There was no augmentation along the front-center part of the chin. Following the surgery, she did undergo some additional injections with Bellafill to provide even more symmetry. But the end result shows what a nice improvement can be seen with a smoother jawline.

#### Case-3733
Rhinoplasty surgery to reshape the nasal tip primarily. The bridge was reduced and smoothed out. But more attention was given to making her nasal tip appear more refined. Note how her nasal tip has been lifted slightly - plus it now looks more like a 'soft triangle' and is also more symmetrical on her face.

#### Case-3734
Example of septorhinoplasty to help address a hump deformity and a very bulbous nasal tip. These results are years after her surgery and show a very stable outcome. Notice how her bridge is much straighter now and her tip no longer looks so rounded.

#### Case-3735
Example of reconstructive septorhinoplasty with grafting of cartilage. Notice, in particular, how her nostril walls were reinforced to prevent collapse as was noted prior to her surgery (best seen on the view from below).

#### Case-3736
Open reconstructive revision rhinoplasty performed on this patient - prior nose surgery performed by a different plastic surgeon. She was, unfortunately, left with functional problems as well as aesthetic issues with her nose. I performed an open revision rhinoplasty technique - that included revision septoplasty, nasal valve repair and cartilage grafting. You can now see how much better her nose looks following this type of very complex revision repair.

#### Case-3737
This is an example of upper and lower lip enhancement with placement of Surgisil Permalip silicone lip implants. Notice how natural her upper and lower lip still appear following placement of the implants. Also note how her smile still looks quite natural with the implants in place. Surgisil Permalip lip implants are a great option for those patients seeking a long-term or permanent alternative to upper and lower lip filler injections.

#### Case-3738
Example of reconstructive rhinoplasty surgery to fix a collapsed nostril wall. This patient was quite bothered by nasal obstruction due to a weak nostril wall and nasal tip complex. I reconstructed his nose using standard rhinoplasty technique to help provide him marked improvement in stability and subjective breathing.

#### Case-3739
Example of scar revision reconstruction to remove this keloid scar that formed along the rim of the ear. Notice how her ear now looks quite normal without much distortion or sign of having had this type of abnormal growth.

#### Case-3740
Teenage rhinoplasty - a great example of cosmetic nose work to lift this young lady's droopy tip while narrowing the tip of the nose to create more definition. She is quite happy with the results - as is her mom!

#### Case-3741
Great example of what an upper eyelid tuck can do for you! She had an upper eyelid blepharoplasty to remove the excess, weighted skin. Here she is months later with a fantastic improvement.

#### Case-3742
Gauge earring repair to recreate a natural looking lobule.

#### Case-3743
Cosmetic ear pinning to make her ears less prominent.

#### Case-3744
Another example of subnasale upper lip lift to shorten the distance between the bottom of the nose and the pink lip border.

#### Case-3745
Cosmetic ear pinning, or otoplasty, to help make this young lady's ears less prominent.

#### Case-3746
Example of rhinoplasty to help repair a markedly abnormal nose with a crooked alignment. Despite what many plastic surgeons say, crooked noses, indeed, can be improved through surgery.

#### Case-3747
Great example of revision reconstructive rhinoplasty to correct a saddle-type of deformity. This patient had prior surgery by a different plastic surgeon that resulted in an abnormal bridge depression. He also had weakness of the tip support and nostril rims. An ear graft was performed as part of the reconstruction to help create a more normal, natural looking nose that also functioned much better. As you can see, he still looks like himself - just a better version with improvement in terms of his nasal shape.

#### Case-3748
Example of Sculptra liquid facelift injections to create more shape and volume in this patient from San Diego.

#### Case-3749
Example of a revision upper lip lift in this middle-aged female patient from out of state. She had a prior lip lift performed by a different plastic surgeon, but, unfortunately developed recurrent elongation of the upper lip. I performed a revision subnasale upper lip lift using my standard surgical technique. Notice how her upper lip is now shorter, yet it still looks natural for her face.

#### Case-3750
Example of cosmetic ear pinning to create less prominent ears in this young lady from San Diego.

#### Case-3751
This is another example of laser resurfacing, or laser surgery, to help correct rhinophyma of the nose. Rhinophyma is a skin condition that creates an overly bulbous appearance to the nose. I used a CO2 laser to help sculpt the lower one half of his nose - creating a much more normal looking contour and shape. You can see from the bottom view that I was also able to get his nostrils more open by taking away some of the overlying heavy, weighted skin.

#### Case-3752
This is an example of revision rhinoplasty to help correct a collapsed nostril on the patient's right side following prior rhinoplasty performed by a different plastic surgeon. In addition, the patient's nose was over-projected - meaning his nose stuck out too far from his face. In the process of restoring proper nasal tip support by reconstructing his collapse nostril wall, the tip was made more proportional to the rest of his nose (and face). He now has a much more functional nose without collapse - plus his nose now looks more symmetrical and in balance with his overall facial appearance.

#### Case-3753
Another example of cosmetic upper lip shortening, or an upper lip lift, to create more balance and harmony. This is a patient who has more ethnic skin, which normally can take a bit longer to heal. These photos show her ongoing results at about 3 months out from the subnasale lip lift procedure. You can see that her incision line is still a bit red, but should continue to fade away nicely as the months go on. Notice how her upper lip length is much improved. She also has better definition along the pink border of the lip and her philtral ridges are now more pronounced. Overall, she is quite happy with her lip lift results! See more examples of upper lip lift surgery by linking here.

#### Case-3754
This is an example of male septorhinoplasty surgery to correct a crooked nose deformity. Notice how much straighter his nose is following surgery. In the process, his nasal bridge was made to be straighter in contour.

#### Case-3755
Example of cosmetic rhinoplasty to help reduce the prominent bridge contour while lifting the nasal tip and columella region. Notice how his nose still looks strong and masculine and continues to be fitting for his face. The goal in this case was not to completely transform his nose and his facial appearance - it was simply to address certain features of his nose that he did not like.

#### Case-3756
Example of a lower face and upper neck lift procedure to provide this patient with a more rejuvenated appearance. As you can see, she now looks much more rested and youthful. But she certainly does not have the stigma of looking as if she had a surgical procedure performed.

#### Case-3757
This is an example of mole removal using a shave technique. Notice the two more prominent moles along her forehead and chin that she desired to have taken off. I recommended a shave technique that was successful in getting rid of the moles without any real obvious, visible scarring.

#### Case-3758
Example of Sculptra, poly-L-lactic acid (PLLA), injections to the face to create more volume and shape. Notice on these views how her cheeks and jawline are now fuller and more shapely - without looking overdone. Sculptra is a wonderful product that can provide nice aesthetic enhancements like this, which can last upwards of 2 years in most cases.

#### Case-3759
Example of a lower face and upper neck tuck to create a more rejuvenated appearance in this lady from San Diego.

#### Case-3760
Another example of gauge defect repair to close up large holes within the lobule of the ear. Notice in this case, the patient had a second, smaller hole just posterior to the larger one. Fortunately, I was able to close both holes in one operation - saving her significant recovery time.

#### Case-3761
Example of lower lip mucosal advancement technique to permanently create a fuller, plumper lower lip - all done without use of injectables and without an implant. Read more about this highly specialized procedure offered by Dr. Hilinski for creating permanent lower lip fullness and plumping. Of note, this patient also underwent an upper lip lift at the same time.

#### Case-3762
Example of neck contouring to create more definition using liposculpture technique along with tightening of the platysma muscle.

#### Case-3763
Example of upper eyelid tuck to create more definition. Patient also had a lower face and upper neck tuck at the same time.

#### Case-3764
Example of cosmetic reshaping of the lower face and neck to provide a more rested, rejuvenated appearance. Notice how her incisions (scars) are minimally visible in and around the ears. This is particularly challenging when dealing with patients like her who have darker, thicker ethnic skin. Most importantly, though, notice how she still looks very natural without obvious stigma of having had a facelift procedure.

#### Case-3765
Bilateral otoplasty to pin the ears back closer to the head.

#### Case-3766
Example of otoplasty to help create a more normal helical contour in this patient with a lop ear deformity. This young male patient was unhappy with how his ears developed (or were under-developed) with an excessive helical rim thickness. An ear with this type of cosmetic deformity is often times referred to as a constricted ear or a lop ear. It is also called a cup ear deformity by some. This deformity is best appreciated on the profile views where you can see how the helix was quite wide. This is a somewhat unusual cosmetic ear deformity that is sometimes referred to as a constricted ear. Others refer to this as a lop ear or cup ear. I performed cosmetic ear surgery to resect some of the extra skin and cartilage - creating a much more normal looking ear on both sides.

#### Case-3767
Example of revision rhinoplasty following prior surgery performed by a different plastic surgeon. I ended up performing tip reshaping primarily to create more symmetry. This involved use of cartilage grafting technique to build up the right side of her nasal tip. Notice preservation of her overall look - but now with a more symmetrical and defined nasal tip.

#### Case-3768
Finesse type rhinoplasty that included smoothing the bridge, lifting the tip slightly and creating more symmetry to the tip region. She also had a chin implant performed to give a better overall balance to her profile view.

#### Case-3769
Example of chin augmentation using a chin implant that was placed from underneath the chin. Notice how her overall facial balance has been improved now that the jawline has been enhanced.

#### Case-3770
Example of lower eyelid cosmetic surgery to reduce the appearance of unwanted 'bags' under the eye. Notice how much more rested she now appears following this type of cosmetic lower eyelid enhancement.

#### Case-3771
Example of rhinoplasty to address a very bulbous, wide nasal tip. In addition, her septal cartilage was quite deviated - going into her right nasal airway as best seen on her base view (from under the nose). Following open open rhinoplasty procedure, her nasal tip is much less bulbous with a more favorable shape and contour. Plus, her nasal base is now improved with much more symmetry in terms of the nostril openings.

#### Case-3772
Example of cosmetic rhinoplasty to provide this young lady from San Diego with a nose that has a smoother bridge and more defined nasal tip. In addition, I rotated the tip just slightly to give a more feminine profile view.

#### Case-3773
Example of rhinoplasty to create improved overall shape and contour. More specifically, I ended up correcting her retracted columella - which was most visible on the side view where you can see the area under the nasal tip looking as if it was excessively tucked up. In addition, I created more nasal tip refinement with a smoother transition into the bridge. Overall, this is somewhat of a finesse type of rhinoplasty surgery.

#### Case-3774
This is an example of nose reconstruction to help improve the alignment of this very crooked nose. This young lady's nose was quite misaligned - deviating markedly to her right side. In addition, her bridge contour was less than optimal. I performed a closed rhinoplasty surgery that involved breaking her nasal bones to move the alignment more toward the midline. In addition, I reshaped her nasal bridge and tip to create a more favorable profile view.

#### Case-3775
This is an example of cosmetic chin and neck reshaping to provide improved definition of the face and neck region. This patient had a chin implant placed in combination with tightening of the neck muscle (platysmaplasty). The surgery was performed through an incision made underneath the chin. Notice the overall improvement across her lower face and upper neck region.

#### Case-3776
Example of a combined lower face and upper neck lift in this male patient from San Diego who desired to simply look more rested and youthful. Notice how natural he looks without any obvious stigma of having had cosmetic face surgery.

