This is a great case example of a female patient who sought out Dr. Hilinski to revise her nose following prior surgery by a different plastic surgeon.

If you look at her Nasal tip, in particular, you will easily appreciate how distorted her nose appeared as a result of the prior surgery. This type of asymmetry in the nasal tip has what we call the surgical stigmata of a Rhinoplasty surgeon having been in her nose. You can readily see how the tip is over rotated and over projected. It is also quite different from left to right – way beyond what is within the normal range. For instance, she has much more shadowing on her right side – just above the nostril rim – due to a sharp drop-off in the contour of the underlying cartilage. In addition, her columella is quite deviated – further contributing to the overall asymmetry that can be seen.

Prior Rhinoplasty in Mexico

Given the fact that Dr. Hilinski practices in San Diego, he happens to see quite a few patients who have had prior, unsuccessful rhinoplasty surgery performed in Mexico. Now don’t get us wrong – there are plenty of great rhinoplasty surgeons who practice in Mexico – and in Tijuana, in particular. But the reality is that many of our Revision Rhinoplasty patients have a history of having had prior nose jobs in Mexico that simply didn’t turn out the way they hoped. In many of these cases, the patients crossed the border into Mexico to have their nose done – primarily because the cost to have the surgery is much cheaper in Mexico. When things turn out well, that is great. The patient is happy and they saved money in the process of getting their rhinoplasty surgery. Unfortunately, if the outcome is less than ideal, the costs to have a revision rhinoplasty expert perform reshaping of the nose can be substantially more – usually a multiple of the original rhinoplasty cost.

Rhinoplasty in Mexico Outcome

Here are some additional views of this patient’s nose following her rhinoplasty in Mexico. As you can see on her oblique view of the nose, the abnormal tip shadowing is arguably even more obvious. Much of this is directly attributed to the fact that her nasal tip cartilage was cut and contoured in an aggressive manner – more so on her right side. This resulted in some of the overlying soft tissue collapsing inward – and detracting from a natural, smooth, convex shape that should normally be seen across this area of the nose.

On her side view, you can see how the nasal tip was over rotated, or turned up too much. In addition, the nasal tip was over projected. This means her nasal tip stuck out too far from the plane of her face. In combination, the over rotation and over projection made her nose look too big for her face.

When you add it all up, there were a number of problems with her nose that needed to be addressed following her rhinoplasty in Mexico. The patient and Dr. Hilinski consulted and talked in detail about could and could not be done to help her achieve a more beautiful, natural looking nose. Ultimately, they both decided to proceed with an open rhinoplasty approach for her revision surgery. The primary aim was to make significant changes to her nasal tip position and shape – but this could only be done in conjunction with blending her nasal bridge into the new nasal tip.

Operative Findings

An open revision rhinoplasty provided Dr. Hilinski the ideal exposure to reshape the entire nasal tip region. As you can see in the adjacent photo diagram, it was vividly clear why her nasal tip looked the way it did.

The photo on the left (A) highlights the severe, abnormal shadowing of the tip. The middle photo (B) was taken during her actual surgery. This shows exactly why there was such shadowing – the blue dots correspond directly with the shadowing seen in the first photo. In the middle photo, you can also see how different her tip is compared to relatively normal nasal tip cartilage. On the right (C) is exposure of a relatively normal nasal tip during a rhinoplasty procedure. You can see there is a pair of cartilages that comprise most of the nasal tip region. In this particular instance, her tip cartilage was so distorted and scarred, it barely resembled anything close to normal. When there is this much distortion and scarring of the nasal tip, it makes for an incredibly challenging revision rhinoplasty procedure.

Fortunately, Dr. Hilinski has extensive experience when it comes to revision rhinoplasty and repair of work done by other plastic surgeons. Also fortunate was the fact she had septal cartilage remaining despite having had prior rhinoplasty surgery. If she didn’t have septal cartilage leftover, Dr. Hilinski would have needed to go get ear cartilage or rib cartilage in order to successfully complete the operation. As part of the surgery, Dr. Hilinski ended up reducing her nasal bridge height and completely rebuilding her distorted nasal tip. This included reducing her nasal tip rotation and projection at the same time.

Revision Rhinoplasty Results

The end result of this effort is shown here. As you can see, her symmetry is markedly improved after Dr. Hilinski’s revision rhinoplasty. Her tip is now also brought down to a more appropriate position and does not stick out as far any longer. The overall impression, though, is a nose that looks (1) less surgical, (2) more natural and (3) more in balance with her facial features.