This is a great case showing what finesse rhinoplasty can do to create a nice, natural looking enhancement. This young lady from San Diego desired to have a more refined, defined looking nose – but didn’t necessarily want to look entirely different.
If you look at her nose, you don’t immediately see a desperate need for cosmetic rhinoplasty surgery. However, she was still bothered by her wide, somewhat bulbous nasal tip as well as the bump on her nasal bridge. Enough so that she sough out Dr. Hilinski to perform cosmetic nose reshaping.
Believe it or not, doing rhinoplasty on this type of nose is actually quite difficult. The reason is there is little margin for error. After all, she is starting off with a nose that already looks quite good. It is not as if she has a huge bump that needs to be taken down or a nasal tip that is drooping down really low. This type of rhinoplasty – which I termed ‘finesse rhinoplasty’ many years ago – can, therefore, be quite a challenge even for a rhinoplasty expert like San Diego surgeon, Dr. John Hilinski.
Tip Rhinoplasty Changes
Here are some quick photos taken intraoperatively during her actual rhinoplasty surgery. The photo on the left is taken from above the nose while on the operating room table – and shows how her tip cartilage was somewhat wide. More importantly, you can see how the general outline and shape of the two pieces of cartilage (called the lower lateral cartilages) is fairly asymmetrical – meaning they are very different between the right and left sides.
The photo on the right is taken from under the nose – called the basal view in rhinoplasty terminology. Again, you can see how rounded the overall shape of the cartilage is – but, more importantly, you can appreciate just how different the cartilage is from right to left. In fact, the cartilage on her right side (left side in the photo) does not project out as much as it does on the other side.
An open rhinoplasty approach was used for her case so that optimal exposure of the cartilage was achieved by Dr. Hilinski. He ended up using a number of sutures in combination with septal cartilage grafting in order to help reshape her nasal tip.
Here are intraoperative photos from the actual rhinoplasty surgery. As you can see, a number of strategically placed sutures were used to help in the reshaping process. In addition, though, cartilage grafts were needed to make the tip more narrowed and symmetrical. What types of cartilage grafts are these? Some rhinoplasty surgeons would describe them as onlay grafts. But that is not really important. What is important is the fact that segments of cartilage were used to try and make her nasal tip more symmetrical and defined. For example, on her right side (left side in the photo) where her lateral crus cartilage was not as wide, grafts were needed to widen her native cartilage framework. Notice how there were barely any grafts placed on her left side (right side in the photo). This is actually quite common in the world of rhinoplasty. Do whatever you need to do to try and achieve a more symmetrical and defined nose.
Finesse Rhinoplasty Photos
Here is the end result of this patient’s finesse rhinoplasty surgery. As you can see, her tip is now more defined and is quite symmetrical. And her nasal bridge has been smoothed down. Yet – she still appears very natural looking.