#### Case-3777
Example of revision rhinoplasty (original nose job performed by a different plastic surgeon) to help create a smoother bridge and more refined tip. Unfortunately, her nasal skin and underlying cartilage were damaged by the previous surgeon - resulting in unusual contour irregularities along the bridge and tip. Notice how, overall, her nose appears more narrow and defined from the frontal view and smoother from the side view. Keep in mind that ethnic patients often times have much thicker skin, which can impact just how much improvement can be realized from surgery. Despite this limitation, her results are still a notable improvement.

#### Case-3778
Rhinoplasty surgery to help improve the undesirable 'bony horns' that you can see along the front view of her bridge. In addition, her tip cartilage was reshaped to create a softer overall contour.

#### Case-3779
This is an example of revision Asian cosmetic rhinoplasty to correct problems arising from placement of a silicone nasal implant performed by a different plastic surgeon. Notice how the irregular contour from the silicone implant has now been corrected by removal of the implant and reshaping of the bridge. This case was also the focus of one of our online rhinoplasty tutorial discussions regarding revision rhinoplasty in Asian patients.

#### Case-3780
This is an example of septorhinoplasty surgery to help correct a severely asymmetric and abnormal nostril shape. This patient desired to have the base of the nose reshaped to help provide a more normal looking foundation for his nasal tip region. Notice the dramatic improvement following an open septorhinoplasty surgery.

#### Case-3781
Cosmetic rhinoplasty to smooth ‘bony horns’ along the bridge in combination with finesse tip refinement and reduction of her bump - providing her with a beautiful, natural result.

#### Case-3782
Example of revision open rhinoplasty to help improve the shape of the nose following two prior rhinoplasties performed by a different plastic surgeon. The main issue with this nose was the abnormal bridge contour. As you can see, his bridge was quite thin for his nose (and face). In addition, the bridge had a curved contour as seen from the front. This was because a silicone implant was used to augment his bridge during one of the prior rhinoplasty surgeries - which ultimately bent to the side. I performed a revision rhinoplasty procedure that included removal of the silicone implant. I replaced the implant with cadaveric costal (rib) cartilage to help restore a more normal looking bridge. His post-rhinoplasty photo shown here confirms a much improved bridge width that is more appropriate for his nose (and face) and is better in terms of overall symmetry. Most importantly, his nose now looks more natural.

#### Case-3783
This is an example of cosmetic cheek enhancement using Bellafill injections. Bellafill, one of the only non-absorbable injectable fillers on the market, was used to create more shape and contour to the cheeks of this young lady.

#### Case-3784
This is an example of lower eyelid blepharoplasty performed to reduce the excess prominence of skin and muscle. Notice in her before photo how there is a prominent ridge or fullness running along the lower eyelid just below the lashes. I performed a lower eyelid tuck that involved making an incision along the lower eyelid and tightening the skin and underlying muscle. This is not a case where the patient had excess fatty tissue under the eyes (also referred to as eye bags). This is, instead, a case where the orbicularis oculi muscle was too thick - creating a ridging effect. Notice how her surgical scar is barely visible following the procedure. And, more importantly, notice how much smoother her lower eyelid now is after the skin and muscle have been reshaped.

#### Case-3785
Example of cosmetic rhinoplasty to narrow the nasal bones and bridge while bringing the nasal tip closer to the face.

#### Case-3786
This is an example of a male rhinoplasty patient who had prior cosmetic nose work done by a different plastic surgeon. Unfortunately, too much cartilage was removed from his nose - resulting in a pinched, feminized tip and a somewhat scooped bridge contour. I performed a revision rhinoplasty procedure using cadaveric costal (rib) cartilage grafting to help restore a more proper tip and bridge shape. He now has a nose that is more masculine and in balance with his facial features.

#### Case-3787
Example of earlobe reduction in this male patient who disliked how large his earlobes appeared. I performed a wedge excision reduction on his ears to create more normal-sized lobes.

#### Case-3788
This is an example of excision (cutting out) of a mole. You can see how, in many cases, there can be very minimal scarring - even in a patient like this who has moderately dark, ethnic skin.

#### Case-3789
Another example of mole shaving for a mole just above the tip of the nose. Following a quick, 10-minute office procedure - the mole is now essentially gone. If you look closely, there is minimal evidence of any scarring.

#### Case-3790
Example of facial mole shaving. This patient had a bothersome mole located near the right side of the tip of the nose. I recommended facial mole shaving, which was done under local anesthesia in the office - taking 10 minutes to complete. Note how the mole is now gone with minimal evidence of having had a surgical procedure.

#### Case-3791
This is an example of revision reconstructive rhinoplasty to help restore proper structural support to the nose following prior work done by a different surgeon. Notice how her tip is markedly asymmetrical - deviating off to her right side. Following surgery, her alignment is much improved and her nose now looks more natural overall. Keep in mind that this patient has very thick skin, which significantly limits how much change can be accomplished.

#### Case-3792
This is an example of cosmetic rhinoplasty to help address what is called a ptotic nasal tip - a tip that droops down excessively. Notice on how her front view, the tip of the nose appears too wide and misshapen. Using an open rhinoplasty approach, I was able to reposition her tip to a higher location while providing with her a nice improvement on the side view as well. Even with smiling (where her tip looked even more droopy), her nasal tip remains appropriately in place.

#### Case-3793
This is another example of ethnic rhinoplasty done to create a natural looking, refined nose. Notice how her bridge is smoother and more defined. Her tip has also been modified to create more definition. Overall, she has a better looking nose, but she still looks like herself.

#### Case-3794
Example of a subnasale upper lip lift to help shorten this patient's upper lip. By performing this type of upper lip enhancement, I was able to create a more proportional facial balance. In the process, I was able to provide her with increased 'red lip show' that makes her upper lip appear more volumized and youthful.

#### Case-3795
This is an example of Bellafill (Artefill) injection to the mid face (cheek region) and lower face (jowl region). Notice how her face now appears volumized, which provides her with a nice, rejuvenated, more youthful look.

#### Case-3796
This is an example of revision rhinoplasty to help provide her with improved tip definition. This patient had prior rhinoplasty by a different plastic surgeon, but was still unhappy with the appearance of her nasal tip region. I ended up performing cadaveric costal (rib) grafting to create a more define and refined looking nasal tip.

#### Case-3797
This is an example of reconstructive rhinoplasty to correct a saddle nose deformity in this pleasant lady from San Diego. She suffered trauma to the bridge as a result of being accidentally hit in the nose. This particular reconstruction involved use of ear cartilage to help rebuild the bridge to a more natural looking, normal height.

#### Case-3798
Example of macrotia surgery to reduce an excessively large scapha in this male patient. Notice how both ears are now much smaller following the scapha reduction procedure. Of note, this patient had prior cosmetic otoplasty by a different plastic surgeon that left the upper half of the ear still too large for the patient's liking. I incorporated his prior helical scar into the macrotia repair.

#### Case-3799
Example of ethnic rhinoplasty to create a more defined, narrowed appearance in this young lady from San Diego. I ended up performing an open cosmetic rhinoplasty that included bridge reshaping, tip refinement and overall narrowing of the nose. If you look at her nose from the base (bottom) view, you can really appreciate how the tip of her nose is now much more triangular in shape, rather than rounded.

#### Case-3800
Example of rhinoplasty surgery to address a ptotic nasal tip that was also quite bulbous in appearance. Note how her nose now looks much better balanced with her surrounding facial features.

#### Case-3801
This is an example of rhinoplasty surgery (nasal reshaping) to address unwanted skin changes from a condition called rhinophyma. A CO2 laser was used to reshape the entire lower one-third of his nose with specific attention paid to reduce the bulky skin changes. You can really see a big difference when you look at his nose from the bottom (base) and from the 45 degree angled views.

#### Case-3802
Another example of an upper lip lift to shorten the distance between the pink vermillion border of the upper lip and the bottom of the nose. Notice how this patient now looks more proportional in terms of this area. A nice secondary effect in this patient is the increase in pink 'show' in terms of the upper lip also looking more volumized.

#### Case-3803
Example of a lower facelift and upper neck lift in this very pleasant lady from San Diego who simply desired to look more rested and youthful. As you can see, she still looks very much like herself - but now appears more rejuvenated.

#### Case-3804
Example of rhinoplasty surgery to shorten a long nose. This patient had moderately severe tip ptosis with an elongated appearance to his nose. Following surgery, note how I was able to shorten the overall length to make the nose look much more proportional and balanced with his face.

#### Case-3805
Example of Sculptra injections to the temples, mid face and pre jowl regions to help restore lost volume from aging. Notice how her face is now fuller following this series of Sculptra injections. Using very strategic placement of the Sculptra, one's face can literally be sculpted to provide a much more rested, rejuvenated appearance. Not a bad non-surgical option for someone desiring to look younger.

#### Case-3806
An example of chin augmentation with an implant combined with liposuction of the neck and tightening of the platysma muscle (platysmaplasty) to create a more defined appearance. Notice how she still looks quite natural following the surgery (including her smile) with an overall enhancement in her chin and neck region.

#### Case-3807
A more dramatic example of upper eyelid cosmetic surgery to remove heavy, weighted skin along both eyelid margins. Notice how much more rested and youthful she looks following upper eyelid blepharoplasty.

#### Case-3808
This is an example of revision rhinoplasty to correct residual issues arising from prior rhinoplasty done by another plastic surgeon. This patient had prior nose surgery by someone in Beverly Hills. Unfortunately, he was left with marked asymmetry of this tip where his right side was collapsed versus his left side. In addition, his nasal tip stuck out too far as best seen on his side view.

I performed an open revision rhinoplasty to help provide him with more symmetry in the tip region. You can readily see how his right nostril rim is now much more even with his left side. An ear graft was used along with remaining septal cartilage to help reconstruct the right side of his nasal tip. At the same time his nasal tip was made less pointy to give him a more natural overall look.

#### Case-3809
This is an example of nasal reconstruction using a composite graft taken from the patient's ear to repair a defect that arose after having MOHS skin cancer surgery. As you can see, she has a full thickness defect where her nose is missing tissue along the nostril arch. I ended up using a composite ear graft - skin, soft tissue and cartilage combined - to help restore a more normal and natural contour.

#### Case-3810
Example of revision rhinoplasty (prior surgery done by a different plastic surgeon) to reconstruct the nasal tip region in particular. Notice how her right nostril was much different than her left, which also had implications in terms of obstructed breathing. I was able to reconstruct the nasal tip to create more symmetry while helping to restore proper support for function.

#### Case-3811
URL: https://www.drhilinski.com/gallery/patient/case-3811/

#### Case-3812
Example of Persian, or Middle Eastern, rhinoplasty surgery to reshape the nasal bridge while creating more definition to the nasal tip region.

#### Case-3813
This is an example of Sculptra injections to the face as a non-surgical facelift alternative. Sculptra is used as an injectable volumizer for the face. In this particular example, we injected Sculptra in the cheek region as well as along the jawline. Notice how her overall appearance is now more youthful while maintaining a very natural look. This is especially true in the region of the cheek (yellow arrows) and the pre jowl/jawline (red arrows).

#### Case-3814
Lower face and upper neck lift surgery to provide a more rejuvenated appearance in this very pleasant female patient. Notice how much more rested and youthful she now appears - without the appearance of having been pulled too tight.

#### Case-3815
Example of African-American cosmetic rhinoplasty that included bridge augmentation using Goretex and tip cartilage grafting using her septum. Notice how she still looks quite natural after surgery without having an obvious surgical appearance.

#### Case-3816
This is an example of African-American cosmetic rhinoplasty to help refine the nasal tip while giving the bridge improved height and contour.

#### Case-3817
Example of Sculptra injections to rejuvenate the face while creating volumetric enhancement of the natural facial contour.

#### Case-3818
Example of cosmetic ear reshaping (otoplasty) to pin this young lady's ears back.

#### Case-3819
This is an example of ear reconstruction to address an abnormal notched contour along this male patient's auricle. The surgery was done under local anesthesia and involved moving the tissue around in the adjacent area to try and recreate a more natural looking external ear. As you can see, he now has a much more acceptable appearance following surgery.

#### Case-3820
Example of reconstructive upper eyelid surgery (blepharoplasty) to remove the excess, weighted skin along the upper eyelid in this female patient from San Diego. In this particular case, her skin was contributing to a deficit in her peripheral vision. Therefore, the patient's insurance company covered the costs of the operation.

#### Case-3821
This is an example of functional nose reconstruction (corrective septorhinoplasty) in a male patient from San Diego who had trouble breathing through his nose. An open reconstructive septorhinoplasty was performed. In this process, you can see how much of the nasal framework was reshaped - providing him with a nice passive change in terms of the appearance of his nose. Of note, this is the type of reconstructive nose surgery that was covered by his insurance company since the thrust of the operation was to provide him improved nasal function (breathing).

#### Case-3822
Example of Persian rhinoplasty surgery to reshape the entire nose - including smoothing of the bridge, narrowing of the nasal bones along with refinement and lifting of the tip.

#### Case-3823
Asian revision rhinoplasty to create a more defined and symmetrical nose following prior nasal plastic surgery by a different surgeon. Read more about this Asian rhinoplasty case here in our online rhinoplasty tutorial.

#### Case-3824
Example of cosmetic upper eyelid blepharoplasty surgery to enhance the appearance of this female's eye region. Notice how prior to surgery she had excess, weighted skin that draped over her upper eyelid crease. Following cosmetic upper eyelid surgery, she now has a marked improvement that gives her a more rested look.

#### Case-3825
Example of a lower facelift and upper neck lift procedure to create a more youthful, rested look in this female patient from San Diego, CA. Notice how the area under her chin has been reshaped to give a more rejuvenated overall appearance.

#### Case-3826
Example of a lower face and upper neck lift in this female patient from San Diego who desired to look more rested and youthful. I performed a standard SMAS-type of facelift surgery to give her a more rejuvenated look overall. Her upper eyelids were also done to further enhance her appearance.

#### Case-3827
Example of cosmetic otoplasty surgery in this young male patient from outside of San Diego who desired to have less prominent ears. He also desired to have more symmetrical ears. Notice how he has an overall improvement in the shape of his ears following otoplasty, including more symmetry.

#### Case-3828
This is an example of functional reconstructive rhinoplasty surgery to help this patient breathe better. Notice on his frontal view prior to surgery that the nasal bridge is quite crooked. In fact, you can see how it curves off to the patient's left side in a C-shaped configuration. I ended up reconstructing the nose to function better using a variety of cartilage grafts to build up the right side of his nose. In this process, there is an obvious improvement made in terms of symmetry of the bridge. The oblique and profile views demonstrate how this type of reconstructive rhinoplasty can be performed while preserving much of the original appearance of the nose.

#### Case-3829
Example of cosmetic rhinoplasty to totally refine this young lady's nose. In addition to reducing the convexity along her nasal bridge, I lifted her nasal tip and narrowed the nose to create a more defined, feminine shape overall. In the end, you can see that she has a nice transformation, yet still looks quite natural.

#### Case-3830
Example of permanent smile line correction using surgical technique that involves cutting the deep crease out. Notice how this male patient from San Diego has much less shadowing of the smile line region following permanent smile line correction.

#### Case-3831
Example of a female patient from San Diego who desired a more defined neck and jawline. I performed liposuction, or lipo-sculpture, of her neck region using tumescent anesthesia to remove the excess fatty tissue. Her results demonstrate a very nice improvement in definition with a much more youthful overall appearance.

#### Case-3832
Female ethnic rhinoplasty patient who desired reduction of the bridge height and a more narrow, defined looking nasal tip.

#### Case-3833
Example of bilateral (both sides) otoplasty or cosmetic ear reshaping to make this young lady's ears less noticeable.

#### Case-3834
Example of an upper lip lift using a subnasale bullhorn incision. Notice how her upper lip has been shortened very nicely, yet she still looks quite natural.

#### Case-3835
Example of Hispanic ethnic rhinoplasty to reduce the bump on the bridge and to create a more narrow, defined looking nasal tip.

#### Case-3836
Example of male, ethnic rhinoplasty in this patient from San Diego who desired a more refined looking nose. His surgery included augmentation of the bridge using an implant, tip narrowing and grafting, and reduction of the nasal base region. Overall, you can tell his nose is more defined from top to bottom, yet still fits his face.

#### Case-3837
Example of lower facelift and upper neck lift combined with liposuction of the sub mental region in this female patient from San Diego. She also underwent an upper eyelid tuck to create a more rested look. Overall, you can appreciate an improved cosmetic look to her face and neck without looking surgically done.

#### Case-3838
Example of permanent smile line correction as an alternative to injectable dermal filler treatment for unwanted, deep smile lines.

#### Case-3839
Example of combined lower eyelid tuck and fat transfer in this female patient who desired to look less tired and more rejuvenated. Notice how much of an improvement the fat volume provides, especially through the mid cheek area.

#### Case-3840
This is a great example of the subnasale lip lift procedure in this young lady who desired a shorter upper lip. You can see how the subnasale upper lip lift created a more proportional balance between her lips and the lower face region. In addition, you can see very nicely how the upper lip cupid's bow has been enhanced following the lip shortening. Also note how her scar is barely visible - even at this early point in her healing.

#### Case-3841
Example of upper lip lift in this female patient who desired a shorter upper lip. Notice how much shorter her upper lip is now that we removed the excess length. Just compare the red and yellow markings that really highlight the amount of change that was made from before to after surgery.

#### Case-3842
Example of an upper lip lift to shorten this patient's lip to create a more proportional appearance

#### Case-3843
Example of subnasale upper lip lift in this female patient who desired to have a shorter upper lip while enhancing the visibility of her pink lip.

#### Case-3844
Example of an upper lip subnasale lip lift procedure performed by San Diego lip enhancement expert Dr. John Hilinski

#### Case-3845
Example of mole removal from the face for cosmetic reasons. Notice how the mole has been removed with minimal signs of scarring noted.

#### Case-3846
Example of cancer reconstruction using plastic surgery technique to repair the defect. This male patient had an aggressive skin cancer removed from his left cheek region - leaving him with a large defect or hole. I was able to repair the defect by using the surrounding skin and soft tissue. This is called a 'rotation flap' where the adjacent skin is mobilized and used to close the hole. Notice after reconstructive surgery how he appears essentially normal with minimal signs of me having done any work to him.

#### Case-3847
Example of reconstructive facial plastic surgery to remove a relatively large growth from this male's forehead region. Note the red outlined oval indicating the size and location of the soft tissue mass that was creating abnormal contour and shadowing. Notice the near absence of any signs of scarring in the forehead region after removal. And note how his forehead now looks much more normal from the three different angles.

#### Case-3848
Example of skin cancer reconstruction following MOHS surgery in this attractive young lady. This result at nearly 1 year out from surgery was achieved using a full thickness skin graft taken from the neck region to rebuild her nose and lower eyelid.

#### Case-3849
Example of how to remove a mole from the face without creating excessive scar tissue and visibility. Notice how this scar was removed from someone with ethnic type skin, which is even more difficult to operate on given the risk of skin pigmentation. At several months postop you can barely see the scar left from removal of the mole.

#### Case-3850
Example of reconstructive surgery to remove upper and lower lip pearly moles from this male patient from San Diego, CA. Notice with very careful surgical technique and fine suturing, his scars are barely visible several months out from surgery.

#### Case-3851
Example of neck reconstruction following removal of a large skin cancer in the middle of the neck

#### Case-3852
Example of reconstructive face surgery to remove a bony growth from the forehead of this female patient from San Diego. She had developed discomfort as well as an obvious unsightly bump as a result of the growth along her upper forehead. Dr. Hilinski performed a surgery to remove the bony tumor with final results shown here. Notice, no obvious signs of having had surgery with an end result that shows a nice, natural, smooth looking forehead.

#### Case-3853
Example of repair of a large nasal defect using a paramedian forehead flap for reconstruction. Take a look at the side view, which emphasizes just how deep this hole went into the nose.

#### Case-3854
Example of reconstructive face surgery to remove a growth from the mid forehead region. Notice nearly invisible scar following removal by Dr. Hilinski.

#### Case-3855
Example of scar revision in this patient from San Diego who suffered a traumatic injury to the forehead region. The injury was first repaired by the emergency room physicians, but was considered suboptimal in terms of the outcome. She elected to have Dr. Hilinski revise the scar so that it would be less visible. Results shown here are beyond one year out and demonstrate an obvious improvement in the appearance of her forehead.

#### Case-3856
Example of mole excision for cosmetic improvement of the facial appearance

#### Case-3857
Example of reconstruction of a nasal defect following removal of a basal cell carcinoma (skin cancer).

#### Case-3858
Scalp reconstruction using a rotation advancement flap performed by Dr. Hilinski

#### Case-3859
Example of a paramedian forehead flap reconstruction in this San Diego female who had an aggressive skin cancer involving her nose. Dr. Hilinski performed the surgery in two stages to restore a more normal looking appearance.

#### Case-3860
Facial laceration repair following trauma.

#### Case-3861
Example of reconstructive nose surgery following removal of a skin cancer from this San Diego patient's nasal bridge. This is an example of a full thickness skin graft to the nose.

#### Case-3862
Example of face reconstruction by San Diego facial plastic surgeon Dr. Hilinski. Following excision, or removal, of an extensive, aggressive skin cancer from his left cheek, Dr. Hilinski helped to restore a more normal appearance using the surrounding facial soft tissue.

#### Case-3863
Example of lip reconstruction in this male patient from San Diego who required facial reconstruction after removal of a lip cancer.

#### Case-3864
Example of excisional scar revision on this patient from Inland Empire region who traveled to San Diego to have Dr. Hilinski revise her chin scar. Notice obvious overall improvement in the appearance of her scar.

#### Case-3865
Example of scar revision of the ear for an unwanted keloid scar formation.

#### Case-3866
Example of scar revision in this patient from San Diego who had a large keloid along the upper ear. Dr. Hilinski removed the scar to create a more natural looking ear contour.

#### Case-3867
Example of a gauge earring hole repair

#### Case-3868
Example of bilateral gauge earring repair using cosmetic ear reshaping surgery technique

#### Case-3869
Example of earlobe laceration (tear) repair in this female patient from San Diego

#### Case-3870
Example of earlobe gauge repair. This young female patient from San Diego desired to correct the defects (holes) from prior earlobe gauge piercing. Dr. Hilinski performed the procedure under local anesthesia to restore her ears to a more normal appearance.

#### Case-3871
Example of earlobe reshaping for gauging - results show the immediate postoperative result.

#### Case-3872
Earlobe repair in San Diego

#### Case-3873
Earlobe surgical repair by Dr. John Hilinski in San Diego

#### Case-3874
Example of earlobe repair in this patient from San Diego

#### Case-3875
Example of hyaluronic acid filler to the forehead in this male patient from San Diego who desired to have a very deep furrow filled in to be less obvious

#### Case-3876
Example of micro-silicone injections to achieve a permanent volume enhancement of the cheeks in this male patient with severe hollowing of the face. These are off-label liquid silicone injections using Silikon 1000.

#### Case-3877
Example of Artefill soft tissue augmentation of the prejowl region (off label use). This patient was bothered by the deep creases and lines in the prejowl region (below and to the outside of his lower lip) resulting from prior acne scarring. Dr. Hilinski used Artefill to plump out this tissue and create a much smoother contour.

#### Case-3878
URL: https://www.drhilinski.com/gallery/patient/case-3878/

#### Case-3879
URL: https://www.drhilinski.com/gallery/patient/case-3879/

#### Case-3880
URL: https://www.drhilinski.com/gallery/patient/case-3880/

#### Case-3881
URL: https://www.drhilinski.com/gallery/patient/case-3881/

#### Case-3882
URL: https://www.drhilinski.com/gallery/patient/case-3882/

#### Case-3883
URL: https://www.drhilinski.com/gallery/patient/case-3883/

#### Case-3884
URL: https://www.drhilinski.com/gallery/patient/case-3884/

#### Case-3885
URL: https://www.drhilinski.com/gallery/patient/case-3885/

#### Case-3886
URL: https://www.drhilinski.com/gallery/patient/case-3886/

#### Case-3887
URL: https://www.drhilinski.com/gallery/patient/case-3887/

#### Case-3888
URL: https://www.drhilinski.com/gallery/patient/case-3888/

#### Case-3889
URL: https://www.drhilinski.com/gallery/patient/case-3889/

#### Case-3890
URL: https://www.drhilinski.com/gallery/patient/case-3890/

#### Case-3891
URL: https://www.drhilinski.com/gallery/patient/case-3891/

#### Case-3892
Another example of lip enhancement using an injectable filler in this pleasant female patient from San Diego who simply desired more definition and contour. Notice how her vermillion border (the junction of the red and white lip segments) is now more defined. Her lips appear more volumized and plumper, but certainly do not appear overdone as you so often see from other surgeons' offices.

#### Case-3893
Example of permanent lip augmentation using a lip implant.

#### Case-3894
URL: https://www.drhilinski.com/gallery/patient/case-3894/

#### Case-3895
URL: https://www.drhilinski.com/gallery/patient/case-3895/

#### Case-3896
URL: https://www.drhilinski.com/gallery/patient/case-3896/

#### Case-3897
Example of combined liposuction with platysmaplasty to achieve this type of improvement in her neckline. This patient simply did not wish to have a formal lower face/upper neck lift. Therefore, we opted to contour her upper neck and lower jaw with liposuction and muscle tightening from under the chin. Notice overall improvement with a more youthful look - with markedly less healing compared with a standard facelift procedure.

#### Case-3898
Example of neck liposuction combined with muscle tightening and a prejowl implant to create more definition along the jawline. This patient specifically did not wish to undergo a formal neck lift/facelift where the incisions are made around the ears.

#### Case-3899
Example of combined submental liposuction and platysmaplasty to achieve a more rested and youthful look without having to undergo a formal facelift procedure.

#### Case-3900
Example of combined liposuction, platysmaplasty and chin implant to create a more youthful look in this female patient

#### Case-3901
Example of chin and neck liposuction in combination with a chin implant to create a more defined jaw in this female patient

#### Case-3902
Example of submental liposuction to provide a more defined jaw and neckline in this younger female patient.

#### Case-3903
Example of liposuction and platysmaplasty neck lift to contour this female patients upper neck to create more definition. Note overall how much more rested and youthful she appears.

#### Case-3904
Example of lipocontouring of the upper neck and lower face in this female patient from San Diego who desired to have better definition

#### Case-3905
Example of combined liposuction of the neck and platysmaplasty to refine the neck in this female patient from San Diego, CA

#### Case-3906
Example of neck and submental liposuction to redefine the lower jaw and upper neck regions

#### Case-3907
Example of neck and lower face liposuction with platysma muscle tightening as well

#### Case-3908
URL: https://www.drhilinski.com/gallery/patient/case-3908/

#### Case-3909
URL: https://www.drhilinski.com/gallery/patient/case-3909/

#### Case-3910
URL: https://www.drhilinski.com/gallery/patient/case-3910/

#### Case-3911
URL: https://www.drhilinski.com/gallery/patient/case-3911/

#### Case-3912
URL: https://www.drhilinski.com/gallery/patient/case-3912/

#### Case-3913
Another example of gauge earring defect repair to help restore a more natural looking earlobe.

#### Case-3914
Example of a rare type of cosmetic ear surgery intended to reduce the actual size of the upper auricle. This condition, known as macrotia, involves an overly developed upper one half of the ear. Ear reduction surgery was performed to create a smaller looking ear. This was done by removing excess cartilage (not by pinning the ear closer to the head). This type of surgery is also referred to as scapha or scaphoid reduction of the ear. If you compare the before and after surgery photos, you can appreciate how the ear is now smaller from top to bottom as well as from front to back. In this particular case, you can also see how the upper portion of the ear does not appear as 'pointed' as it once did.

#### Case-3915
Example of a unique type of cosmetic ear surgery intended to reduce the actual size of the upper auricle. This condition, known as macrotia, involves an overly developed upper half of the ear. Ear reduction surgery was performed to create a smaller ear. This was done by removing excess cartilage and not by pinning the ear back as in normal otoplasty surgery. This type of surgery is also referred to as scapha or scaphoid reduction of the ear. If you compare the before and after surgery photos, you can appreciate how the ear is now smaller from top to bottom as well as from front to back.

#### Case-3916
Another example of cosmetic ear reshaping in a male patient from San Diego. Notice the asymmetric (difference between the left and right sides) that he started off with before otoplasty. Following surgery to pin his ears back, his ears now look much less prominent and more symmetric.

#### Case-3917
Example of cosmetic otoplasty for a gauge earring defect on both sides. This very pleasant young lady decided to get rid of her gauge earrings for professional reasons. I performed a gauge earring repair to close the holes using soft tissue from the surrounding area of her ears. Notice how the holes are now gone - completely - and her ears are now restored to a more natural contour and appearance. In fact, right after these photos, I pierced her ears with a beautiful new set of earrings!

#### Case-3918
Example of cosmetic ear reshaping, or otoplasty, in this young male patient from San Diego, CA.

#### Case-3919
Example of gauge earring repair in this female patient who desired to have her earlobes restored to a more natural look. These photos show her results at essentially one week out. We are showing these photos to demonstrate how the healing process unfolds and how normal patients can generally expect to appear this soon after surgery. Although you can still that her scar is everted and healing, with more time this will fade away. Overall, you can really appreciate how much change was made to the ear in an attempt to restore a naturally looking earlobe following gauge piercing.

#### Case-3920
Example of gauge earring repair bilaterally. Notice restoration of a nearly normal looking ear now.

#### Case-3921
Ear pinning example in this female patient who simply desired to have ears that appeared less prominent

#### Case-3922
Example of ear pinning in this male patient from San Diego, CA

#### Case-3923
Example of bilateral ear pinning in this male patient

#### Case-3924
Example of otoplasty in this male patient who desired to have the ear brought in closer to the head

#### Case-3925
Example of ear pinning in this cute young boy from San Diego, CA

#### Case-3926
Example of repair of a gauge hole defect in the lobule of this male patient from San Diego, CA

#### Case-3927
Example of young female patient who had surgery by Dr. Hilinski to reduce the prominent appearance of her ears. As you can see, like many patients, one ear is more prominent than the other. Dr. Hilinski performed bilateral otoplasty surgery to create a more natural looking contour.

#### Case-3928
Example of otoplasty surgery (ear reshaping) to create a straighter looking lobule, which is the fleshy portion of the ear. Notice how the lobule has been reshaped to create a less rounded look, which is precisely what the patient was striving to achieve.

#### Case-3929
Example of otoplasty, ear pinning, to reshape this male patient's ears to appear less prominent.

#### Case-3930
Example of cosmetic ear reshaping in this young female patient from San Diego who desired to have her ears made less prominent using otoplasty surgery technique

#### Case-3931
Example of limited otoplasty to reshape this female's ear following prior piercing with development of keloid scarring. She had previously undergone attempted repair by a different plastic surgeon, which was unsuccessful. Dr. Hilinski performed a revision otoplasty procedure to further reshape the ear to achieve these results.

#### Case-3932
Otoplasty to reshape the earlobes in this young female patient from San Diego, CA

#### Case-3933
Example of ear reshaping in this young female from San Diego, CA who desired to have smaller looking ears. Note obvious improvement in the shape and size of the ears. This includes the side view demonstrating how the ear has been brought closer to the head to now be more parallel with the surface of the scalp rather than sticking out toward the side.

#### Case-3934
Example of pediatric cosmetic ear pinning

#### Case-3935
URL: https://www.drhilinski.com/gallery/patient/case-3935/

#### Case-3936
Example of otoplasty in this female patient from San Diego, CA.

#### Case-3937
Example of otoplasty in this attractive female patient who desired to have her ears reshaped to appear less prominent.

#### Case-3938
Example of otoplasty in this young male patient from San Diego. Learn more about otoplasty, or ear pinning, by clicking here.

#### Case-3939
Example of male otoplasty to reshape overly prominent ears. To learn more about ear pinning in San Diego, use this link here to be taken to our Otoplasty procedure discussion page.

#### Case-3940
Example of a male ear pinning patient

#### Case-3941
Example of unilateral, or one-sided, otoplasty, ear reshaping in this male patient who traveled from outside of San Diego to have Dr. Hilinski perform his surgery.

#### Case-3942
Example of otoplasty in this male patient from San Diego who desired less prominent ears. Notice overall change in positioning of his ears to remove attention away from his ears.

#### Case-3943
Otoplasty is this male patient from San Diego

#### Case-3944
URL: https://www.drhilinski.com/gallery/patient/case-3944/

#### Case-3945
URL: https://www.drhilinski.com/gallery/patient/case-3945/

#### Case-3946
URL: https://www.drhilinski.com/gallery/patient/case-3946/

#### Case-3947
URL: https://www.drhilinski.com/gallery/patient/case-3947/

#### Case-3948
URL: https://www.drhilinski.com/gallery/patient/case-3948/

#### Case-3949
URL: https://www.drhilinski.com/gallery/patient/case-3949/

#### Case-3950
URL: https://www.drhilinski.com/gallery/patient/case-3950/

#### Case-3951
URL: https://www.drhilinski.com/gallery/patient/case-3951/

#### Case-3952
URL: https://www.drhilinski.com/gallery/patient/case-3952/

#### Case-3953
URL: https://www.drhilinski.com/gallery/patient/case-3953/

#### Case-3954
URL: https://www.drhilinski.com/gallery/patient/case-3954/

#### Case-3955
URL: https://www.drhilinski.com/gallery/patient/case-3955/

#### Case-3956
URL: https://www.drhilinski.com/gallery/patient/case-3956/

#### Case-3957
Example of chin augmentation (solid silicone chin implant) combined with liposuction (lipo-contouring) of the upper neck region in this female patient from San Diego. This very pleasant patient was complaining that her chin was simply too small in comparison to her other facial features. She also desired a more defined jawline. I performed a chin implant and liposuction to achieve the desired goals. Notice how her facial proportions and overall balance have been nicely enhanced following surgery.

#### Case-3958
Example of chin augmentation with an implant along with liposuction in this female patient who desired treatment for a recessed chin.

#### Case-3959
Example of chin augmentation with an implant in this male African American patient from San Diego.

#### Case-3960
Example of combined chin implant, lipocontouring of the neck and platysmaplasty

#### Case-3961
Example of chin implant and liposuction in this male patient from San Diego, CA

#### Case-3962
Example of chin implant and lipocontouring of the neck to create a much more defined lower face-neck region.

#### Case-3963
URL: https://www.drhilinski.com/gallery/patient/case-3963/

#### Case-3964
Example of chin augmentation with an implant in combination with platysmaplasty surgery

#### Case-3965
Example of chin augmentation with an implant in this male patient who also desired increased definition of his neck. Dr. Hilinski also performed tightening of his platysma muscle to help achieve an overall improvement in his lower face and upper neck appearance.

#### Case-3966
Example of chin augmentation with an implant to create more harmony and balance of her lower face region

#### Case-3967
Chin implant in this ethnic male patient from San Diego who desired more definition along the lower face and upper chin region.

#### Case-3968
Example of chin augmentation using an implant in this patient from San Diego who desired more definition along the lower face. He also had a neck lift and lower face lift performed to enhance his overall appearance.

#### Case-3969
URL: https://www.drhilinski.com/gallery/patient/case-3969/

#### Case-3970
URL: https://www.drhilinski.com/gallery/patient/case-3970/

#### Case-3971
URL: https://www.drhilinski.com/gallery/patient/case-3971/

#### Case-3972
URL: https://www.drhilinski.com/gallery/patient/case-3972/

#### Case-3973
URL: https://www.drhilinski.com/gallery/patient/case-3973/

#### Case-3974
URL: https://www.drhilinski.com/gallery/patient/case-3974/

#### Case-3975
URL: https://www.drhilinski.com/gallery/patient/case-3975/

#### Case-3976
URL: https://www.drhilinski.com/gallery/patient/case-3976/

#### Case-3977
Example of combined platysmaplasty and liposuction to give this patient a neck lift appearance. Of note, she did NOT undergo a standard facelift/necklift procedure with incisions around the ears. This surgery was done essentially all through an incision under her chin.

#### Case-3978
Example of combined necklift and lower facelift to make a dramatic change in her overall appearance

#### Case-3979
Example of upper neck lift combined with a lower face tuck

#### Case-3980
This is a great example of combined submental liposuction and platysmaplasty to achieve a more youthful look and defined jawline in this female patient who did not want to undergo a formal facelift procedure.

#### Case-3981
Neck lift in this female patient from San Diego, CA who desired a more defined upper neck and jawline. This was accomplished by a combined platysmaplasty and neck lift.

#### Case-3982
Example of neck liposuction, platysmaplasty and chin augmentation

#### Case-3983
Example of neck liposuction and contouring to create a more defined lower jawline and upper neck appearance

#### Case-3984
Example of combined neck liposuction with neck muscle tightening (platysmaplasty)

#### Case-3985
Example of neck lift in this younger patient from San Diego. She had combined platysmaplasty as well as liposuctioning.

#### Case-3986
Example of neck lift in this middle-aged female patient who desired a more defined lower face and upper neck contour.

#### Case-3987
Example of neck lift in this elderly patient who had very poor chin projection and neck definition. Dr. Hilinski performed a lower face and neck lift procedure along with chin augmentation using an implant. Although he has now grown a beard, one can still easily appreciate how much more definition he now has along his jawline with a more masculine look overall.

#### Case-3988
Example of neck lift in this male patient from San Diego who desired more definition and a stronger jawline. Dr. Hilinski performed a neck lift using a platysma tightening technique in addition to liposuction and chin augmentation.

#### Case-3989
URL: https://www.drhilinski.com/gallery/patient/case-3989/

#### Case-3990
URL: https://www.drhilinski.com/gallery/patient/case-3990/

#### Case-3991
Example of crevice-facial rhytidectomy - also known as a lower face and upper neck lift procedure. Note how she still looks quite natural following surgery with a more youthful, rested overall appearance.

#### Case-3992
Example of a combined facelift and necklift procedure to create a more defined, youthful looking jaw and neckline.

#### Case-3993
URL: https://www.drhilinski.com/gallery/patient/case-3993/

#### Case-3994
Example of lower facelift surgery to create a more rested jawline and neck in this female patient from San Diego. Notice how she looks more rested and youthful, but not pulled or stretched.

#### Case-3995
Example of facelift surgery combined with neck lift, fat transfer and lower eyelid blepharoplasty surgery. Notice overall more rested look without looking surgically pulled or stretched.

#### Case-3996
Example of facelift surgery in this female patient who simply desired to look younger and more rested.

#### Case-3997
Example of lower face and upper neck lift

#### Case-3998
Example of combined neck lift and facelift surgery in this very pleasant female from San Diego who simply desired to look more rested and youthful. You can see how much of an improvement was made in her overall appearance via facelift surgery - and most importantly she still looks quite natural without any obvious signs of having had surgical facial rejuvenation.

#### Case-3999
Example of mini lift in this middle-aged female patient

#### Case-4000
Example of facelift surgery to create a more youthful, rested look in this very pleasant female patient from San Diego, CA. She had a lower face and upper neck tuck along with chin implant and eyelid lift. Notice how she appears more refreshed yet still quite natural.

#### Case-4001
Example of a mini facelift procedure in this female patient from San Diego, CA

#### Case-4002
Example of lower face and upper neck lift in this female patient from San Diego, CA.

#### Case-4003
Example of facelift and necklift in this very pleasant lady from San Diego

#### Case-4004
Example of a facelift procedure to rejuvenate this very pleasant 67 year old female who desired a more youthful look.

#### Case-4005
URL: https://www.drhilinski.com/gallery/patient/case-4005/

#### Case-4006
URL: https://www.drhilinski.com/gallery/patient/case-4006/

#### Case-4007
Traditional lower face and upper neck lift surgery performed on this female patient who simply wanted to look younger and more refreshed - without looking surgically pulled or done.

#### Case-4008
Example of lower face lift combined with neck lift and chin implant to create a more defined and masculine overall look.

#### Case-4009
URL: https://www.drhilinski.com/gallery/patient/case-4009/

#### Case-4010
URL: https://www.drhilinski.com/gallery/patient/case-4010/

#### Case-4011
URL: https://www.drhilinski.com/gallery/patient/case-4011/

#### Case-4012
URL: https://www.drhilinski.com/gallery/patient/case-4012/

#### Case-4013
URL: https://www.drhilinski.com/gallery/patient/case-4013/

#### Case-4014
URL: https://www.drhilinski.com/gallery/patient/case-4014/

#### Case-4015
URL: https://www.drhilinski.com/gallery/patient/case-4015/

#### Case-4016
URL: https://www.drhilinski.com/gallery/patient/case-4016/

#### Case-4017
URL: https://www.drhilinski.com/gallery/patient/case-4017/

#### Case-4018
URL: https://www.drhilinski.com/gallery/patient/case-4018/

#### Case-4019
URL: https://www.drhilinski.com/gallery/patient/case-4019/

#### Case-4020
Example of revision reconstructive rhinoplasty (prior surgery done by a different plastic surgeon) to correct moderate asymmetry of the bridge and tip regions. Notice, in particular, how her nostrils and tip region were reshaped to create a more stable and symmetrical looking nose.

#### Case-4021
Example of reconstructive nose surgery to restore a more normal nasal tip in this patient who had prior rhinoplasty surgery by a different plastic surgeon. I performed an open revision rhinoplasty surgery that included reshaping and restructuring of the entire nasal tip region. Notice how the nasal tip now appears more like a normal nose.

#### Case-4022
Example of a very difficult revision rhinoplasty case that took years to evolve and heal. This patient had prior surgery by another plastic surgeon that resulted in severe abnormalities of his nose. You can see how asymmetrical and twisted his nasal tip was - including severe collapse of the structural framework of his nose. Notice the global change following revision rhinoplasty surgery to create a nose that looks much more natural and fitting for his face.

#### Case-4023
Example of male revision rhinoplasty

#### Case-4024
Example of revision reconstructive nose surgery to addressed a pinched, collapsed nasal tip that was interfering with breathing. The bridge was also reshaped in this process to help restore a more normal anatomical contour and shape.

#### Case-4025
Example of revision rhinoplasty in a patient who had prior rhinoplasty surgery by a different plastic surgeon. In this particular case, Dr. Hilinski reshaped the tip and columella to provide a more natural looking nose that was more fitting for her overall facial features.

#### Case-4026
Example of revision rhinoplasty to correct a hanging columella deformity that was created following prior rhinoplasty by another plastic surgeon. Note that her nose now looks much more proportional and shapely following surgery with Dr. Hilinski. In addition, this patient suffered from significant trouble breathing through her nose following the prior surgeon's work. Dr. Hilinski was also able to repair the blockage inside of her nose to provide her with a marked improvement in nasal breathing.

#### Case-4027
Example of revision rhinoplasty performed by Dr. Hilinski who performed a revision nose surgery on this female patient who had a prior nose job done by a different plastic surgeon. As you can see, she had an obvious abnormal contour involving the upper bridge area. Dr. Hilinski performed an incredibly challenging revision rhinoplasty to reshape the bridge area. The end result is a nose that looks much more normal than it did and causes much less unwanted attention to be drawn to the area.

#### Case-4028
Example of revision rhinoplasty to correct a hanging columella and ptotic tip (drooping nasal tip) following prior rhinoplasty surgery by a different plastic surgeon.

#### Case-4029
Example of revision rhinoplasty nose reconstruction in this female patient who had prior surgery performed by a different facial surgeon. She suffered collapse of the lower one-half of her nose with a drop in her tip position (back closer to her face) as a result of the first surgery. Dr. Hilinski performed an open revision rhinoplasty to rebuild the nose to a more appropriate height while restoring a more natural looking nose for her face.

#### Case-4030
Example of revision rhinoplasty following prior cosmetic nose job by a different plastic surgeon.

#### Case-4031
Example of closed revision rhinoplasty with ear grafting to the nose to reconstruct the entire right side of her nose to create a more natural look

#### Case-4032
Example of revision rhinoplasty to correct a hanging columella deformity that was bothering this male rhinoplasty patient from San Diego, CA

#### Case-4033
Revision rhinoplasty to correct an obvious tip deformity following prior surgery by another plastic surgeon.

#### Case-4034
Example of revision open rhinoplasty in this patient from San Diego who had prior nose reshaping by a different plastic surgeon. Dr. Hilinski performed an open revision rhinoplasty including use of composite grafts to the nostrils on both sides to bring the rims down.

#### Case-4035
Example of very complex Asian revision rhinoplasty in this patient who had prior cosmetic nose reshaping elsewhere by a different plastic surgeon. We performed bridge reshaping including placement of bilateral spreader grafts. In addition, her tip was reshaped to provide better tip definition.

#### Case-4036
Example of revision rhinoplasty to correct a blunted nasal tip with poor tip definition

#### Case-4037
Example of revision rhinoplasty to correct a pinched nose deformity that resulted from prior rhinoplasty performed by another plastic surgeon.

#### Case-4038
URL: https://www.drhilinski.com/gallery/patient/case-4038/

#### Case-4039
Example of revision rhinoplasty in this patient who had prior cosmetic nose surgery done elsewhere before consulting with Dr. Hilinski. She underwent an open revision rhinoplasty with ear cartilage grafting to create a nose that is more feminine and refined.

#### Case-4040
URL: https://www.drhilinski.com/gallery/patient/case-4040/

#### Case-4041
Example of revision rhinoplasty in this female patient who had previous rhinoplasty surgery by a different plastic surgeon. She desired reshaping of the columella to create a softer look that did not appear so surgical. Dr. Hilinski performed a closed revision rhinoplasty to reshape the columella and infratip region. To a certain degree, Dr. Hilinski repaired what is termed a hanging columella by some people. Notice subtle yet appreciable difference in her tip region.

#### Case-4042
This patient desired revision rhinoplasty following prior surgery by a different plastic surgeon. She was most concerned about a previously placed silicone implant that was displaced in between her eyes. As seen in the photos and indicated by the red arrows, she had an usual contour that was distracting. Dr. Hilinski performed a revision open rhinoplasty to provide a more natural contour and improved symmetry. He also created more tip definition while maintaining balance with her overall ethnic facial features.

#### Case-4043
Example of revision open rhinoplasty in this female patient from San Diego who desired to have symmetry of her tip following prior rhinoplasty by a different plastic surgeon. Notice improved symmetry of the nostril rims following revision by Dr. Hilinski. Patient also had chin augmentation with an implant.

#### Case-4044
URL: https://www.drhilinski.com/gallery/patient/case-4044/

#### Case-4045
URL: https://www.drhilinski.com/gallery/patient/case-4045/

#### Case-4046
URL: https://www.drhilinski.com/gallery/patient/case-4046/

#### Case-4047
URL: https://www.drhilinski.com/gallery/patient/case-4047/

#### Case-4048
URL: https://www.drhilinski.com/gallery/patient/case-4048/

#### Case-4049
URL: https://www.drhilinski.com/gallery/patient/case-4049/

#### Case-4050
URL: https://www.drhilinski.com/gallery/patient/case-4050/

#### Case-4051
URL: https://www.drhilinski.com/gallery/patient/case-4051/

#### Case-4052
URL: https://www.drhilinski.com/gallery/patient/case-4052/

#### Case-4053
URL: https://www.drhilinski.com/gallery/patient/case-4053/

#### Case-4054
URL: https://www.drhilinski.com/gallery/patient/case-4054/

#### Case-4055
URL: https://www.drhilinski.com/gallery/patient/case-4055/

#### Case-4056
URL: https://www.drhilinski.com/gallery/patient/case-4056/

#### Case-4057
URL: https://www.drhilinski.com/gallery/patient/case-4057/

#### Case-4058
URL: https://www.drhilinski.com/gallery/patient/case-4058/

#### Case-4059
URL: https://www.drhilinski.com/gallery/patient/case-4059/

#### Case-4060
URL: https://www.drhilinski.com/gallery/patient/case-4060/

#### Case-4061
URL: https://www.drhilinski.com/gallery/patient/case-4061/

#### Case-4062
URL: https://www.drhilinski.com/gallery/patient/case-4062/

#### Case-4063
Example of revision rhinoplasty in this female patient from San Diego who desired more definition of her nose. She had three previous rhinoplasty procedures before consulting with Dr. Hilinski who agreed to reoperate on her nose. Dr. Hilinski was able to thin her nose out while reducing the bridge height and elevating the tip. She had incredibly thick skin that had to be managed appropriately in order for her to see any notable difference. The end result of her revision rhinoplasty with Dr. Hilinski was a more defined, feminine looking nose with an overall natural appearance.

#### Case-4064
URL: https://www.drhilinski.com/gallery/patient/case-4064/

#### Case-4065
URL: https://www.drhilinski.com/gallery/patient/case-4065/

#### Case-4066
URL: https://www.drhilinski.com/gallery/patient/case-4066/

#### Case-4067
URL: https://www.drhilinski.com/gallery/patient/case-4067/

#### Case-4068
Example of revision nose reshaping using injectable steroids in this male patient from San Diego who had prior rhinoplasty twenty years prior. He desired reduction of the upper bridge height and more symmetry on frontal view - both of which were achieved for him by Dr. Hilinski. Notice after revision nose reshaping more symmetry on his front view and a smoother dorsal contour on side view. To learn more about this revision rhinoplasty patient in our online plastic surgery blog case example, use this link here.

#### Case-4069
URL: https://www.drhilinski.com/gallery/patient/case-4069/

#### Case-4070
Example of open revision rhinoplasty in this female patient from San Diego. She originally had a rhinoplasty performed by a different plastic surgeon. Unfortunately, she was left with severe asymmetry of her tip. I performed an open revision rhinoplasty procedure to help provide her with a more natural looking nose with less obvious signs of having had prior surgery.

#### Case-4071
Example of revision open rhinoplasty with two previous nose jobs performed by other plastic surgeons. To see more about the details of her surgery, use this link here for a case discussion.

#### Case-4072
URL: https://www.drhilinski.com/gallery/patient/case-4072/

#### Case-4073
URL: https://www.drhilinski.com/gallery/patient/case-4073/

#### Case-4074
Example of finesse eyebrow lift on this patient's left side to create more symmetry with her right.

#### Case-4075
Example of an open, or trichophytic brow lift procedure where an incision is made in the hairline to lift the forehead. Notice that she has a more rested yet natural looking appearance following the brow lift.

#### Case-4076
Example of endoscopic brow lift procedure to elevate this young patient's brow that demonstrates moderately severe ptosis, or drooping.

#### Case-4077
Example of combined endoscopic brow lift and blepharoplasty procedure.

#### Case-4078
Example of an upper eyelid lift to create a more rejuvenated appearance giving this patient a more rested and youthful look.

#### Case-4079
Example of ethnic upper eyelid surgery in this male patient who had trouble seeing in terms of his peripheral vision. Notice how much excess skin was removed from his upper eyelid region. The end result is that he can now see much better and he looks more rested and youthful. In this particular case, health insurance provided coverage for the blepharoplasty surgery.

#### Case-4080
Example of functional upper eyelid blepharoplasty to remove excess, heavy weighted skin that was causing this male patient to have trouble seeing. Following surgery using cosmetic surgery techniques, this patient was able to see markedly better in his peripheral field and looked much more rested in youthful. The best part for this patient was that his health insurance covered the actual surgery!

#### Case-4081
Example of an upper eyelid lift procedure

#### Case-4082
Example of an upper eyelid lift procedure to give this female patient a more rested, youthful look without appearing different overall

#### Case-4083
Example of upper eyelid tuck in this relatively younger female patient who simply disliked the heaviness over her eyelids.

#### Case-4084
Example of a lower eyelid skin blepharoplasty to provide smoother contour. Notice how her lower eyelids simply look smoother and more rested with minimal signs of scarring noted

#### Case-4085
Example of ethnic male upper eyelid enhancement surgery to create a more defined looking and symmetric upper eyelid region

#### Case-4086
Example of upper eyelid lift in this male patient from San Diego, CA

#### Case-4087
This is an example of an eyelid lift with ptosis (pronounced toe-sis) repair. This patient had a functional problem with her upper eyelids where they hung down too low into her iris (the colored part of the eye). Dr. Hilinski performed an eyelid lift with shortening of the levator muscle in the eyelid to give her eyes a more open appearance. In addition, he corrected the asymmetry, or difference between the two eyes.

#### Case-4088
Example of a lower eyelid lift patient from San Diego who desired to have the excess fat removed from the lower eyelid region

#### Case-4089
Upper eyelid lift for visual problems related to excess skin draping over the upper eyelashes.

#### Case-4090
Example of a lower eyelid tuck to address unwanted lower eyelid bags in this young female patient. Notice nearly invisible incision that was made along the lower eyelid region just under her lash line.

#### Case-4091
Example of an upper eyelid tuck or lift

#### Case-4092
Example of male upper lid eyelid lift

#### Case-4093
URL: https://www.drhilinski.com/gallery/patient/case-4093/

#### Case-4094
URL: https://www.drhilinski.com/gallery/patient/case-4094/

#### Case-4095
URL: https://www.drhilinski.com/gallery/patient/case-4095/

#### Case-4096
URL: https://www.drhilinski.com/gallery/patient/case-4096/

#### Case-4097
URL: https://www.drhilinski.com/gallery/patient/case-4097/

#### Case-4098
URL: https://www.drhilinski.com/gallery/patient/case-4098/

#### Case-4099
URL: https://www.drhilinski.com/gallery/patient/case-4099/

#### Case-4100
URL: https://www.drhilinski.com/gallery/patient/case-4100/

#### Case-4101
URL: https://www.drhilinski.com/gallery/patient/case-4101/

#### Case-4102
URL: https://www.drhilinski.com/gallery/patient/case-4102/

#### Case-4103
URL: https://www.drhilinski.com/gallery/patient/case-4103/

#### Case-4104
URL: https://www.drhilinski.com/gallery/patient/case-4104/

#### Case-4105
URL: https://www.drhilinski.com/gallery/patient/case-4105/

#### Case-4106
URL: https://www.drhilinski.com/gallery/patient/case-4106/

#### Case-4107
URL: https://www.drhilinski.com/gallery/patient/case-4107/

#### Case-4108
URL: https://www.drhilinski.com/gallery/patient/case-4108/

#### Case-4109
URL: https://www.drhilinski.com/gallery/patient/case-4109/

#### Case-4110
URL: https://www.drhilinski.com/gallery/patient/case-4110/

#### Case-4111
Example of middle eastern ethnic rhinoplasty to reshape the columella (hanging columella deformity), the nasal tip and the bridge. Notice overall improvement in her nose while maintaining a natural look.

#### Case-4112
Example of finesse ethnic female rhinoplasty in this young lady from San Diego. Her main desire was to have a nose that appeared smaller and more refined. I performed a septorhinoplasty using an open approach, which included narrowing of the bones, rotating the tip slightly and refining the tip shape. Overall, you can tell that her nose looks better on her face. Yet, she still looks quite natural.

#### Case-4113
Example of male ethnic rhinoplasty. This young patient desired reshaping of the nose, but had very thick skin. Ultimately, a nice result was able to be obtained, but only after using a series of steroid injections to help force the skin to shrink wrap down around the underlying framework of the nose.

#### Case-4114
Example of cosmetic rhinoplasty to reshape the nasal tip and the bridge in this young female patient from San Diego.

#### Case-4115
Example of tip and bridge reshaping surgery with creation of a more defined and refined looking nose without changing her overall look.

#### Case-4116
Example of female ethnic rhinoplasty to create a smoother looking bridge in this young lady from San Diego. I also reshaped her nasal tip with the goal of creating a nose that still looked like it fit on her face.

#### Case-4117
Example of Hispanic male rhinoplasty in this patient from San Diego who had reconstructive nose surgery by me over one year ago. He had broke the nose and had trouble breathing through the nose. I performed a reconstructive septorhinoplasty surgery to correct the functional problems with his nose. In addition, I reshaped the nose to help restore a more normal looking structure. Overall, you can see the marked improvement in shape and size - all the while maintaining ethnic consistency with his facial features.

#### Case-4118
This is an example of rhinophyma surgery to correct the external shape of the nose. This patient from San Diego had excessive glandular tissue affecting his nose that created trouble with breathing due to a heavy, weighted effect. I performed rhinophyma surgery using a laser to help reduce the volume of his nose - thus helping it look better while functioning much more efficiently.

#### Case-4119
Male rhinoplasty on this patient who had a crooked nose deformity. As you can see from the photos, his nose was deviated to his right side. The diagrammed photos highlight this as indicated by the curved line and arrow (pointing to the depressed side of his nose). I performed a reconstructive rhinoplasty procedure to help straighten the nose. As you can appreciate, his nose was reshaped to create a much straighter alignment with improved contour of his nasal bridge as well.

#### Case-4120
Example of reconstructive rhinoplasty to correct an asymmetric (crooked) nose deformity. Notice how prior to surgery his nose was crooked as seen from the frontal view. Look more closely at the middle one-third of his nose where you can see that his left side was depressed versus the right side. In addition, his tip was canted off to his right side. The surgery was performed using cartilage grafting techniques to create a more symmetrical anatomical contour and shape. Note how now his nose has relatively equal brow-tip esthetic lines. In doing so, the nose was also made to function better after surgery.

#### Case-4121
This is a great example of correction of a crooked nose deformity to help this male patient look and breathe better. His nose was significantly deviated off to his right side prior to reconstructive septorhinoplasty. I was able to reshape and reposition the nose such that it was now much straighter on his face. In doing so, the patient is now able to also breathe much better now.

#### Case-4122
Example of Hispanic rhinoplasty in this female patient who desired more definition in the tip region and a less prominent bridge. Overall, you can see a dramatic transformation in her nose, yet she still appears ethnically consistent. Of note, I also shaved off the mole that was located along her bridge region.

#### Case-4123
This is another example of finesse rhinoplasty. This attractive young lady simply desired to have a more refined looking nose. More specifically she wanted to remove the bump and smooth the bridge without looking too different. I ended up performing a finesse type rhinoplasty to create a smoother looking bridge that retained the overall appearance of her old nose. If you look at her before and after photos, you can appreciate an overall improvement - yet she still looks like herself. Could you possibly do more to this particular nose? Sure. But why when the only thing you should do is take away some of the features of her nose that bothered her - while bringing out her overall facial beauty. In my humble opinion, this is the essence of doing great rhinoplasty.

#### Case-4124
Example of rhinoplasty surgery to primarily address the nasal tip in this younger female patient from San Diego. As you can see, her nasal tip projected out too far from her face while also being quite wide or bulbous. Rhinoplasty surgery was able to provide her with a smaller nose that was in much better balance with her facial features. Although it would have been nice to go even smaller and more narrow, she happened to have relatively thicker skin. This very important distinction limited the amount of change that could be ultimately made with her particular nose. Despite this, she has an overall marked improvement in her nose - which is, after all, the most realistic of goals when it comes to cosmetic nose reshaping.

#### Case-4125
Example of ethnic male (Indian) rhinoplasty surgery. Notice finesse type changes in the shape and size of the nose while maintaining ethnic consistency with his facial features. Learn more about Indian rhinoplasty surgery in our online rhinoplasty tutorial.

#### Case-4126
Example of Asian rhinoplasty, or Asian nose job, surgery to create a more refined overall look. This patient is nearly 2 years out from cosmetic nose job surgery to make an Asian nose less rounded and more defined - yet natural looking.

#### Case-4127
This is an example of reconstructive nose surgery to straighten the crooked bridge, which also involved correcting the bump on the dorsum. Notice that her nose has now been reconstructed with an overall improvement in the appearance while maintaining a very natural look for her. A closed rhinoplasty approach was used. This is a great example of how reconstructive rhinoplasty can be done to improve the nose without making someone look completely different.

#### Case-4128
URL: https://www.drhilinski.com/gallery/patient/case-4128/

#### Case-4129
Example of cosmetic and functional septorhinoplasty to create a more feminine overall look while also improving her breathing.

#### Case-4130
Example of African American rhinoplasty surgery to create a more narrow nasal tip and less prominent bridge while maintaining ethnic consistency with her facial features.

#### Case-4131
Repair of a crooked nose deformity, reduction of a dorsal hump and overall refinement of a male ethnic nose to create a final result that looks quite natural for his face

#### Case-4132
Example of septorhinoplasty to reduce the bridge on this female patient while also creating a less bulbous nasal tip. Note the overall transformation while keeping her nose natural looking.

#### Case-4133
Example of nasal fracture repair to straighten the bridge alignment of the nose following a sports injury.

#### Case-4134
Example of nasal fracture rhinoplasty repair. This is another example of how some patients require more of a finesse type of rhinoplasty reconstruction to repair a fractured (broken) nose. This patient broke his nose with the result being his left bone was pushed out to the side creating asymmetrical shadowing when seen from the front. The nose was fixed using rhinoplasty technique to re-create a symmetrical bridge contour on both sides. Is this somewhat subtle? Yes - but in some cases this is a sufficient enough change to bother a patient and warrants surgical repair.

#### Case-4135
Example of ethnic rhinoplasty in this male patient from San Diego who desired to have his tip lifted with more definition along with narrowing of the nasal base

#### Case-4136
Example of African American rhinoplasty in this male patient from San Diego who desired reshaping to appear less ethnic in terms of the nose

#### Case-4137
Example of rhinoplasty to repair a crooked nose deformity following traumatic injury to the nose

#### Case-4138
Example of cosmetic rhinoplasty in this female patient from San Diego

#### Case-4139
Example of ethnic rhinoplasty to create a less rounded, bulbous nasal tip along with a more narrow base in this female patient

#### Case-4140
URL: https://www.drhilinski.com/gallery/patient/case-4140/

#### Case-4141
Example of rhinoplasty to primarily refine the appearance of this bulbous nasal tip. This patient desired to have her wide, rounded looking nasal tip made more narrow to match the remainder of her overall facial features.

#### Case-4142
Example of finesse rhinoplasty to reshape this female patient's bridge and tip. A conservative amount of change was made to the bridge to create a straighter profile without looking scooped. The tip was reshaped to create more symmetry without making her look much different.

#### Case-4143
Example of rhinoplasty to create a less bulbous nasal tip appearance in this female patient from San Diego, CA

#### Case-4144
Example of hump reduction in this female rhinoplasty patient from San Diego, CA

#### Case-4145
Example of closed rhinoplasty in this male patient to correct a crooked nose deformity and a dorsal hump deformity

#### Case-4146
Example of rhinoplasty surgery to correct a dorsal hump and crooked alignment in this male patient from San Diego, CA

#### Case-4147
Example of plastic surgery of the nose to correct a large dorsal hump deformity as well as a markedly crooked nose. This patient underwent reconstructive plastic surgery of the nose with a result that shows obvious improvement in the shape of the nose, while still appearing very natural looking and in balance with her surrounding facial features.

#### Case-4148
Example of rhinoplasty in a female patient with relatively thick nasal skin. You can see an obvious overall improvement in her bridge and tip regions, which includes elevation of the tip and narrowing. In cases like this with thicker than average skin, there is a limitation to how much definition can be gained through rhinoplasty surgery. In cases like this, patients need to be realistic in terms of how much rhinoplasty surgery can do for them.

#### Case-4149
Example of lengthening of the nasal tip to bring down the nose that is congenitally turned upward.

#### Case-4150
Example of finesse rhinoplasty to elevate or raise the tip of this female patient from San Diego, CA

#### Case-4151
Example of finesse rhinoplasty to reshape this nose to create a more narrowed, refined look from the front while preserving her overall facial features.

#### Case-4152
Example of cosmetic rhinoplasty in this male patient

#### Case-4153
Example of dorsal hump reduction to reduce the bridge height while also making the nose appear less narrow as seen from the frontal view. A closed rhinoplasty approach was used to achieve this type of result.

#### Case-4154
Example of male ethnic rhinoplasty in this Hispanic patient who desired reshaping of his bridge and nasal tip region.

#### Case-4155
Example of female ethnic rhinoplasty in this attractive young lady who simply desired less attention to her nose. She had a dorsal hump and a wide base that she wanted reshaped. Note obvious overall improvement in her nasal appearance with a more feminine shape now.

#### Case-4156
Example of ethnic (Hispanic) rhinoplasty in this female patient from San Diego who desired refinement of her nose. Notice reduction of the dorsal hump and narrowing of the bridge and tip while maintaining an ethnically consistent appearing nose.

#### Case-4157
Example of closed rhinoplasty to reposition and reshape the nasal tip that was notably droopy

#### Case-4158
Example of tip rhinoplasty to create more symmetry in the tip of the nose where she was noted to have a significant collapse on her left side.

#### Case-4159
URL: https://www.drhilinski.com/gallery/patient/case-4159/

#### Case-4160
Example of deprojection of the nasal tip to bring the nose closer to the face

#### Case-4161
Example of ethnic hispanic rhinoplasty

#### Case-4162
Example of female rhinoplasty in this San Diego patient looking to refine her nose. She did not want drastic alterations and wanted to preserve a nice, natural look that simply better matched her face.

#### Case-4163
Example of a congenital saddle nose deformity causing flattening of the nasal bridge and abnormal shadowing on the frontal view. Notice overall improvement with rhinoplasty while maintaining a natural looking nose.

#### Case-4164
Example of closed rhinoplasty in this young female patient from San Diego who desired refinement of her nose. Notice reduction of her bridge height and reshaping of her tip. To learn more about nose reshaping in San Diego, use this link here to be taken to our rhinoplasty discussion page.

#### Case-4165
Example of an ethnic nose undergoing rhinoplasty or nose reshaping to address a crooked nose deformity and high bridge. The one limitation in this type of rhinoplasty patient is the thickness of the skin. In order to make her nose smaller, we had to make sure that her skin would shrink wrap down sufficiently after making the skeletal structure of the nose smaller. In many cases, as in this one, there is a limitation to how much the skin will shrink wrap down. That being said, there is a noticeable improvement in the appearance of her nose with much less attention now being drawn to this region of her face.

#### Case-4166
URL: https://www.drhilinski.com/gallery/patient/case-4166/

#### Case-4167
URL: https://www.drhilinski.com/gallery/patient/case-4167/

#### Case-4168
Example of finesse rhinoplasty to reduce a bridge hump, rotate the tip and narrow the nose as seen on frontal view. As you can see, her nose still looks quite natural yet more refined without obvious signs of having had prior nose reshaping surgery.

#### Case-4169
Example of ethnic rhinoplasty to address a large dorsal hump and tip ptosis

#### Case-4170
Example of ethnic rhinoplasty in this female patient from San Diego. Note overall more refined look despite thick, ethnic nasal skin - while maintaining a natural looking nose without stigma of having had nose reshaping surgery.

#### Case-4171
Example of open rhinoplasty combined with spreader graft placement for reshaping of her nose

#### Case-4172
URL: https://www.drhilinski.com/gallery/patient/case-4172/

#### Case-4173
URL: https://www.drhilinski.com/gallery/patient/case-4173/

#### Case-4174
URL: https://www.drhilinski.com/gallery/patient/case-4174/

#### Case-4175
URL: https://www.drhilinski.com/gallery/patient/case-4175/

#### Case-4176
URL: https://www.drhilinski.com/gallery/patient/case-4176/

#### Case-4177
URL: https://www.drhilinski.com/gallery/patient/case-4177/

#### Case-4178
URL: https://www.drhilinski.com/gallery/patient/case-4178/

#### Case-4179
URL: https://www.drhilinski.com/gallery/patient/case-4179/

#### Case-4180
URL: https://www.drhilinski.com/gallery/patient/case-4180/

#### Case-4181
URL: https://www.drhilinski.com/gallery/patient/case-4181/

#### Case-4182
URL: https://www.drhilinski.com/gallery/patient/case-4182/

#### Case-4183
URL: https://www.drhilinski.com/gallery/patient/case-4183/

#### Case-4184
URL: https://www.drhilinski.com/gallery/patient/case-4184/

#### Case-4185
URL: https://www.drhilinski.com/gallery/patient/case-4185/

#### Case-4186
URL: https://www.drhilinski.com/gallery/patient/case-4186/

#### Case-4187
URL: https://www.drhilinski.com/gallery/patient/case-4187/

#### Case-4188
URL: https://www.drhilinski.com/gallery/patient/case-4188/

#### Case-4189
URL: https://www.drhilinski.com/gallery/patient/case-4189/

#### Case-4190
URL: https://www.drhilinski.com/gallery/patient/case-4190/

#### Case-4191
URL: https://www.drhilinski.com/gallery/patient/case-4191/

#### Case-4192
URL: https://www.drhilinski.com/gallery/patient/case-4192/

#### Case-4193
URL: https://www.drhilinski.com/gallery/patient/case-4193/

#### Case-4194
URL: https://www.drhilinski.com/gallery/patient/case-4194/

#### Case-4195
URL: https://www.drhilinski.com/gallery/patient/case-4195/

#### Case-4196
URL: https://www.drhilinski.com/gallery/patient/case-4196/

#### Case-4197
URL: https://www.drhilinski.com/gallery/patient/case-4197/

#### Case-4198
URL: https://www.drhilinski.com/gallery/patient/case-4198/

#### Case-4199
URL: https://www.drhilinski.com/gallery/patient/case-4199/

#### Case-4200
URL: https://www.drhilinski.com/gallery/patient/case-4200/

#### Case-4201
URL: https://www.drhilinski.com/gallery/patient/case-4201/

#### Case-4202
URL: https://www.drhilinski.com/gallery/patient/case-4202/

#### Case-4203
URL: https://www.drhilinski.com/gallery/patient/case-4203/

#### Case-4204
URL: https://www.drhilinski.com/gallery/patient/case-4204/

#### Case-4205
URL: https://www.drhilinski.com/gallery/patient/case-4205/

#### Case-4206
URL: https://www.drhilinski.com/gallery/patient/case-4206/

#### Case-4207
URL: https://www.drhilinski.com/gallery/patient/case-4207/

#### Case-4208
URL: https://www.drhilinski.com/gallery/patient/case-4208/

#### Case-4209
URL: https://www.drhilinski.com/gallery/patient/case-4209/

#### Case-4210
URL: https://www.drhilinski.com/gallery/patient/case-4210/

#### Case-4211
URL: https://www.drhilinski.com/gallery/patient/case-4211/

#### Case-4212
URL: https://www.drhilinski.com/gallery/patient/case-4212/

#### Case-4213
URL: https://www.drhilinski.com/gallery/patient/case-4213/

#### Case-4214
URL: https://www.drhilinski.com/gallery/patient/case-4214/

#### Case-4215
URL: https://www.drhilinski.com/gallery/patient/case-4215/

#### Case-4216
URL: https://www.drhilinski.com/gallery/patient/case-4216/

#### Case-4217
URL: https://www.drhilinski.com/gallery/patient/case-4217/

#### Case-4218
URL: https://www.drhilinski.com/gallery/patient/case-4218/

#### Case-4219
URL: https://www.drhilinski.com/gallery/patient/case-4219/

#### Case-4220
URL: https://www.drhilinski.com/gallery/patient/case-4220/

#### Case-4221
URL: https://www.drhilinski.com/gallery/patient/case-4221/

#### Case-4222
URL: https://www.drhilinski.com/gallery/patient/case-4222/

#### Case-4223
URL: https://www.drhilinski.com/gallery/patient/case-4223/

#### Case-4224
URL: https://www.drhilinski.com/gallery/patient/case-4224/

#### Case-4225
URL: https://www.drhilinski.com/gallery/patient/case-4225/

#### Case-4226
URL: https://www.drhilinski.com/gallery/patient/case-4226/

#### Case-4227
URL: https://www.drhilinski.com/gallery/patient/case-4227/

#### Case-4228
URL: https://www.drhilinski.com/gallery/patient/case-4228/

#### Case-4229
URL: https://www.drhilinski.com/gallery/patient/case-4229/

#### Case-4230
URL: https://www.drhilinski.com/gallery/patient/case-4230/

#### Case-4231
URL: https://www.drhilinski.com/gallery/patient/case-4231/

#### Case-4232
URL: https://www.drhilinski.com/gallery/patient/case-4232/

#### Case-4233
URL: https://www.drhilinski.com/gallery/patient/case-4233/

#### Case-4234
URL: https://www.drhilinski.com/gallery/patient/case-4234/

#### Case-4235
URL: https://www.drhilinski.com/gallery/patient/case-4235/

#### Case-4236
URL: https://www.drhilinski.com/gallery/patient/case-4236/

#### Case-4237
URL: https://www.drhilinski.com/gallery/patient/case-4237/

#### Case-4238
URL: https://www.drhilinski.com/gallery/patient/case-4238/

#### Case-4239
URL: https://www.drhilinski.com/gallery/patient/case-4239/

#### Case-4240
URL: https://www.drhilinski.com/gallery/patient/case-4240/

#### Case-4241
URL: https://www.drhilinski.com/gallery/patient/case-4241/

#### Case-4242
URL: https://www.drhilinski.com/gallery/patient/case-4242/

#### Case-4243
URL: https://www.drhilinski.com/gallery/patient/case-4243/

#### Case-4244
URL: https://www.drhilinski.com/gallery/patient/case-4244/

#### Case-4245
URL: https://www.drhilinski.com/gallery/patient/case-4245/

#### Case-4246
URL: https://www.drhilinski.com/gallery/patient/case-4246/

#### Case-4247
URL: https://www.drhilinski.com/gallery/patient/case-4247/

#### Case-4248
URL: https://www.drhilinski.com/gallery/patient/case-4248/

#### Case-4249
URL: https://www.drhilinski.com/gallery/patient/case-4249/

#### Case-4250
URL: https://www.drhilinski.com/gallery/patient/case-4250/

#### Case-4251
URL: https://www.drhilinski.com/gallery/patient/case-4251/

#### Case-4252
URL: https://www.drhilinski.com/gallery/patient/case-4252/

#### Case-4253
URL: https://www.drhilinski.com/gallery/patient/case-4253/

#### Case-4254
URL: https://www.drhilinski.com/gallery/patient/case-4254/

#### Case-4255
URL: https://www.drhilinski.com/gallery/patient/case-4255/

#### Case-4256
URL: https://www.drhilinski.com/gallery/patient/case-4256/

#### Case-4257
URL: https://www.drhilinski.com/gallery/patient/case-4257/

#### Case-4258
URL: https://www.drhilinski.com/gallery/patient/case-4258/

#### Case-9951
Incredibly complex revision rhinoplasty case using rib grafting to restore a more natural looking bridge and tip following failed surgery performed by a different plastic surgeon.

### Team

#### Aesthetic Nurse Jordan Olivera, R.N.
Jordan Olivera is a registered nurse who graduated from Point Loma Nazarene University with a Bachelor of Science in Nursing. Jordan has over 8 years of experience in aesthetics with a background in dermatology and medical spa settings. Nurse Jordan has attended numerous trainings and conferences thru Allergan Medical Institute and Galderma Aesthetic Injector Network. Jordan has been mentored by some of the industry’s top injectors.

Nurse Jordan specializes in regenerative aesthetic treatments as well as the classics including Botox, Dermal Filler, Sculptra, Lasers and medical grade skincare.

Nurse Jordan prides herself in providing patient-centered care. She takes a holistic approach to collaborate with her patients to create a customized treatment plan to achieve the most optimal results.

In her free time, you may catch her walking on the beach or participating in dog shows with her miniature schnauzer, CJ.

#### Kathy – Perioperative Registered Nurse
Kathy is The Hilinski Ambulatory Surgery Center’s lead perioperative Registered Nurse. She has extensive experience in clinical nursing and is a wonderful resource for all of our patients having surgery at The Hilinski Ambulatory Surgery Center. Kathy has been working with Dr. Hilinski for almost 10 years! Kathy is the person you will likely be accompanied by prior, during and after surgery.

Outside of the operating room, Kathy enjoys spending time with her dog, Radish, and also creates her own jewelry and skin care products!

#### Nicole – Surgical Consultant
Nicole is our office’s surgical consultant who will help guide you through the process of meeting Dr. Hilinski and discussing your desired plastic surgery procedure. She will also help you through the decision-making period and, ultimately, shepherd you through the actual surgery and recovery process.

Nicole came to Dr. Hilinski’s office with prior experience in plastic and reconstructive surgery, in addition to over 10 years in the aesthetic industry. She is the often times the pleasant voice you will hear when calling to schedule a new appointment with Dr. Hilinski. She is also a great resource for all of your questions and concerns. Nicole is knowledgeable on all the procedures we offer and can answer any questions you might have before and after surgery. She is also a great contact for any patients traveling from out of town.

Nicole is originally from Northern California and lives with her husband Mario and their three dogs – Zoe, Boone and Nacho. In her free time, Nicole likes to explore restaurants throughout San Diego and enjoys motorcycle riding with her husband.